One intake packet is required per child.

Intake packets can be turned into:
Youth Programming & Outreach Coordinator:
Sha' Hill, MSW, LSW
ohill@fsadekalbcounty.org
815-758-8616 ext.1206

 
Director of Youth Programming & Services:
Shatoya Jackson, MSW, LSW, MRT, CCTP
sjackson@fsadekalbcounty.org
815-758-8616 ext. 1204

Welcome to FSA's Little Campers - Summer 2026!

Thank you for your interest in FSA’s Little Campers, a summer program specially designed for Campers ages 6 to 11 who reside in DeKalb County, Illinois. Our camp also offers limited Camp Helper opportunities for youth ages 12 to 17, providing older participants with a chance to build leadership skills while supporting younger campers. As a youth mental health agency, our camp emphasizes Social Emotional Learning (SEL) through a variety of engaging, supportive, and developmentally appropriate group activities and experiences.

These groups may explore topics related to:

• Building self-confidence
• Managing emotions
• Positive relationships
• Creative expression
• Problem-solving
• Personal safety And more!

Please note: Specific group offerings and activities may vary, and final programming will be determined by staff based on the needs of the participants.

Important Enrollment Information
Completing this intake packet does not guarantee enrollment in the Little Campers program. There is a multi- step enrollment process:

1. Families will receive a confirmation email once the completed intake packet has been received.
2. Staff will follow up with screening and additional information as needed.
3. A separate email and/or phone call will be sent to notify families if their child has been accepted into summer camp.

We're excited about the opportunity to offer a summer filled with growth, fun, and connection!

Location & Environment

Pending acceptance into the program, Little Campers is expected to take place at:

Tyler Elementary 1021 Alden Circle DeKalb, IL 60115

Camp activities may be held both indoors and outdoors, including occasional use of Lions Park, located 0.2 miles from the school.

Note: If additional off-site activities are scheduled, parental permission will be required in advance.

Participation & Attendance Overview

If your child is accepted into the Little Campers program, here is a general overview of what to expect regarding participation and attendance:

• Camp is scheduled to run Monday through Friday, 9:00 AM - 3:00 PM, from June 1st - July 31st, 2026.
• Consistent attendance is required, as activities are designed based on the number of youths participating.
• Space in the program is limited, and regular attendance supports safety, planning, and group connection.

Please note:

• Families will be notified of any schedule changes, cancellations, or emergency updates once the program begins.
• Excessive unexcused absences or tardiness may impact continued participation if a child is enrolled.
• If your child is unable to attend due to illness, emergency, or other reasons, contact information will be provided upon acceptance. Advanced notice is required for excused absences.

Social Emotional Learning (SEL) Services

If your child is accepted into FSA's Little Campers, FSA staff and interns will run Social Emotional Learning (SEL) group activities designed to support emotional growth, self-awareness, and positive peer relationships. Core group topics and activities are subject to change based on participant needs and staff availability.

Additional Support Services

FSA may also provide information or referrals to other services available through our School-Based & Youth Programming department (such as Youth Mentoring or Individual Counseling) or through other departments at FSA, including:

• Community Action Program
• Children's Advocacy Center
• Center for Counseling

Parental/guardian consent will always be obtained before any additional services are provided.

Program Descriptions

Body Image: This interactive group gives youth space to explore body image issues while building self-acceptance, confidence, self-esteem, and peer support.

Brave Voices: This is a supportive, youth-centered group that empowers participants to build confidence, express themselves authentically, and develop healthy communication skills in a safe and encouraging space. Offered by parent/guardian request only.

Bullying Prevention: Using the Second Step curriculum, this group teaches effective strategies to prevent and reduce bullying behaviors in schools.

Color Me Happy (Expressive Art Group): Through creative expression, youth explore thoughts and emotions while learning mindfulness, emotional regulation, and positive coping strategies through the process of making art.

Empowerment (Building Confidence): A strength-based group that helps youth discover and use their voice and power, both individually and collectively, to address issues important to them.

Managing Emotions, Triggers & Actions (META): This program equips youth with skills to recognize, manage, and express emotions appropriately, reducing aggression, improving self-control, and building pro-social behaviors.

Overcoming Obstacles: Youth build trust, respect, and peer connections while reducing conflict, discipline issues, and anxiety in group settings.

Proud & Empowered: This is a strengths-based group that helps youth build self-confidence, embrace their identity, and develop the skills to advocate for themselves in a positive and supportive environment. Offered by parent/guardian request only.

Safety Squad: This group promotes safety, confidence, and personal boundaries, empowering children to recognize and respond to inappropriate behavior in safe, supportive ways.

Superheroes Social Skills: An evidence-based program designed to improve social skills in students with ASD, behavioral disorders, or developmental delays. Offered by parent/guardian request only.

Celebrating Diversity - Words Around the World: This literacy group promotes cultural awareness, family engagement, language development, and a love for reading, especially for English Language Learners.

40 Developmental Assets: Based on Search Institute's model, this group explores 40 key strengths that help youth thrive-focusing on both external supports (family, school, community) and internal strengths (values, social-emotional skills

Parent Contact & Emergency Information

Please list all legal guardians and their preferred contact numbers.

