Type of Visit
Room to Room
If "Other," in a few words, please describe:
If you checked "Performance," please provide video links, references, and/or groups' website.
Please Describe Your Proposed Event
Event Date You're Requesting (**NOT GUARANTEED)
Date Picker Icon
Is This Date Flexible?
Describe Your Event Set-Up ; Do you require additional time, equipment, etc.?
Number of People Attending (Please Note: All Visitors MUST be AT LEAST 18 YEARS OLD----NO EXCEPTIONS!)
Thank you for understanding that our young patients can be extremely overwhelmed by large groups of people.
Additional Comments or Information
Thank you for completing this form; we will respond to your inquiry with in 7 business days.
We appreciate you thinking of our families at Connecticut Children's Medical Center!
Should be Empty: