"Application for License Exemption" - Delaware

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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 April 1, 2018;
  • The latest edition currently provided by the Delaware Department of Services for Children, Youth and their Families;
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Download "Application for License Exemption" - Delaware

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OFFICE USE ONLY
State of Delaware
INSTRUCTIONS
Revised April 2018
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 
NEW CASTLE COUNTY SITES
KENT OR SUSSEX COUNTY SITES
OFFICE OF CHILD CARE LICENSING
OFFICE OF CHILD CARE LICENSING
3411 Silverside Road
821 SILVER LAKE BOULEVARD, SUITE 103
Concord Plaza, Hagley Building
DOVER, DELAWARE 19904
WILMINGTON, DELAWARE 19810
PHONE: 302-739-5487
PHONE: 302-892-5800
FAX: 302-739-6589
FAX: 302-633-5112
Email: kimberly.garvey@state.de.us
Email: ann.ryan@state.de.us
SECTION A – Identification
Applicant:
Title:
Program Email:
Phone #:
Alternate or Cell Phone #:
Fax #:
Program
Name:
Location:
(Street Address)
(City)
(County)
(Zip)
State Operated
Church
School *
Check all that apply to the
Organization/Club Facility
site location:
Outdoors
*Delaware DOE School Registration #:
____________________________
Commercial Site
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:
(Street Address)
(City)
(County)
(Zip)
Telephone Number:
Fax #:
Email Address:
Contact Person
Title
Has the Applicant been previously licensed, approved, or exempted to provide child care, foster care, adoption, or residential day
treatment to children in Delaware or any other state?
Yes
No
If “Yes,” note below the state, the specific location, and the dates of operation:
* IF YOU ARE A SCHOOL REGISTERED WITH DELAWARE DOE, PLEASE SKIP TO SECTION E.
SECTION B – Program Information
1.
Dates of Operation: __________________________________________ Days:
M
T
W
Th
F
Sa
Su
Program Hours: ____________________AM/PM to ____________________AM/PM
2.
Ages of the children to be served: _____________________________________________________________________________
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 a “drop-in” 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
Revised April 2018
OFFICE USE ONLY
State of Delaware
INSTRUCTIONS
Revised April 2018
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 
NEW CASTLE COUNTY SITES
KENT OR SUSSEX COUNTY SITES
OFFICE OF CHILD CARE LICENSING
OFFICE OF CHILD CARE LICENSING
3411 Silverside Road
821 SILVER LAKE BOULEVARD, SUITE 103
Concord Plaza, Hagley Building
DOVER, DELAWARE 19904
WILMINGTON, DELAWARE 19810
PHONE: 302-739-5487
PHONE: 302-892-5800
FAX: 302-739-6589
FAX: 302-633-5112
Email: kimberly.garvey@state.de.us
Email: ann.ryan@state.de.us
SECTION A – Identification
Applicant:
Title:
Program Email:
Phone #:
Alternate or Cell Phone #:
Fax #:
Program
Name:
Location:
(Street Address)
(City)
(County)
(Zip)
State Operated
Church
School *
Check all that apply to the
Organization/Club Facility
site location:
Outdoors
*Delaware DOE School Registration #:
____________________________
Commercial Site
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:
(Street Address)
(City)
(County)
(Zip)
Telephone Number:
Fax #:
Email Address:
Contact Person
Title
Has the Applicant been previously licensed, approved, or exempted to provide child care, foster care, adoption, or residential day
treatment to children in Delaware or any other state?
Yes
No
If “Yes,” note below the state, the specific location, and the dates of operation:
* IF YOU ARE A SCHOOL REGISTERED WITH DELAWARE DOE, PLEASE SKIP TO SECTION E.
SECTION B – Program Information
1.
Dates of Operation: __________________________________________ Days:
M
T
W
Th
F
Sa
Su
Program Hours: ____________________AM/PM to ____________________AM/PM
2.
Ages of the children to be served: _____________________________________________________________________________
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 a “drop-in” 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
Revised April 2018
SECTION C – Program/Service
Instructions: List activities provided:
A
/S
CTIVITIES
ERVICES
SECTION D – Additional Information Attachments
Exemptions from Delacare Regulations for Early Care and Education and School-Age Centers may be granted under the
following conditions:
A. Camps issued permits by the Division of Public Health;
B. An institution, agency, association, or organization under State of Delaware ownership and control;
C. Classes for religious instruction conducted by religious institutions during the summer months for periods not to exceed
four weeks;
D. Programs established in connection with a business, recreation center, or religious institution in which children are provided
care for brief periods of time, while parent/guardian is on the premises, are readily accessible at all times on an on-call
basis, and are able to resume control of the child immediately;
E. Programs that offer activities for children over the age of six who attend at their own discretion on an ‘open door’ basis,
where there is no compensation, and where there is no agreement, written or implied, between the program and the
parent/guardian for the program to assume responsibility for the care of the child;
F. Programs that offer school-age care on an ad hoc, sporadic, and isolated basis in order to meet an emergency or special need
or to provide specific skill instruction; or
G. A public or private school that provides regular and thorough instruction through at least the sixth grade in the subjects
prescribed for the schools of the State, in a manner suitable to the children of the same age and stage of advancement, and
that reports to the State Board of Education pursuant to 14 Delaware Code, Section 2704. This exclusion shall include all
programs operated by these schools, except as stated above, and shall also include preschool education programs for people
with disabilities as defined by 14 Delaware Code, Section 3101(4).
Required Attachments:
(1)
Explanation of why a licensing exemption applies to this program using the criteria in Section D,
(2)
Daily Activity Schedule with times per day for a 2-week period.
SECTION E - Signature
Signature of Applicant
Date
Title/Relationship to Facility
Revised April 2018
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