Please provide all email addresses you'd like us to use for communication, as we occasionally send important updates such as weather cancellations, requests for special clothing or items, behavioral concerns, reminders about events or field trips, and general program announcements. (At least one email is required)

Emergency Contact Information

(Used if parent/guardian cannot be reached. If no emergency contact, enter parent/guardian information)

Authorized Pick-Up List

 Please list any additional adults, aside from the parent/guardians and emergency contacts, who are allowed to pick up or care for your child regularly (at least 50% of the week)

Camp Dates & Hours

June 1st – July 31st, 2026
Monday – Friday, 9:00 AM – 2:45 PM
Dropoff – 9:00 AM – 9:15 AM
Pickup – 2:45 PM – 3:00 PM

Attendance Requirement
This is a full‑time summer camp program. Camp is designed for young people aged 6 through 11 years old, who can attend five days per week for the full camp timeframe. 

Priority enrollment will be given to youth who can attend Monday–Friday on a consistent, full‑time basis.
Limited exceptions may be considered for unavoidable conflicts (e.g., medical appointments, vacations, illness).

Why We Ask for This Information

As a mental health-focused summer camp, our goal is to create a supportive, safe, and enriching environment for all participants. This checklist helps us better understand your child's emotional and behavioral needs SO we can plan appropriately and ensure they receive the right level of support. Please note: Your responses will not be used to discriminate or exclude your child from services. However, if a child's needs exceed the level of care we are able to safely and effectively provide within the camp setting, we may follow up with you to discuss alternative recommendations or referrals to more intensive services.

Parent/Guardian Consent - Little Campers 2026

Group Participation & Activities

I understand that Family Service Agency (FSA) is a youth mental health and social service agency, and that all camp groups will incorporate elements of Social Emotional Learning (SEL) and/or mental health themes. These groups may include:

• SEL Groups: Body Image, Color Me Happy, Empowerment, META (Managing Emotions, Triggers & Actions), Overcoming Obstacles, Safety Squad, and Words Around the World

• SEL Classroom Lessons: Bullying Prevention and 40 Developmental Assets

• Specialized Group (by request): Superheroes Social Skills

Campers may participate in activities that involve creative expression, emotional processing, social skill building, and age-appropriate discussions related to mental health and behavior.

Physical Activity & Clothing

I understand that my child may engage in daily physical activities, such as walking, running, jumping, stretching, exercising, and gardening. Campers should come dressed in comfortable, weather-appropriate clothing that can get messy. Valuable or special clothing is not recommended.

Materials, Tools & Supervision

I understand that my child may use a variety of materials, tools, and supplies throughout the camp day, including during group activities, outdoor play, and counseling-based sessions. These may include, but are not limited to:

• Art supplies (paint, crayons, colored pencils, glue, scissors, staplers)
• Outdoor toys and games
• Sensory and coping tools such as fidgets, stress balls, therapeutic games, or journaling materials

These items are used to support creativity, emotional regulation, social development, and engagement. I give permission for my child to use these materials and understand that all activities will be supervised, risk-assessed, and conducted in accordance with FSA's child safety guidelines.

Media Release

I understand that photographs and/or videos may be taken during Little Campers activities and may be used by Family Service Agency for publicity purposes, including on social media, the FSA website, or in printed materials.

Personal Belongings

Family Service Agency is not responsible for any personal items that are lost or damaged during camp. It is strongly recommended that children do not bring mobile phones or valuables to camp. Children will not be permitted to use phones during camp.

Emergency Medical Consent

In the event of an emergency, I understand that every effort will be made to contact me. However, I authorize any necessary emergency medical treatment to be administered to my child if I cannot be reached.

Transportation & Walking Permission

I understand that Family Service Agency will not transport my child during the Little Campers program unless it is for an approved field trip. For all field trips requiring transportation, FSA will use group vehicles such as vans or buses, and all children will travel together under staff supervision. Separate parental permission will be obtained in advance for each field trip involving transportation.

I also understand that campers may walk, under staff supervision, to and from nearby locations such as Lions Park and Tyler Elementary School or take short walks in the immediate area (no more than approximately half a mile Any walking trips beyond this distance will require additional parent permission prior to the activity.

Authorized Pick-Up List

I understand that my child may only be released to parents/guardians, emergency contacts, or individuals listed on the Authorized Pick-Up List. If changes to the pick-up list are needed, I understand I must notify staff in writing.

Communication Consent

I give permission for FSA staff to communicate with me regarding my child's participation via phone, email, or approved communication platforms such as ClassDojo. I understand I may opt out at any time by notifying staff in writing. However, by opting out, I acknowledge that I may miss important and time-sensitive information related to special events, behavioral issues, field trips, or schedule changes.

Consent for Mental Health Services

I understand that Little Campers may include brief check-ins or supportive mental health interactions provided by licensed mental health professionals and/or qualified staff under professional supervision, in accordance with agency policies and ethical standards. These interactions are not formal therapy sessions but are intended to promote camper well-being-particularly in response to behavioral incidents, concerns for a child's safety, or situations where a child may pose a risk to others. If it is determined that additional or ongoing support is needed, I will be contacted to provide further consent.

