Guardianship of the Person and the Pro Per Guardianship Clinic 2013
WHO SHOULD READ THIS PAMPHLET? You should read this pamphlet if you are: 1. A non-parent caring for a child and you need help getting legal guardianship (custody) of him/her through Probate Court. 2. A non-parent who already has legal guardianship of a child through Probate Court and you want to terminate the guardianship and return the child to the care of his/her parent(s) or to another caregiver. 3. A parent whose child is under the legal guardianship of a relative or family friend through Probate Court and you want to terminate the guardianship and have your child returned to your care. 4. A parent who has received notice that a guardianship is pending and you want to object to the guardianship so the child remains in your custody. 5. A relative or family friend of a child who is under the legal guardian ship of a non-parent and you want to have the Probate Court determine a visitation schedule for you and the child. WHERE DO I GO FOR HELP? Pro Per Guardianship Clinic Los Angeles Superior Court 111 N. Hill Street, Room 230 Monday through Wednesday 9:30 a.m. - 12:30 p.m. and 1:30 p.m. - 3:30 p.m. Due to high volume please arrive by 9:00 A.M. to sign-in PRO PER means you don t have an attorney and are acting as your own attorney in court. -1-
Yes, you must: ARE THERE ANY REQUIREMENTS TO GET HELP AT THE CLINIC? 1. Meet the low-income guidelines of Public Counsel Law Center. See Appendix A for our income guidelines chart. 2. Have physical custody of the minor, meaning the minor must be living in your home.* *Exceptions to this requirement are as follows: i. If you are a parent trying to terminate someone else s guardianship over your child, the minor does not need to be living with you. ii. If you are filing a competing petition for guardianship against someone else that filed for guardianship, the minor does not need to be living with you. 3. And the minor must have lived in Los Angeles County for the past six months. WHAT HAPPENS AT THE CLINIC? We help people on a first-come, first-served basis according to our sign-in sheet and do not take appointments. You should arrive at the clinic as early in the day as possible. There is no guarantee of assistance on any particular day. We help you fill out all the paperwork required to file for guardianship, tell you where to go to file your paperwork and explain the court process. It can be very busy so please be patient. We will do our best to assist you as soon as possible. -2-
DO I HAVE TO PAY ANYTHING? We do not charge a fee for preparing your legal paperwork if you qualify for our services. However, the court charges a filing fee of $1,325.00. There is an additional $40 fee if you also file a petition for temporary guardianship. You may qualify for a fee waiver if your income falls within the fee waiver schedule or if you are unable to pay court fees and your household s basic needs. If you receive government benefits under one or more of the following programs you do not have to pay the court fees. CalWORKs (formerly AFDC) CalFresh (Formerly Food Stamps) MediCal SSI (Supplemental Security Income) General Relief (GR) or General Assistance (GA) IHSS (In-Home Support Services) CAPI (Cash Assistance Program for Aged, Blind, Disabled) WHAT DO I NEED TO BRING? 1. You need to bring information regarding your income and expenses in order to apply for a fee waiver, such as: An employment pay stub Your government benefits withdrawal card Bank statement Copies of bills 2. You need to have the information listed on the intake sheet provided at the Guardianship Clinic. (See Appendix B ) 3. Children should stay home or go to school if possible. However, if you do not have any child care options, there is a supervised child waiting room on the second floor. -3-
WHAT DOESN T THE CLINIC HELP WITH? We assist with Petitions for Guardianship of the Estate only in cases where the funds will be placed in a blocked bank account until the child turns the age of eighteen. If the proposed guardian needs to have access to the funds on an on-going basis, he or she should contact an attorney. The Los Angeles County Bar Association has a list of attorneys with experience in probate cases. They can be reached at 213-243-1525 or at their website at www.lacba.org. We do not assist with estate probate proceedings or accountings. We do not represent you in court. There is no attorney client relationship between you and the attorneys at the clinic, and your conversations are not confidential. CAN I GET OTHER REFERRALS? Yes, we offer referrals to: Non-profit law firms for family law, conservatorship, adoption and other issues. Social service agencies for assistance with public benefits, housing, medical care, education, childcare, mental health needs, substance abuse and disability. Public Counsel and other law firms for more complicated cases, including cases involving the immigration needs of abused or abandoned minors. IS HELP AVAILABLE IN SPANISH? HAY ASISTENCIA DISPONIBLE EN ESPAÑOL? Yes, most of the time. Si, la mayoriá del tiempo. DO I NEED TO BRING AN INTERPRETER TO THE CLINIC? NECESITO TRAER UN INTERPRETE A LA CLINICA? If you are able to, it is helpful. Si puede hacerlo, sería útil. -4-
TERMINOLOGY Definitions of words used in this pamphlet. Consent and Waiver of Notice: The document that a minor, a minor s parent, grandparent or sibling can sign if they do not object to the guardianship. Department of Children and Family Services Social Worker: The agency which conducts the home visit and investigation for the court if you are unrelated to the minor. If you are related beyond first cousin you are considered unrelated. Guardianship (General): The term used when a non-parent has custody. Guardianship allows you to make decisions about the care, custody, control and education of a minor. A Guardianship is valid until the child is eighteen or until terminated by court order. Guardian/Proposed Guardian: The non-parent caregiver who has legal guardianship (custody) of the minor or who is asking the court for legal guardianship of the minor. Hearing (Temporary and General): The court date when a judge will consider your case. He or she will decide if the guardianship is necessary and convenient to serve the best interests of the minor. Letters of Guardianship: The document that is issued by the court and filed after you obtain the Order Appointing Guardian of Minor and which makes the Order valid. Note: After the guardianship hearing (temporary or permanent) you must file the Order Appointing Guardian and the Letters of Guardianship. Minor: Someone under the age of 18, a child. -5-
Notice of Hearing: The document you use, along with a copy of the petition, to inform relatives within the second degree and 2 state agencies of the date, time and place of the guardianship hearing. The relatives and agencies entitled to notice include: Parents of the minor(s) Grandparents on both sides (maternal and paternal) Siblings 12 years of age or older Person having the care of the minor (usually the proposed guardian) The minor Department of Children and Family Services (DCFS) Department of Public Social Services (DPSS) (only for non-related guardians). Note: If any person signed the Consent and Waiver of Notice form, you do not need to notify them. You must always notify DCFS. Order Appointing Guardian of Minor: The document signed by the judge and filed with the court, which gives you guardianship of the minor. Petition: The document in which you ask the court to appoint you as Guardian. You must include an explanation of why the guardianship is necessary and convenient to serve the best interests of the minor. Probate Court Investigator: The representative who conducts the investigation for the court if you are related to the minor. The investigation report helps the judge determine what is in the best interests of the minor and whether to grant the guardianship. Proof of Service: The document you must file with the court that shows all parties were given notice of the hearing and a copy of the petition. The process of notifying all parties is called serving them. Temporary Guardianship: In cases where there is a risk of immediate harm or detriment to the child, the court may grant you an early court hearing to establish temporary custody, usually within 5-7 days. You must be very specific about what the harm to the child will be for example, the child needs immediate surgery which cannot be performed without a guardianship. A petition for Temporary Guardianship cannot be filed on its own. It can only be filed after (or at the same time) as a petition for Guardianship is filed. A temporary guardianship gives the guardian custody of the child until the date of the permanent guardianship hearing. -6-
GUARDIANSHIP LAW What is legal guardianship? To establish legal guardianship a court order must be obtained. At the guardianship hearing the clerk will stamp the judge s signature on the Order Appointing Guardian of Minor. This document along with the Letters of Guardianship is your proof of legal guardianship. After a guardianship has been granted, the minor is called a ward. Legal guardianship of the person of a minor suspends the parents right to the custody of their child and places custody with the legal guardian. It does not permanently terminate parental rights. How do I get a guardianship? To establish a guardianship, a petition and related documents must be filed with the Probate Court. If the minor is a dependent child, that is, the Dependency Court has determined that the child has been abused or neglected by his parents, the Dependency Court will handle the custody proceeding. The Pro Per Guardianship Clinic only assists with guardianships in Probate Court. If you are eligible, we can help refer your case to Dependency Court. If you have questions, ask us. Do I have to go to court? Yes. A judge decides if guardianship is appropriate at the guardianship hearing. You will have separate hearings for temporary guardianship and general guardianship. Note: The temporary guardianship hearing occurs about 5-10 days from the day you file your paperwork and the general guardianship hearing occurs about 6-8 weeks from the date of filing. Does an investigator or social worker come to my home? Maybe. If you are unrelated to the child, before the hearing a social worker from the Department of Children and Family Services will visit the proposed guardian s home and interview the proposed guardian(s) and the minor(s). This is not a surprise visit; the social worker will call you to set up an appointment. If you are related to the child, you will have an appointment with the court -7-
investigator at the courthouse, You will receive notice of this Case Review Conference by mail. Background checks will be conducted on all adults living in the household to make sure no one has a serious criminal record or a history of abuse or neglect of children. The proposed guardian, and the child if he/she is old enough will be interviewed, and the child s school and medical records will be reviewed. If you have a home visit your home will be inspected to ensure that it is a safe and healthy home environment for the child. The investigator or social worker provides a report to the court so the judge can make an informed decision about whether to grant the guardianship. Tip! It is important for the proposed guardian(s) and minor(s) to be very cooperative with the investigator or social worker as their report will strongly influence the court s decision about whether to grant the guardianship. Do I have to let the parents know about my petition for guardianship? General Guardianship: Yes. Both the mother and father of the minor must be given personal notice of the hearing and a copy of the petition requesting guardianship. This is called serving them. Someone who is 18 years of age or older and who is not a party to the case must serve the minor s parent(s) in person. Since the petition contains the address and phone number of the proposed guardian(s), you need to let the clinic know if telling either parent this information would put you or the minor at risk so we can help keep it confidential. Note: Grandparents and siblings 12 years of age or older also must be given notice of the hearing and a copy of the petition. You should return to the Pro Per Guardianship Clinic after your temporary hearing or at least 20 days before your hearing on general guardianship for assistance with completing notice requirements. Temporary Guardianship: Yes. You need to notify the parents of the date, time and place of the hearing at least 5 days in advance. You must make your best efforts to notify them in person, but if you are unable to do so, you must at least attempt to notify them by pone or by telling them in person. -8-
Is a notarized letter a valid guardianship? A notarized letter that states it grants guardianship is of no legal value. A guardianship designated in a will does not grant guardianship. Either of these documents may serve as a nomination of guardian for a guardianship petition filed with the court. Also, a simple agreement between the parent and the caregiver does not establish a guardianship. Do I need a legal guardianship to enroll a child in school? No. If all you need to do is enroll a minor in school you can use a Caregiver s Affidavit (See Appendix C). California law allows a caregiver (whether related or unrelated) to use this form to prove that the minor lives in the caretaker s home in order to enroll the minor in school in the caregiver s district and authorize schoolrelated medical care. A related caregiver can also make general medical decisions using a Caregiver s Affidavit. Do I need legal guardianship to obtain financial assistance and Medi-Cal? Maybe. You do not need a legal guardianship to obtain benefits if you are related to the minor. You must provide proof of relationship, for example, have the child s birth certificate and the birth certificate of the family member that links you to the minor, (if you are the minor s maternal grandmother you would need your daughter s birth certificate and the minor s birth certificate). However, if you do not have the birth certificates, you can use other documents, such as baptismal or education records, or if you don t have anything else, you may even sign an affidavit. If you are unrelated to the minor you need to obtain legal guardianship to apply for foster care payments. However you can obtain Medi-Cal without first obtaining a legal guardianship. Please see the section entitled Financial Support of the Minor for more information. -9-
What if I just want a family member or friend to be able to consent to medical treatment for my child, but do not want to give them guardianship? You can give someone authority in writing to consent to medical and dental care for your child. You should have this document notarized, though it is not required. (See Appendix D for a sample Child Care Authorization.) What happens in Probate Court? 1. You must arrive on time. Guardianship hearings in the Central district courthouse start at 10:30 a.m. You should plan to be there no later than 10:15 a.m. 2. You must bring the minor if he/she is four years of age or older. 3. The court will usually provide an interpreter if you are not comfortable speaking or understanding English. If your primary language is Spanish, you can request an interpreter from the court clerk just before the hearing. If your primary language is something other than English, you should bring your own interpreter, as the court will probably not have one available on the date of the hearing. The interpreter must be over the age of 18 and not a party to the case. 4. Please remember to bring all the paperwork that we prepared for you at the Clinic, including your Order Appointing Guardian of Minor and Letters of Guardianship, your set of copies and any other documents you need to file. 5. When you arrive at the courtroom, go in, sit down and wait for instructions from the court clerk. 6. If the bench officer that day is a Commissioner and not a Judge, the clerk will ask you to sign a form agreeing to have the Commissioner hear your case. This form is called a stipulation. If you do not agree to have the Commissioner hear your case, do not sign the stipulation and your case will be transferred to a courtroom with a Judge. The difference between a Commissioner and a Judge is that a Commissioner is appointed by County officials and a Judge is elected by voters. 7. If you have any documents to hand in, such as Notice of Hearing or Consent and Waiver of Notice forms, give them to the clerk before the hearing. Remember to listen to the clerk. The clerk is in charge of the courtroom until the judge comes out and takes the bench. -10-
8. When the judge takes the bench you cannot talk. At all times in the courtroom you cannot eat or drink. 9. Your case will be called by the minor s last name and a number, starting by 401. For Example, 401 will be called first, 402 second, and so forth. The docket sheet posted outside the courtroom will list you number. When your case is called, the proposed guardian(s) and minor should walk up to the table facing the judge. 10. Each person will state her name, spell her last name and indicate if she was sworn. If you were present in court while the bailiff recited the oath and you raised your right hand and faced the flag, you were sworn with the rest of the courtroom. Example: My name is Rosa Mendez, M-E-N-D-E-Z and I have been sworn. 11. If you haven t been sworn, the clerk will swear you in when your case is called. 12. The judge may ask you or the minor a few simple questions to determine if you are willing and able to care for the minor and if the minor is well cared for in your home. Keep in mind that at the hearing on general guardianship the judge will have the report from the investigator or social worker and may not need to ask you any questions. 13. The judge will also ask if you have submitted Notice of Hearing or Consent and Waiver of Notice forms for parents, grandparents, DCFS (and DPSS if you are an unrelated guardian). Notifying family members and the agencies of the general guardianship hearing is a requirement and you will have to show proof that you did this to obtain guardianship. 14. If the judge grants the guardianship, take your seat and wait for the clerk to call you to have your Order Appointing Guardian signed and filed. 15. If the judge continues the hearing to a later date, write the date down and return on that day with any supplemental documentation requested by the judge. 16. If the judge denies your guardianship, you may petition again at a later time as long as your case was denied without prejudice. -11-
What do I do after court? After the hearing you need to go to room 426 on the fourth floor to have the Letters of Guardianship issued and certified. You may have to wait until after 12:30 p.m. on the day of the hearing. To request certified copies, fill out a form. If you have a fee waiver, the certified copy is free of charge. If you do not have a fee waiver, it will cost you about $16 to get a certified copy of the court order. The Order Appointing Guardian and certified Letters of Guardianship are your proof of guardianship. Note: You must complete this process after your hearing on temporary guardianship as well. If this is the hearing on temporary guardianship please return to the Pro Per Guardianship Clinic for help with serving notice of the hearing on general guardianship, if you have not already done so. RIGHTS AND RESPONSIBILITIES OF A GUARDIAN What rights do I have as a guardian? 1. The guardian has the same rights as a parent to consent to medical treatment for the minor. There are some limited exceptions. See the Public Counsel brochure entitled Consent and Confidentiality for more information. 2. The guardian has the right to consent to a minor obtaining a driver s license. The guardian must give written consent. By signing the DMV (Department of Motor Vehicles) application, the guardian agrees to be responsible for any civil damages that result from the minor s driving. However, the law limits the amount of damages for which a guardian can be held liable. The guardian must have insurance to cover the minor. The guardian can withdraw consent at any time by filing the appropriate DMV form. 3. The guardian may determine where the minor goes to school and may request special education services on behalf of the minor. -12-
What responsibilities do I have as a guardian? 1. The guardian has the duty and responsibility for the care, custody, control and education of the minor. 2. The guardian may determine the residence of the minor within the state without the permission of the court, but must inform the court and the child s relatives of the new address. Come to the clinic for assistance in filing these forms. Also, the minor need not live with the guardian (but the guardian will remain responsible for the minor). 3. You may not move outside of California without first obtaining court permission. Come to the clinic for assistance. 4. The guardian may be liable for the minor s conduct, if it causes harm to other persons or property. The guardian, like a parent, is liable to third parties for acts of the minor, if the guardian did not take steps to control the minor s conduct or did not properly supervise the minor. What limits are there on my rights as a guardian? The court may include in the Order Appointing Guardian of Minor other conditions or limitations as it deems necessary for the care, treatment, education and welfare of the minor. For example, the judge may ask the guardian to follow specific visitation orders between the minor and his/her parents or siblings. If the guardian anticipates needing special powers to accomplish the duties of guardianship, these powers must be requested and explained in the Petition for Appointment of Guardian of Minor. Generally, the guardian may not place the minor in a mental health facility against his/her will, consent to sterilization of the minor, convulsive treatment or administering an experimental drug to the minor. What about visitation for parents? Generally, the guardian will determine visitation arrangements between the minor and the minor s parents and relatives. In some cases, the court will make an order regarding visitation or will send the parties to mediation to agree on a visitation schedule. -13-
FINANCIAL SUPPORT OF THE MINOR Although the minor s parents remain legally responsible for financially supporting the minor, the guardian frequently volunteers to accept this responsibility. This is not required. How can I get financial support for the minor? A minor living with a relative caregiver is eligible to receive non-needy Cal-Works benefits with or without guardianship. The caregiver s income should not be taken into account. Non-related caregivers cannot receive Cal-Works. A non-related legal guardian may receive state foster care payments. These benefits are generally higher than the monthly Cal-Works payments. The process for applying, however, is different than when a related caregiver applies for Cal-Works. Applying for Cal-Works benefits will alert the County to issue a child support order against the minor s parent(s). What is the process for applying for Cal-Works? Go to the Department of Public Social Services (DPSS) office nearest your home to complete an application. If you have already obtained guardianship (even temporary) take your Order Appointing Guardian of Minor and Letters of Guardianship with you. You should expect a long wait. What is the process for applying for foster care payments? After obtaining guardianship (even temporary) call the Department of Children and Family Services at (213) 765-7260 between the hours of 9 a.m. and 5 p.m. Monday-Friday and say: I am an unrelated legal guardian through Probate Court and am requesting foster care payments. Your home will need to be approved as a suitable placement for the minor, which involves a home visit and completing and application. Eligibility for payment will begin on the date you call but it may take 30-45 days to be approved and for payments to begin, The minor must be a U.S. citizen, permanent resident, or qualified immigrant. Note: If you have trouble getting Cal-Works or foster care benefits call one of the legal providers listed in the back of this brochure. -14-
What if the minor is undocumented, meaning he/she was not born in the United States? If the minor is undocumented a guardian may not obtain Cal-Works, general Medi-Cal or foster care benefits, but the minor may be eligible for health care benefits such as California Children s Services, minor consent Medi-Cal and emergency Medi-Cal. Go to the DPSS office nearest your home or call 888-747-1222 to have an application mailed to you. If a minor has been abused, abandoned, or neglected by his or her parents and is not likely to return to the parents custody, the minor may be eligible under a federal law to apply for a green card from the United States Citizenship and Immigration Services USCIS (formerly called the INS.) Ask at the Guardianship Clinic for information. STANDARDS FOR APPOINTMENT OF GUARDIAN How does the court decide whether or not to grant the guardianship? At the hearing, the judge will appoint a guardian if it appears necessary and convenient. Before appointing a guardian, the court must make a finding that the guardianship is required to serve the best interests of the minor, and that parental custody is detrimental to the minor. The court will also consider the proposed guardian s concern for and interest in the welfare of the minor and the minor s wishes. TERMINATION OF GUARDIANSHIP AND CONTESTED GUARDIANSHIPS Can a guardianship be terminated? Yes. A guardianship of the person of a minor automatically ends upon the minor s reaching majority at age 18. A guardianship also ends automatically at the minor s death, adoption or marriage. The minor, parent, or legal Guardian can petition the court for termination of the guardianship or for removal of a particular guardian. The court will end the guardianship and return custody of the custody of the minor to the parents if the guardianship is no longer necessary, convenient or in the best interests of the minor. The court can remove the guardian and appoint a new guardian, for example, the guardian s failure to perform duties suitably, conviction of a felony, or gross immorality. -15-
