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¿El paciente que recibe atención tiene 21 años o menos?
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¿Vive en el condado de Jefferson, KY, o en los condados de Floyd/Clark de Indiana?
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¿Se ha hospedado en RMHC Kentuckiana en el pasado?
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En caso afirmativo, ¿ha estado en los últimos 30 días?
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Confirme que comprende que la disponibilidad de habitaciones cambia todos los días. Completar el registro en línea no garantiza una estadía.
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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.
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Please confirm that you understand if your stay exceeds 30 days you may be asked to switch rooms or a deep clean of your current room may be required.
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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.
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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
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Acepto recibir mensajes de texto en este número.
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Does anyone in the family have any food allergies? If yes please list their name, age, and the allergy.
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Invitados adicionales / miembros de la familia

Agregar otro invitado

CONDITIONS OF STAY
 
The conditions of stay outline the requirements and expectations for families during their time at Ronald McDonald House Charities of Kentuckiana. Understanding and agreeing to these conditions helps ensure that RMHCK can provide a supportive environment conducive to the well-being of all families.
 
  1. Guestrooms must be used on a daily basis. Guests with repeated non-use of room within a 24-hour period may forfeit their continued stay at RMHCK.
  2. A significant amount of daily participation and visitation with the patient is expected during your stay (4-6 hours per day). Not meeting this expectation will jeopardize your stay.
  3. For continued eligibility, the patient must have a continuum of weekly medical care with a minimum of 3 visits per week. 
  4. For your safety and security, do not let anyone into the House who is not a registered guest. Doing so could result in being asked to check out. 
  5. Visitors are restricted to the main level - Private Intake Room, Dining Area, Front Lobby, and Playroom.
  6. Notify the Front Desk if you experience symptoms of a potentially contagious disease. 
  7. Ronald McDonald Hosue Charities of Kentuckiana is NOT responsible for personal injury, medical care, or loss of personal property. 
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ACKNOWLEDGEMENT OF CONDITIONS OF STAY
 
By signing below, you acknowledge that you have read and understand the Conditions of Stay and grant RMHCK permission to enforce it if needed at any time during your stay.

GUEST GUIDELINES

The guest guidelines ensure a harmonious and safe communal living environment for all families staying at Ronald McDonald House Charities of Kentuckiana. They outline acceptable behaviors and practices that each guest must follow. Adhering to these guidelines helps maintain a comfortable, respectful, and clean space for everyone. 

Zero Tolerance Leading to Immediate Eviction

  • Smoking anywhere inside the House or in other restricted areas.
  • Possession of alcohol, illegal drugs, or weapons, including concealed, on House property.
  • Room abandonment.
  • Violation of a Final Warning.
  • Being under the influence of alcohol and/or drugs.
  • Theft from RMHCK or any family.
  • Changing your permanent address to RMHCK
  • Violating RMHCK’s Code of Conduct

Room Policy

  • One room is provided per family, with a maximum of six people, including babies.
  • Registered guests are expected to use the room each night. Exceptions may be made for one night only (24 hours) but must be approved by Family Services staff before leaving the House.
  • When the child is discharged from the hospital or clinic, the family is expected to check out.
  • Anyone 16 years of age or older must wear an RMHCK wristband for the duration of their stay.
  • Guest families are NOT allowed to visit another guest’s room. If you want to visit with other guests staying at the House, we ask that you use the common areas of the House, like the play areas, dining room, and living rooms.

Smoking

  • Smoking, vaping, and the use of tobacco products or marijuana are prohibited inside the House.
  • Smoking is prohibited within 50 feet of any entrance/exit or near the playground. This includes the steps on the backside of our building.
  • Smoking is only allowed outside the gate in the ADA parking lot on Chestnut Street.

Recent Exposure to Contagious Disease

  • We ask that guests with recent exposure (within the past 14 days) to an illness considered contagious (i.e., COVID-19, monkeypox, measles, flu, strep, scabies, chickenpox, head lice, hepatitis, mumps, tuberculosis, mononucleosis, bacterial meningitis, etc.) wear a mask when outside of your guestroom.
  • If you have been exposed to a contagious disease or start feeling poorly during your stay, please notify the Family Services staff at the Front Desk right away.

Security

  • Family Services staff are available from 9 am - 9 pm to assist families with making their stay as comfortable as possible. A Security Officer supervises and monitors the House from 9 pm - 8 am.
  • Security and Family Services Staff are responsible for enforcing House Rules; disrespect towards others (staff, guests, and volunteers) will not be tolerated.
  • Your room key gets you into the House from 6 am - 10 pm. If you need to enter the House outside those hours, you must provide your room number and last name to be buzzed in.

