Group Intake

GROUP INTAKE
15995 SW 74^th Ave, Suite 200 Tigard, Oregon 97224
503.746.6646 phone 503.746.6944 fax
info@teamsynergo.com www.teamsynergo.com
GROUP NAME:
DATE:

MonthDayYear
Date
Time

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
LOCATION:
GROUP CONTACT:
CONTACT PHONE:
# OF PARTICIPANTS:
GROUP POPULATION:
ADDITIONAL STAFF:
LEAD FACILITATOR | CONTACT INFO.
CO-FACILITATOR(S) | CONTACT INFO.
GOALS | OBJECTIVES | EXPLANATIONS
SPECIAL/SPECIFIC NEEDS | DISABILITIES:
GROUP SPLIT:
GROUP TRANSPORTATION:
FACILITATOR MEETING SPOT:
GROUP LUNCH DETAILS:
FACILITATOR LUNCH DETAILS:
PLAN FOR THE DAY | SEQUENCING & TIME FRAMES:
Should be Empty:

GROUP INTAKE