RMHC Central West NSW : Application

APPLICATION FOR A DAY PASS

Ronald McDonald House Central West, Orange NSW

First Name of Parent *

Last Name of Parent *

Mobile Number *

Email *

Patient - Child's First and Last Name *

Patient - Child's Date of Birth *

Home Address

Home Town *

Postcode *

Which Ward is Your Child Being Treated On? *

Date you would like for DAY PASS *

Number of Family Members for DAY PASS *

Names of Family Members (First and Last) and ages for DAY PASS *

I understand that there is a 'Guest Agreement' which must be signed prior to entry to the House *

All guests visiting Ronald McDonald House Central West NSW agree to abide by our 'Day Pass Guest Agreement'.

A copy will be provided for you to sign upon arrival at the House. Ronald McDonald House Central West NSW reserves the right to refuse entry to anyone not willing to sign the agreement or is deemed to be in breach of the Guest Agreement during their visit.

I understand that visiting hours are on Weekdays only (excluding Public Holidays) between 10am - 2pm *