Free California Affidavit of Caregiver’s Authorization - PDF Download

Updated on May 16, 2024

The California Caregiver’s Authorization Affidavit is a legal document that allows a caregiver to enroll a minor in school and authorize school-related medical care. This form is particularly useful for non-parental caregivers, such as grandparents, aunts, uncles, or other relatives, to provide necessary care for the minor.

Why Use This California Caregiver’s Authorization Affidavit?

This affidavit is important because it:

• Empowers caregivers to make educational and medical decisions for the minor.
• Provides legal documentation of the caregiver’s authority.
• Ensures that the minor receives timely care and access to education.

How to Write This California Caregiver’s Authorization Affidavit

1. Minor Information: Fill in the minor’s name and birth date.
2. Caregiver Information: Provide your name, home address, date of birth, and driver’s license or identification card number.
3. Relationship to Minor: Indicate your relationship to the minor (e.g., grandparent, aunt, uncle).
4. Parental Notification: Check the appropriate box to indicate whether you have notified the minor’s parent(s) or if you are unable to contact them.
5. Signature: Sign and date the affidavit, affirming the truthfulness of the information provided.

Additional Information for Caregivers

There are some additional considerations for caregivers using this affidavit:

• “Qualified relative” includes a wide range of family members such as grandparents, aunts, uncles, siblings, and others.
• If you are not a relative or a licensed foster parent, you may need to obtain a foster home license to care for the minor.
• If the minor stops living with you, you must notify any relevant school or healthcare provider.
• If you do not have a California driver’s license or ID, you may use another form of identification, such as a social security number or Medi-Cal number.

California Laws

• California Courts – Forms
• California Courts Self-Help