Confidentiality & Limits of Confidentiality

I understand that any mental health support or group discussions provided to my child during the Little Campers program will remain confidential, except in cases where FSA staff are legally required to report suspected abuse, neglect, harm to self or others, or other situations covered under Illinois mandated reporter guidelines.

 

Give my consent for my child to participate in Family Service Agency of DeKalb County's Little Campers program. This camp is scheduled to run Monday through Friday, 9:00 AM - 2:30 PM, from June 2nd through August 1st, 2025, and is expected to be held at:

Tyler Elementary School 1021 Alden Circle, DeKalb, IL 60115

By completing and signing this form, I, as the parent or legal guardian, give my informed consent for my child to participate in the FSA Little Campers program and agree to the terms and conditions outlined throughout this Intake Paperwork.

FSA Little Campers - Behavior Policy & Expectations

At Family Service Agency (FSA), we are committed to providing a safe, respectful, and engaging environment for every child in the Little Campers program. We believe that positive behavior grows from strong relationships, consistent routines, and caring guidance. Our staff actively model and encourage teamwork, kindness, inclusion, self-awareness, and mutual respect-values that are built into our daily games, group sessions, art activities, teambuilding, and outdoor play.

Positive Behavior Reinforcement

FSA uses a positive behavioral approach that recognizes and celebrates growth, effort, and progress. Campers are encouraged and acknowledged when they:

• Show kindness or help others
• Practice conflict resolution skills
• Stay engaged and follow group expectations
• Demonstrate empathy or positive self-expression

Staff may reinforce positive behaviors through:

Verbal praise and encouragement Stickers, activity-based incentives, or group privileges Opportunities to lead or model for peers Calm, reflective conversations to build confidence and reinforce strengths

We believe that children thrive when their positive choices are noticed and affirmed, and we prioritize these moments in our daily interactions.

Group-Developed Guidelines

At the beginning of camp, youth will work alongside staff to co-create shared expectations that reflect respect, safety, and cooperation. When campers help shape these guidelines, they are more likely to understand and follow them. These expectations are revisited throughout the summer to keep group norms consistent and supportive. Managing Challenging Behavior If a child exhibits unsafe, disruptive, or inappropriate behavior (e.g., not following directions, aggression, damaging property, or disrespect toward others), staff respond in a supportive and restorative way. Our process includes:

1. Time for regulation: The camper is given a brief break to calm down, reflect, and reset-away from the
2. Supportive conversation: A staff member gently checks in to help the child identify their emotions, the cause of the behavior and works with them on healthier choices for next time.
3. Staff follow-up: The incident is discussed with the program coordinator and/or the team member responsible for sign-out to ensure consistent follow-through.
4. Parent communication: The staff member who observed the behavior will speak directly with the parent or guardian at pickup. A Behavior Report will be completed, and a parent signature collected to confirm the discussion.
5. Planning as needed: If the behavior becomes frequent or severe, staff and caregivers may collaborate on a behavior support plan or determine if additional services are appropriate.

Possible Consequences for Ongoing Behavior

While our focus is on redirection and learning, if challenging behaviors are repeated or pose safety risks, consequences may include:

• Temporary removal from an activity
• Missing a field trip or special event 
• Suspension from camp for one or more days 
• Discontinuation from the program if necessary for group safety 
• Each situation will be addressed with consideration of the child's needs, history, and developmental level.

Responsibility & Safety Expectations 

All campers are expected to: Always follow directions from staff Treat others and property with care and respect Participate safely and positively in camp activities FSA is committed to creating a space where children feel safe, supported, and capable of making good choices. By working together with families and focusing on growth-not just consequences-we aim to help every camper succeed.

Physical Contact & Crisis Response Policy 

Family Service Agency staff are not permitted to physically restrain or touch campers in any form of discipline or redirection. Our approach is grounded in trauma-informed care, and we prioritize de-escalation, emotional regulation, and verbal support to manage challenging behaviors. 

If a camper becomes physically aggressive (such as hitting, kicking, biting, throwing objects, or attempting to harm themselves or others), staff will do everything possible to maintain a calm and safe environment. This includes giving the child space while remaining nearby to ensure safety, offering verbal support, and using calming strategies to help the camper regulate their emotions and express their needs. 

If these strategies are not effective and the camper continues to present a serious and immediate safety risk, staff may be required to contact emergency services (911) for additional support. This would only occur as a last resort and in the interest of everyone's safety. Parents/guardians will be contacted immediately if such a situation occurs. 

We recognize that crisis situations can be distressing for the child involved as well as the group. Our staff will provide appropriate support afterward to help all campers process the experience and return to a safe, supportive environment.

 

Acknowledgment of Behavior Policy & Expectations

By signing below, I acknowledge that I have read and understood the FSA Little Campers Behavior Policy & Expectations. I agree to support my child's participation in creating a positive, safe, and respectful camp environment. I understand the process for addressing challenging behaviors, including how communication and follow-up will be handled if needed.