I alone shall be responsible for keeping the information contained on this emergency contact form current. I will notify Talega Gallery Community Association when I believe the information on this form should be changed by providing a new and updated form. I release management and the Talega Gallery Community Association from any liability or responsibility with the dissemination of same information.
Do NOT enter data below this line. Thank You!
I hereby authorize and approve management to release the above medical emergency information to those people indicated above. I also authorize and approve management to contact those individuals listed as “emergency contact(s)” above should the need arise during my occupancy at this association.
22 Calle Galeria San Clemente, CA 92673 (949) 361-4685
Talega.gallery@seabreezemgmt.com