Hotel Special Needs Accommodation Consent Form
Guest Name
Reservation Number
Check-in Date
Check-out Date
Contact Email
Contact Phone
Details of Special Needs or Accessibility Requirements
Mobility Assistance
Hearing Impairment Support
Vision Impairment Support
Special Dietary Requirements
Other (please specify below)
If "Other", please specify
Consent
I consent to the hotel using my information to provide special accommodations as described above.
Guest Signature
Date