Free California Affidavit of Caregiver’s Authorization PDF Template

Updated on November 2, 2021

A California caregiver’s authorization affidavit is an official document that recognizes adults living with minors as their caregivers. The caregiver can use the form for education and health care purposes. It is written according to the California family code division 11. Minors [6500 – 7143] and PART 1.5. Caregivers section [6550 – 6552].

Using this form, caregivers can enroll a child in public school and make school-related medical decisions among other decisions on behalf of the minor.

The section filled allows for school enrolment and school-related medical care authorization as well as any other medical care.

Details of the minor (below 18 years) and the caregiver

  • Name of the minor
  • Date of birth
  • The name of the caregiver
  • The home address of the caregiver
  • Identify who you are to the minor (whether an Aunt, uncle, grandparent, or qualified relative).
  • Check on either of the boxes or both whether you have advised the parents of the minor or you are unable to locate them for authorization.
  • Caregiver’s date of birth.
  • Caregiver’s identification card number or driver’s license.

Once the information is affirmed to be true, the caregiver undersigns with a date and signature.

  • The form contains additional information addressed to the caregivers, school officials, and health care providers following California laws. The California caregiver’s authorization affidavit is valid for one year since its execution date, and the person relying on the affidavit is not obligated to make any further investigations.

It is also important to understand that the affidavit does not declare the caregiver as a legal custodian of the minor. It should not in any way affect the rights of the minor’s parents or legal guardian when it comes to matters regarding the custody, care, and control of the minor.