Unit Climbing Instructor Application Form

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Unit Climbing Instructor Application
Northeast Georgia Council, BSA

Personal Information

Name: First MI Last
Date of Birth: Sex: Male Female
Address
City State Zipcode
Phones: Evening Day
Fax E-mail

Scouting History

Council
District
Type of Unit Unit Number
Position in Unit

Describe your experiences in Scouting including past positions, dates and training.

Are you willing to complete extensive Youth Protection Training, Risk Management Training and difficult physical training?
Yes No

Are you able to do physically difficult activities?
Yes No
Explain your answer in detail...

Do you have Climbing and Rappelling experience?
Yes No
Please list types, dates, locations, etc.

Have you taught Boy Scout Training or other training involving youth and adults together?
Yes No
Please list types, dates, locations, etc.

Would you be interested in working with the Council Mountaineering (Climbing and Rappelling) program?
Yes No

Is there any other information you feel may assist the committee?

References

Please provide the following information from two (2) references

Name:
Address
City State Zipcode
Phones: Evening Day
Position in Scouting
Years associated with applicant