General Contact Information

For the LPC office to proceed with scheduling your group in our space, we must have on file this form and proof of a participant passing the applicable training quiz: https://www.surveymonkey.com/r/G37CSTJ. Our policies can all be found on our website here: http://lakesidechurch.org/index.php/healthyatchurch/.

Question Title

* 1. Name of Group

Question Title

* 2. Contact information of person making request

Question Title

* 3. Secondary contact

Question Title

* 4. This request is for

T