Adult Skill Level & Information Form for Family Camp
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Cell Phone:
*
Male or Female:
*
Male
Female
Medical & Dietary Concerns or Allergies? If yes, please explain.
*
Please note any dietary concerns such as vegetarian
Have you attended a Jeremiah Project work camp before?
*
Yes
No
Have you attended other work camps before?
*
Yes
No
Please indicate your experience level in each of the following areas:
Carpentry
No Experience
Limited Experience
Handy Person
Professional
Concrete
No Experience
Limited Experience
Handy Person
Professional
Flooring
No Experience
Limited Experience
Handy Person
Professional
Painting
No Experience
Limited Experience
Handy Person
Professional
Roofing
No Experience
Limited Experience
Handy Person
Professional
Using Power Tools
No Experience
Limited Experience
Handy Person
Professional
Briefly describe any experience indicated above:
Check any reservations concerning the following:
Ladders
Roofing
Heavy Lifting
Please select the phrase that best describes your comfort level with leading a work team on a work site:
*
Please Select
Not comfortable at all
A little nervous but will give it a shot
I've done it before and am comfortable
Submit
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