Request edit access
The Izzy Foundation Special Visitors/Entertainment Application
Thank you for thinking of The Izzy Foundation. We appreciate your interest in visiting the Izzy Family Room and sharing your time and talent with our patients and families. Please complete the following form with details of your proposed visit.

Please feel free to email a video, pictures or audio recording of your activity to our office at admin@theizzyfoundation.org .

For more information about The Izzy Foundation please visit our website at www.theizzyfoundation.org

Planning your visit:

• All special visits must be screened and approved in advance through The Izzy Foundation and visitors must be 18 years or older to participate in a program in the Izzy Family Room.

• Any visitor having recent contact or exposure to a communicable disease, or having recent contact with an ill person, must receive approval from infection control. Any visitor who is currently ill is not permitted to visit.

• We usually only approve a max of six volunteers per visit. Due to space limitations, and the health and safety of patients, the number of participants may be limited to only those deemed necessary .

• The Izzy Foundation will provide the guest with orientation to appropriate patients safety and infection control guidelines for the visit or event.

• We cannot guarantee the size of an audience due to a patient’s condition and availability.

• Since children often have short attention spans, events should be interactive and no more than 30 minutes.

• Attire must be appropriate for all ages to reflect The Izzy Foundation and Hasbro Children’s Hospital. The following dress code is required: no open toes shoes, logo T-shirts with inappropriate slogans, short skirts, tank tops, and/or low cut tops. All tattoos must be covered with clothing.

• No religious or political implications are permitted in special programs.

• No food or donation is to be distributed to patients without prior approval.

• Please note that visiting groups are required to bring all the supplies necessary for the activity they will facilitate.

• Guest are responsible for paying for their own parking.

• Performances may not include any potentially harmful materials, including: latex balloons or other latex items, fire, candles, knives or weapons. No plants or animals are permitted in the hospital.

• No music/lyrics that contain references to one or more of the following will be allowed to be played or performed: violence of any kind; alcohol; drugs; sex; criminal behavior; profane, discriminatory or abusive language.

• No photographs/video may be taken without prior approval from The Izzy Foundation and Hasbro Children's Hospital. Any request to invite media must be approved 2 weeks in advance. Please note that media presence may interfere with a patient's experience and is therefore not encouraged.

• The Izzy Foundation may not be responsible for any injury, loss of personal belongings or equipment while you visit.

• The Izzy Foundation reserves the right to cancel or discontinue special programs/events at any time including if they are thought to be inappropriate or unsafe for patients.

Have fun and enjoy yourself!

Name of Group: *
Your answer
Contact Name: *
Your answer
Mailing Address: *
Your answer
City, State and Zip: *
Your answer
Email Address: *
Your answer
Phone Number: *
Your answer
Please describe in detail what activity/event/programming you would like to provide ( request will be delayed or returned without detailed information) *
Your answer
Please list in detail the craft items, gifts, handouts that you would like to provide. *
Your answer
Number of persons in your group: *please note all visitors to the Izzy Family Room must be over the age of 18 to interact with patients*
Your answer
Proposed date of visit: *
Your answer
Please list your preferred time: *
Are you flexible with your time? *
Duration of visit: *
Your answer
In this a one-time visit or recurring visit: *
Your answer
If recurring, how often *
Your answer
Please list two organizations for which you have provided your services and/or two reference who can verify your efforts: *list name/phone/email and relationship *
Your answer
Please list two organizations for which you have provided your services and/or two reference who can verify your efforts: *list name/phone/email and relationship *
Your answer
Thank you! We look forward to talking with you soon!
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service