Northwest Burn
    Foundation:

    1515 NW 52nd St.
    Suite A
    Seattle, WA 98107

    Phone:
    206-789-6838

    Toll Free:
    1-888-NOBURNS
    1-888-662-8767


 

Scald Prevention Kit Order Form:
Free Scald Prevention Kits are available to families in our 5 state region of Washington, Oregon, Idaho, Montana and Alaska.
  • Please provide the following contact information:
    First Name (required)  
    Last Name (required)  
    Address (required)  
    Address 2  
    City (required)  
    State (WA, OR, ID, MT, AK only) (required)  
    Zip/Postal Code (required)  
    County (required)  
    Home Phone  
  • Number of Children:

     

  • Age(s) of Children:

     

  • Please identify the ethnic origin with which you most identify:
    African American/Black   American Indian/Alaska Native  Arabic/Arab American  
    Asian/Pacific Islander   	Latino/Hispanic	    White/Caucasian   Other

 

 



© 2011  The Northwest Burn Foundation, Inc. All rights reserved.