Download Caregivers Authorization Affidavit Template Access Editor Here

Download Caregivers Authorization Affidavit Template

The Caregiver's Authorization Affidavit form is a legally recognized document in California that enables a caregiver to take certain responsibilities for a minor, such as enrolling them in school and authorizing school-related medical care without needing formal custody. Authorized by Part 1.5 of Division 11 of the California Family Code, it requires completion and signing to be valid for use. To ensure the wellbeing of a minor in your care, consider filling out the Caregiver's Authorization Affidavit form by clicking the button below.

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Navigating the legalities of caregiving for a minor can be daunting, especially when it involves making critical decisions relating to their schooling and medical care without formal custody. This is where the Caregiver's Authorization Affidavit form steps in – a powerful tool authorized by Part 1.5 of Division 11 of the California Family Code designed to simplify this process. Aimed at non-parental caregivers, it empowers them to legally enroll minors in school and authorize medical care on the child's behalf. Completing parts 1 through 4 of the form grants authority for school enrollment and related medical decisions, whereas filling out items 5 through 8 extends authorization to broader medical care. Crucially, the person signing the affidavit must be a qualified relative, or meet specific caregiving criteria, and declare their relationship to the minor under the penalty of perjury, ensuring the child's safety remains paramount. This affidavit does not alter parental rights but provides a caregiver with a temporary, verifiable right to make essential decisions. For the caregiver, the journey does not end with signing the form; they are obliged to inform the appropriate parties if the minor ceases to reside with them and ensure the affidavit remains valid for no more than one year or until a renewal is necessary. Furthermore, both educational and medical institutions are encouraged to accept the affidavit without further investigation, provided the document is filled out correctly, thus easing the caregiver's path to securing the minor’s welfare.

Document Example

Caregiver's Authorization Affidavit

Use of this affidavit is authorized by Part 1.5 (commencing with Section 6550) of Division 11 of the California Family Code.

Instructions: Completion of items 1 - 4 and the signing of the affidavit is sufficient to authorize enrollment of a minor in school and authorize school- related medical care. Completion of items 5-8 is additionally required to authorize any other medical care. Print clearly.

The minor named below lives in my home and I am 18 years of age or older.

1.Name of minor: ______________________________.

2.Minor's birth date: _____________________.

3.My name (adult giving authorization): _______________________________.

4.My home address (street, apartment number, city, state, zip code):

______________________________________________

______________________________________________

______________________________________________

5.I am a grandparent, aunt, uncle, or other qualified relative of the minor (see page 2 of this form for a definition of "qualified relative").

6.Check one or both (for example, if one parent was advised and the other cannot be located):

I have advised the parent(s) or other person(s) having legal custody of the minor of my intent to authorize medical care, and have received no objection.

I am unable to contact the parent(s) or other person(s) having legal custody of the minor at this time, to notify them of my intended authorization.

7.My date of birth: ______________________.

8.My California's driver's license or identification card number: ____________.

Warning: Do not sign this form if any of the statements above are incorrect, or you will be committing a crime punishable by a fine, imprisonment, or both.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Dated: _____________________ Signed: ________________________

California Courts Self-Help Center

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Notices:

1.This declaration does not affect the rights of the minor's parents or legal guardian regarding the care, custody, and control of the minor, and does not mean that the caregiver has legal custody of the minor.

2.A person who relies on this affidavit has no obligation to make any further inquiry or investigation.

3.This affidavit is not valid for more than one year after the date on which it is executed.

Additional Information:

TO CAREGIVERS:

1."Qualified relative," for purposes of item 5, means a spouse, parent, stepparent, brother, sister, stepbrother, stepsister, half-brother, half-sister, uncle, aunt, niece, nephew, first cousin, or any person denoted by the prefix "grand" or "great," or the spouse of any of the persons specified in this definition, even after the marriage has been terminated by death or dissolution.

2.The law may require you, if you are not a relative or a currently licensed foster parent, to obtain a foster home license in order to care for a minor. If you have any questions, please contact your local department of social services.

