*1. Camp is a high energy environment with a lot of people in close quarters. This may stir up behaviours that don't generally arise. Please describe any behaviours that may arise while at Camp:
AnxietyDepressionDifficulty Listening/Following InstructionsDifficulty with AuthorityHyperactivityPhysical AggressionSelf HarmTantrumsVerbal AggressionWandering/Running Away
*2a. Is there a root issue that these behaviours arise from?
b. How do we address the root issue?
*3. How does your camper relate to:
*a. their peers?
Well (no issues)Fights/argues when behaviours ariseFights/argues at any timeWants to be in charge (bossy)Submits easily to peer pressure
*b. authority figures?
*4. All campers wake up at 7:30 am. Bedtime is between 9:30 pm and 11:00 pm, depending on age group. What are your campers' sleeping habits?
*a. Sleeps wellBed wettingStruggles to fall asleepSuffers from nightmaresWakes up frequently for the washroom
b. Regular bedtime
Regular wake up time
*5. Are these behaviours specific to:
*a. certain situations?
Change of SurroundingsChaotic Times (lots going on around them)Down time/Unstructured TimeFeeling TeasedSudden ChangeWhen there are too many rulesWhen they aren't sure what is expected of them
* b. certain times of day?
Morning (7am-12pm)Afternoon (12pm-5pm)Evening (5pm-11pm)Any time of day
*6. What are the initial signs that the behavior may start?
Agitation (talking really fast, twitching/shaking, etc.)Being LoudBeing Physical with others (pushing, poking, etc.)Withdrawal (avoiding other people)
*7. Once the initial signs have started, what can we do to prevent the behavior going further?
*a. in addressing the camper:
Give them some encouragement (a pat on the back, some kind words, etc.)Ask if they would like to go for a walk with a leaderPull them aside and talk it out with them
b. in the environment:
Ask the other campers to quiet downTake your camper to a calmer area
*8. If the behavior continues:
*a. what are the best words to use?:
*b. should they be separated from the group?:
*a. should there be any consequences?
b. if so, what is the best type of consequence?
Asking them to apologizeMissing an activityScraping plates after a mealTime Out
*Note: Missing a meal (other than Tuck) will never be used as a consequence. Staff are trained to give out consequences privately.*
10. What is a positive message or action that will keep your camper in a deescalated state?
*11. What should be done if the main plan does not succeed? Who should we seek for advice?
*12. We MUST be able to contact someone regarding any issues that arise at Camp. Please provide an alternate contact to yourself who can assist us with any behaviours that arise:
13. Do you have any further comments?
* By checking this box I indicate that I have provided the above information as accurately as possible, based on previous dealings with these challenges. If I have passed on recommendations provided to me by other professionals, these are recommendations that I as a parent/guardian support. I support the implementation of this plan by the Camp Arnes staff. I give permission to share this information with the Camp Arnes staff that are directly involved with my child.