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Caregiver Affidavit Template for United States

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Key Requirements PROMPT example:

Caregiver Affidavit

"I need a Caregiver Affidavit that authorizes my sister to make medical and educational decisions for my two children while I'm deployed overseas with the military from January 2025 to December 2025, with specific provisions for emergency medical care."

Document background

The Caregiver Affidavit serves as a crucial legal tool when parents need to temporarily delegate caregiving authority to another person, such as a relative or trusted friend. This document is particularly important in situations where parents are temporarily unable to care for their children due to military deployment, illness, work obligations, or other circumstances. While requirements vary by state, the affidavit typically includes detailed information about all parties involved, specific authorities granted, and duration of the arrangement. Unlike guardianship, this document does not terminate parental rights and can be revoked by the parents. The document must comply with both federal regulations (such as HIPAA and FERPA) and state-specific requirements.

Suggested Sections

1. Declaration and Identification: Caregiver's personal information and relationship to child

2. Child Information: Child's full name, date of birth, and current address

3. Parent/Guardian Information: Parents' or legal guardians' details and contact information

4. Scope of Authority: Specific powers granted to caregiver including medical, educational, and daily care decisions

5. Duration: Time period for which the affidavit is valid

6. Attestation: Sworn statement of truth and accuracy of information provided

Optional Sections

1. Medical Authorization: Detailed authorization for medical decision-making, including emergency care, routine checkups, and medication administration

2. Educational Authorization: Specific powers related to school enrollment, access to records, and educational decision-making

3. Travel Authorization: Authorization for in-state, interstate, or international travel with the child

4. Financial Responsibility: Statement regarding financial obligations and responsibilities for child's care

Suggested Schedules

1. Schedule A - Medical History: Detailed medical history including conditions, allergies, medications, and immunization records

2. Schedule B - Emergency Contacts: Comprehensive list of emergency contacts including backup caregivers and medical providers

3. Schedule C - Supporting Documentation: Copies of identification documents, relevant court orders, or prior agreements

4. Schedule D - State-Specific Requirements: Additional forms or documentation required by specific state laws

Authors

Alex Denne

Head of Growth (Open Source Law) @ ¶¶Òõ¶ÌÊÓÆµ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Clauses





















Industries

State-Specific Laws: Core state legislation governing caregiver authorization, including state family law codes, notarization requirements, and state-specific definitions of caregiving authority

FERPA: Family Educational Rights and Privacy Act - Federal law protecting the privacy of student education records and affecting caregiver's access to educational information

HIPAA: Health Insurance Portability and Accountability Act - Federal law governing medical privacy and caregiver's access to healthcare information

ADA: Americans with Disabilities Act - Federal law ensuring equal rights for individuals with disabilities, potentially relevant for caregiving situations involving disabled individuals

Child Protection Laws: State-specific regulations regarding child welfare, mandatory reporting requirements, and background check requirements for caregivers

Medical Consent Laws: State-specific legislation governing medical consent rights for non-parent caregivers, including emergency medical treatment authorization

Educational Authorization Laws: Regulations governing school enrollment, educational decision-making authority, and access to educational records by caregivers

Legal Authority Framework: Laws governing powers of attorney, guardianship, and temporary custody provisions affecting caregiver rights and responsibilities

Documentation Requirements: State-specific requirements for affidavit forms, notarization procedures, and ongoing record-keeping obligations for caregivers

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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