Application Form For Wood Badge
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1
2Quapaw Area Council
Wood Badge
WHERE:
WHEN:
February 19-21, 2016
Donald W. Reynolds Training Center
AND
Gus Blass Scout Reservation
March 11-13, 2016
Damascus, AR
PURPOSE: Wood Badge is the Boy Scouts of America’s advanced training course for all registered adult leaders, whether
they are involved with Cub Scouting, Boy Scouting, Varsity Scouting, Venturing, are district/council volunteers, or
professional Scouters.
QUALIFICATIONS: Each participant must be a registered adult leader and have completed Youth Protection Training and
the Leader Specific Training appropriate to his/her position in Scouting. Attendance at all six course days is required.
Because of the advanced nature of Wood Badge, these requirements will not be waived.
COST: The course fee is $225.00, and includes all training materials, recognition items, and meals for both weekends. A
non-refundable deposit of $50.00, submitted by January 4, 2016, is required to reserve a place on the course. The balance
of your course fee must be paid by January 19, 2016.
For more information contact:
Chris Phillips – Course Director
Blake Cole – Wood Badge Staff Advisor
or
336-508-7167 (Mobile)
501-664-4780, ext. 277
APPLICATION FOR WOOD BADGE S8-18-16
You may reserve a place in the course and pay your course fee online at
:
-OR-
Mail your application and check to: Quapaw Area Council-Boy Scouts of America, 3220 Cantrell Road, Little Rock, AR 72202
Council _________________________________ District ________________________ Unit _________________
Full Name: _____________________________________ e-Mail _______________________________________
Address __________________________________ City ____________________State _______ Zip ___________
Phone (Home) (____) ________________ (Work) (____) ________________ Date of Birth _________________
Scouting Experience: Youth (years and rank obtained) __________________________ Adult (years) __________
Primary Scouting Position: ___________________________________ How long in current position? __________
Special Dietary Needs: _________________________________________________________________________
T-shirt size (One t-Shirt is included in your fee. You may purchase additional shirts during the course) __________
By applying to attend Wood Badge, I acknowledge that attendance at both weekends and all sessions during those weekends is mandatory
and required for certification. I certify that I am a registered adult leader, have completed Youth Protection Training, Leader Specific
Training for my current position, and any outdoor skills training relevant to my Scouting position. Statement of Medical Condition: I
understand that my participation in Wood Badge is conditional on the submission of a current BSA Annual Health and Medical Record at
check-in when the course begins. Enclosed is my deposit of $50.00 to reserve my place in the 2016 course, or my full payment of $225.00
Signature _______________________________________
(see reverse side for additional course information)
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