Patient Information
Please fill out patient information only in this section. If you are part of the Fetal Care program, please imput the child's information as the patient.
To add an additional patient, use the 'other guests' section below and select 'Patient' under the relationship field. 


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Treatment & Facility Details


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Inpatient - Hospitalized   Outpatient - Non-Hospitalized   Both, during this stay.




Primary Guest Details
Who is going to be the main person staying at the Ronald McDonald House? This should be a mom, dad, or a legal guardian of the patient.


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I agree to receive texts at this number.
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Is Guardian/Caregiver currently a McDonald's employee?
No   Yes



When do you need to stay with us, and for how long?


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Physical Address
Your current physical address


Enter your zip code below to prefill the address fields.
U.S. / Canadian Postal Code lookup


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Other Guests
Who else will need to stay with you? You may register up to two primary caregivers and up to two siblings of the patient receiving treatment. Please note that it costs RMHCCF an average of $10 to run one background check. A donation to help offset the cost is greatly appreciated.
Additional Guests / Family Members

Add Another Guest
Are any guests currently McDonald's Employees?



Emergency Contact
Please list an emergency contact who will not be staying with you at Ronald McDonald House.
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Transportation


Do you have transportation?



Vehicle Details


Will you have a vehicle on premises?



During Your Stay


Does anyone staying in your room take medication or have breast milk that requires refrigeration?
Will you need a crib or pack ’n play?



Background Check


Thank you for your inquiry to stay at one of Central Florida’s Ronald McDonald Houses. We hope to assist your family during this challenging time.
 
Ronald McDonald House Charities of Central Florida (“RMHCCF”), in order to undertake reasonable efforts to protect the safety of the guest families residing with us, now requires that each individual applicant (age 18 or older) who applies to stay at one of our Houses undergo a formal inquiry into their background (“background check”) to assess eligibility. This background check will include a private, multi‒jurisdictional database of criminal records as well as a search of the National Sex Offender Public Registry for each individual age 18 or older.
 
All guest applicants are required to go through this process. You have the right to decline to have this background check performed. However, if you do decline the background check, we will have no choice but to deny your request for access to our facilities out of the need to take all reasonable efforts to protect the safety of our families. Please understand that RMHCCF solely will obtain a background check to assist in determining whether to grant you access to our facilities. RMHCCF is not obtaining a “consumer report” for any other purpose. RMHCCF will not be conducting a credit check. By accepting this authorization, you authorize us to obtain the background report described in it from a consumer reporting agency. RMHCCF contracts a third party criminal background screening service in order to screen each individual guest applicant age 18 or older. Criminal background screening is required as part of the Guest application process for temporary residence at RMH. RMHCCF will neither admit nor allow on premises any individual who provides false, incomplete, or misleading responses during the criminal background check process. Personal information required to complete background authorization forms is provided solely to the third-party screening service with consent from each individual applicant. The information obtained during the background check process will only be used by RMHCCF to determine whether to grant access to our facilities and will only be divulged on a “need to know” basis to those individuals or entities that it deems necessary to review that information. The information will not be disclosed for any other reason. All personal background information will be managed and stored by the contracted third-party service per said third-party’s standard policies and procedures.
 
RMHCCF reserves the right to refuse access to our facilities to any guest applicant who has a criminal history, including certain convictions, pending criminal charges or active probation, warrants, or restraining orders. Anyone with a felony or misdemeanor conviction that may threaten the health, safety, welfare and ability of other individuals to peacefully enjoy the House is not permitted on RMHCCF premises. RMHCCF may also deny access to any individual with a pending criminal charge, active warrant or active restraining order, if the circumstances indicate such access may negatively impact the health, safety, welfare and ability of others to peacefully enjoy the House. If denial is based on circumstances other than a conviction, the individual may present additional information regarding the circumstances and ask for reconsiderations of the decision. Nonetheless, any uncertainty will be resolved in favor of RMHCCF’s commitment to provide a safe and peaceful environment.
 
Individuals who have criminal convictions involving drugs, sexual misconduct, or violence will generally be denied access to Ronald McDonald House Charities of Central Florida. The following is an illustrative, but not exhaustive, list of such convictions:
 
• Sexual predator crimes – all offenses
• Sexual misconduct, including sexual battery
• Murder/manslaughter
• Child abuse, aggravated child abuse
• Kidnapping
• False imprisonment
• Lewdness/indecent exposure
• Voyeurism and video voyeurism
• Luring or enticing a child • Terrorism • Arson • Burglary • Any crime against a person (i.e. aggravated assault, battery, robbery, home invasion robbery, carjacking, domestic violence) • Fleeing from a criminal institution
• Resisting arrest with violence
• Any felony or multiple misdemeanor (s)drug conviction (Including: illegal sale and delivery of narcotics, drug manufacturing/cultivation, possession, trafficking, distribution)
• Prostitution
• Stalking
 
If you have failed the background check, you will need to find other accommodations. Other individual members of your family/group may be permitted access to our facilities with a passing background check. The background check will be performed by AB Global. The toll‒free telephone number that you can use to contact AB Global is 1-866-590-8715. AB Global address is 12651 Walsingham Rd Ste. C, Largo, FL 33774. You have important rights under the Fair Credit and Reporting Act that you can exercise by contacting AB Global. If AB Global reports negative information to us causing you to fail our background check, you can obtain a copy of your report from AB Global free of charge. You can dispute any inaccurate, incomplete, or out‒of‒date information in AB Global's Report by contacting AB Global. If you do, AB Global will re‒investigate the information that you dispute, remove or correct any inaccurate or incomplete or out‒of‒date information, and send us a replacement report. AB Global will also take steps to prevent any inaccurate or incomplete or out‒of‒date information from appearing in any future reports they prepare about you.
 
In addition to this policy, RMHCCF reserves the right, in its sole discretion, to expel a guest for any inappropriate, irresponsible or criminal behavior that takes place while temporarily residing at one of our Houses. While RMHCCF has implemented this background check policy in order to take reasonable efforts to protect the safety of our guest families, RMHCCF cannot and does not warrant or guarantee the personal safety of any temporary resident, guest, visitor or staff member.
 
Please confirm that you agree to have a background check and have read the above.

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I have read and understand all of the above and authorize RMHCCF to obtain a background report described above from a consumer reporting agency.