Online Registration

Ronald McDonald House of South Louisiana

* Patient Name ( First and Last )

* Patient Date of Birth (MM/DD/YYYY)

* Unit

Who will be staying at the House with you?

Caregivers and immediate family members are eligible to stay. The maximum number our rooms can accommodate is 5 guests.

* Primary Guardian

U.S. / Canadian Postal Code lookup

* Country

* Address

City/Villa/Town

County/District

State/Province

Zip

* Primary Phone Number

I agree to receive texts at this number.

Parent or guardian's email address

Additional Guests / Family Members: * * * *

Add Another Guest

* Requested Check in Date

* Anticipated Check Out Date

Please provide the appointment, treatment, or surgery date of the patient.

Please provide the name of the hospital and/or doctor's office you will visit during your stay.

Has any family member or guest who are planning to stay been exposed to any infectious disease such as mumps, measles, chicken pox, or tuberculosis?

Does everyone 18 and older who is planning to stay at RMHCSLA have a valid ID showing their current address? If not, proof of residency will be required.

Does anyone who will be staying with us have any dietary restrictions? If yes, please provide details.