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Wood Badge 2141 Participant Personal Resource Questionnaire
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* Indicates required question
Last Name
*
Your answer
First Name (as listed on your BSA registration)
*
Your answer
I would like to be called
Your answer
Gender
*
Male
Female
Birthdate
*
MM
/
DD
/
YYYY
Address (number and street)
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Home Phone
*
Your answer
Work Phone
*
Your answer
Cell Phone
*
Your answer
Email
*
Your answer
Alternate Email
Your answer
Best Contact Method
*
Email
Home Phone
Cell Phone
Required
Occupation
*
Your answer
Scouting District
*
Your answer
Council
*
Your answer
Years in Scouting as Adult
Your answer
Years in Scouting as Youth
Your answer
Rank attained as Youth
Scout
Tenderfoot
Second Class
First Class
Star
Life
Eagle
Clear selection
T-shirt size
*
S
M
L
XL
XXL
3XL
4XL
My primary scouting position is with a
*
Pack
Troop
Crew
Ship
District
Council
Unit Number
*
Your answer
Primary Registered Position
*
Your answer
Other Registered Unit Type, Number and Position
Your answer
Scouting positions held in the past and for how long
Your answer
Scouting Awards Received
Your answer
State what you feel is a fair evaluation of your physical condition.
*
Excellent
Good
Fair
Poor
Other:
List any special needs (CPAP, Food Allergies, Food intolerances, Religious Limitations, etc.)
Your answer
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.
*
Your answer
Camping Experience
*
Never or rarely camp
Camp occasionally (a few times a year)
Camp often (monthly camping)
Very experienced camper (Extended backpacking and other high adventure type camping)
An Interfaith Worship Service will be held. If you have any particular religious needs, please specify them here, or inform the Course Director.
Your answer
Please list any hobbies or special skills
Your answer
Favorite song
*
Your answer
Interesting facts or story about yourself.
Your answer
Spouse's name
Your answer
Children's names and ages
Your answer
Please list all scout leader training and dates (You must be fully trained for your primary scouting position.)
*
Your answer
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)
*
5
4
3
2
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
5
4
3
2
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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