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Kentucky Children's Hospital Group Visits

Application for community groups wishing to visit patients

Please review the following guidelines for group visits.  Once you have finished, click the box to acknowledge that you will comply with the hospital guidelines.

I understand that:

  • completion of this application does not guarantee that my group will be able to visit the children’s hospital.
  • all members of my group must be in high school or older.
  • no one should enter the hospital if he/she has any signs or symptoms of illness.
  • we cannot take pictures of the patients.
  • we must follow the instructions of the hospital staff person escorting us through the hospital.
  • activities cannot promote one religion.
  • if gifts or prizes are distributed we must provide enough for all children.
  • media coverage is discouraged. If requested, reason has been provided and UK HealthCare public relations have been contacted.

 

Contact Information

Items marked with an * are required information. 

Group's name:

  

Group's purpose or mission:

 
 

  (Maximum characters: 2000) You have characters left. 


 

*Contact person:

  

Address:

   

City:

  

State:

  

Zip code:

  

*Telephone:

  (000)-000-0000

Alternate telephone:

  

*E-mail:

  

 

Planning information

Possible dates/times:

1st preference:

  

2nd preference:

  

3rd preference:

  

 

Description of proposed activities/visit:

 

  (Maximum characters: 2000) You have characters left. 

Number of members in your group: 

(No more than 14, please)

Do you need assistance from us? 

 

 

 

 

 

Click the button below to submit completed form.

 

If you have any questions please contact Judi Martin, Child Life Coordinator, 859-323-6551 or jamart8@email.uky.edu.

You can also print out this form and mail it here:

Attn: Judi Martin, Child & Family Life Coordinator
Kentucky Children’s Hospital
Room HA 444
1000 South Limestone
Lexington, KY 40536-0293