The 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, authorized by the California Family Code, requires completion of specific items to ensure the minor's well-being while in the caregiver's care. If you are a qualified relative caring for a minor, consider filling out the form by clicking the button below.
The Caregivers Authorization Affidavit form serves as a vital tool for individuals who take on the responsibility of caring for minors in California. This form, authorized by specific sections of the California Family Code, enables caregivers to enroll a child in school and grant permission for school-related medical care, simplifying the process for those who may not have legal custody. To complete the affidavit, caregivers must provide basic information about the minor, such as their name and birth date, as well as details about themselves, including their relationship to the child and their address. Additionally, the form requires caregivers to indicate whether they have notified the minor's parents or legal guardians about their intent to authorize medical care. Importantly, the affidavit does not grant legal custody to the caregiver, nor does it affect the rights of the minor's parents or guardians. It is also essential to note that this document is valid for only one year from the date of execution. Caregivers are advised to keep the form updated and notify relevant parties if the minor ceases to reside with them. This affidavit not only streamlines the process for caregivers but also provides peace of mind, ensuring that the minor can receive necessary care and education without undue delay.
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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www.courtinfo.ca.gov/selfhelp/
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.
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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.
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After completing the Caregivers Authorization Affidavit form, you will be able to authorize the enrollment of a minor in school and approve school-related medical care. If you wish to authorize additional medical care, further information will need to be provided. Follow the steps below to fill out the form correctly.
What is the purpose of the Caregiver's Authorization Affidavit?
The Caregiver's Authorization Affidavit allows a caregiver to enroll a minor in school and authorize school-related medical care. It is a legal document recognized under California Family Code, specifically designed to facilitate care for minors by individuals who are not their parents or legal guardians.
Who can complete this affidavit?
Any individual who is 18 years of age or older and qualifies as a relative of the minor can complete this affidavit. This includes grandparents, aunts, uncles, and other specified relatives. The definition of a "qualified relative" is detailed in the affidavit itself.
What information is required to complete the affidavit?
You need to provide the minor's name and birth date, your name and address, your relationship to the minor, and your date of birth. Additionally, you must include your California driver's license or identification card number. If you do not have this information, you can provide an alternative form of identification.
What if I cannot contact the minor's parents?
If you are unable to contact the parents or legal guardians of the minor, you can indicate this on the affidavit. However, it is important to note that you should make every effort to inform them of your intent to authorize medical care.
How long is the affidavit valid?
The Caregiver's Authorization Affidavit is valid for one year from the date it is signed. After this period, you will need to complete a new affidavit if continued authorization is necessary.
Does this affidavit grant legal custody of the minor?
No, this affidavit does not grant legal custody of the minor to the caregiver. The rights of the minor's parents or legal guardians remain intact, and the caregiver does not assume legal custody through this document.
What happens if the minor stops living with me?
If the minor ceases to reside with you, you are required to notify any school or healthcare provider to whom you have given this affidavit. This ensures that the records are kept accurate and up-to-date.
What should I do if I have questions about the affidavit?
If you have questions or need clarification about the Caregiver's Authorization Affidavit, you can contact your local department of social services. They can provide guidance and information specific to your situation.
Can schools or healthcare providers require additional information?
Yes, schools and healthcare providers may request additional evidence to confirm your residency or relationship to the minor. This is to ensure that the affidavit is being used appropriately and that the minor's best interests are being considered.
Filling out the Caregiver's Authorization Affidavit form can be straightforward, but many individuals make common mistakes that can lead to complications. Understanding these pitfalls is essential for ensuring the form is completed correctly.
One frequent error is illegible handwriting. It is crucial to print clearly. If the information is difficult to read, it may cause delays or misunderstandings. Always take your time to ensure that every detail is legible.
Another mistake involves omitting required information. Items 1 through 4 must be completed to authorize enrollment in school and medical care. Skipping any of these sections can invalidate the affidavit.
Some caregivers fail to confirm their relationship to the minor. It is important to accurately state whether you are a grandparent, aunt, uncle, or another qualified relative. Misrepresenting this information can lead to legal consequences.
