Ronald McDonald House Charities of Northwest Florida Family Stories

Family Story

The Ronald McDonald House is made possible because of the generosity of the community, people and businesses who faithfully give their support to help families stay near their children during a medical crisis. What keeps our donors engaged with our mission is hearing the stories of families like yours. We are grateful to you for allowing us to share your family’s story. We appreciate your time in providing a thoughtful response to each of the items listed below.
Family Information
Patient Name*

First NameLast Name
Date of Birth *

MonthDayYear
Reason for Medical Treatment*
Mother

First NameLast Name
Father

First NameLast Name
Sibling

First NameLast Name
Sibling

First NameLast Name
Other Family Members
Please give name and relationship to patient. For example: Joe Smith, Grandfather
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Was this your first stay at this Ronald McDonald House

YesNo
If you have stayed with us before, please provide an update below. Tell us things like…why you were here for this stay, how medical situations have changed, new impacts to child and/or family, or any other news you would like to share.
How did you find out about Ronald McDonald House (RMH)?*

Can you tell me a bit about your family's journey and the circumstances that led you to stay at RMHC?*

How did staying at RMHC impact your family during this challenging time?*

How did staying at RMH relieve stress?
Were there any particular moments or experiences at RMHC that stood out to you or your family?*

Can you share a specific memory or interaction with staff or volunteers that left a lasting impression on your family?*

How did your family spend time when you were not at the hospital? Did you use any of the services offered by RMH (i.e. dentist, eye doctor, mini golf, haircuts, etc.)?
Describe how friendships with other families staying at RMH developed and how they helped your family deal with the issues facing you.
What gave you comfort and hope during this difficult time?
How did the support from RMHC and the community influence your overall experience?*

What special memories did you take with you when you checked out?
How did staying at RMHC help you maintain a sense of normalcy and routine during a difficult period?*

Is there a message or advice you would like to share with other families who may find themselves in a similar situation?
Share your precious moments with us
Photo*

Upload a File

Cancelof
Photo

Upload a File

Cancelof
Photo

Upload a File

Cancelof
Photo

Upload a File

Cancelof
Grant, Assignment, Release and Waiver
I hereby grant to Ronald McDonald House Charities (RMHC), its local Chapters and programs, advertising and promotional agencies, and their agents (collectively, "RMHC"), the irrevocable, unrestricted right to use, publish, display and distribute materials bearing my name, voice, likeness or any other identifiable representation of myself. These materials may appear in any form, style, color or medium whatsoever now or hereafter known (including, without limitation, photographs, videotapes, films, sound recordings, software, drawings, prints, broadcast, internet and electronic media).

I agree that all materials containing any identifiable representation of me (including, without limitation, all negatives, plates and masters of any photographs, files, prints or tapes) shall be and remain the sole and exclusive property of RMHC, and I hereby assign any proprietary right I may have acquired in or to such material to RMHC. I hereby release and forever discharge RMHC from any and all liability and damages relating to the use of my name, voice, likeness or any other identifiable representation of me.

I hereby waive any right I may have to inspect or approve the finished materials or any part or element thereof that incorporates my name, voice, likeness or any other identifiable representation of myself.

I have agreed to the above in consideration of the opportunity given to me by RMHC to appear in these materials. I acknowledge that I have fully read and understand this document and that I have had any questions regarding its effect or the meaning of its terms answered to my satisfaction. I certify that I am at least 18 years of age, unless this document is also signed by my parent or legal guardian. I represent that I am a parent or legal guardian of the minors identified and consent to the use of his/her name, voice, likeness and/or other identifiable representation of him/her as set forth above.
Name*

First NameLast Name
Signature*

Clear
Date

MonthDayYear
Date
Should be Empty:

Family Story

Family Information

Share your precious moments with us

Grant, Assignment, Release and Waiver