Lakeshore Care Request
Thank you for submitting a care request. A member of the pastoral care team will follow up within 24 hours.
About The Person Needing Care and Support
Name *
Your answer
Phone *
Your answer
Email *
Your answer
Preferred Method of Contact *
Home Campus of Individual with Need
About the Need
All details of this form will be kept confidential and sensitive information will not broadly shared with LCF staff or leaders.
Which best describes the situation *
Required
Describe the Need *
Write as much as needed to fully describe. Use as many lines as needed.
Your answer
Location of Need
If applicable, include address
Your answer
Age of Person in Need
Background
Source of Information *
Identify the source of this information so the person following up can do so with appropriate context.
Your Name *
If different from the person submitting the request
Your answer
Your Contact Information
Your answer
Submit
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