Form DCF-2302 "Wilderness School - Student Contract" - Connecticut

What Is Form DCF-2302?

This is a legal form that was released by the Connecticut State Department of Children and Families - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2018;
  • The latest edition provided by the Connecticut State Department of Children and Families;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DCF-2302 by clicking the link below or browse more documents and templates provided by the Connecticut State Department of Children and Families.

ADVERTISEMENT
ADVERTISEMENT

Download Form DCF-2302 "Wilderness School - Student Contract" - Connecticut

1021 times
Rate (4.5 / 5) 71 votes
Connecticut Department of Children and Families
WILDERNESS SCHOOL – STUDENT CONTRACT
DCF-2302
1/18 (Rev.)
Page 1 of 2
Student LAST Name:
Student FIRST Name:
Parent/Caregiver LAST Name:
Parent/Caregiver FIRST Name:
Referring Agent/SW LAST Name:
Referring Agent/SW FIRST Name:
Referring Agency Name:
The Student Contract is an agreement made between students, families, their Referring Agencies, and the Wilderness School. This agreement relates directly to
what students want to gain from participating in the program. It also outlines the basic expectations of students when they are attending Wilderness School.
Student Goals
(This section to be completed by Student)
Why do you want to attend the Wilderness School Expedition and Follow-Up year?
Please choose two or three areas from the list below that you would like to work on while you are at the Wilderness School:
Believe that I am capable of success
Learn and develop personal strengths
Deal with frustration or anger in healthy ways
Identify and verbalize needs and feelings; express my emotions in healthy ways
Complete what I start/don’t give up
Recognize and take responsibility for choices, actions and consequences
Think before acting/practice patience
Show empathy: identify and understand the thoughts and feelings of others
Ask for help
Improve adult interactions and relationships
Make and keep friends
Improve conflict resolution and compromise
Respect boundaries of self and other
Other: Please list:
By working on the goals checked above, how will this help you?:
Parent/Caregiver Support and Involvement
(This section to be completed by Parent / Caregiver)
What do you hope that the above named student will get from the Wilderness School Experience?
Connecticut Department of Children and Families
WILDERNESS SCHOOL – STUDENT CONTRACT
DCF-2302
1/18 (Rev.)
Page 1 of 2
Student LAST Name:
Student FIRST Name:
Parent/Caregiver LAST Name:
Parent/Caregiver FIRST Name:
Referring Agent/SW LAST Name:
Referring Agent/SW FIRST Name:
Referring Agency Name:
The Student Contract is an agreement made between students, families, their Referring Agencies, and the Wilderness School. This agreement relates directly to
what students want to gain from participating in the program. It also outlines the basic expectations of students when they are attending Wilderness School.
Student Goals
(This section to be completed by Student)
Why do you want to attend the Wilderness School Expedition and Follow-Up year?
Please choose two or three areas from the list below that you would like to work on while you are at the Wilderness School:
Believe that I am capable of success
Learn and develop personal strengths
Deal with frustration or anger in healthy ways
Identify and verbalize needs and feelings; express my emotions in healthy ways
Complete what I start/don’t give up
Recognize and take responsibility for choices, actions and consequences
Think before acting/practice patience
Show empathy: identify and understand the thoughts and feelings of others
Ask for help
Improve adult interactions and relationships
Make and keep friends
Improve conflict resolution and compromise
Respect boundaries of self and other
Other: Please list:
By working on the goals checked above, how will this help you?:
Parent/Caregiver Support and Involvement
(This section to be completed by Parent / Caregiver)
What do you hope that the above named student will get from the Wilderness School Experience?
WILDERNESS SCHOOL – STUDENT CONTRACT
Page 2 of 2
Referring Agent/Social Worker Support and Involvement
(This section to be completed by Referring Agent or Social Worker)
What do you hope that the above named student will get from the Wilderness School Experience?
Basic Expectations
Wilderness School courses take place in isolated areas where the consequences of accidents and injuries are potentially serious. Students must be aware of the
rules listed below so all crew members remain safe and healthy at all times. Group members must be conscientious of themselves as well as all other
participants on the course. Wilderness School requires all students to read and agree to follow the behavioral policies, basic safety rules, and rules for
participation listed below. Violations of Wilderness School Behavioral Policies require intervention from program staff and removal from the course to determine
whether the student shall be allowed to continue participating in the program.
Behavioral Policies
1.
Non-Compliance: Failure to comply with program policies, procedures, expectations, or staff directions or requests in a deliberate, repetitive manner
could result in removal from the course activity and group participation, with contact made with the Referring Agency and/or family.
2.
Violence and Threatening: Violent or threatening behavior could result in the student’s removal from the course activity and group participation, with
contact made with the Referring Agency and/or family.
3.
Severe Emotional Disturbance: When a student’s actions present a reasonably assured risk of harm to self or others, the student could be removed from
the courses and care of the student will be relinquished to an emergency medical service, an M.D., parent or family, or Referring Agent.
4.
Emotional Safety: Intentional, repetitive actions (verbal or physical) that result in emotional distress or intimidation of a persistent nature could result in
removal from the course activity and group participation, with contact made with the Referring Agency and/or family.
5.
Sexual Activity: Engaging in or being suspected of sexual activity could result in removal from the course activity and group participation, with contact
made with the Referring Agency and/or family, law enforcement and DCF Careline as necessary.
6.
Drugs and Alcohol: Using or being suspected of using drugs or alcohol could result in removal from the course activity and group participation, with
contact made with the Referring Agency and/or family. Please note: There is no use of tobacco products at the Wilderness School.
Basic Safety Rules and Rules for Participation
Stay with the group at all times.
1.
Do not attempt to leave the program on your own.
2.
Personal knives are not allowed on the course.
3.
Everyone must eat three meals every day.
4.
Prescription medications must be taken in accordance with Doctor’s orders
5.
Shoes must be worn at all times, even when in the water.
6.
Listen to and follow all procedures for specific activities, such as canoeing or rock climbing
7.
Show respect for all Wilderness School participants and staff.
8.
Show respect for the environment, public property and private property.
9.
10. Show respect for yourself -- always be willing to try.
Student Agreement
By signing my name below, I agree to work towards the goals I have written in this contract. I also agree that I have read and understand the rules detailed in this
contract and that I will follow them for the safety and well-being of all Wilderness School participants.
Student Name:
Student Signature:
Date:
Parent/Caregiver Name:
Parent/Caregiver Signature:
Date:
Referring Agent/SW Name
Referring Agent/SW Signature
Date:
Wilderness School Agreement
By signing my name below, I agree that I have read this contract and agree to the goals and areas of support as written above. I also agree to
provide guidance for this student to thoroughly understand all expectations.
Wilderness School Staff Name:
Wilderness School Staff Signature:
Date:
Page of 2