Thank you for your interest in visiting The Children's Center Rehabilitation Hospital. Please complete this form if you are interested in bringing a group to perform for the patients or to volunteer for a one-time event. Once you complete the form, click the submit button at the bottom of the page.


Contact Information

Please include the contact information for one representative of the group. It is not necessary to submit this form for each group member.



Entertainment/Group Visit Information

How many people are in your group? What is the age range of the participants?



Description of Activity

Please describe the type of activity that is of interest to your group (i.e. volunteer activity, performance, tour).



Date of Visit

Please list three preferred dates for your visit as well as your preferred time(s).



Equipment Needs

Will your performance require any special equipment such as speakers, a CD player or a microphone? If so, please specify.



Additional Information

Please include any additional information that you would like us to know about your group, including any special accommodations that may be needed.



Agreement

I understand that the form I am submitting is a request, and that The Children's Center Rehabilitation Hospital may not be able to accommodate my request due to the scheduling and medical needs of patients and staff. I understand that there may be additional requirements for group visits and I affirm my group's willingness to adhere to these guidelines.