DSHS Kinship Caregiver Forms in Washington: 22-996, NJP Health 752 and WashingtonLawHelp

Searching for kinship caregiver forms in Washington turns up a confusing mix of form numbers, agency names, and legal-aid websites. The two forms that matter most are the DSHS 22-996x and the NJP Health 752 — and understanding which one does what saves you a wasted trip to the clinic.

DSHS 22-996x: The Caregiver Health Declaration Template

DSHS 22-996x is the Department of Social and Health Services template for the Kinship Caregiver's Declaration of Responsibility for a Minor's Health Care. It implements RCW 7.70.065; the statute sets the requirements, not a mandatory state form.

The 22-996x includes:

• An overview of kinship caregiver rights in Washington
• Contact information for Kinship Navigators and DSHS offices
• A sample health declaration template

DSHS also publishes other kinship resources and programme contacts. The DSHS template and the NJP form are agency and legal-aid resources, not mandatory state forms.

NJP Health 752: The Declaration That Clinics Recognise

The Health 752 form is published by the Northwest Justice Project on WashingtonLawHelp.org. It is a standard template for the RCW 7.70.065 relative caregiver health declaration — the document that lets a qualifying relative consent to a child's medical, dental, and mental-health care.

The form includes:

• Fields for the caregiver's name, relationship to the child, and contact information
• The child's name, date of birth, and identifying details
• A statement that the parents are unavailable
• The penalty-of-perjury attestation required under RCW 9A.72.085

The Health 752 is one standardized template; a provider may still request supporting evidence of the relative relationship. If you are filling out a health declaration for the first time, it is a practical template to use.

You Are Not Locked Into Any Template

Here is the part that confuses people: RCW 7.70.065 does not mandate a specific form. It sets the legal standard — a written declaration under penalty of perjury by a qualifying relative stating that the parents are unavailable. Any document that meets those elements satisfies the statute.

The NJP Health 752 and the DSHS 22-996x template are convenient starting points, but a provider who refuses one form is not entitled to demand the other. If your declaration hits the statutory elements, it is legally valid regardless of which template it is printed on.

Where School Enrolment Forms Come From

Neither the DSHS forms nor the NJP Health 752 cover school enrolment. School caregiver authorisation forms come from individual school districts — Seattle Public Schools has its own, so does Spokane, Tacoma, and every rural district. There is no single statewide school caregiver form from OSPI.

When you enrol a child, ask the district for its caregiver authorisation or affidavit form. If it does not have one, ask the registrar what documentation it accepts; a caregiver affidavit can document the child's residence.

DCYF Form 10-454: The Form That Does Not Apply

One form that often surfaces in kinship care searches is DCYF Form 10-454, the "Caregiver Authorization." This is exclusively for state-supervised foster care placements — not for informal kinship arrangements. If someone at an agency hands you this form, clarify that the child is in informal kinship care, not a DCYF placement.

Our Washington School and Medical Consent Guide includes every form you need — the health declaration, the school caregiver authorisation, and the parental power of attorney — with field-by-field instructions so you fill them out right the first time.

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