Before you fill out the Caregiver's Authorization Affidavit
A printable from Caregiver Form Help. Fill it in by hand. Nothing you write is collected by this website.
Before you fill out the Caregiver's Authorization Affidavit
Gather this first. Do not write immigration details or case numbers on this sheet.
About the child
- Full legal name, as on the birth certificate
- Birth date
- School name, and the doctor or clinic name
About you, the caregiver
- Full name and date of birth
- Home address where the child lives with you
- California license or ID number, or consular card number
- Are you a relative? Yes: fill out items 1 to 8. No: items 1 to 4.
If you are a relative
- I told the parent, and they did not object (6a). Date and how: __________
- I cannot reach the parent right now (6b)
After you sign
- Original kept safe at home
- Copy to school
- Copy to doctor, dentist or clinic
- School emergency contacts updated
- Reminder set to sign a fresh form in one year: ____ / ____ / ______
From Caregiver Form Help. Facts checked October 21, 2026. Free information, not legal or medical advice.