1 (855) 451-6703

Ronald McDonald House BC Reservation Request

 

Families who stay with us:

1 Must live a minimum distance of 50 km outside of Greater Vancouver.

2 Are parents/legal guardians of a child under the age of 19 who is receiving medical care for a life-threatening illness at BC Children’s Hospital, Sunnyhill Health Centre, or another local medical facility.

Siblings and family members are welcome to come with the parents of the ill child and can stay in the one bedroom per family. Parent supervision of all children under the age of 19 years is required at all times.

Important Note:
Anyone suffering from, or who has recently been exposed to, a communicable illness, including a cold or the flu, cannot be admitted in order to minimize the risk to children with weakened immune systems who are staying in the House.

Booking Information

Please provide as much information as you are able to. Questions marked with an asterisk* are required.

Relationship



Repeat Visit



 




 

Patient Information


Patient Name (the child or the name of the pregnant mother)





Gender



Patient Status



 



 


 

Caregiver Information


Primary Caregiver














Parking


(parking is limited and cannot be guaranteed)

Funding Source




 

Caregivers

Additional caregivers may be in attendance. This form will allow you to add up to three additional caregivers.


Please provide the full name and their relationship to the patient.


Secondary Caregiver







3rd Caregiver







4th Caregiver




 

Siblings

You can register up to six brothers and sisters.


Please provide full names and birthdates


Siblings Name







Second Siblings Name







Third Siblings Name







Fourth Siblings Name







Fifth Siblings Name







Sixth Siblings Name




 

Guests

You may also register up to 4 guests.


Please provide full names and their relationship to the patient.


Guest #1







Guest #2







Guest #3







Guest #4




 

 

Accessibility

Wheelchair Access





Ceiling Lift Certifiction



Equipment Liability







Equipment Request




 

Qualifications

Allergies



Illness



Criminal



Custody