Go to the Ronald McDonald House Charities of Kansas City website.
Felony Exception Request
Felony conviction exception request
It is the policy of RMHC-KC that any person with a felony conviction is ineligible to stay unless an exception has been granted. Please complete the following information in full detail; RMHC-KC will use the provided information to decide if an exception will be granted.
If you need assistance completing this form, please call 816-541-8460.
Please note: RMHC-KC will not consider an exception for the following: a criminal history of violence (including assault), sexual misconduct, or abuse/neglect of a child.
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Your Name (First/Middle/Last Required)
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Date of Birth mm/dd/yyyy
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Relationship to patient
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Are you the primary caregiver of the patient?
Yes
No
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Patient Name ( First and Last )
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Patient Date of Birth (MM/DD/YYYY)
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Please list all criminal convictions, misdemeanor(s) and/or felonies.
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Sentence/Punishment
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Date of Conviction (Month/Year)
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Are you still on parole or Probation?
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When were you released from jail/prison?
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The committee takes many factors into consideration when making their decision. Please give the committee as many factual details as possible in relation your offenses/ charges. The more detail the better.
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Who is filling out this form?
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This should always be the person with felony.
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What's the best way to contact you?
I certify that the above information is true and correct.
Help Request Sent
Ok
Name of person completing this form
Patient Name ( First and Last )
Phone
Email
Submit
