Caregiver choice worksheet
A printable from Who Cares for My Children. Fill it in by hand. Nothing you write is collected by this website.
Caregiver choice worksheet
Fill this out at home. Do not write immigration details or case numbers on it.
My first choice caregiver
- Name and phone: ______________________
- Relative? Yes / No
- We talked about how long, money, school and how to reach me
My backup caregiver
- Name and phone: ______________________
- We talked too
Which tools I will use
- Caregiver's Authorization Affidavit (2026 form), signed by my caregiver
- Copies for my caregiver, home and school
- GC-211 Nomination of Guardian, signed and kept with my papers
- I asked the court self help center or a lawyer about guardianship or joint guardianship
- For my child age 18 to 20: we asked an immigration provider about SIJS
Who I told
- School and child care emergency contacts updated
- My children know who will care for them
- My caregiver knows where my papers are
Next check: ____ / ____ / ______ (every 6 to 12 months, and sign a fresh caregiver form each year)
From Who Cares for My Children. Facts checked October 21, 2026. Free information, not legal or medical advice.