I have the consent of the child(ren)'s parent(s), legal guardian(s), or legal custodian(s) to provide care for the child(ren)
I understand that I have the following rights and responsibilities as a caregiver: the right to make decisions regarding the child(ren)'s health care, including consenting to medical and dental treatment, taking the child(ren) to appointments, and providing medication to the child(ren).
I undertand that I may not make any decision that conflicts with the decision of the child(ren)'s parent(s), legal guardian(s), or legal custodian(s).
I agree to provide the child(ren) with a safe and nurturing envirnment.
I agree to communicate regularly with the child(ren)'s parent(s), legal guardian(s), or legal custodian(s) about the child(ren)'s well-being as possible.
I agree to follow all applicable laws and regulations regarding the care of the child(ren).
I hereby declare under penalty of perjury that the foregoing statements are true and correct. This document expires one year and will need to be filled out each year.