Child Welfare Record Check Request

If you require a Child Welfare Record Check for employment, please fill out the Child Welfare Record Check form.

You must attach one copy of valid government issued photo identification along with your request. This request should be made to the child protection agency in your place of residence, including past residences. Durham CAS cannot provide child welfare information from another Society.

"*" indicates required fields

Personal Details

Name*

First Name Last Name

Alternate name (e.g. birth name, preferred name, alias)

Date of birth*

Contact Information

Address*

Number and street name Unit number City Province Postal code Country

Phone Number*

Preferred Phone Number*

Home

Work

Cell

Email address*

Previous Places of Residence

I have lived in the following places since I reached the age of 18 years or became a parent, whichever first occurred:

City, province, country

Dates (from – to)

Additional Information

Searches may result in multiple records with similar names and dates of birth. The additional information provided below will be used only to assist in locating any child protection records pertaining to you.

My child’s name

Child’s date of birth (DD/MM/YYYY)

Child’s mother’s birth name

Request Details

Request Description

If possible, please provide additional details regarding the reason for your request as this will assist us to provide you with the information you require.

Additional Information

You or any additional person aged 16 years and older is required to provide their identification. Please attach relevant document(s) to support your request.

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Additional Information File 1

No file chosenMax. file size: 50 MB.

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Additional Information File 2

No file chosenMax. file size: 50 MB.

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Additional Information File 3

No file chosenMax. file size: 50 MB.

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Additional Information File 4

No file chosenMax. file size: 50 MB.

File Upload

Drop files here or

Max. file size: 50 MB.

Confirmation & Consent*

I certify the above information to be accurate.

Confirmation & Consent Checkbox 2*

I consent to a search of the provincial Child Protection Information Network (CPIN) and of Durham Children’s Aid Society’s legacy system in order for the Society to fulfil my request.

Confirmation & Consent Checkbox 3*

I agree that my submitted data is being collected and stored by the Durham Children’s Aid Society. Please note: Durham Children’s Aid Society must abide by the privacy rules set out in the Child, Youth and Family Services Act, 2017.

Centred Content

If you require a Child Welfare Record Check for employment, please fill out the Child Welfare Record Check form.

Personal Details

Contact Information

Previous Places of Residence

Additional Information

Request Details

Additional Information

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