Camp Climbing Instructor Training with WILD GUYde Adventures: Skills and Experience Checklist

Name __________________________________ Organization _______________________________

Address __________________________________________________________________________________

Ph. No. ________________ Cell _____________________ Email ________________________

Age at Course Time (18 minimum): __________________ DOB _______________________________

I am registering for the:

_____ Virginia Staff Training Seminar (June 9-10, 2008)

_____ Pennsylvania Staff Training Seminar (June 2-3, 2008)

Current medical credential (check all that apply):

_____ CPR _____ First Responder, or WFR

_____ Red Cross First Aid _____ EMT or WEMT

_____ Wilderness First Aid, or Advanced Other: __________________________________________

Please briefly describe your recreational climbing (how many years, what type – top-rope, indoor/outdoor, sport leading, traditional leading, multi-pitch); use back if necessary:

Briefly describe your outdoor leadership/teaching experiences (camp counselor, adventure leading, etc.); use back if necessary:

For each item below, check the most appropriate box →	Unfamiliar	Reasonably proficient	Able to teach
Bowline knot
Fig. 8 Retrace knot
Fig. 8 Loop knot
Super (2-loop) 8 knot
Double Fisherman’s knot
Prussik knot, or Kleimheist
Girth Hitch
Water knot
Non-Tension Hitch
Munter Hitch
Mule knot, or Munter Mule
Belaying and signals (preferred device? )
Rappelling
Building top-rope anchors (natural: trees and boulders)
Building artificial anchors (nuts and cams)
Building rappel anchors
Escaping the belay
Personal climbing level	<5.5	5.6 - 5.8	>5.9