A drawing of a House with a heart inside of it

Thank you for your interest in staying at the Philadelphia Ronald McDonald House.
This form is for domestic families who have stayed with us within the past two years and are requesting accommodations,
subject to availability.

By submitting a room request, you acknowledge that you have reviewed and understand the
policies and procedures listed on our website under the Staying With Us tab.

For questions or updates about your request, please contact Family Services at
RoomRequests@rmhcphilly.org or 267-969-6220. Our team is available seven days a week from 9:00 AM to 5:00 PM.

A red asterisk * indicates a required field.

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Have you stayed at the Ronald McDonald House in Philadelphia in the past two years?
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RMHC Philadelphia and RMH of Southern New Jersey work together to serve the Philadelphia region
and utilize a shared database system to ensure that families are served efficiently.
Please acknowledge your understanding and consent that all information entered into the room request form below will be
available to both organizations. If you have questions before proceeding, please do not hesitate to call us at (267) 969-6220.
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Who is completing this form?
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HEALTH & SAFETY INFORMATION
The Ronald McDonald House of Philadelphia supports families on their children’s medical journey with a community of comfort and hope.
For the health and safety of the community, we ask the following:
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Are all guests vaccinated for Measles, Mumps, Rubella, and Chickenpox (or had Chickenpox in the past)?
If no, a medical exemption signed by a physician must be provided for medically exempt patients. 
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Will any guests have an open Child Protective Services case?
If yes, please call Family Services to discuss.
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Do any guests currently have an active Protection from Abuse (PFA) order issued against them, or have they obtained a PFA order against another individual?
If yes, please call Family Services to discuss.
PATIENT INFORMATION
To add an additional patient, use the additional guest block below and select "patient" under the relationship field. 
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TREATMENT INFORMATION
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Inpatient - Hospitalized   Outpatient - Non-Hospitalized   Both, during this stay.

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Hospital Social Workers Phone Number
HEALTH INSURANCE INFORMATION
We collect insurance information because it may help Ronald McDonald House qualify for government and grant funding.
Some insurance companies may also retroactively contribute to the cost of your stay. Sharing your insurance details does not open a claim, cost you anything, or affect your eligibility for a room.
To learn about potential lodging or transportation benefits available from your provider, please call the customer service number on the back of your insurance card.
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PATIENT EDUCATION QUESTIONS
The following information is gathered for grant funding purposes. These questions apply to school aged (K-12) patients.
If not applicable or you prefer not to answer, enter "N/A" in the School Grade field
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PATIENT/GUARDIAN ADDRESS 
Families are qualified to stay if they live 25 miles or more from the House
U.S. / Canadian Postal Code lookup


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GUARDIAN INFORMATION
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I agree to receive texts at this number.
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I agree to receive texts at this number.
EMERGENCY CONTACT INFORMATION
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VEHICLE INFORMATION
The Chestnut Street location provides parking validation at CHOP's Buerger Center for one vehicle during your stay. Our Front & Erie location has a gated parking lot on-site.  
No car? Enter "N/A" below
 
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ADDITIONAL ROOM OCCUPANTS 
Please note that each room can only accommodate up to 4 individuals.
Additional Guests / Family Members

Add Another Guest
ADDITIONAL CHILDREN EDUCATION QUESTIONS 
These questions apply to any additional patients or school aged (K-12) sibling(s) expected to stay at the House.
Enter grade, school type, and school district below:
ACCOMMODATION REQUESTS
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Do any guests use a service animal?
If yes, please provide the name of the service dog and the type of service it provides. Proof of rabies vaccination is required prior to arrival.
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Do any guests use a wheelchair or medical equipment?
If yes, please list the name(s) and the pertinent information:
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ALTERNATIVE RMH LODGING
Our Chestnut Street location which primarily serves CHOP is often full.
In the event that we do not have a room on the day of your request, are you interested in being considered for another Ronald McDonald House?
Disregard this section if your child is a patient at St. Christopher's. 
 
Front & Erie: 100 East Erie Avenue, Philadelphia, PA 19134
  • Operated by RMH Philadelphia
  • 8 miles to CHOP
  • No shuttle
 
Southern New Jersey: 550 Mickle Blvd, Camden, NJ 08103
  • Operated separately from RMH Philadelphia
  • 6 miles to CHOP
  • Shriner’s Shuttle/Volunteer Shuttle Services
  • Gated parking lot on-site
  • Continental breakfast and hot dinner each day
  • Grab & go food items
  • Free laundry services
  • Suggested donation: $15/night
  • Have their own policies and procedures that differ from Philadelphia
  • Call 856-966-4663 to learn more.
 
Please note that confirmation at one House will remove you from all other lists. Transfers from one House to another are not permitted. 
GENERAL REQUEST NOTES: