[an error occurred while processing this directive] High Adventure Instructor Application Form

High Adventure Instructor Application
Northeast Georgia Council, BSA

Which High Adventure program(s) are you applying for:
Caving C.O.P.E. Mountain Biking Mountaineering Pioneer Village Ranger Camp Trek Whitewater Kayaking

Personal Information

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

Scouting History

District
Type of Unit Unit Number
Position in Unit

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

Why are you interested in working on the High Adventure team?

If chosen, you will be asked to schedule some weekends at Camp Rainey Mountain throughout the year to assist groups involved with High Adventure programs. You will be required to attend at least two (2) sessions per year. Are you willing to make this commitment?
Yes No

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...

Have you had High Adventure 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.

Have you signed a contract or agreed to work on Camp Rainey Mountain staff for the upcoming summer?
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

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