Facilitator Log

Name

First Name

Last Name

Email Address

Date of group

MM

DD

YYYY

Other KH facilitator present? If so, name:

Counselor / LCS Representative Present?

Yes

No

School Name

Number of Participants

Number of hours planning and facilitating group

Brief description of group

Observations

Action Plan (if necessary)

Date/Time of Next Group Meeting

MM

DD

YYYY

Other Comments

Please do not record names or other identifying information of any participant in accordance with Kids' Haven's confidentialty policy.

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