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Application for Assistance

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Instructions:
Please complete this application to apply for assistance from The RescYOU Group, Inc.  If you need assistance in completing this application, please contact Shannon Leger @ (337) 256-1515.


* Denotes Required Field

Parent/Guardian/Caretaker Information

2nd Parent/Guardian/Caretaker Information

Child Information

TRG serves a 10 parish region in Acadiana.  If residence is outside this area, some services may not be available.

Assistance Desired

Please check all applicable boxes Required

Additional Information

Did you recieve a RescYOU Group Resource Folder? Required

Application Prepared By:

Privacy Policy

We keep your personal information private and secure.  Your information will be protected and treated with sensitivity.  A consent form is required to release any personal information to a third party.  All information is used for the sole purposes of The RescYOU Group, Inc. in providing the requested service(s).

Thank you for submitting your application. Someone will contact you soon.

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337.534.4446

221 Rue De Jean Ste. 136, Lafayette, Louisiana 70508.

© 2024 The RescYOU Group

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