Caregiver Affidavit Items 1 Through 8 California: What Each Section Does

The Two-Tier Design

California's Caregiver's Authorization Affidavit isn't one uniform document. It's built with two tiers of authority: items 1–4 for everyone, and items 5–8 for relatives only. The distinction matters because it determines whether you can take the child to a doctor, not just to school.

Understanding this structure before you fill the form out prevents the most common mistake: a relative completing only items 1–4 and unknowingly limiting themselves to school-related authority when they're entitled to full medical consent.

Items 1 Through 4: Universal School Authority

Every adult caregiver — relative or not — completes this section. The four items collect:

Item 1: The child's full legal name.

Item 2: The child's date of birth.

Item 3: Your full name.

Item 4: Your home address — the address where the child physically lives with you. This establishes district residency for school enrollment under Education Code Section 48204(a)(5).

The signature and date are in the declaration at the end of the form, after item 8.

Completing items 1–4 authorizes you to:

• Enroll the child in a public school in your district
• Consent to school-related medical care: immunizations required for enrollment, sports physicals, TB screenings, emergency first aid on school grounds

It does not authorize:

• Routine doctor visits outside the school context
• Dental care
• Prescriptions
• Specialist referrals
• Any medical care unrelated to school attendance

If you're a family friend, godparent or unrelated caregiver, items 1–4 are the full extent of your authority under the affidavit. For broader medical consent, you'd need a parent-signed authorization under Family Code Section 6910 or a court guardianship.

Items 5 Through 8: Relative Medical Authority

This section is only for adults who meet the statutory definition of "relative" — related to the child by blood, marriage or adoption within the fifth degree (expanded by AB 495). Grandparents, aunts, uncles, adult siblings, adult nieces and nephews, stepparents and their spouses all qualify.

Item 5: A checkbox confirming you are a qualified relative under the statute.

Item 6: The parental notification declaration — you must check at least one of two sub-items:

• 6a: You have advised the parent(s) of your intent to authorize medical care and they have not objected.
• 6b: You are unable to contact the parent(s) after reasonable efforts.

Both can apply simultaneously. If one parent consents (6a) and the other can't be found (6b), check both.

Item 7: Your date of birth.

Item 8: Your California driver's license or ID number, or government-issued consular card number. The form allows another form of identification if you do not have one of these.

Completing items 5–8 in addition to 1–4 gives you the same medical consent authority as a court-appointed probate guardian under Probate Code Section 2353:

• All routine medical and dental care
• Prescriptions and pharmacy pickups
• Specialist referrals and follow-up care
• Diagnostic tests

The Most Common Mistake

A grandparent who only fills out items 1–4 — either because they didn't know about items 5–8 or because they were confused by the form layout — has limited themselves to school-related authority. They can enroll the child but can't consent to a regular doctor visit.

If you're a relative, complete all eight items. There's no downside, and it unlocks the full scope of medical authority the law provides.

The Parental Notification Question

Item 6 is where caregivers hesitate. The declarations are made under penalty of perjury, and nobody wants to sign something false. Here's how to handle common situations:

Parent in rehab and consents: Check 6a. You advised them and they didn't object.

Parent incarcerated and you sent a letter but got no response: Check 6b. You made reasonable efforts to contact them and were unable to.

Parent incarcerated, facility put you through, and they said okay: Check 6a.

Parent missing entirely — no phone, no address, no contact for months: Check 6b.

One parent cooperative, one parent unreachable: Check both 6a and 6b — one applies to each parent.

Parent explicitly objects: You cannot truthfully check either box. The affidavit route stops here, and you'd need to explore guardianship.

No Gray Area on Perjury

The perjury language is there for a reason. The affidavit is a legal declaration, and making a false statement is punishable under California law. Don't check 6a if the parent actually objected. Don't check 6b if you haven't actually tried to reach them. The declarations have to match your real situation.

The California School and Medical Consent Guide walks through item 6 for every common scenario and explains what "reasonable efforts" means under the statute.

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