Code of Conduct

We believe everyone deserves the chance to stay, work, and volunteer in an environment that is safe and free from intimidation, hostility, racism, and white supremacist behaviors.

Our staff, volunteers, and guest families deserve kindness and respect, and all will be held to the same high standards of conduct.

Ronald McDonald House Charities of Kentuckiana does not tolerate harassment of our staff, volunteers, or guest families in any form.

Anyone who fails to comply with these expectations will be asked to leave the House.

 Children

  • Anyone 16 or younger must always have an adult family member with them. No Hit Zone
  • Our House is a "No Hit Zone." No person shall hit another person ever.

Quiet Hours

  • Quiet hours are from 10 pm-9 am daily.
  • You'll notice some lights will dim at night. You can still use the common spaces, but please be courteous of others who may be getting some much-needed rest.

Receiving Mail

  • You are allowed to receive mail and packages at RMHCK. Mail should be addressed to Ronald McDonald House, c/o Your Name, Room #.

Visitors

  • Visitors are welcome from 9 am to 9 pm daily.
  • Please sign in visitors at the Front Desk and LobbyGuard during each visit.
  • Visitors should only visit the main level of our House.
  • You should stay with your guests during their visit in the designated visiting areas only.
  • You are responsible for the behavior and conduct of individuals visiting you.
  • All House rules and codes of conduct apply to visitors.

Parking Lots

  • The parking lot on 1st Street is for all guests.
  • The rear parking lot on Chestnut Street is for guests requiring accessible parking, RMHCK staff, and volunteers. Only one car per family is permitted in the Chestnut lot due to limited space.

Dress Code

  • All Houseguests should always wear shoes or slippers, along with appropriate clothing, when outside their rooms.
  • Appropriate clothing includes shoes, shirt, pants, dress, adequate coverage.
  • Clothing or visible tattoos should be without offensive language or inappropriate designs.

Check-Out

  • Please check out before 11 am.
  • Follow the checkout procedures listed on our app and in the Guestroom Binder. You can also request a copy from the Front Desk. Allow at least 30 minutes to complete the process.
  • Guests who leave without checking out properly may be ineligible to return.
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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.

Photo Release Ronald McDonald House Charities® (RMHC®) Grant, Assignment, Release and Waiver

I hereby grant to Ronald McDonald House Charities, its affiliates, subsidiaries, franchises, advertising and promotional agencies, and their agents and representatives, any of its Chapter organizations (defined as an entity having the right to Ronald McDonald House Charities, Ronald McDonald House, Ronald McDonald Family Room, and/or Ronald McDonald Care Mobile, or other trademarks for charitable purposes) (collectively, “RMHC”) and McDonald’s Corporation, its affiliates, subsidiaries, franchises, advertising and promotional agencies, and their agents and representatives (collectively, “McDonald’s”), the irrevocable, unrestricted worldwide right to use, publish, display, broadcast, edit, modify and distribute materials bearing my name, voice, image, likeness and/or any other identifiable representation of myself (collectively, “My Likeness”.) These materials may appear in any form, style, color or medium whatsoever now known or later developed (including, without limitation, photographs, videotapes, films, sound recordings, software, drawings, prints, broadcast, internet and electronic media.) McDonald’s use of My Likeness will be limited to use involving raising awareness of or for support of RMHC.

I agree that all materials containing my likeness (including, without limitation, all negatives, plates and masters of any photographs, files, prints or tapes) shall be and remain the sole and exclusive property of RMHC and/or McDonald’s, and I hereby assign any right I may have acquired in or to such material to RMHC and/or McDonald’s. I hereby release and forever discharge RMHC and/or McDonald’s from any and all claims, liabilities and damages relating to the use of My Likeness. I hereby waive any right I may have to inspect or approve the finished materials or any part or element thereof that incorporates My Likeness.

I have agreed to the above in consideration of the opportunity given to me by RMHC and/or McDonald’s to appear in these materials. I acknowledge that I have fully read and understand this document and that I have had any questions regarding its effect, or the meaning of its terms answered to my satisfaction. I certify that I am at least 18 years of age unless this document is also signed by my parent or legal guardian.
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I represent that I am a parent or legal guardian of the patient. I understand the above and consent to the use of his/her likeness as set forth above.
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Electronic Signature:

Demographic Questions
 
Is anyone staying at RMHC Kentuckiana a veteran?
Total Household Income Level
The following questions will only be used for reporting purposes.
Please list the place of employment for Each Guardian:
Guardian One Employer:
Guardian Two Employer:

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Guardian 1 Electronic Signature:
Guardian 2 Electronic Signature: