Caregiver's Authorization

  • Caregiver's Authorization Affidavit
    To transfer responsibilities to a qualified caregiver, you will need to fill out the Caregiver’s Authorization Affidavit. It is a form that requires the signature of the proposed caregiver. Additionally, we need a Statement from one or both parents, a copy of the minor's birth certificate, a copy of the proposed caregiver’s California driver’s license or California ID card, and proof of residence for the proposed caregiver: utility service bill (gas, electricity, trash, water).  Click below for a copy of the form, information/regulations, and a checklist of required documents:  

    Caregiver’s Authorization Affidavit forms are also available in Student Support Services, District Office and must be approved by the Director of Student Support Services.

    Qualified Relative
    A qualified relative 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.

    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.

Contact Information

  • Christina Harrison
    Director, Student Support Services
    (805) 497-9511 x3321

    Gloria Alamir
    Secretary, Student Support Services
    (805) 497-9511 x3320