Camper Application Camper Application The online form you are about to submit is the first part of your child's application to Camp. At the end of this online form, you will see a download link for a PDF containing the remainder of the forms that need to be physically completed by you, your camper, and your physician. These additional forms must be returned to CBCF by email, direct mail, or fax, else your child will not be allowed to attend Camp. If you have any questions, additions, or corrections after submitting this form, please contact Tara Sullivan-Colon at 203-878-6744 or cbcf@ctburnscarefoundation.org. GENERAL CAMPER INFO Has your child attended the Children's Burn Camp before? * Yes, my child is a returning camper No, this is my child's first time applying for Camp First Name * Middle Name * Last Name * Date of Birth * Age * List your child's preferred name/nicknames: Child's Gender * Female Male What type of t-shirt size: * Child Adult T-Shirt Size: * Residential Street Address * City * State/Province * Zip/Postal Code * Country * Primary Phone Number * Please Upload a Recent Photo of your Child (.jpg, .png, or .heic) * Drop a file here or click to upload Choose File Maximum file size: 267.39MB Does your child any dietary restrictions (non-allergy)? * Yes No What is your child's non-allergy dietary restriction? Vegetarian Vegan Kosher Halal OtherOther Parent/Guardian #1 - Full Name * Parent/Guardian #1's Relation to Camper * Parent/Guardian #1 - Phone (in case of Emergency) * Parent/Guardian #1 Email * Parent/Guardian #2 - Full Name * Parent/Guardian #2's Relation to Camper * Parent/Guardian #2 - Phone (in case of Emergency) * Parent/Guardian #2 Email * If neither mother nor father are available in an Emergency, please indicate an additional emergency contact. Please Include the full name of the emergency contact and their relationship to Child and Phone Number/s. Alternate Contact's Full Name * Alternate Contact's Phone * Alternate Contact's Relation to Camper * How will your child be transported to camp on Sunday, July 27, 2025 and picked up on August 3, 2025 from the camp? NOTE: Pick up locations and times, will be sent to you as we get closer to camp. * We will be driving our child to and from camp My child needs to be picked up in the Boston area My child needs to be picked up in the NYC/New Jersey area My child needs to be picked up in the Washington D.C/Maryland/Virginia area My child will need to fly in to either New Haven Tweed Airport or Bradley International Airport (Please contact Tara in the office to discuss this matter) If you are human, leave this field blank. Next
