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Fill Out Your Delaware Child Protective Registry Form

The Delaware Child Protective Registry form is a document used to authorize the release of information regarding substantiated cases of child abuse or neglect. Individuals seeking to access their records or provide consent for information sharing must complete this form accurately. Timely submission is crucial, as requests must be made within 90 days of the signature date for processing.

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Fill Out Your Delaware Child Protective Registry Form

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Example - Delaware Child Protective Registry Form

DELAWARE CHILD PROTECTION REGISTRY CONSENT FORM

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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

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

Delaware Child Protective Registry: Usage Guide

Once you have gathered all the necessary information, you're ready to fill out the Delaware Child Protective Registry form. This form needs to be completed accurately to ensure it can be processed without delays. Follow these steps carefully to complete the form.

Start by filling in your name. Write your last name, first name, and middle name in the designated spaces.
If you have any other names you’ve used, list them under "Other Name(s) used." If not, write "None."
Provide your Social Security number in the format: XXX-XX-XXXX.
Enter your date of birth using the format mm/dd/yyyy.
Select your gender by marking either "Male" or "Female."
Indicate your race in the provided space.
Select your ethnicity by marking either "Hispanic" or "Non-Hispanic."
Fill in your address, including street, city, state, and zip code.
Answer the question about whether you are on the Delaware Child Protection Registry for any substantiated cases of child abuse/neglect by marking "Yes" or "No." If you answer "Yes," provide an explanation in the space provided.
Sign and date the form in the designated areas. If you are under 18, a parent or guardian must also sign.
In Part II, choose the appropriate requester information option. If it's an agency request, fill in "DIVISION OF PROFESSIONAL REGULATION." For an individual request, select "Self."

After completing the form, you will need to send it to the Division of Professional Regulation. You can do this by faxing it to (302) 739-2711 or emailing it to customerservice.dpr@delaware.gov. Make sure to submit your request within 90 days of signing the form for it to be processed.

Documents used along the form

The Delaware Child Protective Registry form is a critical document for individuals seeking to understand their status regarding child abuse or neglect allegations. Alongside this form, several other documents may be necessary for various related processes. Below is a list of forms and documents that are commonly used in conjunction with the Delaware Child Protective Registry form.

Child Abuse History Clearance Application: This application allows individuals to request a background check regarding any history of child abuse or neglect. It is essential for those applying for jobs or volunteering in child-related fields.
Authorization for Release of Information: This form grants permission for specific agencies or individuals to access a person's records. It is often required when applying for positions that involve working with children.
Background Check Request Form: Used to request a comprehensive background check, this form is vital for employers in childcare settings. It ensures that individuals have no criminal history that would disqualify them from working with children.
ATV Bill of Sale Form: For a reliable transfer of ownership, refer to the comprehensive ATV Bill of Sale form resources to ensure all legal requirements are satisfied.
Child Protection Services Report: This document provides detailed information about any investigations conducted by child protection services. It is often necessary for legal proceedings or when appealing a decision made by the agency.
Affidavit of Good Moral Character: This affidavit is typically required for individuals seeking employment in sensitive positions. It attests to the individual's character and suitability for working with children.
Consent for Drug Testing: Some positions may require drug testing as part of the hiring process. This consent form allows employers to conduct drug tests in compliance with applicable laws.
Employment Application for Childcare Positions: This application form collects personal and professional information from candidates applying for jobs in childcare. It often includes questions about the applicant's background and experience with children.

Understanding these documents can help streamline the process of ensuring compliance with child protection laws and regulations. Each form serves a specific purpose and may be essential depending on individual circumstances. Always consult with the appropriate agency or legal professional if there are questions regarding these documents.

Key takeaways

Filling out the Delaware Child Protective Registry form is an important process. Here are key takeaways to ensure you complete it correctly:

Submit Promptly: Your request must be made within 90 days of the signature date for it to be processed.
Provide Accurate Information: Ensure that all personal details, such as name, social security number, and date of birth, are filled out accurately.
Understand Your Rights: By signing the form, you authorize the Delaware Department of Services for Children, Youth and Their Families to share information regarding any substantiated cases of child abuse or neglect.
Release of Liability: You release the Department from any claims related to the information shared about you.
Signature Requirement: If the applicant is under 18, a parent or guardian must also sign the form.
Contact Information: Submit the completed form via fax at (302) 739-2711 or email to customerservice.dpr@delaware.gov.

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File Details

Fact Name	Details
Governing Law	The Delaware Child Protection Registry is governed by Title 16, Chapter 903 of the Delaware Code.
Form Purpose	This form is used to request information from the Delaware Child Protection Registry regarding substantiated cases of child abuse or neglect.
Submission Method	The completed form must be faxed or emailed directly to the Division of Professional Regulation.
Contact Information	Fax submissions should be sent to (302) 739-2711. Email submissions can be sent to customerservice.dpr@delaware.gov.
Application Number	Each request requires an application number, which is to be filled in the designated space on the form.
Deadline for Requests	Requests must be made within 90 days of the date the form is signed to be processed.
Applicant Information	The form requires detailed personal information, including name, social security number, date of birth, and address.
Child Abuse History	Applicants must disclose if they are on the Delaware Child Protection Registry for any substantiated cases of child abuse or neglect.
Signature Requirement	Both the applicant and, if applicable, a parent or guardian must sign the form to authorize the release of information.

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