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Can Shake Permit Form

  1. ***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.

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

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

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

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

  6. Enter your first name

  7. Enter your last name

  8. Enter your address

  9. Enter your city

  10. Enter your zip code

  11. Enter your email address

  12. Enter your phone number

  13. Type of Event*

    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.

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

  15. Enter the date can shake will take place

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

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

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

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

  20. 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.

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  22. This field is not part of the form submission.