Louisiana Shelter Registry Form

In order to complete your registration, please provide all requested information.

SHELTER NAME*
MAILING ADDRESS*
Street Address Address Line 2 City State ZIP Code
PHYSICAL ADDRESS
Same as previous

Street Address Address Line 2 City State ZIP Code

Please provide the physical address of the the shelter if it is different from the mailing address.
HOURS OF OPERATION
TELEPHONE NUMBER*
WEBSITE
PARISH OR MUNICIPAL ANIMAL CONTROL OFFICER
First Last
PARISH OR MUNICIPAL ANIMAL CONTROL OFFICER CONTACT INFORMATION
SHELTER CONTACT PERSON
First Last
SHELTER CONTACT PHONE NUMBER
If different from the shelter phone number.
SHELTER CONTACT EMAIL ADDRESS
HAVE YOU SUBMITTED THE BASIC ANIMAL DATA MATRIX ONLINE AT www.shelteranimalscount.org?
- Yes
- No
CAPTCHA

All information requested must be submitted on or before the first day of February of each calendar year.