Counselor Application

The following form must be completed by both New and Returning Counselors for the 2025 Camp! If you have any difficulty using this form, please contact the office at cbcf@ctburnsfoundation.org.

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PERSONAL INFO

First Name *

Middle Name *

Last Name *

Date of Birth *

Email Address *

US Citizen? *

Yes

Adult T-Shirt Size: *

Are you a New or a Returning Counselor?

New

Returning

If Returning, has your residential or mailing address changed within the last 5 years??

Yes

If New, how did you hear about CBCF and why are you applying, including what contributions you can make to Burn Camp?

Residential Street Address *

City *

State/Province *

Zip/Postal Code *

Country *

List All of Your Residences For The Past Ten (10) Years with Dates To/From: *

Is your mailing address the same as your residential address?

Yes

Please type in your complete Mailing Address:

Primary Phone Number

Secondary Phone Number

Please list all other languages besides English that you are fluent in:

Please Upload a Recent Photo (.jpg, .png, or .heic under 256MB))

Maximum file size: 267.39MB

A current photo is needed for use by camp administration only for security purposes and will not be used in any other form or outlet except for camp security use.

List your preferred name/nicknames and/or any aliases you have been known by:

Marital Status

Full Name of Spouse/Domestic Partner/Etc. *

Do you have any children?

Yes

Please list your children's ages:

Please list any prescription or over-the-counter medication that you are currently taking:

Do you have any dietary restrictions (non-allergy)? *

Yes

What is your non-allergy dietary restriction?

Do you have any allergies to food, medicine, seasonal? *

Yes

Do you carry an epi pen? *

Yes

Please list your allergies and the reaction/s you get:

Are you able to volunteer as a staff member for the FULL WEEK of camp (Sunday, July 27 - Sunday August 3, 2025) or only HALF of that week?

I am able to volunteer for the full week of camp!

I am only able to volunteer for half a week of camp.

Please indicate your half-week availability:

Sunday, July 27 - Wednesday, July 30, 2025

Wednesday, July 30 - Sunday, August 3, 2025

Emergency Contacts

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone Number

Emergency Contact Phone #2

Emergency Contact Phone #3

Secondary Emergency Contact Name

Secondary Emergency Contact Relationship

Secondary Emergency Contact Phone Number

Secondary Emergency Contact Phone #2

Secondary Emergency Contact Phone #3

If you are human, leave this field blank.