How to fill out the California Caregiver's Authorization Affidavit

This page is line by line help with the form. To decide who should be the caregiver, or whether you need a guardianship instead, see Who can care for my children if I am detained. This is general information, not legal advice.

Who fills out this form?

The caregiver does. That is the adult the child lives with. The caregiver fills it out and signs it. The parent does not sign it, though it helps to fill it out together while the parent is available.

To use it, two things must be true:

• The child lives in the caregiver's home.
• The caregiver is 18 or older.

If the child does not live with you yet, you can fill out the form ahead of time and keep it ready. Give it to the school or doctor when the child actually moves in with you.

Which items do I fill out?

It depends on whether you are related to the child.

"Relative" is broad. It means any adult related to the child within the fifth degree by blood, adoption or marriage. That includes grandparents, aunts, uncles, cousins, stepparents, stepsiblings, great and great great relatives, and their spouses, even after a divorce or death. The second page of the form explains this too.

Items 1 to 4: for every caregiver

1. Name of minor. Write the child's full legal name, the way it appears on the birth certificate or school records. The form has room for one child. If you care for more than one child, fill out a form for each.

2. Minor's birth date. Month, day and year.

3. My name. Your full name, as the adult giving permission.

4. My home address. The address where you and the child live. This is the address the school will use.

That is all a friend or neighbor needs. Go to Sign and date it.

Items 5 to 8: for relatives only

5. I am a relative of the child. Mark this item only if you fit the definition above.

6. Tell the parents. Check one box, or both:

• a. You told the parent or parents (or anyone else with legal custody) that you plan to give permission for medical care, and they did not object.
• b. You cannot reach the parent or parents right now to tell them.

Check both when one parent was told and the other cannot be found. Write down when and how you told the parent, in your own notes, in case anyone asks later.

7. My date of birth. Your own birth date.

8. ID number. Your California driver's license number, California ID card number, or the number of a government issued consular card. If you have none of these, the form lets you give another identifying number, such as a Medi-Cal number. You do not have to write your immigration status anywhere on this form.

Sign and date it

Read every line again. At the bottom of page 1, you declare under penalty of perjury under California law that everything is true. Then date it and sign your name.

Do I need a notary or a court?

No. The form says on its face that it does not need a court seal, a clerk or judge's signature, or a notary. You do not file it anywhere. This is on purpose, so schools and doctors can see it is valid as written.

What do I do with it after I sign?

1. Make copies. Keep the signed original in a safe place at home.
2. Give a copy to the school when you enroll the child. The school must accept the form as proof the child lives with you. It may also ask for something reasonable that shows your address, like a utility bill.
3. Give a copy to the doctor, dentist or clinic, and to the health plan if needed. A health care provider who relies on a completed form in good faith is protected under the law.
4. Give a copy to the county welfare office if you apply for help for the child there.
5. Tell the parent where the papers are, if you can.

Also update the child's emergency contacts at school. Since 2026, schools must first follow the parent's emergency contact instructions when a parent is not available. See Every child can go to public school.

What can this form not do?

Know its limits so there are no surprises:

• It does not give you custody. The parent keeps all their rights.
• The parent's medical decision comes first. If you and the parent disagree about medical or dental care, the parent's decision wins, unless it would put the child's life, health or safety at risk.
• It cannot be used to keep a child against the parent's wishes.
• It works only in California.
• It does not add the child to your health insurance as your dependent.
• It does not cover money matters or passports. For a longer absence or bigger decisions, see guardianship in Who can care for my children if I am detained.

California is also preparing court forms for a joint guardianship, where a parent and another adult can share guardianship. As of October 21, 2026 they were not adopted yet. They are set for the Judicial Council meeting on October 24, 2026, with a proposed start date of January 1, 2027 (court advisory committee agenda). A court cannot name joint guardians over the objection of a parent who does not have custody unless it finds that giving that parent custody would harm the child (Probate Code 2105).

When does it stop working?

When the child stops living with you. Then you must tell any school, doctor or health plan that got a copy. The form is no longer valid once they get your notice.

Does it expire? The January 2026 form says it does not. The California Courts Self Help Guide says to sign a new one each year, and some clinics ask for a new one yearly as their own rule. Our advice: fill out a fresh copy every year on the newest form. It is quick and avoids problems.

Using an older form? Fill out the January 2026 version. The 2026 law widened who counts as a relative and added mental health care to what a relative can agree to.

What mistakes should I avoid?

• Using the Spanish copy as your signed form. Read it in Spanish if that helps. Sign the English one.
• Checking "relative" when you are not one. Friends fill out items 1 to 4 only.
• Leaving item 6 blank as a relative. Without it, you cannot agree to medical care beyond school.
• Giving away your original. Hand out copies.
• Forgetting to update the school when the child moves out or the plan changes.
• Paying someone to fill it out. The form is free. A notario cannot give legal advice. See Warning signs of an immigration scam.

Who can help?

These are free public offices and nonprofit legal services. Contact them to confirm hours, languages and openings. Being listed here is not a referral or a promise of service.

• Your county court's self help center: free help with family and guardianship forms. Start at the California Courts Self Help Guide. San Mateo County's center offers LiveChat.
• Your county social services office: for questions about resource family approval if you are not a relative.
• Community Legal Services in East Palo Alto (CLSEPA): for people with low income in San Mateo and Santa Clara counties. (650) 326-6440, 1861 Bay Road, East Palo Alto. Walk ins Monday to Friday, 9 a.m. to 1 p.m.
• Legal Aid Society of San Mateo County: for San Mateo County residents. (650) 558-0915.
• More free help: Free legal help in the Bay Area.

Questions people ask

Can a parent fill it out for the caregiver? The caregiver signs and swears it is true, so the caregiver should fill it out, or at least read and check every line before signing.

I am not a relative. Can I take the child to the doctor for a cold? The form lets you agree only to school related health care. For other care, ask the parent to give written permission, or talk with a family law helper about other options.

Can I use this form in another state? No. It is valid only in California.

Do I need to give the school my immigration status? No. Item 8 asks for an ID number, and a consular card number works.

The parent is detained. Do I check 6a or 6b? If you told the parent and they did not object, check 6a. If you cannot reach them, check 6b. Ask a family law helper if you are unsure.

Can the parent cancel it? Yes, at any time.

Is there a sheet to help me get ready?

Stepping in for a child is a gift. This form helps you do it with confidence. If anything feels unclear, ask for free help before you sign.