Temporary Authorization For Kinship Care (Page 7 of 8) in pdf

Temporary Authorization For Kinship Care

Purposes of this Document

Michigan Law allows parents to give someone else the power to care for their children when the par-

ents are temporarily unable to care for their children, or feel that it would be best for the children to

stay temporarily with that person. When that person is a relative, sometimes they are known as a

“Kinship Caregiver.” The parent(s), child(ren), and Kinship Caregiver to whom this authorization ap-

plies are named below. The parent or parent(s) who have custody of the children are signing this docu-

ment so that the Kinship Caregiver has the ability to do what is needed to ensure the safe and efficient

care of the child(ren). This document should be read and interpreted with that purpose in mind.

“The parent(s)” who have had custody of the children covered by this document

Name(s) ___________________________________________________________________________

Address: __________________________________________________________________________

Phone number: _____________________________________________________________________

“The child (ren)” who will be cared for by the Kinship Caregiver

Name(s) and birthdate(s) of the child (ren): _______________________________________________

__________________________________________________________________________________

The “Kinship Caregiver” who will be caring for the children

Name of the Kinship Caregiver: ________________________________________________________

Caregiver’s address: __________________________________________________________________

Caregiver’s phone number: ____________________________________________________________

Relation to the Child(ren) (grandparent, aunt, etc) __________________________________________

What the Kinship Caregiver is Authorized to Do

The Kinship Caregiver is authorized to do all things necessary to ensure the safety and well being of

the child(ren) listed above while in the Caregiver’s care. The Kinship Caregiver has the ability to

(check the box by each paragraph below that applies):

make medical (including dental) decisions for the child(ren). The Kinship Caregiver (choose one)

____shall or _____shall not notify the parent(s) listed above about any emergency treatment re-

ceived by the children within (insert a number) ____days of the treatment.

see, discuss and receive any medical records or information about the child(ren)

see and discuss any educational records or information about the child(ren), and make educational

decisions, including enrollment in school. The parent(s) listed above (choose one) ______shall

____shall not continue to receive copies of any reports sent by the school to the Kinship caregiver.

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