Get Caregiver''s Authorization Affidavit (revised 04-04-05).doc - Centinela K12 Ca

This guide provides a comprehensive overview of how to complete the Caregiver's Authorization Affidavit, which is important for authorizing the enrollment and medical care of a minor. Follow the steps below to ensure that the affidavit is filled out correctly and efficiently.

Follow the steps to fill out the Caregiver's Authorization Affidavit online.

1. Click ‘Get Form’ button to obtain the Caregiver's Authorization Affidavit and open it in your preferred editing tool.
2. Begin by filling in the 'Name of Minor' and 'Minor’s Birth Date'. Make sure to provide accurate details for these fields.
3. Next, enter the 'Caregiver’s Name', ensuring that you accurately represent yourself in this section.
4. Provide the 'Caregiver’s Home Address'. This is essential for contacting the caregiver and ensuring proper residency verification.
5. Fill in the 'Caregiver’s Telephone Number'. It's important to ensure this number is reachable for any necessary communications.
6. If the caregiver's residence is rented, the owner or manager must complete the relevant section affirming they are aware of the caregiver sharing the residence with the minor.
7. Indicate your relationship to the minor by checking the appropriate box ('grandparent,' 'aunt,' 'uncle,' or another qualified relative) and specify the relationship.
8. Choose either of the options to confirm whether you have notified the parents or legal custodians about your intent to authorize medical care.
9. Complete your details such as 'Caregiver’s Birth Date' and 'California Driver’s License or Identification Card Number'. If this information is unavailable, consider providing alternative identification.
10. Be cautious while signing the form, ensuring that all provided information is accurate to avoid legal repercussions. Review the warnings outlined before your signature.
11. Once completed, save your changes, and choose to download, print, or share the form as needed, based on your situation.

Start filling out the Caregiver's Authorization Affidavit online to ensure the welfare and proper authorization for the minor.