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    Please complete the form below to attend.

    1. How many people in your party attending?

    2. If this campaign is a physical event, the organization may need to contact you. Please provide your info below.

    Additional Info.

    Please review the information and complete this form.

    1. Room Requests are made by families and will be reviewed upon receipt by staff at the House. Once your eligibility is determined you will be placed on our wait-list. The wait-list is triaged by how critical the child's illness and how far the family lives from the treatment h
      1. Patient Name *
      2. Patient Date of Birth *
      3. Unit of Hospital
      4. Mothers Name *
      5. Fathers Name *
      6. Home Address *
      7. Contact Phone *
      8. Contact Email *
      9. Do you own a car? *
      10. Do you rely on public transportation? *
      11. Will you have other children staying with you? *

    The Home Stretch.

    You're done. Click the Finish button to register.

    I understand that by agreeing to the terms of this request the Ronald McDonald House will contact the treating hospital to verify the information I have submitted. I allow Ronald McDonald House to contact hospital personnel in order to verify the information I have submitted. I understand that if I do not agree to this, my request will not be submitted for review.


    1. You can OPTIONALLY create an account to be able to make changes in the future.

      If you don't want to create an account, click Finish to complete.

      or

      Create a new account with email and password. Click Finish to complete.