Laws
Statutes – Massachusetts General Laws: Chapter 201F
Definition – ”Caregiver authorization affidavit”, an affidavit prepared pursuant to this chapter that authorizes a designated caregiver to act relative to a minor’s education and health care (201F § 1).
Statutory Form – 201F § 6
Signing Requirements – The principal must sign the document in the presence of two (2) witnesses and a notary public for acknowledgment purposes (201F § 5).
Maximum Term – The term of this instrument shall last no longer than a period of two (2) years (201F § 5).
Other Versions (3)
Download: Adobe PDF, MS Word (.docx)
Download: Adobe PDF, MS Word (.docx)
Download: Adobe PDF, MS Word (.docx)
Additional Resources
- Massachusetts Law Reform Institute – Caregiver Authorization Affidavit Sample Form
- Massachusetts Law Reform Institute – Planning for a Family Emergency
Related Forms
Child’s Vital Information Form
Download: Adobe PDF, MS Word (.docx)
Temporary Agent Appointment for the Care, Custody, or Property of a Minor Child
Download: Adobe PDF, MS Word (.docx)
Sample Form: Adobe PDF
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