Emergency Contact Information
& CLVFA Member Information

CLVFA would like to keep you informed about emergencies and member meetings. Please provide an emergency contact in case of a medical emergency. If you have renters, please provide their contact information in the additional information section. All information will be kept private and confidential.

Provide as much information as possible. If you have multiple household members, use the additional information section for cell phone numbers. We will only use cell phone numbers to provide information in case of an emergency. If we respond to a medical emergency and a household member is taken to a hospital, we would like to notify other household members.

Name:
Property Address Number:
Casa Loma Road:
Loma Chiquita Road:
Twin Falls Road:
Rent:
Own:
Email:
Mailing Address:
Street:
City, State, Zip:
Phone Number:
Cell Phone:
Emergency Contact:
Emergency Contact Phone:
Additional Information: