Online Guest Stay Request

COVID-19 UPDATE

The fast-changing facts and information regarding COVID-19 is of concern for the well being of the houseguests and staff at the Ronald McDonald House.
After careful consideration, and in abundance of caution, no new families are being admitted as of Monday, March 16, 2020

If you have any questions or concerns please contact us at (305)324-5683 or e-mail at referral@rmhcsouthflorida.org

 


1. Stay Request


2. Patient Information



* 1. Insurance Provider

* If Other, Please Specify



3. Guest Information



* Emergency Contact Name

* Emergency Contact Phone Number

* Emergency Contact Relationship



4. Additional Information

* Estimated Time of Arrival

Has family stayed before?

Main language?

Vehicle on premises?


Any special request or need, please write below:




Your application has been received.

The information provided in this application has consent of the individuals for the sole purpose of referral information for temporary lodging at Ronald McDonald House Charities of South Florida.  This information is confidential and may not be used, published or redistributed at any time without prior consent of the individuals.  

 

For any questions, feel free to give us a call at 305-324-5683.



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