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1. Declarant Information: Full legal name, address, and contact information of the relative caregiver making the affidavit
2. Child Information: Full legal name, date of birth, and current address of the child(ren) covered by this affidavit
3. Relationship Declaration: Statement of the precise familial relationship between the caregiver and the child(ren)
4. Parent Information: Names and last known addresses of the child(ren)'s legal parents or guardians
5. Authority Statement: Declaration of the caregiver's authority and responsibilities regarding the child(ren)'s care
6. Duration of Care: Specification of how long the caregiving arrangement has been in place and/or is expected to continue
7. Certification of Ability: Declaration that the caregiver is able and willing to assume responsibility for the child(ren)'s care
8. Statutory Declaration: Formal declaration of truth and accuracy of the statements made in the affidavit
1. Emergency Contact Information: Additional emergency contacts when the caregiver cannot be reached, used when there are no other legal guardians readily available
2. Special Needs Declaration: Details of any special medical, educational, or other needs of the child(ren), included when the child has specific requirements that caregivers need authority to address
3. Parent Consent: Written consent from the legal parents/guardians, included when parents are available and willing to provide formal consent
4. Financial Responsibility: Declaration regarding financial responsibility for the child(ren)'s care, included when specific financial arrangements need to be documented
5. Travel Authorization: Specific authorization for interstate or international travel, included when such travel may be necessary
1. Schedule A - Supporting Documentation: Copies of relevant identification documents, birth certificates, and proof of relationship
2. Schedule B - Medical Authorization: Detailed medical care authorization form including any specific health conditions or medications
3. Schedule C - Educational Authorization: Authorization for school enrollment and educational decision-making
4. Schedule D - Parent Contact Schedule: If applicable, schedule of contact or visitation with parents/legal guardians
5. Appendix 1 - Witness Statements: Supporting statements from witnesses confirming the caregiving arrangement, if required
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