Washington Kinship Perjury Declaration Requirement: RCW 9A.72 and Your Caregiver Form

Why the Form Says "Under Penalty of Perjury"

If you've looked at Washington's kinship caregiver health declaration — the form that lets a grandparent or relative consent to a child's medical care under RCW 7.70.065 — you've probably noticed a line near the signature block that reads something like: "I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct."

That language is not boilerplate. It carries the weight of RCW 9A.72.085, Washington's statute on declarations made under penalty of perjury. And understanding what it actually requires — and what it doesn't — matters more than most caregivers realize.

What Perjury Means Under RCW 9A.72

Under RCW 7.70.065(5), knowingly providing a false caregiver declaration exposes the signer to criminal perjury penalties under Chapter 9A.72 RCW, a Class B felony. Sign only statements you believe are accurate. If you are unsure whether a parent is unavailable, contact legal aid before signing.

In the context of a kinship caregiver health declaration, the material claims you're making are:

• You are a relative (or qualifying adult) responsible for the child's health care
• The child's parents or legal guardians are not readily available to provide consent
• The relationship you describe is accurate

What Triggers Actual Criminal Risk

A perjury risk arises when someone signs the declaration knowing the statements are false — for example, claiming to be the child's aunt when there is no familial relationship whatsoever, or signing the form while the child's parent is sitting in the waiting room and has already refused to consent.

Honest caregivers who are genuinely raising a relative's child and filling out the form in good faith are exactly the people the statute was designed to protect, not prosecute. The perjury requirement exists to give healthcare providers confidence that the declaration is reliable, which is why they accept it without demanding a court order.

How to Fill Out the Declaration Correctly

The standard form — whether you use the DSHS 22-996x template, the Northwest Justice Project's Health 752, or a custom version — asks you to state specific facts under that perjury declaration:

Your identity and relationship. Use the precise familial term: maternal grandmother, paternal uncle, adult sibling. If you are not a blood or marriage relative, you may still qualify under RCW 7.70.065(1)(a)(x)(A) as an adult who has exhibited special care and concern for the child — but describe the actual relationship honestly.

Parental availability. State that the child's parents or legal guardians are not readily available. This covers incarceration, substance abuse treatment, unknown whereabouts, military deployment, hospitalization, or simply being unreachable. You do not need to explain the reason in detail on the form.

Date and location of signing. The exact phrasing required by RCW 9A.72.085 includes the date and the city and state where you sign.

The Six-Month Clock and Renewal

The declaration expires six months from the date you sign it. When you renew, you're making the same attestation again — that the child is still in your care and the parents are still unavailable. If circumstances have changed (the parent has returned, for instance), signing a renewal would be a false statement. Calendar a reminder at month five.

What Providers Actually Look For

Most healthcare providers are not legal experts reviewing your declaration for technical compliance. They are looking for a signed document that references RCW 7.70.065, states the relationship, and includes the penalty-of-perjury language. The statute protects providers from civil liability for failure to secure informed consent when they render care in good-faith reliance on a properly executed declaration.

If a provider does ask questions, they are following the statute's provision that allows them to request supporting evidence. A school enrollment record listing you as the primary contact, a letter from a social worker, or a prior medical record with your name as the responsible adult can help document the relationship.

The Bigger Picture

The perjury language protects both sides. It protects you, because providers trust the form and let you get your grandchild or relative's child to the doctor. And it protects the child, because it ensures the person signing is who they say they are.

The Washington Consent Guide for Kinship Caregivers walks through every field of the health declaration, the exact perjury language you need, and what to do if a provider questions your form — including escalation scripts for refusals.

If you're signing the declaration honestly and the child genuinely lives with you, the perjury requirement is a formality that works in your favor. Fill it out carefully, keep copies, and get the child to the doctor.

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