Dfps Form J-800-2839 - Request For Exemption From Regulation Page 3

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J-800-2839
Revised June 2014
SECTION D - PARENTS ON THE PREMISES
Does the parent or person responsible for the child attend or engage in an activity nearby?
No
Yes
If yes, what is the parent's primary activity?
How many hours of the day do children attend your program?
Name the specific days of the week that children attend your program?
Is the child care provided to enable the parent to attend an educational class provided by a nonprofit entity in a
county that is adjacent to an international border and has a population of 800,000 or more?
No
Yes
Is the program's caregiver able to contact the parent or person responsible for the child at all times?
No
Yes
SECTION E - SHORT-TERM PROGRAM
Complete this section if you are requesting an exemption based on meeting the requirements for a short-term
program under 40 TAC §745.117(2).
Does your program operate for fewer than three consecutive weeks and for fewer than 40 days in a 12-month period?
No
Yes
Does your program operate as a stand-alone operation; that is, one that is not part of an operation that is subject to
regulation by DFPS?
No
Yes
SECTION F: RELIGIOUS PROGRAM
Complete this section if you are requesting an exemption based on meeting the requirements for a religious
program under 40 TAC §745.117(3).
Does your program offer religious instruction, such as Sunday school or weekly catechism?
No
Yes
Is your program of a religious nature and does it last for two weeks or less?
No
Yes
SECTION G: FOREIGN EXCHANGE OR FOREIGN SPONSORSHIP PROGRAM
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