Louisiana registry form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Name of Licensed Facility' at the top of the form. Ensure this is printed or typed clearly.
3. Next, fill in the 'Physical Address of Licensed Facility' and 'License #' accurately to avoid any discrepancies.
4. Provide your personal details in the 'Name of Individual/Applicant', 'Date of Birth', and 'Social Security #' fields. Double-check for accuracy.
5. Complete the sections for 'Maiden, Previous or Any Other Name Used', 'Race', and 'Sex'. This information is crucial for identification purposes.
6. Fill out your current address details, including 'Current Street Address', 'City and State', and 'Zip Code'.
7. If applicable, provide your most recent previous address along with its city, state, and zip code.
8. Enter your current home phone number, cell phone number, and work phone number in their respective fields.
9. Indicate whether you have been recorded as a perpetrator on the State Central Registry by checking the appropriate box.
10. Finally, sign and date the form at the bottom. Ensure that a representative from the licensed facility also signs and dates it.

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