Children's of Mississippi

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Child Life Patient Special Event Request Form

Thank you for your interest in hosting a special event for our patients at Children's of Mississippi! Please review the following guidelines to ensure a positive experience for both our patients and your organization, then complete and submit the Patient Special Event Request Form below at least two weeks prior to your requested visit.

Children's of Mississippi looks forward to partnering with community organizations in facilitating patient special events that are:

  • Highly engaging, therapeutic, and educational for children
  • Developmentally appropriate for patients of all ages (infant-young adult)
  • Physically and emotionally safe for patients, their families, and staff

Planning Your Visit

  • Each visitor is screened on-site upon entrance to Children's of Mississippi, and visitor compliance with the following safety precautions is required throughout the entirety of the visit:
    • Frequent hand washing
    • Social distancing
    • Wearing a mask over nose and mouth in areas required by COVID-19 guidelines 
    • Truthful responses to screening questions
    • Self-monitoring for symptoms of illness
  • Patient special event visitors present their driver's licenses or state-issued photo ID cards on the day of the scheduled visit for screening purposes.
  • Patient special event visitors are escorted by a UMMC staff member at all times. Patient special event visitors under 18 years of age are chaperoned by adult members of the visiting group. Patient special event visitors under the age of 16 are not permitted to visit clinical areas within the hospital (this includes the children and siblings of visiting group members).
  • Visitors may not distribute materials, discuss, or plan activities related to religious or political content.
  • Patient special events include a therapeutic element for patients and their families to enjoy. A Child Life representative reviews event details with your organization prior to the event.
  • Due to patient confidentiality, patient special event visitors are NOT permitted to take pictures or videos of patients and families. Visitors may take photographs of themselves in areas approved and monitored by Child Life staff. Children's of Mississippi's Office of Communications and Marketing oversees requests for photographs or videos of patients.
  • Patient special event guidelines, scheduling availability, and confirmation of events are subject to change based on the current health status of our community and hospital policy.

During Your Visit

  • Due to a fluctuating hospital census and patients' individual circumstances, we are unable to predict the number of patients available during your visit.
  • Groups of up to 15 visitors are accommodated. Groups larger than five may be divided into smaller groups during the event to meet safety standards related to the COVID-19 pandemic.
  • Please note that children in a hospital setting are often feeling unwell, receiving treatment, or experiencing stressful circumstances. Patient reactions, event attendance, length of patient attendance, and attention spans vary based on what children and their families are experiencing in the medical setting.
  • We encourage patient special event visitors to carpool due to parking availability. We are able to accommodate visitor parking in Garage C next to the Sanderson Tower. Bring your parking ticket with you to the Sanderson Tower entrance for a hospital representative to provide parking validation.
  • Oversized vehicle or bus parking requires approval before your visit. Please note on the attached form if patient special event visitors are arriving by car, oversized vehicle, or bus.
  • Plan to arrive 15 minutes before your scheduled visit. If you are arriving late or need to cancel your visit, email at your earliest convenience.
  • Dress appropriate for a hospital setting. Please wear closed-toe shoes. Mascot and character costumes require approval by the Child Life department prior to your visit.
  • Patients can be very sensitive to smells. Refrain from the use of tobacco products and perfume/cologne prior to your visit.
  • Due to the Health Insurance Portability and Accountability Act (HIPAA), patient information including diagnosis and treatment details is not disclosed by staff and is not discussed during your visit.
  • Items provided to patients and activity supplies are reviewed and approved by the Child Life representative prior to the patient special event.
  • Due to food allergies and diet restrictions, food and beverage items are discouraged and require pre-approval prior to patient special events.
  • Patient special events are primarily scheduled for 1 hour on Monday-Friday between 10 AM-12 PM and 1 PM-3 PM.

Thank you again for your interest in visiting Children's of Mississippi and hosting a meaningful experience for our patients. We greatly appreciate your willingness to share your time, talents, and compassion with our patients and their families!

Name of Group* 
     City/State/Zip -
Contact Person* 
Email Address* 
Phone Number*() -    
Number in Group (no more than 15)*  
Ages (16+)
Preferred Date/Time of Visit (M-F, 1 hour between 10am-12pm or 1pm-3pm, weekends unavailable
     First Choice* Date:      Time: :    
     Second Choice* Date:      Time: :    
Please describe your patient special event/activity* 
As a representative of
Contact Name 
By checking the Affirmation box above, I affirm that the information I have provided is correct and true, and that this checkbox represents my signature as the Contact Name listed.