Disability Services Request
Please complete and submit this form by June 9 to request Disability Services.

Contact the Disability Services Coordinator (disability@pennsicwar.org) if you have any questions.

Contact Info
Modern Name *
Your answer
SCA Name
Your answer
Email address *
Your answer
Cell phone number *
(reachable at Pennsic)
Your answer
Arrival Date *
The estimated date you will arrive at Pennsic
MM
/
DD
Recharging Services
Recharging Request
Will you need to recharge a scooter or battery for a medically-required device?
Device Type
Please enter a description of your device:
Your answer
Timeslot
Your preferred time to recharge:
Charging Station
The location you prefer to use:
Frequency
How often will you need to recharge?
Your answer
Port-a-john Request
This is only a request; we cannot guarantee port-a-john placement
Port-a-john Request
Are you requesting placement of a port-a-john?
Reason for Request
Your answer
Placement
Where are you requesting that it be placed? Be specific: camp name / block number / road intersection
Your answer
Other
Questions or Comments
Your answer
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