Online Room Request

Complete your online request and click on SUBMIT.

1. Stay Request

2. Patient Information

Does your child require a ventilator machine?
Household Income
Primary Language

3. Guest Information

Contact Information

Are you are returning family?
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/used.
Would you agree to undergo a background check?

4. Additional Information

Please provide the address of Guest #2.
* Have all patients and family members who will be staying at the House been vaccinated for measles, mumps, and rubella (MMR), and been vaccinated for and/or diagnosed with chickenpox in the past?
If no, please explain in the comment box

Notes regarding this request:

Your request will be processed. Do you want to continue?


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