Stay Agreement

Symptoms of contagious illness must be reported to staff immediately. You must notify staff immediately if you or your guest(s) test positive for COVID-19 or have been recently exposed to COVID-19.  

Face coverings throughout the building are optional, but if you prefer that a staff member/volunteer wear a mask during your interaction with them at the front desk, please request as needed and/or practice physical distancing.  

Each adult guest will be given a lanyard to wear during your stay. All registered adult guests must wear lanyards while in the building. Any guest checking out MUST RETURN KEY and LANYARD before checking out. 

Ronald McDonald House (RMHC) does not allow: 
  1. Smoking of any kind in the House or on the property.
  2. Alcohol in any community or public spaces. 
  3. All weapons, illegal drugs, candles, or incense are also not permitted.
  4. Hot plates, electric fryers, electric skillets, pressure cookers, and toaster ovens are not allowed. 
  5. Pets, companion, and emotional support animals are not allowed in the House, nor can they stay inside cars parked on House premises.
  6. Unsafe, disruptive, or illegal behavior is grounds for immediate eviction. 

 

Service Dogs are allowed to stay at the House. Guests will need to fill out the Service Animal Stay Agreement and abide by all the rules, failure to follow the rules may result in the guests current and future stays being cancelled. 

We do not tolerate harassment or discrimination of any kind. We are committed to an inclusive culture that is safe and creates a respectful and healthy environment for all.  
Children 15 and younger must be supervised by an adult at all times. Children under 6 may not use the top bunk of rooms with bunk beds.  

Please keep staff informed of treatment changes. Your family qualifies to stay while the patient is in treatment - if treatment ends earlier than expected your check out date will change.  

Each guest room may have day visitors (total registered guests & visitors not to exceed 6 people) between 8:00am and 11:30 pm. Inquire with staff for visitor parking options. 

Occupying your room daily is required. If you need to check out to go home for a little while, you are welcome to submit another request to stay. If patient care ends earlier than planned, your stay will be shortened and you will need to check out the day after discharge/final appointment by 12pm. Please call Family Placement if you need an exception. 
 
Guest rooms can accommodate a maximum of 6 people (toddlers under the age of 24 months are not counted towards the 6 maximum). 

You are required to maintain the condition and the cleanliness of your room during your stay. If there is any excessive damage beyond normal wear and tear, or if items go missing, you may be responsible for covering the costs of cleaning and repair.

In order to ensure quality maintenance of all guest rooms, staff will visit guest rooms approximately once per month during your family’s stay.  Please note: Due to the fragile paint we use in this building, we ask that you do not hang anything on the walls (using tape or other adhesives).   

We may also need to enter your room for an emergency, for maintenance work or to do a routine room check. We reserve the right to enter your room for the health and safety of all guests staying with us and appreciate your understanding in advance. 

Quiet hours are from 10pm-7am daily.  


Stay Agreement Acknowledgement

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First and Last Name of Adult Guardian Signing this Form
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Your Relationship to Patient
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I agree to abide by the House Stay Agreement. I am responsible for all members of my party complying with these guidelines. Anyone unwilling to follow these guidelines will be asked to leave and may jeopardize my privilege to stay at a Ronald McDonald House in the future. 
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Type your electronic signature here

Patient Information

Please ensure the name is the same name used to submit the referral. For example, if the patient is a newborn, their first name was submitted as "baby". 
 
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 Release of Information

For purposes of this form, “Family” includes you as parent or legal guardian of the patient and other children and others residing or visiting with you during your stay at the Ronald McDonald House Charities of Oregon & SW Washington.
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Can we share with others (outside callers, visitors, friends, etc.) that your family is staying at the Ronald McDonald House? 
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Permission to take photos/video/audio and share your family story 

I grant Ronald McDonald House Charities of Oregon & SW Washington permission to take photographs, video, and/or audio of me and my family to use in promotional and other fundraising materials. I authorize RMHC, its assigns and transfers to copyright, use and publish the same in print and/or electronically. I agree that RMHC may use such photographs for any lawful purpose such as: Publicity (public news, blogs, radio), Illustration, Advertising (print, digital), Fundraising, Web, Social media.

Communication with treating medical facility 

I understand that under certain circumstances confidential information, including personally identifying information may be shared between the treating medical facility and RMHC during my stay. I understand that this information may include a patient’s diagnosis, reason for admission, date and time of medical appointments and other information pertaining to the patients’ medical condition.   

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Type your electronic signature here:
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Date