Non-Parental Affidavit
Introduction
I, [Your Name], residing at [Your Address], hereby affirm the following facts and statements in support of the authorization granted to [Non-Parental Caregiver's Name], residing at [Caregiver's Address], as the designated caregiver for my child, [Child's Name], born on [Child's Date of Birth].
Statement of Facts
I, [Your Name], am the legal parent/guardian of [Child's Name]. The designated caregiver, [Non-Parental Caregiver's Name], is a trusted individual known to me and resides at [Caregiver's Address].
Due to unforeseen circumstances [Explain briefly the reason why the parent(s) cannot provide care], I am unable to fulfill my parental duties and responsibilities for [Child's Name].
This authorization shall be effective from [Start Date] to [End Date], unless otherwise revoked in writing by me.
I hereby grant [Non-Parental Caregiver's Name] the authority to make decisions regarding the health, education, and general welfare of [Child's Name], including but not limited to medical treatment, educational enrollment, and participation in extracurricular activities.
I affirm that this authorization is voluntary and granted with full knowledge and consent. I understand that [Non-Parental Caregiver's Name] will act in the best interests of [Child's Name] while under their care.
I hereby acknowledge that my signature below is made under oath and that this affidavit is executed with the full understanding of its contents.
Sworn Oath
I, [Your Name], do hereby solemnly affirm under oath that the foregoing statements are true and correct to the best of my knowledge, belief, and understanding.
Signature
[Your Name]
Parent/Legal Guardian
[Date]
[Notary Public's Name]
Notary Public
[Date]
[Caregiver's Name]
Caregiver
[Date]
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