Delaware Child Protective Registry PDF Details

The Delaware Child Protective Registry Form is a required form for anyone who works with or has contact with children in the state of Delaware. The form is used to track child abuse and maltreatment reports in the state, and must be completed by anyone who works with children in a professional capacity. Completing the form is easy, and can be done online through the Delaware Department of Services for Children, Youth, and Their Families website. The registration process takes just a few minutes, and provides important information on how to report suspected child abuse or maltreatment. Anyone working with children in Delaware should complete this important form.

Listed below are some details about delaware child protective registry. This table can provide information regarding the form's size, completion duration, and the parts you'll be needed to fill.

QuestionAnswer
Form NameDelaware Child Protective Registry
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameschild protection registry, delaware child abuse clearance, delaware child abuse registry, child abuse registry in delaware

Form Preview Example

DELAWARE CHILD PROTECTION REGISTRY CONSENT FORM

Web Portal

Instructions

Complete the below form and fax or email directly to the Division of Professional Regulation at the contact information below:

Fax: (302) 739-2711

DE Application Number: APP-__________________

Email: customerservice.dpr@delaware.gov

 

Request must be within 90 days of signature date in order to be processed

PART I - APPLICANT INFORMATION

Name (Last*, First*, Middle): *___________________________, *_________________________, __________________

Other Name(s) used:

None ________________________________________________________________________

Social Security #: ________ - ________ - ___________

Date of Birth (mm/dd/yyyy)*: _____ - _____ - _______

Gender*:

Male

Female

Race: ______________________________________

Ethnicity: Hispanic

Non-Hispanic

Address (Street, City, State, Zip): ______________________________________ _______________ _____ __________

Are you on the Delaware Child Protection Registry for any substantiated cases of child abuse/neglect?

Yes

No

If yes, explain:_____________________________________________________________________________________

I hereby authorize The Delaware Department of Services for Children, Youth and Their Families to provide the below named requester with all substantiated cases of child abuse or neglect concerning me that are active on the Delaware Child Protection Registry. I further release the Delaware Department of Services for Children, Youth and Their Families, its officers and employees from any and all claims arising out of or in any way connected to the release or dissemination of any information concerning me.

Signature: ____________________________________________

Date: __________________

Parent/Guardian Signature (If applicant is under the age of 18): ______________________________________________

PART II - REQUESTER INFORMATION

Check one option below and complete required information*:

1. Agency Request – Agency Name*: DIVISION OF PROFESSIONAL REGULATION

2. Individual Request - Self

*Mandatory

Revised 6/2020

How to Edit Delaware Child Protective Registry Online for Free

The delaware child protection registry consent form completing course of action is hassle-free. Our editor enables you to use any PDF file.

Step 1: Initially, choose the orange button "Get Form Now".

Step 2: After you've entered the delaware child protection registry consent form editing page you can see all of the options you may perform relating to your file at the upper menu.

Complete the delaware child protection registry consent form PDF and provide the content for every single segment:

portion of fields in delaware child abuse clearance

Write the required details in the Are you on the Delaware Child, Yes, If yes explain, I hereby authorize The Delaware, Signature, Date, ParentGuardian Signature If, PART II REQUESTER INFORMATION, Check one option below and, Agency Request Agency Name, and Individual Request Self part.

Completing delaware child abuse clearance stage 2

Step 3: Select the button "Done". Your PDF file may be transferred. You will be able obtain it to your pc or email it.

Step 4: To protect yourself from any type of problems in the future, try to get around two or three duplicates of the document.

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