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HOSPITAL STAFF ROOM REQUEST FORM

The Ronald McDonald House of the Philadelphia Region requires all NEW families have a room request submitted by the hospital their child is visiting.

Questions? Please call Family Services between 9 a.m. and 5 p.m. EST at 267-969-6220.

BEFORE SUBMITTING YOUR ROOM REQUEST, PLEASE READ AND ACKNOWLEDGE THAT YOU UNDERSTAND THE FOLLOWING: 

Please review our Eligibility Requirements and House Policies before submitting your request.

Please Note: Submitting an application does not guarantee that a family is eligible to stay or that a room is available. We work to fill rooms as quickly as possible, but due to the wide variety of conditions and treatment plans our guest families are facing, we cannot determine room availability until the date of a family’s request.

  • We strongly encourage all families to make back up plans in the event that we are unable to accommodate you. A discount hotel list is attached to the acknowledgment email we send once your request is submitted. 
  • All caregivers, patients, and guests 18 and older must complete and clear a criminal background check prior to their stay. We reserve the right to deny entry to those whose criminal records may jeopardize the health, safety, and welfare of the House. We value honesty and transparency when discussing the contents of a criminal background check.  
  • For updates or questions regarding your room request, please call the Family Services office at 267-969-6220 or email us at RoomRequests@philarmh.org. 
  • For additional information, please check out our FAQ.

An RMH staff member will follow up with the family by email or phone once the request is processed.

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HOSPITAL REQUESTER INFORMATION

Who is requesting this room on behalf of the family?

Name

PATIENT INFORMATION

Date of Birth
Must be 21 years old or younger to stay.
Address
If your room request is same day, please call the Family Services Office.
Have all patients and family members who will be staying at the House been vaccinated for measles, mumps, and rubella (MMR), and been vaccinated for and/or diagnosed with chickenpox in the past?
Are all individuals requesting to stay at the House vaccinated for COVID-19? (Not required to stay)
Does the patient have medical insurance? (Including state run insurance, such as Medicaid, or private)

Guest Information

Please list the names of each room guest and their relationship to the patient. Please note that each room can only accommodate up to 4 individuals.

Guest 1

Guest Date of Birth
Guardian?

Guest 2

Guest Date of Birth
Guardian? (copy) (copy) (copy) (copy)

Guest 3

Guest Date of Birth
Guardian? (copy) (copy) (copy)

Guest 4

Guest Date of Birth
Guardian? (copy) (copy)

SPECIAL REQUESTS

Checkboxes