RECOVERY SUPPORT ACTIVITIES DOCUMENTATION
Check the activities you participated in to support your sobriety and recovery support plan. Client ID # ______Date due: ______
EDUCATION / CULTURAL/TRADITIONAL / ELDER ACTIVITIES
GED / ____ / Sewing Class / ____ / Bingo
Attend school / ____ / Arts/Crafts / ____ / Luncheon Education Class
Voc Tech / ____ / Hunting/fishing / ____ / Holiday Parties
Job Skills training / ____ / Making Regalia / ____ / Meetings
Daily living skills / ____ / Drumming/singing / ____ / Field Trips
Academic Counseling/Tutor / ____ / Language Class / ____ / Games
Other______/ ____ / Pow-wows/ Round dances / ____ / Other______
____ / Gathering Medicines
MEDICAL / ____ / Other______/ PREVENTION
Physical / ____ / Mothers of Tradition
Medications / SPIRITUAL SUPPORT / ____ / Sons of Tradition
Dental / ____ / Attending Church / ____ / Daughters of Tradition
Keep appointments / ____ / Ceremonies / ____ / Families of Tradition
Alternative therapies / ____ / Smudging / ____ / Fathers of Tradition
Other______/ ____ / Offering Sema / ____ / Group ______
____ / Seasonal feasts / ____ / 12-steps for youth
SUPPORT MEETINGS / ____ / Attending Sweat lodge / ____ / Life Skills ______
AA/NA / ____ / Other______
Talking circles / PERSONAL GROWTH
Meet with my sponsor / RECREATIONAL/FITNESS / ____ / Substance Abuse Education
Mentor someone / ____ / Going to Movies / ____ / Men's Group
Other______/ ____ / Going out to dinner / ____ / Women's Group
____ / Walking/jogging / ____ / Elders Group
COMMUNITY FUNCTIONS / ____ / Playing basket-ball / ___ / Parenting Class
Community meals/potlucks / ____ / Bowling / ____ / Peer Recovery Mentor
Health fair / ____ / Softball / ____ / Other______
Holiday parties / ____ / Stress management
Special gatherings / ____ / Meet with Nutritionist / FAMILY ACTIVITIES
Other______/ ____ / Exercise / ____ / Swimming
____ / Other______/ ____ / Camping
SCHOOL FUNCTIONS / ____ / Reading books
Attending games / NEED ASSISTANCE / ____ / Have Meals together
Parent teacher conferences / ____ / Housing / ____ / Playing cards/board games
After School Programs / ____ / Employment / ____ / Movies
Sports / ____ / Financial/Basic Needs / ____ / Celebrate Holidays
Volunteering at school / ____ / Transportation / ____ / Picnics
Other______/ ____ / Legal______/ ____ / Other______
______Participant Signature ______Date
______Care Coordinator Signature ______Date
Log: Recovery Support Time & Activities for ATR III
Activity (describe) / Date / Total Time Spent on this activity / Signature of provider or person authorized to document attendanceAnishnaabek Healing Circle ATR III Recovery Support Activity Documentation Form Page 1
2010 (2-28-12) ITC