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Burn Family Engagement Form

Burn Family Engagement Form (NEW)

About You

People with lived experience of burn injury, and those who support them, are central to everything we do.

The Burn Family is the Fiona Wood Foundation’s voluntary community engagement program. It provides a consent-led way for burn survivors, their families, caregivers and supporters to connect with the Foundation’s research, education and community initiatives in ways that suit them.

Connection looks different for everyone. You may choose to receive updates, hear about events, access wellbeing and recovery resources, explore opportunities to get involved, or simply stay connected with the Foundation’s work. How you engage is always your choice.

Providing your details is voluntary. You can update your preferences or withdraw at any time by contacting Gabrielle Ryan at gabrielle@fionawoodfoundation.org.au.

Please select the option that best describes your connection.

I am a burn survivor who experienced injury in adulthood

I am a caregiver of an adult burn survivor

I am a burn survivor who experienced injury in childhood

I am a caregiver of a child or young person who experienced a burn injury

I am a family member, friend or supporter

First Name

Last Name

We will use this email in line with your selected opt-in preferences below.

Contact Phone Number (Optional)

Providing a phone number allows us to contact you if needed.

Child or young person’s name (if applicable)

If completing this form on behalf of a child or young person, including their name helps ensure communication is appropriately directed.

Postal Address (optional)

Sharing your address helps us understand where our community members are located and plan local events and activities. You may provide as much or as little detail as you feel comfortable with. State and postcode alone are helpful.

The Burn Journey (optional)

You are welcome to share information about your burn journey. This section is optional. Any information you choose to provide helps us understand burn experiences within the Burn Family community. You may skip any question.

Where have you received care for your burn injury?

Perth Children’s Hospital

Fiona Stanley Hospital

Royal Perth Hospital

Princess Margaret Hospital

Other or outside WA

If known, please share the hospital or health service.

Are you currently receiving care from the Burn Service of Western Australia? (Optional)

Yes

Prefer not to say

Year injury occurred

Age at the time of injury

Type of burn injury

If you feel comfortable, you may share the type of burn injury, such as scald, flame or contact.

Location of injury on the body

Size of burn (Optional)

Some people are told the percentage of their body affected by the burn, known as Total Body Surface Area or TBSA. If you know this percentage, you are welcome to share it.

How You Would Like to Stay Connected with the Foundation

Your connection with the Burn Family is guided by your choice. You decide how you would like to engage with the Fiona Wood Foundation. Participation is separate from clinical care and will not affect your access to services.

Have you previously participated in any Fiona Wood Foundation research, initiatives or events?

Yes

Unsure

Provide details of your previous participation

Research Involvement Opportunities

Research Opportunities

Receiving information about research opportunities does not commit you to participating. If you express interest, you will be connected with the relevant research team. Separate informed consent is required before any involvement occurs.

Yes, I would like to receive communications about research opportunities and updates.

Year of Birth

If you selected yes, sharing your year of birth helps us match you with suitable opportunities. Research opportunities may be available to people with lived experience of burn injury, as well as to family members, caregivers, supporters and community members who contribute valuable perspectives, including through participation in comparison studies.

If completing for a child or young person

Yes, I would like to receive communications about research opportunities for children and young people.

Year of Birth

Please enter their date of birth (optional) information to ensure suitable opportunities are shared. Receiving information about research involvement opportunities for a child or young person does not commit them to participate.

Burn Family Engagement Options

Engagement Opportunities with the Burn Family

If you opt in, the FWF may get in touch about opportunities to share your lived experience, such Our Stories, media engagement, case studies or community awareness initiatives.

Yes, I would like to be contacted about opportunities to share my lived experience and media opportunities.

Information and Resource Hub

If you opt in, the FWF may share information about education programs and support resources that may assist at different stages of recovery. This can include support groups, animations, online programs and community initiatives.

Yes, I would like updates about information and resources available through the Foundation.

FWF Impact Newsletter and Foundation Updates

Stay connected with our quarterly FWF Impact newsletter, updates on research and education initiatives, and occasional opportunities to support the Foundation’s work.

Yes, I would like to receive the FWF Impact Quarterly Newsletter, Foundation updates and opportunities to support your work.

Connect at Events and FWF Activities

This may include being among the first to hear about special events, community fundraisers such as the Central Park Plunge, the FWF Research Impact event, and other opportunities to connect and take part.

Yes, I would like to receive invitations to community events and Foundation activities.

Thank You for Choosing to Be Part of the Burn Family Community

By staying connected, you are part of a growing community of burn survivors, families and caregivers whose shared experiences contribute to greater understanding, research progress and community connection. You can update your communication preferences at any time. If you have any questions, please contact Gabi at gabrielle@fionawoodfoundation.org.au or call +61 8 6285 5647.

How did you hear about the Burn Family? *

For example, through Fiona Wood Foundation research, a clinic poster, hospital team, website or community organisation.

Date of submission

Your personal information is handled in line with the Privacy Act 1988 (Cth), the Australian Privacy Principles and the Foundation’s privacy policy. It is used only for the purposes described here and is not shared with others without your consent. For more information, please refer to our privacy policy.