Fire Prevention
Programs
Resources
Burn Survivors
Programs
Camp Beyond the Scars
Burn Survivor Events
Applications
Our Impact
Get Involved
Donate Now
Ways to Give
Special Events
Volunteer
Internship
About Us
Our Mission
Our Team
Contact Us
News
Financials
English
Español
Fire Prevention
Programs
Resources
Burn Survivors
Programs
Camp Beyond the Scars
Burn Survivor Events
Applications
Our Impact
Get Involved
Donate Now
Ways to Give
Special Events
Volunteer
Internship
About Us
Our Mission
Our Team
Contact Us
News
Financials
Donate Now
Scald Prevention Sign Up
Home
/
Scald Prevention Sign Up
Back To Home
Scald Presentation
Please fill out the information below. Each adult who will attend must fill out this form.
Name
(Required)
First
Last
Email
(Required)
Ethnicity
(Required)
Alaskan Native or American Indian
Asian
Black/African-American
Hispanic
Pacific Islander
White
Multiracial
Other
Language
(Required)
English
Cantonese
Hmong
Korean
Mandarin
Spanish
Tagalog
Vietnamese
Other
City of residence
(Required)
Brawley
Calexico
Calipatria
El Centro
Heber
Holtville
Imperial
Niland
Ocotillo
Seeley
Salton Sea
Westmorland
Winterhaven
Other/not listed
Where do you live?
Relationship to child/children ages 0-5 in your care
(Required)
Parent
Family Member
Caregiver/Professional
Preschool child attends
(Required)
Write "NA" if child does not attend preschool