Family Camp Adult Leader Skill Level & Information Form

Adult Skill Level & Information Form for Family Camp
Name *

First Name Last Name
Address

Street Address

Street Address Line 2

City 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: *
Should be Empty:

Adult Skill Level & Information Form for Family Camp