Adult Camp Camper Report
Camper's Name
First Name
Last Name
Camper's Name
*
Melanie Kelsch
Sarah Lanyon
Randee Sailor
Sheri Geis
Angie Hoerauf
Jason Neis
Justin Neis
William Palmer
AJ Marx
Nick Kurtz
Katelyn Ault
Clara Heyd
Katie Zastoupil
Lacey Thu
Amber Holmen
Jill Mazour
Jenna Roe
Rainann Bull
Marie Delorme
Deion Hanson
Luke Weinburg
Jared Jans
Jason Ehni
Nathan Olds
Jay Hansen
Ty Kersting
Trace Cluck
Josh Boesl
Corey Schlinger
David Corum
Caun Fossum
Dale Palmer
Danny Friedt
Eric Demmers
Interaction with Peers:
Consistently interacted appropriately with peers
Needed occasional reminders to interact appropriately with peers
Needed frequent reminders to interact appropriately with peers
Comments about interaction with peers:
Interaction with Staff:
Consistently interacted appropriately with peers
Needed occasional reminders to interact appropriately with peers
Needed frequent reminders to interact appropriately with peers
Comments about interaction with staff:
Did this camper respect the boundaries of staff/camp?
Rows
Did not cross boundaries
Needed some reminders about boundaries
Frequently crossed this boundary.
Conversational Boundaries (Discussed inappropriate subjects, used inappropriate language.)
Behavioral Boundaries (Acted in an inappropriate manner)
Emotional Boundaries (Tried to involve themselves in personal matters, wanted to form inappropriate relationships.)
Physical Boundaries (Invaded personal space, did not keep hands and feet to selves)
Hygiene/Grooming/Health
Rows
Independent
Supervision
Minimal Assistance
Moderate Assistance
Total Assistance
General Toileting
Toileting after Bowel Movement
Showering Body
Washing Hair
Combing/Brushing Hair
Styling Hair
Dressing While Dry
Dressing While Wet
Brushing Teeth
Mobility
Taking Medication
Washing Hands
Comments about independence, care required, etc.
Comments about eating/drinking/manners/meals, etc.
What types of activities did this camper attend/participate in/enjoy doing at camp? (check all that apply)
crafts
board games
card games
puzzles
fishing
archery
boat rides
swimming
softball game
visiting with peers
visiting with staff
listening to music
walking/running/roaming around camp
eating/coffee breaks
basketball
playground/swings
reading
evening activities
individual activities
small group activities
large group activities
Other
Comments about participation and engagement in camp activities:
Did this camper experience any periods of dysregulation? (crying, refusal, yelling, arguing, etc)
Would you recommend that we accept this camper to this session next year?
yes
no
Are there any additional comments that you would like to add about this camper?
Submit
Should be Empty: