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Who We Are

Issues and Priorities

Committees

Special Program

Other Information

Community Participation

Dedicated to Friendship and Unity, One Neighbor to Another

LAS TIERRAS NEIGHBORHOOD ASSOCIATION HOW TO JOIN A NEIGHBORHOOD WATCH

1. PLEASE FILL IN THE FORM BELOW COMPLETELY.
2. WHEN YOU ARE READY, YOU MAY PRINT THE FORM USING THE "GO TO PRINT PAGE" BUTTON BELOW.
3. AFTER YOU HAVE PRINTED THE FORM, CLOSE THE PRINT PAGE.
4. CLICK ON THE "SUBMIT" BUTTON ON THIS PAGE. THIS WILL EMAIL A COPY OF THE
   FORM TO MANUEL PADILLA
5. HE WILL THEN CONTACT YOU.
6. PLEASE DO NOT CLICK ON THE "SUBMIT" BUTTON MORE THAN ONCE.

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NEIGBORHOOD CRIME WATCH
FAMILY DATA SHEET
(To be maintained by the BLOCK CAPTAIN)

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Home Address:         Email:  

Home Telephone:                        Zip Code:  

Family Name(s):   1:                     2:                       Total Residents:  

Work Telephone 1:          Name to ask for:  

Work Telephone 2:          Name to ask for:  

TOTAL NUMBER OF CHILDREN IN HOUSEHOLD:              LIST NAMES AND AGES BELOW:

Name:      Age:                                                 Name:      Age:  

Name:      Age:                                                 Name:      Age:  

Name:      Age:                                                 Name:      Age:  

NAMES OF OTHER RESIDENTS:                        

IN CASE OF EMERGENCY CONTACT:

Name:                                                        Home Telephone:      

Address:                                                     Work Telephone:      

FAMILY VEHICLES:

No. 1:   MAKE:       STYLE:       COLOR:       LICENSE:  

No. 2:   MAKE:       STYLE:       COLOR:       LICENSE:  

No. 3:   MAKE:       STYLE:       COLOR:       LICENSE:  

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LIST ANY SPECIAL FAMILY HEALTH OR MEDICAL INFORMATION

LIST ANY SPECIAL EMERGENCY MEDICAL CARE TRAINING OR SKILLS

LIST ANY OTHER PERTINENT - IMPORTANT INFORMATION