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
949-552-1299
tustin.ca@sylvanlearning.com
Center Director: Melissa Henderson
Child's Full Name (First Last) *
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Child's Date of Birth *
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Child's Grade in School *
Parent's Full Name (First Last) *
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Parent's Emergency Phone Number *
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Alternate Phone Number
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Parent's Email *
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Primary Care Physician and Phone Number
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Are there any medical conditions we should be made aware of?
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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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