REQUEST FOR RESERVED SEATING FOR INDIVIDUALS WITH DISABILITIES
This form is also available electronically on the Churchill High School website, under “students”
Name of Graduating Senior_____________________________
Name of individual(s)
Disability(ies)
ID#______________
Wheelchair Seating Space
1.
Yes
No
2.
Yes
No
3.
Yes
No
4.
Yes
No
Contact Person:_____________________________________ Phone__________
Contact Email Address: _____________________________
PLEASE NOTE:
 Individuals with handicaps should enter DAR at the D Street entrance.
 Per DAR regulations, each individual requesting reserved seating in the handicapped
section MUST be accompanied by one non-handicapped person. Each person must
present a ticket to enter.
 Restrooms that are reserved for individuals with handicaps are located behind the roped
section where graduates line up on the D Street side of the hall.
 Please arrive early (no later than 9:00 a.m.) to be seated prior to the beginning of the
ceremony.
 Duplicate this form as needed and return a completed copy by April 15, 2016 to Mrs.
[email protected], Winston Churchill High School, 11300 Gainsborough
Road, Potomac, Maryland 20854.