Caregiver Affidavit

Caregiver Affidavit

Frequently parents find that they need someone else, often a grandparent or other family member, to care for and make decisions for their children, but they do not want to establish a formal guardianship. There are a variety of factors that can attribute to why parents and the person who has care and physical custody of a minor may not want to pursue legal guardianship. Some of the factors may include a difficult relationship between the parents and caregiver, parents’ refusal of consent to a legal guardianship, or the caregiver may not want the hassle of applying for legal guardianship. More often it is the case that the caregiver will be taking care of the minor only temporarily.

As an alternative to legal guardianship, caregivers can sign a Caregiver’s Authorization Affidavit. A Caregiver’s Authorization Affidavit is an official form based on California’s recognition that adults who have minors living with them are “caregivers” who often want and need to take some responsibility for the minor’s education and other care. A relative who has signed a Caregiver’s Authorization Affidavit may enroll a child in public school, make school-related medical decisions, and make other important decisions on the minor’s behalf.

Non-relatives may also use this form to enroll a child in school and to receive school-related medical treatment.

According to California Law, schools and medical care providers must accept this form if it completed correctly. It is important to note that only the caregiver is required to sign the form, not the minor’s parents. California Law specifically sets out the requirements for the affidavit.

The affidavit is designed for temporary custodial care of a minor and should be notarized. For more general information on other alternatives to guardianship, visit the California Courts Self-Helpwebsite.

A blank Caregiver’s Authorization Affidavit in English and Spanish is available online. Once completed, the form should be notarized and submitted to Student Services located at 1574 Canal Drive in Room WW-1. For more information, please call Student Services at 667-0632. Information on how to complete the form can be found in “The Guardianship Book for California: How to Become a Child’s Legal Guardian” published by Nolo Press. This book is available for review at the Stanislaus County Public Law Library and at Nolo-Law.

CA Caregiver Regulations

• 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 invalid after the school district receives notice that the student no longer lives with the caregiver.

• Caregivers

  1. “Qualified relative,” for purposes of item 5 means a spouse, parent, step-parent, brother, sister, step-brother, step-sister, 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.
     If you do not have the information requested in item 8 (California driver’s license or ID), provide another form of identification such as your social security number or Medi-Cal number.

• School Officials

  1. Section 48204 of the Education Code provides that this affidavit constitutes a sufficient basis for 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.

• Health Care Provider/Service Plan

  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.

• Homeless Youth

  1. Sharing the housing of other persons due to loss of housing, economic hardship, or a similar reason. Sometimes referred to as doubled-up.  Note: Temporary at said housing 4 weeks or less; otherwise it is a CAREGIVER.
     • Living in motels, hotel, trailer parks, or camping grounds due to lack of alternative adequate accommodations.
     • Living in emergency or transitional shelters.
     • Abandoned in hospitals or
     • Awaiting foster care placement.
  2. Children and youth who have a primary nighttime residence that is a public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings;  
  3. Children and youth who are living in cars, parks, public spaces, abandoned buildings, substandard housing, bus or train stations, or similar settings; and
     Migratory children who qualify as homeless because they are living in circumstances described above.