2022 PFFWCF Camper Registration Form

Camper Information

Camper Information

Camper Information

Camper Information

ClearCamper Information

Camper Information

Camper Information

Camper Information

Camper Information

Camper Information

Camper Information

Camper Information

Camper Information

Camper Information - The PFFWCF is a non-discriminatory organization. This field is only used for statistical data and does not influence acceptance to the camper program.

Camper Information

Camper Information

Camper Information

Camper Information

Contact having legal custody to be reached in event of illness/emergency

Contact having legal custody to be reached in event of illness/emergency.

Contact having legal custody to be reached in event of illness/emergency.

Please type N/A if you don't have an E-mail address but most information on other burn survivor support programs is sent out via E-mail and you will not receive any junk mail.

Second Parent/Guardian Address (ONLY if different from camper)

Only needed if different than campers

Please type N/A if you don't have an E-mail address but most information on other burn survivor support programs is sent out via E-mail and you will not receive any junk mail.

Parent/Guardian Info (ONLY if differnt than from camper)

Second Parent/Guardian Info (ONLY necessary if address differs from campers)

Please share your thoughts on the following questions to help us get to know your child.

Please share your thoughts on the following questions to help us get to know your child.

Please share your thoughts on the following questions to help us get to know your child.

Please share your thoughts on the following questions to help us get to know your child.

Please share your thoughts on the following questions to help us get to know your child.

Please share your thoughts on the following questions to help us get to know your child.

Please share your thoughts on the following questions to help us get to know your child.

Please share your thoughts on the following questions to help us get to know your child.

This portion is to be filled out by the camper.

This portion is to be filled out by the camper.

This portion is to be filled out by the camper.

Camper Medical Information (to be completed by parent/guardian)

Camper Medical Information (to be completed by parent/guardian)

Camper Medical Information (to be completed by parent/guardian)

ClearHistory of Burn Injury

History of Burn Injury

History of Burn Injury

History of Burn Injury

Camper Medical Information (to be completed by parent/guardian)

Camper Medical Information (to be completed by parent/guardian)

Camper Medical Information (to be completed by parent/guardian)

ClearCamp/Sports Physical's are a Burn Camp Requirement. Please list the date of your child caimp health physical (date should be within 1 year of camp). This will help us know when to expect medical forms, preventing unnecessary phone calls.

Addresses and times for the bus stops will be sent out again after applications are completed.

If your child will not be using bus transportation from camp, please select the 'Other' option and type the name of the driver who will be responsible for you child's transportation from camp. Addresses and times for the bus stops will be sent out again after applications are completed.

Campers will only be allowed to accept transportation from parents or authorized personnel as listed by parents above in this application.

This phone number will only be used in the event that a camper needs transportation and parents are unable to be reached.

Campers will only be allowed to accept transportation from parents or authorized personnel as listed by parents above in this application.

This phone number will only be used in the event that a camper needs transportation and parents are unable to be reached.

Campers will only be allowed to accept transportation from parents or authorized personnel as listed by parents above in this application.

This phone number will only be used in the event that a camper needs transportation and parents are unable to be reached.

By checking the boxes above, you acknowledge that you agree with and/or authorize the above-mentioned actions in the event of an emergency.

If you should choose not to allow photos of your camper to be taken, please let him/her know ahead of time so that they don't think camp staff are purposely excluding them from camp activity photos.

By checking the boxes above, you acknowledge that your child and you have read and understand this policy and realize that it will be enforced in order to assure the safety of all campers and staff members. By checking the above boxes both my child and I agree that we have read and understand the above information and agree to the consequences. Both my child and I understand that by checking the boxes we are both responsible for agreeing to the camper behavioral agreement.

By checking the boxes above, you acknowledge that your child and you have read and understand this policy and realize that it will be enforced in order to assure the safety of all campers and staff members. By checking the above boxes both my child and I agree that we have read and understand the above information and agree to the consequences. Both my child and I understand that by checking the boxes we are both responsible for agreeing to the camper behavioral agreement.

By checking the above statements, you agree that both your child and you understand and agree to follow all rules pertaining to electronic devices and you are fully aware of the consequences if your child fails to abide by the rules. Both your child and you understand that by checking the boxes above, you are accepting responsibility for following the rules and statements mentioned above.

By checking the boxes above, you acknowledge that you agree with and/or authorize the above-mentioned actions.

This field is not mandatory because campers under the age of 10 need not complete it. However, if your camper will be 13+ at camp, we recommend completing it. Camp Timber-lee uses a "Challenge by Choice" method and no camper will be forced to engage in an activity if there is a strong objection but it's more difficult for us to get parental permission after the applications are turned in and we don't want campers to miss out on any opportunities.

Camper Health Exam/Record may be scanned and uploaded to this application here. If you completed this online, you can skip this.

By typing your name above you are electronically signing this application document in its entirety.

By typing your name above you are electronically signing this application document in its entirety.