Guest Stay Request


1. Stay Request
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Your Name:
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# Occupants First Night

2. Patient Information
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Inpatient - Hospitalized   Outpatient - Non-Hospitalized   Both, during this stay.

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Does the Medicaid Belong to the Patient or the Parent?
Is the home address the address on file with Mediciad? If not, please enter in the feild below.

3. Guest Information
We ask that all guests conduct themselves in a respectful manner. As a private, non-profit organization, RMHC Charleston reservest the right to refuse and evict guests, at our discretion, to ensure the safety & well-being of our guests, our volunteers, our staff and our facility.
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I agree to receive emails.
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I agree to receive texts at this number.
Guardian/Caregiver Home Address
U.S. / Canadian Postal Code lookup


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I agree to receive emails.
U.S. / Canadian Postal Code lookup


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I agree to receive texts at this number.
(must be different from 1st Guardian's phone number)
Is 2nd Guardian/Caregiver's address the same as 1st Guardian?
2nd Guardian Address (if differnt from 1st guardian):

Additional Guests / Family Members

Add Another Guest

4. Additional Information

Notes Regarding this Request:

  • Your request will be processed, and we will keep you informed about our availability.  Please be advised we generally have long waiting lists.
  • To stay at our House, families must have a child (18 years or younger) who is receiving medical care in the Greater Charleston area.
  • Although families are asked to make a donation per night while staying with us, no family is ever turned away due to inability to contribute.

  

All members of the guest family must meet the RMHC Charleston requirements including:

  1. Please prepare to sign our Conditions-of-Stay Document.  For your reference, copies of our pre-registration packets and Conditions-of-Stay Document are available on our website. 
  2. We are not permitted to accept family members who may be contagious of an infectious disease.
  3. All member of the family must attest to 1) having no current drug/alcohol abuse, 2) having no conviction relating to domestic violence or crimes against children, including status as a registered sex offender; and (3) having no open case or conviction with the South Carolina Department of Social Services or other states comparable department.