Ronald McDonald Family Room – Westmead Registration Form

We are delighted to welcome you to the Ronald McDonald Family Room in The Children’s Hospital at Westmead (CHW).

This space has been designed for you to find rest and comfort away from the clinical hospital environment while remaining just moments from your child’s bedside.

Please register by filling in the form below. If you have any questions, our friendly volunteers will be more than happy to assist you.

Ronald McDonald Family Room - Westmead Registration Form

Company

This field is for validation purposes and should be left unchanged.

Name(Required)

First Last

Email(Required)

Phone(Required)

Home Address Zip Code(Required)

Referring Ward at The Children's Hospital at Westmead(Required)

# of Adults Visiting(Required)

Please enter a number from 1 to 3.

Please fill in name/s below.(Required)

First Last

Please fill in guest names below.(Required)

First Last

Please fill in guest names below.(Required)

First Last

# of Children Visiting(Required)

Please enter a number from 0 to 6.

Please fill in name/s below.(Required)

First Last

Please fill in guest names below.(Required)

First Last

Please fill in guest names below.(Required)

First Last

Please fill in guest names below.(Required)

First Last

Please fill in guest names below.(Required)

First Last

Please fill in guest names below.(Required)

First Last

Ronald McDonald Family Room Guest Agreement(Required)

As a children's charity, the safety of the children, families, volunteers, and staff at Ronald McDonald House Charities Greater Western Sydney (RMHC GWS) is our absolute priority. For this reason, we ask all guests/families to confirm the statements below:

• I have not been convicted of or am under investigation for an offence against a child (this can be by Child Protective Services or another similar agency).

I acknowledge and agree that I will abide by the following conditions while staying at the Ronald McDonald Family Room in Westmead:

• No one can be in the possession of any weapons or illegal drugs and these cannot be used, consumed, or stored anywhere on Ronald McDonald House property.
• All children under the age of 18 years of age must be supervised by a responsible adult in my family at all times.
• Only take photos and videos of my own family member and visitors.
• No one has been exposed to or diagnosed with a contagious illness, and we understand we must notify management immediately if that changes.
• Access to the Family Room is of temporary nature and is at the discretion of RMHC GWS. With notice from management, you may be asked to leave early. Management reserves the right to refuse entry.
• Family Room visitor hours are from Mondays to Sundays, 8:00 am to 5:00 pm. All visitors must sign in via the registration form.
• The security and safety of your personal possessions is your own responsibility and RMHC GWS is not liable for any loss, theft, or damage.
• You agree to notify RMHC GWS about any incidents during your visit.
• An appropriate dress code must be maintained. Shoes or slippers must be worn at all times.
• You are required to properly handle and dispose of any potentially toxic or infectious materials.
• No medical or therapy services will be conducted in the Family Room unless in the case of an emergency or with prior approval from RMHC GWS.
• Should the fire alert tone sound, you will follow all instructions given by staff or volunteers. In the event of an evacuation, you will leave the Family Room immediately.
• RMHC GWS are committed to safeguarding all children and young people and you agree to take care to ensure inappropriate behaviour does not occur. You agree to notify a staff member if a child discloses information that indicates they may be at risk of harm, abuse, or neglect.

I acknowledge and agree that I will always display respectful and courteous behaviour. The following behaviours will not be tolerated within a Ronald McDonald House program:

• Physical, verbal or written abuse, and/or assault
• Discrimination and/or harassment of any kind, including sexual harassment, intimidation, victimisation, or bullying
• Any behaviour that is harmful, including derogatory, belittling, or negative communication
• Careless or reckless behaviour
• Behaviour that breaches any applicable laws or regulations

By checking this box, I confirm I have read the Ronald McDonald Family Room Guest Agreement and agree to abide by the conditions set forth in this agreement. I understand that if a family has been asked to leave the House because they have violated one or more of the conditions in place, they may not be eligible to return as a guest of the Family Room or other RMHC GWS programs.

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Make a Difference for Families & Children

Parents don’t know when their children will need medical help. But they should know they can always access the care they need. With your help, we can support them throughout their journey.