Lighthouse Centre Life Skills Application

Guardian Info

Guardian Name *

Guardian Email *

Guardian Mobile *

Student Info

Student Name *

Gender *

Date of Birth *

Current Grade *

Other Grade

Student Current School *

Language Educated in *

Student’s First Language *

Does the student speak English? *

Yes

Address *

Please select a topic that you would like to improve with this life skills programme. Tick the sub catagories within the topic that you feel your child needs help with (You may select a maximum of 2 topics). *

Behaviour

Disrespectful

Defiant

Entitled

Tantrums

Bullying

Lying

Cheating

Ignoring instructions

Argumentative

Impulsive

Anger Management

Still having toddler tantrums

Get frustrated when they cannot win or solve problems

School reports talk about anger, violence, bullying, frustration, shouting

Their friends don’t want to play with them

They blame others for their problems

They use hurtful or bad/foul language when they are angry

They only respond to discipline

Their behaviour disrupts your family life

They take a lot of your time and energy to get them to calm down

Destructive

Basic Etiquette

Eats with mouth open

Chews loudly

Eats with their hands or shovels food with a spoon

Stares at people

Stands too close to people even strangers

Does not say please and thank you

Does not say excuse me/pushes past people

Talks over people or interrupts

Does not know how to behave in a restaurant or at family gatherings

Telephone manners

Self -Esteem /Self-confidence

Are self-critical and hard on themselves

Feel they’re not as good as other kids

Think of the times they fail rather than when they succeed

Lack confidence

Doubt they can do things well

Scared to try new things

Give up very easily without really trying

Compares themselves with others in a negative way

Shy to speak to people or make good eye contact

Approval seeking

Emotions

Difficulties identifying feelings and emotions

Problems distinguishing between emotions and bodily sensations that relate to those emotions

Limited ability to communicate feelings to others

A lack of fantasies and imagination

A logical and rigid thinking style that does not account for emotions

Poor coping skills when it comes to dealing with stress

Behaving less altruistically than others

Appearing distant, rigid, and humorless

Poor life satisfaction

Being unable to read/understand people’s emotions of facial expressions and not reacting to these emotions/expressions appropriately

Handwriting

Letter size and spacing

Fine motor coordination

Rate or speed of writing

Composition

Difficulties writing in a straight line

Difficulties with holding and controlling a writing tool

Writing letters in reverse

Having trouble recalling how letters are formed

Having trouble knowing when to use lower- or upper-case letters

Anxiety

Letter formation and/or legibility is poor

Feeling nervous, restless or tense

Having a sense of impending danger, panic or doom

Having an increased heart rate

Breathing rapidly (hyperventilation)

Sweating

Trembling

Having trouble sleeping

Experiencing gastrointestinal (GI) problems

Having difficulty controlling worry

Having the urge to avoid things that trigger anxiety

Hates last minute change of plans, cancelations or surprises

Would rather stay in bedroom when relatives or family friends visit

Grief

Death of a close relative

Understanding death and loss

Empathy regarding death

Denial and Anger

Fear of loss

Nightmares and bed wetting

Detachment issues

Anxiety

Persistence sadness

Other unusual behaviour following the loss of a loved one

Gratitude

Expects bribes or rewards for certain behaviour

Does not help around the house

More concerned about themselves than others

Can’t handle disappointment

Always asks to buy stuff when shopping

Expects to be rescued from mistakes

Feel and act as if rules do not apply to them

Constantly wants more

Nothing is ever enough

Attitude of entitlement

Personal Hygiene

Showring

Tooth brushing

Deodorant and body odour

Taking care of finger and toenail

Brushing, washing and cutting hair

Changing clothes regularly

Washing hands

Keeping face clean when eating

Living in a clean environment

Coughing, sneezing, blowing nose and picking teeth

Additional: (Any other points you feel are important for Ms. Lucy to know before the sessions begin).