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Ronald McDonald Family Retreat at Krantz Cottage

Family Application

"*" indicates required fields

Parent/Guardian Information

Please fill out the following information completely.
Name*
MM slash DD slash YYYY
Address*
Add another parent/guardian?*

Patient Information

Name*
MM slash DD slash YYYY
Sex*
Has patient's family stayed at a Ronald McDonald House?*
Do you have additional guests to include?*
Select yes if your stay at the Ronald McDonald Family Retreat would include additional guests beyond the patient and parents/guardians listed above (i.e. siblings, grandparents, etc.)

Summary Information

Please include patient and applicant in totals below.

Visit Information

• Check-in is available Wednesday between 9:00 am and 5:00 pm
• Checkout is Sunday by 9:00 pm
Please indicate a preferred time/season to use the Ronald McDonald Family Retreat.*
Do you or does anyone in your family have any accessibility needs?*
Do you or does anyone in your family have any special requirements, including dietary restrictions?*

RMHC of the Capital Region operates the Ronald McDonald Family Retreat according to the mission of the chapter and program as indicated below. All services of RMHC-CR programs are provided at no cost to families.

Mission of Ronald McDonald Family Retreat at Krantz Cottage
The Ronald McDonald Family Retreat provides a peaceful, supportive setting where families experiencing serious childhood illness can enjoy being together, making lasting memories.

Diversity, Equity, & Inclusion Policy
It is the policy of Ronald McDonald House Charities of the Capital Region (RMHC-CR) and its programs to actively and intentionally embrace the diversity of its stakeholders, including and not limited to: all guest families and program beneficiaries, current and prospective volunteers, staff, supporters, and members of the community at large. RMHC-CR treats its stakeholders fairly and with compassion, without regard to income or ability to pay, race, color, ethnic origin, national origin, religion, political affiliation, age, gender, sexual orientation, gender identification, disability or handicap, housing status, marital status, veteran status or any other group, status or characteristic protected by locally applicable laws and regulations.