Vacaville Unified School District

California 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 formal guardianship. A variety of factors can contribute to why parents and the person who has care and physical custody of a minor may not want to pursue legal guardianship. More often, the caregiver will only temporarily take care of the minor.

As an alternative to legal guardianship, caregivers can sign a Caregiver's Authorization Affidavit. This official form is 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.

According to California Law, schools and medical care providers must accept this form if it is completed correctly. It is important to note that only the caregiver, not the minor's parents, is required to sign the form. California Law specifically sets out the requirements for the affidavit. The Caregiver's Authorization Affidavit is available in English and Spanish. This form must be notarized and renewed each school year. Approval is granted from the Student Attendance and Welfare Department.

California 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. This Affidavit is not valid for more than one year after the current school year on which it is executed.
3. If you are not a relative or currently licensed foster parent, the law requires you to obtain a foster home license in order to care for a minor. (If you have questions, please contact your local Department of Social Services).
4. If the minor stops living with you, you are required to notify the school, health care provider, and/or health care service plan to whom you have given the affidavit.

To Caregivers

1. Execution of an Affidavit under penalty of perjury by the caregiving adult pursuant to Part 1.5 (commencing with Section 6550) of Division 11 of the California Family Code is a sufficient basis for a determination that the pupil lives in the home of the Caregiver unless the school district determines from actual facts that the pupil is not living in the home of the Caregiver.
2. “Qualified relative” 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.
3. A Caregiver who is a qualified relative has the same rights to medical and dental care that are given to legal guardians under Probate Code section 2353. Probate section 2353 states, in pertinent part, that a "guardian has the same right as a parent having legal custody of a child to give consent to medical treatment performed upon the ward and to require the ward to receive medical treatment."
4. Caregivers who are NOT "qualified relatives," as defined by the policy, are only allowed to authorize school-related medical care on behalf of the minor. “School-related medical care" generally means medical care that is required as a condition for school enrollment, including immunizations, physical exams, and medical exams conducted in schools for pupils. California Family Code section 6550.
5. If you do not have a 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 determining the minor's residency 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. You must also provide any and all legal documents indicating legal custody of said minor or signed, notarized documentation from the parent authorizing you as a Caregiver.

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 and is subject to professional disciplinary action, for that reliance if the applicable portions of the form are completed.
2. This Affidavit does not confer dependency for health care coverage purposes. (Amend. Stats. 2004, Ch 895).