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Have you stayed at Ronald McDonald House Charities of Greater Delaware in the past?

Patient Information
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If Medicaid, which state? (Type N/A if the patient does not have Medicaid)
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Stay Information
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Inpatient - Hospitalized   Outpatient - Non-Hospitalized   Both, during this stay.

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Please provide the patient's appointment/procedure schedule below.
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* Guests are qualified to stay at the Ronald McDonald House of Greater Delaware if their child is inpatient or being seen on an outpatient basis with appointments no more than 48 hours apart excluding weekends and official Holidays.

Guardian/Caregiver Information
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Address Information
Family Address:
U.S. / Canadian Postal Code lookup



Patient's Address (skip if same as family address):
U.S. / Canadian Postal Code lookup



Additional Guest(s) Information
Will there be any additional guests staying at the House throughout your stay including children?
Additional Guests / Family Members

Add Another Guest
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Total Number of Adult Guests:
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Total Number of Children:

Additional Information
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Will your family require an ADA room? (our ADA rooms have a wheelchair accessible (roll-in) shower?
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Will the patient or any family member have any sensory needs that may be supported during your stay?
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What is you approximate household income?
(Note: Income information is strictly confidential and will only be used for funding purposes. Sharing this information helps us advocate for resources that better serve families)
Please submit a new background check if it has been 24 months or longer since your previous stay. Clicking on the "Submit Background Check Information" link will submit you room request.


By submitting this form I confirm that all of the information I have provided is true and I consent to RMHDE contacting the health system the patient is seeing to verify appointments, demographic information and any other information that may be necessary to determining my family's eligibility to stay at the House.