2021-2022 Leader Application

First Name

Middle Name

Last Name

Address

Street:

City:

State:

Zip:

Email:

Phone:

Driver's License Number

Driver's License State

Social Security Number

Driver's License information and Social Security Number are necessary so we can run background checks on all volunteers

Occupation:

Employer:

How did you hear about The Woods Project?

Please describe any previous experience you have had working with youth:

Please describe any relevant outdoor experience you have had:

Do you know anyone who is currently a volunteer for The Woods Project? If yes, please tell us who:

First Aid Certification Date:

CPR Certification Date:

Wilderness First Aid Certification Date:

Wilderness First Responder Certification Date:

Lifeguard Certification Date:

Other Certification Date:

Type:

EMERGENCY CONTACT INFO

Emergency Contact #1

Name:

Relationship:

Email:

Primary Phone:

Other Phone:

Emergency Contact #2

Name:

Relationship:

Email:

Primary Phone:

Other Phone:

MEDICAL INSURANCE INFORMATION

If you do not have insurance, please leave the following blank.

Name of Physician:

Medical Insurance Carrier:

Subscriber Name:

Policy/ID Number:

Phone:

Thank you so much for submitting this application. You will be asked to confirm that the information you have entered is correct, and then you will be directed to our Participant Agreement, which must be signed and submitted in order to be a leader with The Woods Project.

weekend trips	summer trip
teaching youth	tabling opportunities
gear maintenance/management	fundraising
evening events	weekday daytime events
young professionals network	club instructor
other