[20208<\/p>\n
Tl 1IRD LAGUNA I [ILLS<\/p>\n
DISABLED CHILD\/GRANDCHILD HEALTH CERTIFICATION<\/p>\n
MANOR ADDRESS<\/p>\n
RESIDENT’S NAME<\/p>\n
TELEPHONE NO.<\/p>\n
RESIDENT’S RELATIONSHIP TO CHILD<\/p>\n
Cl PARENT<\/p>\n
Cl GRANDPARENT<\/p>\n
DISABLED CHILD\u2019S NAME<\/p>\n
BIRTHDATE<\/p>\n
DISABLED CHILD\u2019S SOCIAL SECURITY #<\/p>\n
PHYSICIAN’S CERTIFICATION<\/p>\n
AS THE PHYSICIAN FOR THE ABOVE-NAMED DISABLED CHILD, YOU ARE REQUESTED TO PROVIDE INFORMATION RELATED TO THE<\/p>\n
PHYSICAL AND\/OR MENTAL HEALTH OF THE CHILD. THIS INFORMATION WILL BE CONSIDERED BY THE HOMEOWNERS\u2019 ASSOCIATION<\/p>\n
BOARD OF DIRECTORS IN DETERMINING WHETHER THE CHILD SHOULD BE PERMITTED TO RESIDE IN THIS SENIOR CITIZENS\u2019<\/p>\n
COMMUNITY. YOUR CAREFUL EXPLANATION OF THE CHILD’S CONDITION, REQUIREMENTS FOR CARE, AND POTENTIAL FOR DISRUPTIVE<\/p>\n
OR DANGEROUS BEHAVIOR (TO THE CHILD OR OTHERS) IS CRITICAL TO THIS DETERMINATION.<\/p>\n
PLEASE EXPLAIN THE NATURE OF THE CHILD’S PHYSICAL OR MENTAL IMPAIRMENT OR DISABILITY.<\/p>\n
EXPLAIN THE TYPES OF CARE THAT THE CHILD WILL RECEIVE FROM THE PARENTS (E.G., BEING DRIVEN, BATHING, FEEDING,<\/p>\n
MEDICATION, ETC.) PLEASE BE SPECIFIC.<\/p>\n
INDICATE FREQUENCY OF REQUIRED CARE:<\/p>\n
[J OTHER (PLEASE SPECIFY)<\/p>\n
J pALLY<\/p>\n
J WEEKLY<\/p>\n
[J SEVERAL TIMES DAILY<\/p>\n
J MONTHLY<\/p>\n
IS IMPAIRMENT OR DISABILITY<\/p>\n
IF NO, HOW LONG WILL IT LAST?<\/p>\n
IS CHILD CAPABLE OF LIVING INDEPENDENTLY?<\/p>\n
PERMANENT?<\/p>\n
O YES<\/p>\n
O N<\/p>\n
OYES<\/p>\n
ONO<\/p>\n
IS IT PROBABLE THAT THE CHILD\u2019S BEHAVIOR WILL BE VIOLENT, DISRUPTIVE OR THREATENING TO THE CHILD HIMSELF OR<\/p>\n
HERSELF, TO NEIGHBORS, OTHER RESIDENTS, OR STAFF?<\/p>\n
O YES<\/p>\n
OO NO<\/p>\n
IF YES, INDICATE LEVEL OF PROBABILITY<\/p>\n
J HIGH<\/p>\n
J MEDIUM<\/p>\n
0 Low<\/p>\n
DATE<\/p>\n
PHYSICIAN’S NAME (PRINT)<\/p>\n
TELEPHONE NO.<\/p>\n
PHYSICIAN’S ADDRESS<\/p>\n
CITY<\/p>\n
STATE<\/p>\n
ZIP<\/p>\n
PHYSICIAN’S LICENSE NO.<\/p>\n
PHYSICIAN’S SIGNATURE<\/p>\n
ACKNOWLEDGEMENT BY PARENT OR GRANDPARENT<\/p>\n
DATE<\/p>\n
PARENT’S \/ GRANDPARENT’\u2019S SIGNATURE<\/p>\n
DATE<\/p>\n
PARENT’S \/ GRANDPARENT’\u2019S SIGNATURE<\/p>\n
ACTION BY MUTUAL BOARD OF DIRECTORS<\/p>\n
| HAVE READ THE MUTUAL GUIDELINES AND POLICY PERTAINING TO AN OCCUPANCY REQUEST FOR MY<\/p>\n
DISABLED CHILD\/GRANDCHILD ON THE REVERSE SIDE OF THIS FORM AND AGREE TO ABIDE BY THEM.<\/p>\n
I ATTEST<\/p>\n
THAT ALL THE INFORMATION PROVIDED IN THIS CERTIFICATION FORM IS ACCURATE AND COMPLETE.<\/p>\n
APPLICATION DENIED<\/p>\n
APPLICATION APPROVED<\/p>\n
The Board of Directors of this Mutual Corporation has<\/p>\n
The Board of Directors of this Mutual Corporation has<\/p>\n
reviewed this application. Based on the information<\/p>\n
reviewed this application. Based on the information<\/p>\n
provided, the application is denied.<\/p>\n
provided, the application is approved.<\/p>\n
SIGNATURE<\/p>\n
Date<\/p>\n
SIGNATURE<\/p>\n
Date<\/p>\n
SIGNATURE<\/p>\n
Date<\/p>\n
SIGNATURE<\/p>\n
Date<\/p>\n
SIGNATURE<\/p>\n
Date<\/p>\n
SIGNATURE<\/p>\n
Date<\/p>\n
READ OTHER SIDE OF THIS FORM<\/p>\n
Rev 7\/3\/2023
\n[20208<\/p>\n
GU<\/p>\n
)<\/p>\n
THIRD LA<\/p>\n
\u05d8<\/p>\n
\u05dc<\/p>\n
\u05d2\u05d1\u05e2\u05d5\u05ea \u05e0\u05d0<\/p>\n
POLICY FOR CO-OCCUPANCY BY DISABLED CHILDREN\/GRANDCHILDREN<\/p>\n
It is the policy of Laguna Woods Village to provide rigorous compliance with the State of California\u2019s occupancy<\/p>\n
regulations for senior citizens\u2019 communities.<\/p>\n
California Civil Code Section 51.3 permits a disabled person or person with a disabling illness or injury who is a<\/p>\n
child or grandchild of the senior citizen to reside in an age-restricted community. All references to \u201cchild\u201d herein<\/p>\n
