Requirements for Validly Executed Affidavit; Form

1. Law
2. Georgia Code
3. Education
4. General Provisions
5. Caregiver Educational Consent
6. Requirements for Validly Executed Affidavit; Form

1. A kinship caregiver's affidavit shall be invalid unless it substantially contains, in not less than ten-point boldface type or a reasonable equivalent thereof, the form set forth in subsection (b) of this Code section. The warning statement shall be enclosed in a box with three-point rule lines.
2. The kinship caregiver's affidavit shall be substantially in the following form:

   INSTRUCTIONS: Please print clearly.

   I hereby certify that the child named below lives in my home and I am 18 years of age or older.

   1. Name of child: _______________________________________________________

   2. Child's date of birth: _______________________________________________

   3. My full name (kinship caregiver giving authorization): _______________

   4. My home address: _____________________________________________________

   5. [ ] I am a kinship caregiver.

   6. I have assumed kinship caregiver status because of one or more of the following circumstances (check at least one):

   [ ] A parent being unable to provide care due to the death of the other parent;

   [ ] A serious illness or terminal illness of a parent;

   [ ] The physical or mental condition of the parent or the child such that proper care and supervision of the child cannot be provided by the parent;

   [ ] The incarceration of a parent;

   [ ] The loss or uninhabitability of the child's home as the result of a natural disaster;

   [ ] A period of active military duty of a parent exceeding 24 months; or

   [ ] I am unable to locate a parent or parents at this time to notify them of my intended authorization because (list reasons):

   _________________________________________________________________________

   _________________________________________________________________________.

   7. Names of parent(s) or legal custodian(s): ____________________________

   8. Address of parent(s) or legal custodian(s): __________________________

   9. Phone numbers and email addresses of parent(s) or legal custodian(s):

   _________________________________________________________________________

   10. Kinship caregiver's date of birth: __________________________________

   11. Kinship caregiver's State of Georgia driver's license number or identification card number: _______________________________________________________

   WARNING: DO NOT SIGN THIS FORM IF ANY OF THE STATEMENTS ABOVE ARE INCORRECT OR YOU WILL BE COMMITTING A CRIME PUNISHABLE BY A FINE, IMPRISONMENT, OR BOTH.

   I recognize that if I knowingly and willfully make a false statement in this affidavit, I will be guilty of the crime of false swearing.

   ________________________________

Download our app to see the most-to-date content.