Room Request Form

Referral


Guest Information


Patient


Photo Release

I hereby agree and consent to allow Ronald McDonald House of SNJ to use all past, present, and future photos/videos for media/publicity purposes. I understand that my name and/or child’s name may be used. I agree and consent to allow RMHSNJ to use those names with the photos taken/ publicized.

Please check, if yes.

Please Check, if yes.