Wood Badge Participant Personal Resource Questionnaire


 

1.  First Name:  Middle Name:  Middle Initial:  Last Name:  Title:
 

   I would like to be called:  T-Shirt size:

 

2.  Address:City:State:ZIP:

 

3.  Phone (H): Phone (W): Phone (Cell): FAX:

 

4.  Occupation:email:email2:

 

5.  Date of Birth: (mm/dd/yyyy):District:Unit No.:Type:

 

6.  Council name:Council No.:

 

7.  Years in Scouting; Adult:   Boy:Rank:

 

8.  Current registered position:(List only your primary position)

 

8a.  Unit Position, if not Primary:

 

9. Adult positions held, and how long?

     How Long    How Long
   Scoutmaster:        Assistant Cubmaster:      
   Assistant Scoutmaster:        Den Leader:      
   Unit Committee Chairman:        WEBELOS Den Leader:      
   Unit Committee Member:       Varsity Coach      
   Unit Commissioner:       Assistant Varsity Coach:      
   Cub Scout Roundtable:        Venturing Leader:      
   Boy Scout Roundtable:        Assistant Venturing Leader:      
  Council Committee          
  Council Board        Other Positions Held:
 
   A D C:            
   District Commissioner            
   Cubmaster:            

 

10. Scouting Awards Received:      District Award of Merit:   Silver Beaver:   Eagle:  Adult Religious Award:

 

    Other:

 

11. Physical Condition:

 

12. Camping Experience:

 

13. Training Experience: When Completed:?

  Yes/No  Date Other Training Experiences  Date

 Leader Specific:

 Introduction to Outdoor Leader Skills:

 Youth Protection Training:

BALOO:

 WEBELOS Leader Outdoor:

 

14. State why you decided to participate and what you expect to gain from this experience:

 

15. Religious Preference:

 

16. First Aid Training; Red Cross Advance:    CPR:    EMT:   Other:

 

17. Spouse: Emergency Contact 1: Emergency Phone 1:
                                                             Emergency Contact 2: Emergency Phone 2:

 

 


Participant PRQ (BTC)
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Revised: 2017/10/24