Additionally, caregivers often neglect to check the appropriate boxes regarding notification of the minor's parents or legal guardians. This step is essential, as it demonstrates that you have attempted to communicate your intentions.
Not providing a valid date of birth can also be a mistake. This information is necessary to verify your identity and age. Ensure you include your date of birth accurately.
Another common oversight is failing to include your California driver's license or identification card number. If you do not have this information, providing an alternative form of identification is required. Missing this detail can render the affidavit incomplete.
Some individuals mistakenly sign the affidavit without reviewing all statements for accuracy. It is vital to ensure that every statement is true and correct before signing. Signing an incorrect affidavit can lead to serious legal repercussions.
Caregivers may also forget to date the form. The date is important as it indicates when the affidavit was executed. Without this, the affidavit may not be considered valid.
Finally, many caregivers do not realize that the affidavit is only valid for one year. It is essential to keep track of the expiration date and renew the affidavit as necessary to maintain authorization.
By being aware of these common mistakes, caregivers can complete the Caregiver's Authorization Affidavit form accurately and confidently. Taking the time to double-check all information will help ensure a smoother process for enrolling the minor in school and obtaining necessary medical care.
The Caregivers Authorization Affidavit is an essential document for individuals stepping in to care for a minor. Alongside this affidavit, several other forms and documents may be necessary to ensure that caregivers can effectively manage the minor's educational and medical needs. Below are a few commonly used documents that complement the Caregivers Authorization Affidavit.
Understanding these additional forms can help caregivers navigate the complexities of providing care for a minor. Each document serves a specific purpose and ensures that caregivers can act in the best interest of the child, particularly in urgent situations.
Power of Attorney for Minor Child: This document allows a parent or legal guardian to grant another person the authority to make decisions on behalf of their child. Like the Caregivers Authorization Affidavit, it can be used for medical care and educational decisions, but it often extends to broader legal and financial matters.
Temporary Guardianship Agreement: This form is used when a parent temporarily assigns guardianship of their child to another adult. Similar to the Caregivers Authorization Affidavit, it provides the caregiver with specific rights regarding the child's welfare, but it typically covers a longer duration and may involve court approval.
Minor Consent for Medical Treatment: This document allows minors to consent to their own medical treatment under certain conditions. While the Caregivers Authorization Affidavit authorizes caregivers to make medical decisions, this consent form empowers the minor directly, usually in specific situations like reproductive health or mental health services.
School Enrollment Authorization: This form is used by parents or guardians to authorize a caregiver to enroll a child in school. It is similar to the Caregivers Authorization Affidavit in that it provides necessary information for school officials, but it focuses specifically on educational enrollment rather than broader medical care.
Health Care Proxy: This document designates an individual to make health care decisions on behalf of someone else if they become unable to do so. Like the Caregivers Authorization Affidavit, it is intended to ensure that someone trusted can make important decisions, but it is generally used for adults rather than minors.
When filling out the Caregivers Authorization Affidavit form, keep these tips in mind:
Additionally, avoid these common mistakes:
This form does not give the caregiver legal custody of the minor. It simply allows the caregiver to enroll the child in school and authorize medical care.
While parents can complete it, qualified relatives such as grandparents, aunts, and uncles can also fill out the affidavit to authorize care.
This affidavit is only valid for one year from the date it is signed. After that, a new affidavit must be completed.
As long as the caregiver is a qualified relative, they can complete the affidavit without needing a legal relationship like guardianship.
To authorize all types of medical care, the caregiver must complete additional sections of the affidavit. Basic enrollment in school and school-related medical care requires only items 1-4.
Caregivers must notify the parents or legal guardians of their intent to authorize medical care unless they cannot contact them.
If the minor stops living with the caregiver, the caregiver must inform any school or healthcare provider where the affidavit was submitted.
Caregivers must provide identification. If they do not have a California driver's license or ID, they should submit other forms of identification.
Schools must accept the affidavit as proof of residency unless they have actual facts indicating otherwise.
Here are some key takeaways regarding the Caregivers Authorization Affidavit form: