Wood Badge 2141 Participant Personal Resource Questionnaire
Please complete this form as soon as possible
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Last Name *
First Name (as listed on your BSA registration) *
I would like to be called
Gender *
Birthdate *
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Address (number and street) *
City *
State *
Zip Code *
Home Phone *
Work Phone *
Cell Phone *
Email *
Alternate Email
Best Contact Method *
Required
Occupation *
Scouting District *
Council *
Years in Scouting as Adult
Years in Scouting as Youth
Rank attained as Youth
Clear selection
T-shirt size *
My primary scouting position is with a *
Unit Number *
Primary Registered Position *
Other Registered Unit Type, Number and Position
Scouting positions held in the past and for how long
Scouting Awards Received
State what you feel is a fair evaluation of your physical condition. *
List any special needs (CPAP, Food Allergies, Food intolerances, Religious Limitations, etc.)
Patrols are Beaver, Bobwhite, Eagle, Fox, Owl, Bear, Buffalo, and Antelope.  Do you have any reason (religious, social, etc) to not be assigned to any of these critters as a patrol?  Please explain. *
Camping Experience *
An Interfaith Worship Service will be held.  If you have any particular religious needs, please specify them here, or inform the Course Director.
Please list any hobbies or special skills
Favorite song *
Interesting facts or story about yourself.
Spouse's name
Children's names and ages
Please list all scout leader training and dates (You must be fully trained for your primary scouting position.) *
Scout Skill Assessment--On a scale of 1-5, please assess your ability in each of the following areas.  Please give an honest assessment of your skills as the Course Director will be using this information for patrol development.  You will not be asked to teach any of these skills, and this information will only be available to staff members. (5= Highly skilled, 1=Need help with the skill) *
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1
Backpacking
CPR
Camp Sanitation
Campfire Leadership
Camping
Citizenship
Communications
Conservation
Cooking
Emergency Preparedness
Environment
Fire Building
First Aid
Game Leadership
Hiking
Knots and Lashing
Lifesaving
Low-Impact Camping
Map and Compass
Nature
Orienteering
Pioneering
Safe Swim Defense
Safety Afloat
Song Leading
Star Study
Woods Tools (Axe, saw, knife)
Worship Service
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