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.
*
Your Name (First/Middle/Last Required)
*
Date of Birth mm/dd/yyyy
*
Relationship to patient
*
Are you the primary caregiver of the patient?
Yes
No
*
Patient Name ( First and Last )
*
Patient Date of Birth (MM/DD/YYYY)
*
Please list all criminal convictions, misdemeanor(s) and/or felonies.
*
Sentence/Punishment
*
Date of Conviction (Month/Year)
*
Are you still on parole or Probation?
*
When were you released from jail/prison?
*
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.
*
Who is filling out this form?
*
This should always be the person with felony.
*
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