Totally Tustin Emergency Release
Childcare provided for children ages 4-12 by:
Sylvan of Tustin
14511 Franklin Avenue, Suite 235
(Off Walnut Avenue between Jamboree and Tustin Ranch Road)
Tustin, CA 92780
Center Director: Melissa Henderson
Child's Full Name (First Last)
Child's Date of Birth
Child's Grade in School
Parent's Full Name (First Last)
Parent's Emergency Phone Number
Alternate Phone Number
Primary Care Physician and Phone Number
Are there any medical conditions we should be made aware of?
By electronically signing this form (First Last), I am authorizing Sylvan Learning, in the event of an emergency where I cannot be contacted, to secure whatever medical care is necessary for the safety and well-being of my child. I will assume all costs incurred for emergency care.
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