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:

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:

Wood Badge Participant PRQ.
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Revised: 01/30/12