"Application for License Exemption" - Delaware

Application for License Exemption is a legal document that was released by the Delaware Department of Services for Children, Youth and their Families - a government authority operating within Delaware.

Form Details:

  • Released on October 1, 2019;
  • The latest edition currently provided by the Delaware Department of Services for Children, Youth and their Families;
  • Ready to use and print;
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  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Delaware Department of Services for Children, Youth and Their Families.

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OFFICE USE ONLY
State of Delaware
INSTRUCTIONS
Revised October 2019
Department of Services For Children, Youth and Their Families
PLEASE TYPE OR
OFFICE OF CHILD CARE LICENSING
Date Received:
CLEARLY PRINT
ALL RESPONSES
_______________________
APPLICATION FOR LICENSE EXEMPTION
SUPPLY ALL REQUESTED
Supervisor:
INFORMATION
_____________________
 SUBMIT TO 
OFFICE OF CHILD CARE LICENSING
821 Silver Lake Boulevard
Silver Lake Complex, Barratt Building, Suite 103
DOVER, DELAWARE 19904
PHONE: 302-739-5487
FAX: 302-739-6589
Email:
kimberly.garvey@delaware.gov
SECTION A – Identification
Applicant:
Title:
Program Email:
Phone #:
Alternate or Cell Phone #:
Fax #:
Program Name:
Site Address:
(Street Address)
(City)
(County)
(Zip)
Mailing Address:
(*If different
from site address)
(Street Address)
(City)
(County)
(Zip)
State Operated
*Delaware DOE School Registration #:
Check the appropriate box if
____________________________
applicable to the site location:
School *
Please note an exemption cannot be granted for a private residence.
Currently licensed by OCCL?
No
Yes
License #: _______________
Is this program run by or affiliated with another organization? If yes, please provide organization information below.
Organization Name:
Site Address:
(Street Address)
(City)
(County)
(Zip)
Phone #:
Fax #:
Email Address:
Contact Person:
Title
Has the Applicant been previously licensed, approved, or exempted to provide child care to children in Delaware?
Yes
No
If “Yes,” note the specific location and the dates of operation: _________________________________________________________
* IF YOU ARE A SCHOOL REGISTERED WITH DELAWARE DOE, PLEASE SKIP TO SECTION
D.
Revised October 2019
OFFICE USE ONLY
State of Delaware
INSTRUCTIONS
Revised October 2019
Department of Services For Children, Youth and Their Families
PLEASE TYPE OR
OFFICE OF CHILD CARE LICENSING
Date Received:
CLEARLY PRINT
ALL RESPONSES
_______________________
APPLICATION FOR LICENSE EXEMPTION
SUPPLY ALL REQUESTED
Supervisor:
INFORMATION
_____________________
 SUBMIT TO 
OFFICE OF CHILD CARE LICENSING
821 Silver Lake Boulevard
Silver Lake Complex, Barratt Building, Suite 103
DOVER, DELAWARE 19904
PHONE: 302-739-5487
FAX: 302-739-6589
Email:
kimberly.garvey@delaware.gov
SECTION A – Identification
Applicant:
Title:
Program Email:
Phone #:
Alternate or Cell Phone #:
Fax #:
Program Name:
Site Address:
(Street Address)
(City)
(County)
(Zip)
Mailing Address:
(*If different
from site address)
(Street Address)
(City)
(County)
(Zip)
State Operated
*Delaware DOE School Registration #:
Check the appropriate box if
____________________________
applicable to the site location:
School *
Please note an exemption cannot be granted for a private residence.
Currently licensed by OCCL?
No
Yes
License #: _______________
Is this program run by or affiliated with another organization? If yes, please provide organization information below.
Organization Name:
Site Address:
(Street Address)
(City)
(County)
(Zip)
Phone #:
Fax #:
Email Address:
Contact Person:
Title
Has the Applicant been previously licensed, approved, or exempted to provide child care to children in Delaware?
Yes
No
If “Yes,” note the specific location and the dates of operation: _________________________________________________________
* IF YOU ARE A SCHOOL REGISTERED WITH DELAWARE DOE, PLEASE SKIP TO SECTION
D.
Revised October 2019
SECTION B – Program Information
___________________
___________________
1.
Dates of Operation:
to
Days:
M
T
W
Th
F
Sa
Su
Program Hours: _________________AM/PM to _________________AM/PM
Ages of the children to be served (Use “kindergarten” for 5-year-olds attending kindergarten. Otherwise, use exact ages.)
2.
___________________
___________________
From
to
* A school-age child attends or has attended kindergarten or a higher grade.
3.
Will a parent of each child in attendance remain onsite each day?
Yes
No
4.
Will a fee be charged for attendance to this program?
Yes
No
Is this an “open door” program that children may enter or leave without being placed with a designated adult?
5.
Yes
No
6.
Are you applying for Delaware Child Care Subsidiary Program (Purchase of Care)?
Yes
No
SECTION C – Additional Information Attachments
Exemptions from DELACARE: Regulations for Early Care and Education and School-Age Centers may be granted under the
following conditions:
1.
Youth camps that provide care for only school-age children and are issued permits by the Division of Public Health (DPH);
2.
An institution, agency, association, or organization under State of Delaware ownership and control;
3.
Religion classes conducted by religious institutions during the summer that do not exceed four weeks;
4.
Programs established in connection with a business, recreation center, or religious institution in which children are provided
care for brief periods of time, while a parent/guardian is on the premises and readily accessible at all times;
Programs that offer activities for school-age children who attend at their own discretion on an ‘open door’ basis, where
5.
there is no payment and no agreement, written or implied, between the program and the parent/guardian for the program to
be responsible for the care of the child;
6.
Programs that offer school-age care on a limited basis in order to meet an emergency need;
7.
Programs that solely provide lessons or classes, such as tutoring, music, dance, sport, or art; or
8.
A public or private school that provides education in the subjects prescribed for the schools of the State. This school reports
to the State Board of Education pursuant to 14 Del.C. §2704. This exclusion includes programs and preschool education
programs for people with disabilities as defined by 14 Del.C. §3101(4) operated by these schools, except as stated in
subsection 4.B.
Required Attachments:
(1)
Explanation of why a licensing exemption applies to this program using the criteria in Section C,
(2)
Daily Activity Schedule with times per day for a 2-week period.
SECTION D - Signature
Signature of Applicant
Date
Title/Relationship to Facility
Revised October 2019
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