Caregiver Affidavit Information

A Caregiver's Authorization Affidavit is a form you fill out and give to a child's school or health care provider. You can use the form to enroll the child in school or get medical care for the child. California law specifies the wording that should be used in the form, as well as who can use this form. 
 
A Caregiver's Authorization Affidavit does not affect the rights of the child's parent or give the caregiver custody of the child. A parent may revoke the authorization of the Affidavit at any time.

Who Can Use The Caregiver Authorization Affidavit?

a) School-related medical care: A caregiver with whom a child lives can use the Affidavit to enroll a child in school and to get school-related medical care (such as immunizations and medical examinations conducted in school).

b) Non school-related medical/dental care: The caregiver must be a qualifying relative in order to use the Affidavit to get non school-related medical or dental care for the child. There are some authorization limitations regarding mental health services.

Read this FAQ Sheet for additional information about how and when a Caregiver's Authorization Affidavit may be used.  Download the Affidavit here.

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Need Help?

Download the Family Resource Center Directory and contact the appropriate Family Resource Center for help from an advocate or other staff member.

Family Resource Centers can help with non-medical needs too, such as food, clothing, and shelter.