Housing Application

Application to Stay at the Seattle Ronald McDonald House

Fields marked with an * are required

Please note that you will also have to submit a background check form in addition to this application.

Only fill this form out if you are eligible to stay with RMHC, meaning you

1) are coming from 45 or more miles away from Seattle, WA 

2) have a child receiving treatment at Seattle Children's Hospital or their satellite clinics (such as Proton Therapy)

3) need housing for 4 or more nights

4) are needing housing in the next two weeks.

If you need housing in the next three days, please call our Housing Office at (206) 838-0610. Thank you!

HIPAA Release

In order to access Seattle Children’s Hospital records to confirm demographic information and appointment/admission schedules, please review and sign the following: I authorize RMHC and Seattle Children’s Hospital staff to share pertinent information regarding my child’s care and/or treatment. I also authorize RMHC to release pertinent medical/non-medical information, including appointment schedules, regarding my child’s care and/or treatment to Medicaid/Medicare or its agents to determine benefits for housing needs.

Please note: HIPAA must be signed by the patient’s legal guardian or the guardian, even if the patient is 18 years of age or older.

Patient Information

Address

Please note that if you have international phone numbers with a prefix, this form does not accommodate them. Please type (000) 000-000 into the box above and any other phone boxes if you have a phone outside of the US. We will follow up with you via email for your phone number.

Visit Information

Parent or Guardian Information

Contribution Information

Families are encouraged to contribute $30/night if they can, but no family is turned away for financial reasons. We also accept payments from Medicaid.

Room Guest Information

Our rooms can accommodate a maximum of six people. Please entire information as necessary below for each additional guest.

It is not necessary to repeat information you have already entered into the form, like patient names or the above parent/legal guardian. If you have no other room guests, please scroll to the bottom of the form to submit.

Our Mission:

At Ronald McDonald House Charities of Western Washington & Alaska, we support seriously ill children and their families. At the Seattle House, we provide a "home-away-from-home" to help families through a difficult time. We also provide a van service for families staying in Anchorage while their children receive medical care. Our IRS tax number or EIN is: 91-1061043.

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Get social with us to learn more about our families and happenings at the House.

Contact Us

5130 40th Ave NE

Seattle, WA 98105

Phone: 206.838.0600

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