*
Please confirm you understand Ronald McDonald House Charities of Kentuckiana will conduct a formal public sex offender check for all individuals 18 years of age or older. This measure is to ensure the safety and security of all families, which is of utmost importance to us. Persons who appear on the national sex offender registry will be denied lodging.
*
Please confirm you understand that you, the Guest, are receiving temporary lodging at a private, non-profit institution, that such residence is incidental to the provision of medical or similar services to a child of Guest, that such temporary lodging is similar to a hotel room, and that Guest does not have a right to exclusive possession of the room(s) Guest is assigned by RMHCK.  Guest further acknowledges that this is not a rental agreement as defined by KRS 385.545(11), nor is Guest considered a tenant for purposes of the Kentucky Landlord Tenant Act or other applicable law.
*
I understand and acknowledge that the RMHC Parties may arrange for transportation by one or more third parties for the Guest Parties in connection with their stay at the House. I, for myself, and for the other Guest Parties, acknowledge and agree that such transportation is arranged as a courtesy, and none of the RMHC Parties is responsible for or has any liability in connection with such transportation, and all such responsibility and liability shall be with the third party transportation provider. I, for myself, and for the other Guest Parties, hereby waive and release all Claims against the RMHC Parties related to such transportation, and agree to save and hold the RMHC Parties harmless from all Claims related to such transportation
*
Do you live in Jefferson County KY, or Floyd/Clark Counties of Indiana?
*
*
U.S. / Canadian Postal Code lookup


*
*
*
*
I agree to receive texts at this number.
RMHCK can text me with important information
*

*
Date of appointment (understanding that this application is for a 1 night stay only)
*
ACKNOWLEDGEMENT OF GUEST GUIDELINES
 
By signing below, you acknowledge that you have read and understand the Guest Guidelines and grant RMHCK permission to enforce it if needed at any time during your stay.
Ronald McDonald House Charities of Kentuckiana is NOT responsible for personal injury, medical care or loss of personal property. My signature below acknowledges the preceding and the agreement to abide by all House rules contained in the Guest Guidelines that I received at check in. Also, Ronald McDonald House incorporates by reference in this registration form the document titled, “Authorization to Release Protected Health Care Information.”
*
Electronic Signature: