Family Camp Registration 2026

Children’s Burn Foundation Family Camp – October 2–4, 2026

Waitlist Form

Registration for Family Camp is now closed. Please complete this form to be added to our waitlist.

Camp Location: Simi Valley
Burn Survivor First Name
Burn Survivor Last Name
Burn Survivor Age
Burn Survivor T-shirt Size
Burn Survivor Ethnicity
Burn Survivor Drug Allergies
Burn Survivor Food Allergies
Burn Survivor Other Allergies
Burn Survivor Special Medical/Physical Accommodations/Needs
Dietary Restrictions: Vegetarian, Vegan, Other or No Allergies
BURN HISTORY AND TREATMENT
Injury Date
Body Surface
Hospital
Length of Stay
Area of Body Burned
Cause of Burn
Does your child require any special care for their burns during camp? Does your child have any restrictions of movement? (I.e., pressure garments, dressing changes, requires assistance walking, uses a wheelchair, etc. Please be specific:
FAMILY INFORMATION
Address

Address

Street Address Line 2

CityState

Zip
Parent Email
example@example.com
Emergency Contact Name
Emergency Contact Email
example@example.com
FAMILY MEMBERS INFORMATION

*Please note, this camp is for child burn survivors and their immediate family only*
GUEST #1 (Parent/Caregiver)
Name

First NameLast Name
Age
Relation to Burn Survivor
Phone, and Email (if different from family information):
Drug Allergies
Food Allergies
Other Allergies
Special Medical/Physical Accommodations/Needs
Dietary Restrictions: Vegetarian, Vegan, Other or No Allergies
Parent/Caregiver T-Shirt Size
GUEST #2
Name

First NameLast Name
Age
Relation to Burn Survivor
Phone, and Email (if different from family information):
Drug Allergies
Food Allergies
Other Allergies
Special Medical/Physical Accommodations/Needs
Dietary Restrictions: Vegetarian, Vegan, Other or No Allergies
Guest/Sibling T-Shirt Size
GUEST #3
Name

First NameLast Name
Age
Relation to Burn Survivor
Phone, and Email (if different from family information):
Drug Allergies
Food Allergies
Other Allergies
Special Medical/Physical Accommodations/Needs
Dietary Restrictions: Vegetarian, Vegan, Other or No Allergies
Guest/Sibling T-Shirt Size
Additional Forms:

Contact Kami Collins at (626) 689-7179 if you require extra forms for additional immediate family members attending camp.

*Financial assistance is available for those who need it. Please contact Kami Collins at (626) 689-7179 for additional information.
**This is a 3-day, 2-night camp. As an attendee, please plan to participate in all the days. The camp fees are prepaid per person per night and supported by Children's Burn Foundation. Camp spots will fill up fast. Please RSVP by August 31st. Once camp is full, there will be a waitlist. **
Waivers of Liability - check all the boxes after reading, print your name, sign and date each section
Parent/Guardian Printed Name
Parent/Guardian Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Media Release
I agree and authorize Children's Burn Foundation to use photographs/videos and/or likeness of me and my children taken at CBF Family Camp. I, as a parent/guardian, permit Children's Burn Foundation to use and publish photographs and/or videos for publicity purposes, including Children's Burn Foundation literature and online media. I also give permission for Children's Burn Foundation to release such photographs and/or video to the news media.
Parent/Guardian Printed Name
Parent/Guardian Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Consent for Medical Treatment
Please check box below
Parent/Guardian Printed Name
Parent/Guardian Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Liability Release I understand that camp can pose many hazards (including but not limited to insect bites, uneven stairs, difficult terrain, etc and that my children and I may participate in strenuous activities, including but not limited to ropes courses, rock climbing, swimming, archery, field games, sports, and other physical activities. These activities can entail both known and unknown risks that could result in physical

and emotional harm and even death.

If I or my child/ren are medically at high risk, I understand that we should be evaluated by a physician prior to camp and receive clearance to participate in these camp activities.
Liability Release
Please check the below boxes

I understand that camp can pose many hazards (including but not limited to insect bites, uneven stairs, difficult terrain, etc., and that my children and I may participate in strenuous activities, including but not limited to ropes courses, rock climbing, swimming, archery, field games, sports, and other physical activities. These activities can entail both known and unknown risks that could result in physical and emotional harm and even death.
Parent/Guardian Printed Name
Parent/Guardian Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Family Camp Values
Please check the box below
Parent/Guardian Printed Name
Parent/Guardian Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Please check the box below
Parent/Guardian Printed Name
Parent/Guardian Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Once your registration forms have been received and processed, we will send you more information about camp! We cannot wait to see you and your family there!
Family Camp Values
- I can try new things
- I can be kind and respectful to those around me
- I can trust and rely on my camp community
- I can be helpful and supportive
- I know that my actions and words have consequences
- I can respect everyone's individuality
- I will not be a bully;
- I can lift others up
Family Camp Rules and Regulations

Be respectful of the facility and the people around you. Do not destroy property.

No cursing or vulgar language. Show politeness and kindness in your words and actions.

Participation is mandatory. Everyone must be an active participant in camp activities. You may not sleep in your cabin during daily scheduling.

Refrain from using phones during mealtimes and camp activities.

Smoking is not permitted anywhere at camp, nor in personal vehicles. This includes the use of electronic cigarettes and vapes.

There is zero tolerance at camp for illegal drugs (including marijuana), alcohol, weapons, knives, or explosives (firecrackers, etc If you are found to be in possession of any of these items at camp, you will be required to leave immediately.
AGREEMENT
Please check below
Signature
Should be Empty:

BURN HISTORY AND TREATMENT

FAMILY INFORMATION

FAMILY MEMBERS INFORMATION

GUEST #1 (Parent/Caregiver)

GUEST #2

GUEST #3

Media Release

Consent for Medical Treatment

Liability Release

Family Camp Values

Family Camp Values

Family Camp Rules and Regulations

AGREEMENT