To use California’s Caregiver’s Authorization Affidavit, download the one-page statutory form set out in Family Code Section 6552, fill in items 1 through 4 if you are any adult the child lives with, add items 5 through 8 if you are a relative within the fifth degree of kinship, and sign and date it under penalty of perjury. No notary and no court appearance are required. The form takes effect the moment you sign it, and you give copies to the child’s school and healthcare providers.
Figure Out Which Tier You Fill Out
The form divides into two tiers, and the one that applies to you decides how much of the page you complete and how much authority you get.
Any adult who has the child living in their home fills out items 1 through 4. That is enough to enroll the child in school and consent to school-related medical care, which includes immunizations, physical exams, and medical screenings required for enrollment or extracurricular activities.1California Courts Self-Help. Caregivers Authorization Affidavit
If you are a relative of the child by blood, adoption, or marriage within the fifth degree of kinship — grandparents, aunts and uncles, siblings and half-siblings, stepparents and stepsiblings, great-grandparents, great-aunts and great-uncles, first cousins, and the spouses of any of those, even if that marriage ended by death or divorce — you also complete items 5 through 8.2California Legislative Information. California Code FAM 6550 – Caregivers Authorization Affidavit Completing the full form gives you the same medical consent authority a legal guardian has under Probate Code Section 2353, which covers routine checkups, emergency care, dental work, and ongoing mental health treatment.3California Legislative Information. California Probate Code 2353
The form itself is reproduced in Family Code Section 6552, and printable copies are posted on the California Courts Self-Help site. Many school district enrollment offices also hand them out.4California Legislative Information. California Code Family Code 6552 – Caregivers
Items 1 Through 4: Every Caregiver
Print clearly. The first four items are straightforward identifying information:
- Item 1 asks for the child’s full legal name as it appears on their birth certificate.
- Item 2 is the child’s date of birth.
- Item 3 is your full legal name.
- Item 4 is your home address, which must be the child’s current residence.
A non-relative caregiver can stop here, sign, and date. That is enough for school enrollment and school-related medical care.
Items 5 Through 8: Relatives Only
If you are completing the full form as a relative, continue through the second tier:
- Item 5 is a checkbox confirming you are a relative of the child. The back of the form lists which relationships qualify.
- Item 6 is about parental notification. Check the first box if you told the parent or legal custodian you plan to authorize medical care and they did not object. Check the second box if you were unable to reach them. You can check both — for example, if you notified one parent and could not locate the other.
- Item 7 is your own date of birth.
- Item 8 is your identification number: your California driver’s license, state ID card, or government-issued consular card number.
Item 6 is where most people hesitate. You do not need the parent’s written permission. You just need to have made the effort to inform them. If a parent is reachable and actively objects to a medical decision, their choice generally controls, so the affidavit works best when the parent is absent, unreachable, or agreeable to the arrangement.
Sign and Date the Form
Once the relevant items are filled in, sign and date the affidavit. You are signing under penalty of perjury, which means every statement on the form must be true. Filing a false affidavit is perjury under California Penal Code Section 126, punishable by two, three, or four years in state prison.5California Legislative Information. California Penal Code 126 – Perjury
The form states plainly: “This form is not required to be notarized.”4California Legislative Information. California Code Family Code 6552 – Caregivers No court filing or seal is needed either. Some hospitals and insurance companies are more comfortable with a notarized copy, so having it notarized can head off pushback. A California notary may charge up to $15 per signature.6California Secretary of State. 2026 California Notary Public Handbook
Distribute Copies and Keep the Original
After signing, make several copies. Give one to the child’s school and one to each healthcare provider, dentist, or health plan that treats the child. Keep the original somewhere safe, because you may need to produce it later for verification.
Schools and healthcare providers who rely on a properly completed affidavit in good faith are protected from criminal and civil liability under the statute, and they have no duty to investigate further.7California Legislative Information. California Code Family Code 6550 – Caregivers If a school or clinic resists, that provision is worth pointing to.
What the Affidavit Does Not Do
The affidavit is not a custody order and it does not alter the parent’s legal rights. A parent’s decision about the child’s medical care overrides yours unless the parent’s choice would jeopardize the child’s life, health, or safety.2California Legislative Information. California Code FAM 6550 – Caregivers Authorization Affidavit
You also cannot use this form to change the child’s name, authorize international travel, or get a U.S. passport for the child. A passport for a minor under 16 requires either both parents’ consent or a court order establishing custody or guardianship.
What to Bring to the School Along With the Affidavit
The affidavit answers the question of your legal authority, but the school will still want standard enrollment paperwork:
- The child’s birth certificate, or another document verifying age.
- Immunization records showing required vaccinations, or documentation of a medical exemption.
- Proof of residency at your address, such as a utility bill, lease, or bank statement.
Some districts have their own supplemental or parental designation forms. Call the enrollment office before your visit to confirm what they require.
When the Affidavit Ends and When to Redo It
The affidavit stays valid for as long as the child lives with you. There is no built-in expiration date. If the child moves out, you are legally required to notify every school, healthcare provider, and health plan that received a copy, and the affidavit becomes invalid the moment those institutions receive your notice.7California Legislative Information. California Code Family Code 6550 – Caregivers
Complete a new affidavit any time your address changes, the child’s name changes through a court order, or a different child comes into your care. Each affidavit covers one child, so if you are caring for siblings, fill out and distribute a separate form for each.