Form

Caregiver authorization or temporary agent affidavit

This interview helps a parent or guardian in Massachusetts give temporary permission to someone to make medical and educational decisions for their child. The parent does not lose their rights to make decisions for their child.

You may want to use this interview if you are unable to care for your child for a short period of time, up to 60 days or 2 years, depending on the kind of permission you need to give.

It can make either a caregiver authorization affidavit or the temporary agent affidavit, depending on which kind of permission you want to give.

This form does not need to be filed with the court. It must be signed in front of a notary and two witnesses.

More information:

• Naming a caregiver for your child
• Original form

Can I use this interview?

Any parent or guardian in Massachusetts can use this form to give temporary permission to someone to make medical and educational decisions for their child.

You can use this form to give permission to a trusted adult to make:

• Medical decisions and
• Educational decisions, for up to 2 years

or

• Some other decisions, including decisions over where your child lives and property, for up to 60 days

Before you start

Before you start, decide what you want to allow the caregiver to do and for how long.

You will need the name and contact information for the person that you want to give permission to.

Be ready to print the form and sign it in front of a notary and two witnesses. You may also decide to send a copy of the signed form to the child's school and doctor.

Start interview