601 Boston Post Road Milford, CT 06460
203-878-6744
203-878-4044
cbcf@ctburnsfoundation.org
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Camper Application Part 1

The online form you are about to submit is the first half of your child’s application to Camp.

After you complete and submit this online form, you will be sent to a page where you may download 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.rg.

Camper Application

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) *

Maximum file size: 267.39MB

Does your child any dietary restrictions (non-allergy)? *

Yes

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.

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