3.If the minor stops living with you, you are required to notify any school, health care provider, or health care service plan to which you have given this affidavit.

4.If you do not have the information requested in item 8 (California driver's license or I.D.), provide another form of identification such as your social security number or Medi-Cal number.

TO SCHOOL OFFICIALS:

1.Section 48204 of the Education Code provides that this affidavit constitutes a sufficient basis for a determination of residency of the minor, without the requirement of a guardianship or other custody order, unless the school district determines from actual facts that the minor is not living with the caregiver.

2.The school district may require additional reasonable evidence that the caregiver lives at the address provided in item 4.

California Courts Self-Help Center

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www.courtinfo.ca.gov/selfhelp/

 

TO HEALTH CARE PROVIDERS AND HEALTH CARE SERVICE PLANS:

1.No person who acts in good faith reliance upon a caregiver's authorization affidavit to provide medical or dental care, without actual knowledge of facts contrary to those stated on the affidavit, is subject to criminal liability or to civil liability to any person, or is subject to professional disciplinary action, for such reliance if the applicable portions of the form are completed.

2.This affidavit does not confer dependency for health care coverage purposes.

California Courts Self-Help Center

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www.courtinfo.ca.gov/selfhelp/

 

Form Specifics

Fact Name Description
Governing Laws This affidavit is authorized by Part 1.5 (commencing with Section 6550) of Division 11 of the California Family Code.
Minimum Requirements Completion of items 1 - 4 and the signing of the affidavit authorizes enrollment of a minor in school and school-related medical care.
Additional Medical Care Completion of items 5-8 is required to authorize any other medical care beyond school-related needs.
Qualified Relatives A “qualified relative” includes a broad range of familial relations and their spouses, even after the relationship ends by death or dissolution.
Foster Care License Non-relatives and those not currently licensed as foster parents may need to obtain a foster home license to care for a minor.
Notification Requirement If the minor stops living with the caregiver, the caregiver must notify any school, health care provider, or health care service plan provided with the affidavit.
Alternative Identifications If the caregiver does not have a California driver's license or I.D., they must provide another form of identification like a social security or Medi-Cal number.
Protection for School Officials The affidavit constitutes sufficient basis for determination of residency for school enrollment without a guardianship or other custody order, but schools may require additional proof of residence.
Protection for Health Care Providers Health care providers relying in good faith on this affidavit for medical care are protected from criminal, civil, and professional disciplinary action.

Caregivers Authorization Affidavit - Usage Steps

When preparing to fill out the Caregiver's Authorization Affidavit form, it's crucial to understand the next steps you'll take. This form serves as a legal tool that allows you to take on certain responsibilities concerning a minor's care, particularly in matters of schooling and health without requiring a court order. It's a straightforward process but demands your attention to detail to ensure all the information provided is accurate and aligns with legal requirements.

  1. Start by printing your name in the space provided under the section titled "My name (adult giving authorization)". Ensure your name is written clearly to avoid any misunderstandings.
  2. In the "Name of minor" section, write the full name of the child you are taking responsibility for. Double-check the spelling to ensure it matches their official documents.
  3. Next, fill in the "Minor's birth date" section with the child's date of birth, using the format indicated or a universally accepted format such as MM/DD/YYYY.
  4. Under "My home address", enter your complete address including the street, apartment number, city, state, and zip code. This verifies where you and the minor reside.
  5. If you are a grandparent, aunt, uncle, or meet the criteria for another qualified relative as defined, indicate your relationship to the minor in item 5. Only proceed to this step if it applies to your circumstances.
  6. In the section regarding advising the minor's parents or legal guardians, check the box that aligns with your situation: whether you have notified them without objection, or if you've been unable to contact them. Choose the appropriate option based on your specific case.
  7. Provide your date of birth where requested, ensuring accuracy, as this is used for further identification purposes.
  8. If you possess a California driver's license or identification card, input the number in the space provided. In case you do not have this, be prepared to provide alternative identification details as suggested.
  9. Firmly sign and date the affidavit at the end, acknowledging under penalty of perjury that all information provided is true and correct to the best of your knowledge. Remember, signing this document has legal implications.

