Sample Caregiver Authorization Form with notes (11 - MassLegalHelp 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your name and address as the Authorizing Party. Indicate your relationship to the minor child(ren) listed.
3. List the names and dates of birth of the minor children for whom you are granting authorization.
4. Specify any actions that the caregiver is not permitted to perform in the designated section.
5. If desired, appoint an alternate caregiver by providing their name and address.
6. Read and confirm the statements regarding court orders and your intentions before signing.
7. Sign and print your name, along with your telephone number, at the bottom of the form.
8. Ensure two witnesses sign their names and provide their printed names and phone numbers.
9. Complete notarization by having a notary public witness your signature and complete their section.
10. If applicable, have both caregivers sign their acknowledgments, confirming they understand their responsibilities.

Start using our platform today to easily fill out your Sample Caregiver Authorization Form for free!