What if I am a parent and want to contest the guardianship? If you are a parent and do not want your child in a legal guardianship with a family member or friend you must appear in court for all hearings. You may also file an objection to the guardianship. You can receive assistance with this, at the Pro Per Guardianship Clinic. If you want an attorney to represent you, limited assistance may be available through the Legal Aid Foundation of Los Angeles, Maynard Toll Center located in the Central District courthouse: 111 N. Hill St., room 245 or call 1-800-399-4529. For a referral to a private attorney contact the Los Angeles County Bar Lawyer Referral at 213/243-1525 or visit their website at www.lacba.org. CONCLUSION Guardianship can be an extremely useful and personally fulfilling experience for both the minor and the guardian. In many cases, guardianship allows parents an opportunity to regain custody and provides the minor with a healthy and stable environment in which he/she can feel safe, comfortable and happy. If you have any questions regarding guardianship, please contact Public Counsel s Children s Rights Project at 213/385-2977 extension 500 or 1-800-870-8090 extension 500 or come to the Pro Per Guardianship Clinic in the Central district courthouse. Due to high volume please arrive by 9:00 A.M. to sign-in and bring proof of income. -16-
Helpful Phone Numbers Probate Office, Room 258:............................ 213-974-5471 Probate Investigator s Office, Room 208:................. 213-974-5859 DCFS Guardianship Investigations Clerk:................. 323-526-6892 Department 5, 9, or 11- Call Probate office:............... 213-974-5471 Support Services Info Line: Now called 211 LA County................................ 1-800-339-6993 or 211 Kinship Resource Center:.......................... 888-MYGRAND Grandparents as Parents:.............................. 818-264-0880 Kinship in Action:................................... 323-750-8036 or 323-200-2441 Child Support:...................................... 866-901-3212 Child Abuse Hotline:................................. 800-540-4000 Legal Services Public Counsel, Children s Rights Project intake line:.............. 213-385-2977 x.500 Alliance for Children s Rights:......................... 213-368-6010 Legal Aid Foundation of Los Angeles:................... 800-399-4529 Bet Tzedek:........................................ 213-384-3243-17-
Appendix A Public Counsel Income Guidelines Your income must fall within these guidelines in order to qualify for our free legal services. Household of: Annual Income Monthly Income 1 $35,438 $2,953 2 $40,500 $3,375 3 $45,563 $3,797 4 $50,588 $4,216 5 $54,638 $4,553 6 $58,688 $4,891 7 $62,738 $5,228 8 $66,788 $5,566 For each additional household member add: $4,047 $337.25 -i-
Appendix B GUARDIANSHIP CLINIC INTAKE FORM Household Gross Monthly Income: $ (Fee Waiver Requires Proof of Income) Why is this guardianship necessary? Is the child s situation an emergency? CHILD S GENERAL SITUATION: PROPOSED GUARDIAN S INFORMATION: Name (s): Social Security Number: Address: (City, State, Zip): Telephone: Date of Birth: Driver s License Number: Relationship to Child: CHILD S INFORMATION: Full Name: Date of Birth: Does this child live with the proposed guardian? Does child have Native American Ancestry? Where was the child born? FAMILY HISTORY: Mother s Name: Address: Father s Name: Address: Natural Brother/Sister Names (only if over the age of 12): Address(es): Maternal (Mother s Side) Grandparents Names: Address(es): Paternal (Father s Side) Grandparents Names: Address(es): Child s Addresses for past 5 years: -ii-
Appendix C CAREGIVER S AUTHORIZATION AFFIDAVIT Use of this affidavit is authorized by Part 1.5 (commencing with Section 6550) of Division 11 of the California Family Code. Instructions: Completion of items 1-4 and the signing of the affidavit is sufficient to authorize enrollment of a minor in school and authorize school-related medical care. Completion of items 5-8 is additionally required to authorize any other medical care. Print clearly. The minor named below lives in my home and I am 18 years of age or older. 1. Name of minor: 2. Minor s birth date: 3. My name (adult giving authorization): 4. My home address: Number Street Apt. # City State Zip 5. I am a grandparent, aunt, uncle, or other qualified relative of the minor (see back of this form for a definition of qualified relative ). 6. Check one or both (for example, if one parent was advised and the other cannot be located): I have advised the parent/s or other person/s having legal custody of the minor of my intent to authorize medical care, and have received no objection. I am unable to contact the parent/s or other person/s having legal custody of the minor at this time, to notify them of my intended authorization. 7. My date of birth: 8. My California drivers license or identification card number: I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Signed: Dated: Notices: 1. This declaration does not affect the rights of the minor s parents or legal guardian regarding the care, custody, and control of the minor, and does not mean that the caregiver has legal custody of the minor. 2. A person who relies on this affidavit has no obligation to make any furtherinquiry or investigation. 3. This affidavit is not valid for more than one year after the date on which it is executed. -iii-
TO CAREGIVERS: 1. Qualified relative, for purposes of item 5, means a spouse, parent, stepparent, brother, sister, stepbrother, stepsister, half-brother, half-sister, uncle, aunt, niece, nephew, first cousin, or any person denoted by the prefix grand or great, or the spouse of any of the persons specified in this definition, even after the marriage has been terminated by death or dissolution. 2. The law may require you, if you are not a relative or a currently licensed foster parent, to obtain a foster home license in order to care for a minor. If you have any questions, please contact your local department of social services. 3. If the minor stops living with you, you are required to notify any school, health care provider, or health care service plan to which you have given this affidavit. 4. If you do not have the information requested in item 8 (California drivers license or I.D.), provide another form of identification such as your social security number or Medi-Cal number. TO SCHOOL OFFICIALS: 1. Section 48204 of the Education Code provides that this affidavit constitutes a sufficient basis for a determination of residency of the minor, without the requirement of a guardianship or other custody order, unless the school district determines from actual facts that the minor is not living with the caregiver. 2. The school district may require additional reasonable evidence that the caregiver lives at the address provided in item 4. TO HEALTH CARE PROVIDERS AND HEALTH CARE SERVICE PLANS: 1. No person who acts in good faith reliance upon a caregiver s authorization affidavit to provide medical or dental care, without actual knowledge of facts contrary to those stated on the affidavit, is subject to criminal liability or to civil liability to any person, or is subject to professional disciplinary action, for such reliance if the applicable portions of the form are completed. 2. This affidavit does not confer dependency for health care coverage purposes. If you have questions, please contact Public Counsel s Children s Rights Project at 213/385.2977 -iv-
Appendix D CHILD CARE AUTHORIZATION I, am the parent or guardian of the following child(ren), and legally entitled to grant this authorization. Child s Name: Date of Birth: Child s Name: Date of Birth: Child s Name: Date of Birth: Child s Name: Date of Birth: I grant authority, limited to the below defined powers, over the above child(ren) to: Name of person granted authorization: Address: Name of person granted authorization: Address: The powers granted to are the following (check and initial): To authorize medical and dental care for the above chid(ren), including but not limited to medical examinations, x-rays, tests, anesthetic, surgical operations, hospital care, or other treatments that are needed or useful for my child. Such medical treatment shall only be provided upon the advice of and supervision by a physician, surgeon, dentist, or other medical practitioner licensed to practice in the United States; To provide food and shelter for the above-named child(ren), and to make decisions regarding their day-to-day activities; To enroll the child(ren) in school and/or daycare and make educational decisions, including authority to consent to school-related activities and field trips; To transport the child(ren), including authorization to pick the child up from school or daycare; Other powers granted (for example if you want the caretaker to have authority to take the child(ren) out of state, write that here): Check one: This grant of authority is effective as of and shall remain in effect until terminated by the undersigned parent or guardian. This grant of authority shall be valid for the following time period: From, 20 until, 20. Parent/Guardian s signature: Parent/Guardian s signature: -v- Date: Date:
If you want the Child Care Authorization notarized, please include the portion below (optional). --------------------------------------------------------------------------------- ) ) ) On before me,, Notary Public, personally appeared, who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Notary Public
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Public Counsel, the public interest law office of the Los Angeles County and Beverly Hills Bar Associations, is the largest pro bono law firm in the U.S., and also is the Southern California affiliate of the Lawyers Committee for Civil Rights Under Law. Public Counsel coordinates the contributions of thousands of volunteer lawyers each year. Public Counsel serves those in need such as children and the elderly, literacy projects and low income housing providers, refugees and the homeless by providing legal representation and matching financially eligible clients with volunteer attorneys. While this publication is designed to provide accurate and current information about the law, readers should contact an attorney or other expert for advice in particular cases, and should also consult the relevant statues and court decisions when relying on cited materials. The contents of this brochure may be reprinted. Any adaptation or translation of the contents of this brochure must be authorized by Public Counsel. You may find this booklet and other Public Counsel booklets at www.publiccounsel.org (First click on Practice Areas ; second, click on Children s Rights Project ; third, click on Publications. ) 2013 Public Counsel. All Rights Reserved.
Public Counsel P.O. Box 76900 610 South Ardmore Avenue Los Angeles, CA 90005 213/385-2977 ext. 500 or 800/870-8090 Adoptions: 323/526-6360 www.publiccounsel.org Booklet Number 9