NAME________________________________GROUP___________WEEK_____
1 = strongly disagree and 4 = strongly agree
1. Camper has fun.
1 2 3 4
What are this camper's favorite activities?
2. Camper connects to counselors.
1 2 3 4
What do you like about this camper?
3. Camper tries new things.
1 2 3 4
4. Camper is able to make a friend and be a friend.
1 2 3 4
Names of friends in group:
5. Camper demonstrates appropriate independence.
1 2 3 4
6. Camper is kind to others in group.
1 2 3 4
7. Camper enjoys, learns, and has improved skills at activities.
1 2 3 4
In what activity area does this camper struggle?
8. Camper is an involved group member.
1 2 3 4
ANY CONCERNS??
DO WE NEED TO TALK?? YES____ NO____