Burn Institute Volunteer

Today is the best day to take action!

Burn Institute Volunteer Application

Please complete this form if you are interested in volunteering at the Burn Institute. A member of the Burn Institute staff will reach out to you within a week of completing this form. For any questions, please contact Whitney at 858-541-2277 or [email protected].

Name*
First Last
Address*
Zipcode*
Phone Number*
Email*
Enter Email Confirm Email
Are you over 18?*
- Yes
- No
Education and Work
School
Major
Employer
Occupation
Emergency Contact
Emergency Contact Name*
Emergency Contact Address*
Emergency Contact Phone*
Emergency Contact Relationship*
About You
Are you or an immediate family member a burn survivor?*
- Yes
- No
How did you learn about the Burn Institute*
Current or past volunteer experience/activities--where and duties?*
Relevant experience, education, skills or training helpful in placing you:
Physical limitations that may require assistance?*
- Yes
- No
Have you ever been convicted of a felony?*
- Yes
- No
If yes, please explain
Highlight all you are intereseted in:*
- Fire and Safety Expo and Demo Derby
- Camp Beyond the Scars
- Chiefs' Golf Classic
- Burn Institute Bash
- Health Expos and Fire Department Open Houses
- Senior Smoke Alarms Installations
- Events and Program Preparation
- Data Entry and Research