room reservation

Would you like to make a request for a room reservation in the parents' house or do you have any questions about the parents' house?
We are happy to help you!

Do you have a demand for a room reservation or do you have any other questions concerning a stay in the parents house? Please do not hesitate to contact us!

Tel: 0201-87857-100
Fax: 0201-87857-155
pst@krebskranke-kinder-essen.de

Demand for room reservation

Sicherheitsbereich

Last name of the child *

First name of the child *

Date of birth of the child *

At which hospital ward is your child treated?

Date of arrival *

Estimated arrival time

Estimated departure date (before 10 a.m.) *

Number of persons (adults) *

Number of persons (children) *

How can we easily contact you? *

Have you already been in the Elternhaus before? (Yes/No)

Nein

Special information (e.g. limited mobility)

Enter the characters from the image into the code field.

Captcha code input field Der Captcha Code

Note: Fields marked with * must be filled in.

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