Can Shake Permit Form

2. ***If organization applying for Can Shake permit is a school, a printed form must be submitted at the Police Jury Administration building, as you must have approval and signature of Superintendent of Schools before submission for approval by the Assumption Parish Police Jury.

   ***If organization applying for Can Shake permit is a school, a printed form must be submitted at the Police Jury Administration building, as you must have approval and signature of Superintendent of Schools before submission for approval by the Assumption Parish Police Jury.

4. Assumption Parish Police Jury Can Shake Permit Application

   Governing Solicitation of Money on Public Highways, Streets, and Roads in Assumption Parish

   Governing Solicitation of Money on Public Highways, Streets, and Roads in Assumption Parish

6. Organization Name:*

   Enter the name of the organization can shake permit is being applied for

8. Tax ID Number:*

   Enter tax ID number of organization can shake is being applied for

10. Tax ID Number Owner:*

    Enter owner of the tax ID number being used to apply for can shake permit

12. First Name*

    Enter your first name

13. Last Name*

    Enter your last name

15. Address*

    Enter your address

17. City*

    Enter your city

18. Zip Code*

    Enter your zip code

20. Email Address*

    Enter your email address

21. Phone Number*

    Enter your phone number

23. Type of Event*

    1. Charitable Non-profit
    2. Church Organization

    Choose the type of organization. If organization is a school, a printed form must be submitted at the Police Jury Administration building, as you must have approval and signature of Superintendent of Schools before submission.

25. List the names and ages of all persons participating in the solicitation effort*

    Enter the names and ages of person participating in the solicitation effort. Separate entries by a semi-colon (;)

27. Date of solicitation*
    Date of solicitation

    Date of solicitation

    Enter the date can shake will take place

29. 2nd Date of Solicitation
    2nd Date of Solicitation

    2nd Date of Solicitation

    If applicable, enter the second date, with time, the can shake will take place

31. ***THERE IS A (30) DAY WAITING PERIOD FROM DATE OF APPROVAL TO SOLICITATION DATE

33. Location of Solicitation*

    Enter a detailed description or address of where the can shake will take place.

35. Purpose of solicitation:*

    Enter a detailed description of the purpose for which the can shake is being held.

37. Important Requirement

    A POSTER IDENTIFYING THE ORGANIZATION TO BENEFIT IS REQUIRED AT EACH LOCATION OR INTERSECTION.

    A POSTER IDENTIFYING THE ORGANIZATION TO BENEFIT IS REQUIRED AT EACH LOCATION OR INTERSECTION.

39. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) you understand that no person under the age of fourteen will be allowed to solicit on public highways, roads, and streets in Assumption Parish, 2) a minimum of one adult must be present to supervise solicitations for up to three individuals between the ages of fourteen and seventeen, 3) not more than eight solicitors will be allowed at any one intersection at one time, 4) solicitations are limited to two days per year, wheather consecutive or not, based upon organization name, 5) there is a thirty day waiting period from date of approved permit to solicitation date 6) your application will not be signed in the sense of a traditional paper document, 7) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 8) you may still be required to provide a traditional signature at a later date.

    1. I agree.
41. Electronic Signature*

Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field