Disability Services Request
Please complete and submit this form by June 9 to request Disability Services.
Contact the Disability Services Coordinator (
) if you have any questions.
Cell phone number
(reachable at Pennsic)
The estimated date you will arrive at Pennsic
Will you need to recharge a scooter or battery for a medically-required device?
Please enter a description of your device:
Your preferred time to recharge:
7 am - 3 pm
3 pm - 10 pm
11 pm - 7 am
The location you prefer to use:
B (Battlefield) camping blocks
N (North) camping blocks
How often will you need to recharge?
This is only a request; we cannot guarantee port-a-john placement
Are you requesting placement of a port-a-john?
Reason for Request
Where are you requesting that it be placed? Be specific: camp name / block number / road intersection
Questions or Comments
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