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The following questions will be used for reporting and fundraising purposes only:
What is your annual Household Income?
Does the patient have Medicaid?


Ronald McDonald House Guest Family Agreement

The following policies have been developed for the well-being and safety of our guests at the Ronald McDonald House of Buffalo. (RMHC WNY)

 

Agreement

 

I understand RMHC WNY is a non-medical, Charitable Organization. Staff and Volunteers are not qualified to give medical advice, medical treatment, or give medications. In case of an emergency, 911 will be called.

 

I understand RMHCWNY is not responsible for guest(s) belongings. Valuables stored in guest rooms should be kept to a minimum and should be with you at all times. Guest personal items are not the responsibility of RMHC Staff or Volunteers.

 

Only one room is allotted to each patient family. Room capacity is based on the occupancy of a room.

I understand that my stay may be reevaluated, and I may be asked to move to another room.

 

I understand that smoking is allowed only in the designated smoking area. Smoking is never allowed anywhere inside the Ronald McDonald House, undesignated outside areas, or the RMHC WNY Van.

Proper handwashing and hygiene will be required upon entering back into the house.

 

I understand that verbal profanity, alcohol, illegal substances, and weapons are prohibited on the RMHCWNY Campus. Being at the RMHC WNY facility intoxicated or under the influence of illegal substances is strictly prohibited. Domestic violence is not tolerated. Theft, verbal abuse, physical abuse, bullying of other guest families, staff or volunteers will be reported to the authorities and the referring agent who referred your stay. Any and all of these actions will result in your guest stay being revoked.

 

For their safety, I understand that I must supervise my children (under the age of 18) at all times.

No other guest, staff, or volunteer may watch or supervise my children.

 

I am responsible for keeping my guest room, bathroom, and common areas that I have used neat, clean, and sanitized. I will maintain my linens and towels during my stay. There may be routine inspections of your room done by RMHC Staff.

 

I understand that I can leave the RMH (RMHC WNY), for 1 night to go back home.  I understand that I must notify the RMHC Front Office of my absence for one night. I understand that I have to notify Staff of my return for the following night’s stay. I further understand that if I must stay away for more than 1 night, I may have to forfeit my room.

 

No pets are allowed.

 

* Type your Electronic Signature Here:


 Ronald McDonald House Media Release Form

I HEREBY GIVE PERMISSION TO RONALD MCDONALD HOUSE CHARITIES OF WESTERN NEW YORK TO USE PHOTOGRAPHS AND NAMES OF MYSELF, MY FAMILY AND/OR MY GROUP FOR POSSIBLE PROMOTIONAL PURPOSES.  THIS MAY INCLUDE USE IN NEWSLETTERS, SLIDE AND VIDEO PRESENTATIONS, MEDIA PRESENTATIONS (TELEVISION, RADIO & PRINT PUBLICATIONS) AND THE RONALD MCDONALD HOUSE WEBSITE & SOCIAL MEDIA NETWORKS

 

* I THEREFORE RELEASE RONALD MCDONALD HOUSE CHARITIES OF WESTERN NEW YORK FROM ANY AND ALL CLAIMS WHICH MAY ARRIVE FROM THE USE OF THESE PICTURES.  I AGREE THAT RONALD MCDONALD HOUSE CHARITIES OF WESTERN NEW YORK MAY USE THESE PHOTOS INDEFINITELY:
 

* Type your Electronic Signature Here: