Contact Information

Shauna Ashmore
Director, Student Support Services
(805) 497-9511 x3321
Email

Maria Chavez
Student Support Services
GATE, SARB, Caregiver Authorization, Homeless/Foster Care
(805) 497-9511 x3320
Email

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 NOTARIZED signature from the proposed caregiver. Additionally, we need a NOTARIZED Statement from one or both parents, copy of minor's birth certificate, copy of proposed caregiver’s California driver’s license or California ID card, and proof of residence for proposed caregiver: utility service bill (gas, electric, trash, water).  Click below for a copy of the form, information/regulations, and a checklist of required documents:  

Click here - Caregiver’s Authorization Affidavit form and Instructions (3 pages).

Click here - Caregiver's Authorization Affidavit form  and Instructions in  SPANISH (3 pages).

 

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.