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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
FORE! The House: Visalia
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
Primary Guest(s) Name
(Required)
First
Last
Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Counties
(Required)
Fresno
Madera
Kings
Tulare
Kern
Stanislaus
San Luis Obispo
Other
Other County
(Required)
Patient Information
Patient Name:
(Required)
First
Last
Patient Date of Birth:
(Required)
MM slash DD slash YYYY
Patient Gender
(Required)
MALE
FEMALE
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)
What is the patient’s diagnosis?
(Required)
Trauma/Accident
Cardiovascular
Surgery
Oncology Follow Up
Premature Birth
Respiratory
Orthopedic
Other
What Hospital Unit is the Patient staying in?
(Required)
NICU
PICU
Craycroft
Voyager Explorer
Appollo
Discovery
What Ethnicity is Patient?
(Required)
African American
Asian
Caucasian
Hispanic
Native-American
Other
Cell Phone Number
(Required)
Home Phone Number
(Required)
Email Address
(Required)
Vehicle Make & Model
Vehicle Color
(Required)
Is this your first stay at Ronald McDonald House Central Valley?
(Required)
Yes
No
Are you currently employed?
(Required)
Yes
No
What is your primary language?
(Required)
English
Spanish
Other
Social Worker Name
(Required)
First
Last
Expected length of stay
(Required)
Please list any medical conditions you have
Name
(Required)
First
Last
Medical Condition
(Required)
Medication(s) taken
(Required)
Name
(Required)
First
Last
Emergency Contact Name
(Required)
First
Last
Phone number
(Required)
Has any family member(s) had skin irritation in the past 4 weeks?
(Required)
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