By carefully following these steps, you'll successfully complete the Caregiver's Authorization Affidavit. It's a document that facilitates your ability to make decisions in areas crucial to the minor's wellbeing, making it significantly important to handle with diligence and sincerity. Once filled, keep a copy for your records and be prepared to present it when required at schools, medical facilities, or other relevant institutions.

More About Caregivers Authorization Affidavit

When caring for a minor, situations often arise that require clarity on legal permissions, especially in the absence of the minor's parents. The Caregiver’s Authorization Affidavit is one tool that provides a temporary but formal mechanism to address such situations. Below are answers to some of the most common questions regarding this form.

  1. What is a Caregiver’s Authorization Affidavit?

    This affidavit is a document that allows a caregiver to enroll a minor in school and to make school-related medical decisions for the minor. The form can also authorize additional medical care, provided certain sections are completed. It's recognized by California law to assist those who've taken the responsibility of caring for a minor in the absence of parents or legal guardians.

  2. Who can use this affidavit?

    Any adult 18 years or older living in California, who is taking care of a minor at their home, can use this affidavit. It’s specifically helpful for relatives such as grandparents, aunts, uncles, etc., but others may use it under specific circumstances, and possibly with additional requirements like obtaining a foster home license.

  3. What legal rights does signing this affidavit grant?

    Signing this affidavit allows the caregiver to make decisions about the minor’s education and certain health care needs. However, it’s crucial to understand that it doesn't grant legal custody or affect the rights of the minor's parents or legal guardian in any way regarding care, custody, and control of the minor.

  4. Are there any responsibilities for the caregiver after signing this affidavit?

    Yes. If the minor stops living with the caregiver, the caregiver must notify any school, health care provider, or health care service plan where the affidavit was presented. Caregivers must also be ready to provide additional evidence of their address or relationship to the minor if requested by schools or healthcare providers.

  5. What should I do if I cannot contact the minor's parents or legal guardians?

    The affidavit allows for such situations. You can still complete and sign the form, indicating that you were unable to contact the parents or guardians. However, it’s essential to act in good faith and make reasonable efforts to contact them whenever possible.

  6. How long is the affidavit valid?

    The affidavit is valid for one year after the date it is executed. To continue the authorities granted by the affidavit beyond this term, a new affidavit must be completed and signed each year.

These provisions ensure that children receive the care and support they need, even in complex living situations, while also protecting the rights and responsibilities of all involved parties. For more detailed information or specific concerns, consulting with a legal professional or local family services department is advisable.

Common mistakes

Completing the Caregiver's Authorization Affidavit requires thorough attention to detail and a clear understanding of legal responsibilities. Several common mistakes can lead to issues that may compromise the caregiver's ability to provide for the minor in their care. Awareness of these pitfalls is the first step towards ensuring the affidavit serves its intended purpose effectively.

Firstly, misinformation or failure to provide accurate details in sections 1 through 4 can hinder the affidavit's validity. These sections are crucial for the enrollment of the minor in school and for authorizing school-related medical care, which are essential for the child’s well-being and development.

  1. Not verifying the minor's name and birth date for accuracy can lead to legal complications or delays in obtaining necessary services.
  2. Entering an incorrect or incomplete address undermines the caregiver’s claim of residence, which is key to establishing the legal standing to make decisions on behalf of the minor.
  3. Omitting the caregiver's relationship to the minor or failing to establish that they are a "qualified relative" as specified in the instructions compromises the affidavit's legitimacy.
  4. Failure to properly notify the parent(s) or legal guardian(s) as indicated in the affidavit could be seen as bypassing necessary legal protocol, potentially leading to legal repercussions.
  5. Not providing an alternate form of identification if a California driver's license or ID is unavailable leaves the affidavit incomplete and may question the caregiver’s identity verification.
  6. Assuming the affidavit confers legal custody without understanding that it does not affect the rights of the minor's parents or legal guardian can create misunderstandings about the caregiver’s legal authority.
  7. Lack of awareness that the affidavit is not valid indefinitely and must be renewed yearly can abruptly end the caregiver's authorization, possibly when it's most needed.
  8. Finally, not notifying schools, healthcare providers, or healthcare service plans when the minor stops living with the caregiver fails to close a critical loop in the legal and care provision process.

While the use of the Caregiver's Authorization Affidavit can facilitate necessary care and educational services for minors without going through lengthy legal processes, it's imperative that the form is filled out with precision and a full understanding of its implications. Caregivers should approach this task with the seriousness it demands, ensuring all information is current, accurate, and thoroughly verified. Consulting legal guidance when uncertainties arise can prevent potential issues and ensure the caregiver’s authority is recognized and undisputed.

Documents used along the form

The process of obtaining and using a Caregiver's Authorization Affidavit involves multiple steps and often necessitates gathering additional documents to support the caregiver’s capability and authority to care for a minor. These documents serve various purposes, from proving the caregiver’s relationship and responsibility to the child, to ensuring the minor's health and educational needs are met comprehensively. Here’s a list of documents often used alongside the Caregiver's Authorization Affidavit, each serving an integral role in the caregiving process.

  • Birth Certificate of the Minor: Establishes proof of the child’s age and identity, often requested by schools and medical facilities.
  • Proof of Caregiver's Address: Such as a utility bill or lease agreement, to confirm the caregiver’s residency, which is crucial for school enrollment and legal matters.
  • Guardianship Form: If a caregiver holds guardianship, a signed and notarized Guardianship Form offers legal proof of this status.
  • Medical Records of the Minor: Essential for providing health care, these records show immunization history and any special medical conditions or requirements.
  • School Records: Transfer records and transcripts help in the enrollment process and ensure the minor continues their education without disruption.
  • Parental Consent Form: If the parents are alive and available, their signed consent supports the caregiver’s affidavit and may be necessary for certain legal actions.
  • Photo Identification of Caregiver: A valid ID (driver’s license or state ID) is required for verification of the caregiver’s identity in various administrative and legal situations.
  • Special Education Documentation: If the child is receiving special education services, these documents ensure they will continue to receive appropriate support under the caregiver's supervision.
  • Emergency Contact Form: Schools and medical providers often request a list of emergency contacts, which should be updated to include the caregiver.
  • Insurance Information: To manage the minor's medical care effectively, caregivers should have access to the child's health insurance cards or information.

Collectively, these documents work in conjunction with the Caregiver's Authorization Affidavit to ensure a caregiver has all necessary tools and permissions to provide for a minor's health, education, and well-being. Whenever beginning the process of caregiving or assuming new responsibilities for a minor, acquiring and organizing these documents should be a priority. This comprehensive approach ensures the caregiver is well-prepared to support the minor in all facets of life, from schooling to healthcare, significantly easing transitions and bolstering the caregiver's authority when interacting with schools, medical providers, and legal entities.

Similar forms

The Power of Attorney (POA) form shares some foundational similarities with the Caregiver's Authorization Affidavit, especially in the delegation of certain rights and responsibilities from one individual to another. Unlike the Caregiver's Authorization Affidavit, which is primarily used for the enrollment of minors in school and authorizing school-related medical care, a POA can cover a wide range of responsibilities, from financial decisions to health care determinations and beyond. Both documents are pivotal in circumstances where direct management by the principal or parent is not possible, thereby necessitating a trusted individual to act on their or the minor’s behalf.

Similarly, the Temporary Guardianship Agreement also aligns closely with the Caregiver's Authorization Affidavit with regard to its focus on minors. This agreement typically grants a guardian temporary decision-making authority and care over a child, often including stipulations for medical and educational decisions. While the Caregiver's Authorization focuses more narrowly on educational and school-related medical care without conferring legal custody, the Temporary Guardianship Agreement encompasses a broader spectrum of the child’s needs and usually requires court approval or notarization to be effective.

The Medical Consent form stands as another similar document, specifically in its provision for authorizing medical treatment. Much like the expanded authorizations in the Caregiver's Authorization Affidavit, the Medical Consent form allows an appointed individual to consent to various medical treatments on behalf of someone else, typically a minor or an incapacitated adult. Both documents serve as crucial tools for ensuring that timely and necessary medical care can be provided without delay due to the unavailability of the individual’s legal guardians or holders of parental responsibility.

The Educational Consent form is designed to give certain educational rights to another individual, aligning with the school enrollment and academic medical care authorization aspects of the Caregiver's Authorization Affidavit. This could include making decisions about the child’s schooling, signing off on field trips, and consenting to various school-related activities. While the Educational Consent often needs to be more comprehensive in its coverage of educational decisions, both it and the Caregiver's Authorization play essential roles in facilitating a minor's academic progress under the care of someone other than their parents or legal guardians.

The Child Travel Consent form, while not specifically related to education or health care, shares the spirit of granting permissions for minors under circumstances where their legal guardians are not present. This form is commonly used to authorize a child to travel with an adult who is not their legal guardian, ensuring that they have consent to cross borders or travel domestically under someone else’s supervision. Though its scope is different, the underlying principle of assigning temporary responsibilities and rights over a minor mirrors that of the Caregiver's Authorization Affidavit, focusing on the child's welfare and safety in the absence of their parent or guardian.

The Health Insurance Portability and Accountability Act (HIPAA) Authorization Form is another document that, while broader in application, intersects with the Caregiver's Authorization Affidavit's requirements for medical care decisions. HIPAA Authorization allows individuals to designate who can have access to their private health information, ensuring that caregivers can communicate with healthcare providers and make informed decisions. Though not limited to minors or focused exclusively on medical treatment authorization, HIPAA Authorizations complement the medical care provisions within the Caregiver's Authorization by safeguarding the flow of necessary health information.

Last but not least, the Court-Appointed Guardianship letter, often the result of a legal process, shares similarities with the Caregiver's Authorization Affidavit in its intention to safeguard the well-being of a minor. This letter grants a guardian legal authority over various aspects of a minor's life, ranging from living arrangements to medical and educational decisions. While court-appointed guardianship confers a broader and more permanent scope of authority compared to the Caregiver's Authorization, both documents ultimately aim to ensure that responsible adults are in place to make crucial decisions on behalf of a minor.

Dos and Don'ts

Filling out the Caregiver’s Authorization Affidavit form requires attention to detail and a clear understanding of its instructions to ensure the process is completed accurately and legally. Here are some dos and don’ts that can help guide caregivers through this important process:

  • Do ensure that all information provided is accurate and truthful. Specifically, when filling out details such as the name and birthdate of the minor, your relationship to them, and your contact information, double-check to avoid any errors.
  • Do obtain consent from the parent(s) or legal guardian(s) of the minor, if possible, before signing the affidavit. This step is essential unless you cannot locate the parents or guardians to inform them of your intended authorization.
  • Do notify the necessary parties, such as schools and health care providers, if the minor ceases to live with you. It’s important to keep all relevant parties informed to ensure the continued accuracy of records and the well-being of the minor.
  • Do renew the affidavit as needed since it is not valid for more than one year after the date it was executed. Keeping the affidavit current is crucial for maintaining the authority it grants.
  • Don’t sign the affidavit if any of the statements are incorrect or if you know you will be providing false information. Misrepresenting facts in this legal document is punishable by law.
  • Don’t neglect to provide an alternate form of identification if you do not have a California driver's license or ID, as required in item 8. Acceptable alternatives might include your social security number or Medi-Cal number.
  • Don’t disregard the limitations of the affidavit. Remember, it doesn't affect the rights of the minor's parents or legal guardian regarding their care, custody, and control, nor does it mean you have legal custody.
  • Don’t forget to check whether you require a foster home license to care for the minor, especially if you are not a relative or a currently licensed foster parent. Understanding and complying with your local regulations is essential.

Misconceptions

There are several common misconceptions regarding the Caregiver's Authorization Affidavit form that deserve clarification to ensure both caregivers and those they support understand the form’s scope and limitations.

  • Misconception 1: Completing the form grants legal guardianship over the minor. Many people mistakenly believe that by signing the Caregiver's Authorization Affidavit, they are granted legal guardianship of the minor. In reality, the form does not affect the rights of the minor's parents or legal guardian. It merely allows the caregiver to make decisions pertaining to the child’s education and certain medical care without altering legal custody.

  • Misconception 2: The affidavit is permanent. Another common misunderstanding is that once completed, the Caregiver's Authorization Affidavit is permanent. This document is valid for only one year after the date it is executed and must be renewed annually for the caregiver to continue having the authority to make decisions for the minor.

  • Misconception 3: The form allows the caregiver to authorize all forms of medical care. While it is true that completing items 1 through 4 of the affidavit grants the authority to enroll the minor in school and authorize school-related medical care, some overlook that completing items 5 through 8 is necessary to authorize any other medical care. This distinction is crucial for caregivers to understand to ensure they have the proper authorization needed for the child's wellbeing.

  • Misconception 4: No further action is required after signing the affidavit. Many people assume that after signing the affidavit, no further action is required. However, if the minor stops living with the caregiver, the caregiver is required to notify any school, health care provider, or health care service plan to which the affidavit was provided. Additionally, schools and healthcare providers may require further evidence that the caregiver resides at the address given or that the minor is living with the caregiver.

Understanding these misconceptions and clarifying the actual provisions and limitations of the Caregiver’s Authorization Affidavit ensure that caregivers can adequately provide for the minors in their care while respecting the legal rights of parents or guardians.

Key takeaways

Filling out and using the Caregiver's Authorization Affidavit enables an individual to enroll a minor in school and authorize school-related medical care simply by completing items 1 - 4 and signing the affidavit. This document serves as a powerful tool for caregivers who have taken on the responsibility of caring for a minor without going through the formal process of obtaining legal custody or guardianship.

To authorize any other medical care beyond that related to schooling, the caregiver must fill out items 5-8 additionally. This requirement ensures that the caregiver has the necessary authorization to make broader health care decisions when needed, emphasizing the importance of thoroughly completing the affidavit.

The term "qualified relative" is specifically defined to include a wide range of familial relationships, highlighting the law's recognition of the diverse family structures that exist and their capability to provide care for minors. This inclusivity ensures that many family members can make use of this affidavit without unnecessary legal barriers.

School officials and health care providers are instructed to accept this affidavit without the need for further inquiry or investigation, provided they act in good faith. This provision facilitates the caregiver's ability to ensure the minor's needs are met promptly and effectively, minimizing bureaucratic delays.

The affidavit explicitly does not alter the legal rights of the minor's parents or legal guardians concerning the care, custody, and control of the minor. This clarifies that the caregiver does not obtain legal custody through this document, preserving the rights of parents and guardians while still allowing caregivers to provide essential support.

Importantly, the affidavit is valid for only one year after its execution, necessitating annual renewal. Caregivers must remain vigilant about this expiration to ensure there is no interruption in their authority to make decisions on behalf of the minor.

If the caregiver does not have a California driver's license or ID, they are instructed to provide an alternative form of identification. This flexibility ensures that the absence of specific identification does not hinder the caregiver's ability to complete the affidavit.

Caregivers are obliged to notify any school, health care provider, or health care service plan if the minor ceases to live with them. This responsibility ensures that all entities involved with the minor's care are kept up to date with the current caregiving situation, maintaining the minor's welfare as the paramount concern.

The document cautions caregivers against signing the affidavit if any statements are incorrect, as doing so would be committing a crime, emphasizing the seriousness with which this document should be approached and the importance of providing accurate information.

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