Safe Haven Materials Request

The form below is for Safe Haven facilities in the state of Louisiana to request materials. If you are a Safe Haven facility in Louisiana, please fill out the form below and you will receive your items in 7 to 10 days.

These items, along with the Medical and Genetic History Form, are also available for downloading and printing via http://www.dcfs.louisiana.gov/index.cfm?md=pagebuilder&tmp=home&pid=223

Secondary Email Address

Name of Facility

Contact Person

Type of Faciliity

Mailing Address

City

State

Zip Code

Contact Phone Number

Items Requested

Number Requested of Each

Brochure

Poster

Safe Haven Card

Window Decal

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