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Caregiver Affidavit

January 23, 2022

A caregiver affidavit is an official form in which parents authorize a relative caregiver to temporarily make medical and educational decisions for their child. Continue reading to learn more about Missouri caregiver affidavit laws and requirements.

What Is a Caregiver Affidavit in Missouri?

The state of Missouri provides for the relative caregiver affidavit under statute section RSMo 431.058 revised in 2014. This document allows a relative caregiver with whom a child lives to make decisions on the child's behalf when it comes to medical treatment and educational services. 

When is a caregiver affidavit used?

A caregiver affidavit is a simple alternative to legal guardianship. It can be used when parents need to leave a child temporarily in the care of a relative due to travel, medical treatment, financial hardship, or other circumstances. Without this form, only a child's parents or official guardians are allowed to enroll a child for school or authorize the child’s medical care.

Who is considered a relative caregiver?

According to Missouri statute, a relative caregiver is any person who is related to the child by blood, marriage, or adoption, and who is not the child’s parent, legal guardian, or legal custodian. In other words, a relative caregiver can be a grandparent, a sibling, an aunt, or an uncle. 


To be eligible, the caregiver must be a competent adult over the age of 18. Additionally, the child must live with the relative caregiver for the affidavit to be valid. 

What decisions can a relative caregiver make?

The affidavit gives a relative caregiver the authorization to:

  • Give consent to necessary medical treatments, including dental care, surgery, and mental health care. This also applies to any school-related medical treatments, such as immunizations and physical examinations.
  • Make decisions regarding the child’s education, for example, participation in school activities and deciding where the child goes to school.
  • Acquire the child’s medical, insurance, and educational records.

Relative caregiver’s responsibility

A relative caregiver assumes an informal responsibility for a child without any involvement from the court system, child welfare services, or any other authorities. While relative caregivers have physical custody of the child in their care and provide for the child's basic needs, they don’t have legal custody. Therefore, they have only limited rights to make decisions regarding the child. In addition, once the child ceases to live with the caregiver, the caregiver can no longer consent to medical treatment or educational services.

Caregiver Affidavit Form

The Relative Caregiver Affidavit Form is made available for download by the Missouri Bar Association. You can print and photocopy the form as many times as needed. There is no copyright on this form and it is free to use.

Under Missouri law, all schools and medical care providers in the state must accept this form if it is completed correctly.

Relative caregivers are required to fill out the following information:

  • The name of the child
  • The child's date of birth
  • The caregiver's name
  • The caregiver’s relationship to the child
  • The reason why the child lives with the caregiver
  • The caregiver’s date of birth, and contact information
  • The caregiver’s driver's license or identification card number
  • The parent’s contact information
  • The date of signing the affidavit.

Furthermore, the caregiver must indicate whether there were any attempts to inform the child’s parents of the intent to consent to medical treatment or educational services and whether any response was obtained from the parent. Finally, the relative caregiver must confirm that the information provided in the affidavit is correct and sign the form. 

Who Signs the Affidavit Form?

Missouri law requires that the relative caregiver signs the affidavit in front of a notary public. Note that only the caregiver is required to sign the form and not the child’s parents. However, the parents must sign a delegation of authority to the caregiver and consent to educational services or medical treatment. 

When Does the Affidavit Expire?

The Missouri relative caregiver affidavit expires one year after the date it is given to a health care provider or school. If this date is unknown, the affidavit will expire one year after the date the relative caregiver signs the document. After the expiration date, the caregiver affidavit can be extended in writing.


The affidavit automatically becomes invalid if the child ceases to live with the relative caregiver before the expiration date of the document.

Other Affidavit Laws

Missouri caregiver affidavit laws dictate that: 


  • A parent who is capable of taking care of the child is not allowed to sign over rights to a relative caregiver without a valid reason.
  • The affidavit does not give the relative caregiver legal custody of the child. The document also does not suspend or terminate the legal custody of the parents.
  • The relative caregiver affidavit does not relieve a parent of liability for payment for medical treatment or educational services provided to a child.
  • The affidavit can be changed or revoked by the parent or legal guardian at any time.
  • The parent may decide to exclude the caregiver from making specific decisions.
  • If there is a disagreement between the caregiver and parent regarding a medical or educational decision about the child, the parent’s decision will supersede that of the caregiver, provided that it does not threaten the life, health, or safety of the child.
  • A relative caregiver affidavit is not backed by a court order. This means that parents can withdraw from the agreement and take their child back at any time. 
  • The consent of the relative caregiver is revoked in the case the parent withdraws the authorization.
  • A relative caregiver is required to immediately notify the health care provider or school if the child no longer lives with them, which would make the affidavit invalid.