shall be deemed to include the existing resident(s\u2019) or prospective buyer(s\u2019) grandchild or grandchildren, if<\/p>\n
applicable. Persons who apply for co-occupancy under \u00a751.3 shall submit a disabled child\/grandchild health<\/p>\n
certification application, signed by physician for review by the Board of Directors.<\/p>\n
Applicants are advised of the following:<\/p>\n
\u00b0<\/p>\n
The Board of Directors may deny requests for co-occupancy; therefore, prospective buyer(s)<\/p>\n
are advised to defer opening escrow until a decision is made on the application;<\/p>\n
The Board may request additional documentation in considering this application;<\/p>\n
The Mutual Member is ultimately responsible for the actions of guests, lessees, and co-<\/p>\n
occupants;<\/p>\n
Occupancy of the manor by more than two persons requires a Third-Party Fee;<\/p>\n
Health re-certification shall be required at least annually, unless waived by the Board on a case by<\/p>\n
case bases, such as for a chronic and progressive debilitating disease.<\/p>\n
By signing the acknowledgement on the reverse side of this form, parents\/grandparents agree to hold harmless,<\/p>\n
the Mutual, Golden Rain Foundation and Village Management Services, Inc., Agent, and their respective<\/p>\n
directors, officers, agents and employees from any claims arising or based on the presence of or any alleged<\/p>\n
property damage or bodily injury or death caused in whole or in part or resulting from actions by the DISABLED<\/p>\n
child\/grandchild.<\/p>\n
PROCEDURE FOR REQUESTING CO-OCCUPANCY<\/p>\n
APPROVAL FOR DISABLED CHILDREN \/ GRANDCHILDREN<\/p>\n
Following are the procedures for obtaining approval by the Board of Directors:<\/p>\n
1<\/p>\n
Prospective buyer or existing resident submits Disabled Child Health Certification form to the disabled child’s<\/p>\n
physician for completion.<\/p>\n
2<\/p>\n
Physician completes Physician’s Certification, explaining:<\/p>\n
Ll<\/p>\n
Ll<\/p>\n
Nature\/diagnosis of the physical or mental impairment;<\/p>\n
Probable duration of the impairment;<\/p>\n
Ll<\/p>\n
Whether there is any probability of behavioral problems resulting or arising from the child\u2019s impairment<\/p>\n
which could be harmful to the child or threatening or disturbing to other residents of the community;<\/p>\n
The specific care that the parents will provide to the disabled child.<\/p>\n
Buyer or existing resident completes the acknowledgement of the terms and conditions of approval on the<\/p>\n
Certification form, and submits it to the Community Services Department for transmittal to the Board of<\/p>\n
Directors for review and approval or disapproval.<\/p>\n
Within ten (10) business days from date of receipt of Certification form containing all the required information,<\/p>\n
the Board will make its determination. The Community Services Department will transmit the Board’s decision<\/p>\n
to the prospective buyer. The buyer or resident may appeal the Board’s decision by submitting a written<\/p>\n
request to the Board within 14 days from the date of the denial notice to the buyer or resident.<\/p>\n
Pending Board action regarding the request, prospective buyer or existing resident must complete occupancy<\/p>\n
documents required by the association for Board review.<\/p>\n
Rev 7\/3\/2023<\/p>","protected":false},"author":2,"featured_media":0,"template":"","document_category":[1720],"document_type":[53],"class_list":["post-49014","document","type-document","status-publish","hentry","document_category-admin-services","document_type-other"],"acf":{"document":46839,"resolutions":null,"legacy_id":"4354","pdf_extracted_text":""},"yoast_head":"\n