Request for use of James Samaritan for a Meeting or Visit
James Samaritan is happy to offer our Youth Connection Center for use by DCFS workers, CASAs, or Counselors/Therapists for visits and/or meetings. We are located at 409 N. Jefferson Ave Covington, LA 70433. Please note that this is a request for the selected time. A staff member will respond to this request to confirm availability.
Name
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First Name
Last Name
Purpose of use
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Tell us why you will be using the Youth Connection Center. ie parental visitation, therapy session, meeting, training, adoption celebration...
E-mail
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Choose a Room
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Living Room
Art Room
Backyard
Kitchen
Board Room
Entire Facility
Other
How many people will be attending the visit/meeting?
*
Date(s) requested, Time, Duration
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Check all that apply...
*
I understand I must provide supervision for the duration of parental visitation
I understand James Samaritan cannot supervise visitation or clients
I agree to leave the facility in the same condition as I found it
I agree to model respect for the facility and ask clients/guests to clean up after themselves and their children.
I agree to notify James Samaritan if this visit/meeting is canceled or rescheduled
Notes, Questions, Comments
Submit Request
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