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Ronald McDonald House Charities of the Central Valley
"Providing a Home Away From Home and resources to children and their families."
Home
About
How it Began
Founding Mission Partner
Our Staff
Board of Directors
Annual Reports
What We Do
The Ronald McDonald House
The Day Room
Hotels From the Heart
Get Involved
Donate
Porch Pickup
Volunteers
Meals From the Heart
Community Events
Fundraising Application Form
Request a Speaker
Wish List
Adopt-A-Room
Donate Your Vehicle
Collector Car Drawing
Planned Giving
Beneficiary Designations
Giving from your IRA
Real Estate Gifts
Giving from A Donor Advised Fund
Gifts in your Will or Trust
Gifts of Appreciated Assets
A Gift that Pays You Income for Life
Family Services
How to Stay
Background Check
Events
From Our House To Yours Telethon
Red Heart Ball
Fresno Golf Tournament – October
Visalia Golf Tournament – June
Dollars For Dinner
Volunteers
News
Dollars for Dinner
How to Stay
Donate
Home
About
How it Began
Founding Mission Partner
Our Staff
Board of Directors
Annual Reports
What We Do
The Ronald McDonald House
The Day Room
Hotels From the Heart
Get Involved
Donate
Porch Pickup
Volunteers
Meals From the Heart
Community Events
Fundraising Application Form
Request a Speaker
Wish List
Adopt-A-Room
Donate Your Vehicle
Collector Car Drawing
Planned Giving
Beneficiary Designations
Giving from your IRA
Real Estate Gifts
Giving from A Donor Advised Fund
Gifts in your Will or Trust
Gifts of Appreciated Assets
A Gift that Pays You Income for Life
Family Services
How to Stay
Background Check
Events
From Our House To Yours Telethon
Red Heart Ball
Fresno Golf Tournament – October
Visalia Golf Tournament – June
Dollars For Dinner
Volunteers
News
Ronald McDonald House Central Valley Registration Information
Nombre del huésped(es) principal(es)
(Required)
Nombre
Apellido
Dirección
(Required)
Dirección (Calle y número)
Ciudad
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Estado
Código Postal
Condados
(Required)
Fresno
Madera
Kings
Tulare
Kern
Stanislaus
San Luis Obispo
Other
Otro Condado
(Required)
Información del paciente
Paciente
(Required)
First
Last
Fecha de nacimiento
(Required)
MM slash DD slash YYYY
Genero
(Required)
Masculino
Femenino
Patients Medicaid/Medi-Cal ID# (If Child is over 1 year old)
(Required)
Parents Medicaid/Medi-Cal ID# (If Child is under 1 year old)
Diagnóstico del paciente
(Required)
Trauma/ Accidente
Cardiovascular
Seguimiento
Oncológico
Prematuro
Respiratorio
Cirugía
Other
Hospitalización (círculo)
(Required)
Unidad de cuidados intensivos neonatales NICU
Unidad de cuidados intensivos pediátricos PICU
Craycroft
Voyager Explorer
Appollo
Discovery
Etnia (círculo)
(Required)
Afroamericano
Asiático
Caucásico
Hispano
Americano Nativo
Other
Número de teléfono celular
(Required)
Número de teléfono residencial
(Required)
Correo electrónico
(Required)
Marca y modelo del vehículo
Color del vehículo
(Required)
Es esta su primera estancia en la Casa Ronald McDonald del Valle Central?
(Required)
Yes
No
¿Tiene empleo actualmente?
(Required)
Yes
No
¿Cuál es su idioma principal?
(Required)
English
Spanish
Other
Nombre del trabajador(a) social
(Required)
Nombre
Apellido
Duración prevista de la estancia
(Required)
Por favor, enumere cualquier condición médica que tenga
Nombre
(Required)
Nombre
Apellido
Condición médica
(Required)
Medicamento(s) que toma
(Required)
Nombre del contacto de emergencia
(Required)
Nombre
Apellido
Número de teléfono
(Required)
¿Algún miembro de la familia ha tenido irritación en la piel en las últimas 4 semanas?
(Required)
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