Oregon Relative Caregiver Affidavit: How to Fill It Out and Use It

What the Relative Caregiver Affidavit Is

The Oregon Relative Caregiver Affidavit is a legal document under ORS 109.570 through 109.580 that lets a relative caring for a child consent to educational services and routine medical care — without a court order and without the parent's signature. You sign it yourself, under penalty of perjury, after making reasonable efforts to contact the parent.

It exists for the situation every kinship caregiver knows: a child shows up at your door because a parent is in crisis, and you need to get that child into school and to a doctor now.

Who Qualifies to Sign

The statute is strict on this. You must be:

• A competent adult aged 18 or older
• Related to the child by blood, marriage, or adoption

That includes grandparents, aunts, uncles, adult siblings, adult cousins, and stepparents. It does not include unmarried partners, close family friends, or minor siblings. If you are not a statutory relative, you need either a Delegation of Parental Powers signed by the parent (ORS 109.056) or a court-ordered guardianship.

The 10 Mandatory Elements

ORS 109.580 lists exactly what the affidavit must contain. Miss any of these and the document is legally invalid:

1. The child's full legal name
2. The child's date of birth
3. Your legal name, date of birth, and the address where you and the child live together
4. Your specific relationship to the child (grandmother, maternal aunt, etc.)
5. Your Oregon driver license or state ID number
6. Contact information for the child's legal parent(s) or guardian(s)
7. A description of every attempt you made to contact the parent about your intent to consent to educational or medical services, including any responses
8. The specific reason you were unable to reach the parent (if applicable)
9. The exact date you signed the affidavit
10. A signed declaration under penalty of perjury stating the child lives with you, you are a competent adult aged 18 or older, and everything in the affidavit is true

The statute requires a perjury declaration, not formal notarization. But many schools and clinics expect a notary acknowledgment, so getting it notarized is worth the extra step for smoother acceptance.

Documenting "Reasonable Efforts"

Before the affidavit is legally valid, you must have made reasonable efforts to reach the parent and been unable to get their consent. The statute does not define a specific number of attempts, but you should document:

• Phone calls (dates, times, numbers called)
• Text messages (screenshots help)
• Certified mail sent to the parent's last known address
• Home visits or outreach through other relatives
• Contact attempts with the parent's treatment facility, correctional institution, or employer

If the parent is reachable but explicitly refuses to grant consent, the "unavailability" condition is not met and the affidavit is not legally available. A parent who objects means you need either their cooperation (for an ORS 109.056 delegation) or a court order.

How Long It Lasts

The affidavit expires one year from the date you deliver it to the school or medical provider. If the delivery date is unclear, it expires one year from your signature date.

It also terminates immediately if:

• The parent issues a written revocation or contravening decision
• The child no longer lives with you
• A court order establishes different custody arrangements

One critical exception: a parent's contravening decision does not override your consent if that decision threatens the child's life, health, or safety.

What It Covers and What It Does Not

Covered: School enrollment, routine medical exams, dental and optical care, well-child visits, immunizations, minor illness treatment, emergency room visits, outpatient mental health screenings.

Not covered: Elective or non-emergency surgery with significant clinical risk, consent to the child's marriage or adoption, decisions overriding an actively involved parent.

The affidavit also does not change legal custody, establish child support obligations, or create eligibility for public benefits on its own.

Where to Get the Form

Oregon Law Help (oregonlawhelp.org) publishes a free downloadable template that incorporates all the statutory requirements. There is no single official state-issued form — the statute specifies the mandatory elements, and legal aid organizations build compliant templates from those requirements.

For the complete process — choosing between this affidavit and the ORS 109.056 delegation, handling a school or clinic that refuses your paperwork, and tracking expiration dates across every provider — the Oregon School and Medical Consent Guide covers it all in one organized toolkit.

See more Oregon guides →