Ladera Community Association
 
 
 
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Use the form below to provide your profile details and request access to the member only areas of our website. Your login details will be emailed to the email address you provide once your account is approved by the administrator.

Directory Options
Unless you specify otherwise below, your details will be shown in our online directory which is only viewable by people who we have approved and are logged into our website.
Show Profile
Show Email Address(s)
Show Phone Numbers
Show Children
Your Information
Please provide us complete information so that we can maintain accurate records.
First Name
Last Name
Email
Street Address

Omit City, State Zip
Home Phone Number

Example: 555-5555
Work Phone Number
Cell Phone Number
Occupation
Employer
Hobbies
Second Resident's Information
First Name
Last Name
Email
Work Phone
Cell Phone
Occupation
Employer
Hobbies
Children's Information
Child 1 Name
Child 1 Birth Date
(mm/dd/yyyy)
Child 2 Name
Child 2 Birth Date
(mm/dd/yyyy)
Child 3 Name
Child 3 Birth Date
(mm/dd/yyyy)
Child 4 Name
Child 4 Birth Date
(mm/dd/yyyy)
Additional Household and Emergency Preparedness Information
Additional Household Phone 1
Additional Household Phone 2
Pertinent Family Medical Information


Please include any special needs, and preferred Hospital/Medical Group affiliation (i.e. Kaiser, Stanford, ...)
Two Out of Area Emergency Contacts


To be used to coordinate care and communications in case local lines are unavailable.
Children Contact Information


This information will not appear in directory but may be used to coordinate with your children. Feel free to include cell phone numbers and email addresses.
Household Members with Special Training in Case of Disaster


Please include name and training for each resident as appropriate. Training including but not limited to MD, RN, PA/NP with specialty, EMT, Dentist, Veterinarian, Psychologist, CPR trained, Pharmacist, Law Enforcement, Military, Firefighter, Ham radio operator, plumber,
electrician, contractor, and seismic geologist.
Household Emergency Equipment Relevant for a Disaster


Please include household content including but not limited to generator, ham radio, disaster supplies, shelter, pump, chainsaw, axe, and crowbar.
Where are the Gas, Electrical, and Water Shutoffs


In case of emergency, please provide a brief description of where each of these shutoffs are located, preferably using N, S, E, & W reference points.
Other Details
Enter the Verification Code