Online Guest Stay Request

Guest Stay Request

It is our pleasure to provide you with a home away from home while you are staying with us. Heres what you can expect during your stay at the Ronald McDonald House:

One private bedroom per family (Room sizes vary, sleeping as many as 6 people. A limited number of roll-away beds and pack-n-plays are available.)

Private bath and shower facilities
Kitchen, laundry, and recreation facilities
TV lounge, reading room, outdoor porch grill, computer and internet access
Pantry items, fresh foods and prepared meals provided by the community
Friendly and supportive environment

Ronald McDonald House guests must be referred by a medical facility, social worker or designated nurse clinician and have a child 21 years of age or younger receiving medical treatment.

1. Stay Request

* Stay Location

* Arrival Date

* Expected Departure Date

* # Occupants First Night

Request completed by

2. Patient Information- Who is going to be the child receiving treatment?

3. Guest Information- Who will be staying?

* First Name

Middle Name

* Last Name

* Gender

DOB

* Relationship to Patient

* Email

Type of Email

* Cell Phone

* Home Phone

Type of Address

* Country

County

* Street 1

Street 2

* City

*State/Province

* Zip/Postal Code

Vehicle Information

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4. Additional Information

Enter additional guest information below, Full Name| Date of Birth:

By clicking yes, you verify you understand and agree to the following statements:

The patient receiving evaluation and/or treatment is 21 years of age or younger.

All guests staying at RMH are free of symptoms related to contagious illnesses.

To ensure the safety and security of guests, staff and volunteers, you authorize a background check on all guests 18 and over.

I understand that RMHC-NWFL cannot guarantee my family a room.

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Online Guest Stay Request

Guest Stay Request

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