Guest Group Food Allergy and Dietary Concerns

Please fill out this form if you have any Food Allergies or Dietary Concerns that we need to be aware of as we serve you. (Food Allergies, Vegetarian, Celiac Disease, etc.)

Group Name

Your Name

Your Email

Date of Event

1. Dietary Restrictions include: (check all that apply)

CeliacDiabeticGluten FreeNo PorkNo Red MeatVeganVegetarianOtherNot Applicable
[group group-diabetic]How do you manage the diabetes? (i.e. Are you on insulin? Do you take Metformin? Are you diet controlled? What are your dietary requirements? etc.) [/group]
[group group-1other] If "Other" please specify:
[/group]

2. Food Allergies include: (check all that apply)

Apples / PearsBananasBerriesNo PorkEggsFishKiwiPitted FruitPeanutsShellfishTree NutsDairy / Lactose IntolerantOtherNot Applicable
[group group-dairy-lactose]

How do you manage Dairy Allergen / Lactose Intolerance?

Take medication and eat/drink dairy products.Do not eat/drink dairy products.Generally avoid dairy products, but occasionally takes medication and indulges.

Do you require dairy alternatives while at camp?

YesNo
[/group]
[group group-nuts]

*Please note that we are a nut-aware facility.

[/group]
[group group-2other] If "Other" please specify:
[/group]

3. Please describe any exceptions to your allergy/dietary need. (For instance, "No scrambled eggs, but eggs in cookies is fine".)

4. What is the severity of the food allergy or dietary concern?

ModerateSevereCauses AnaphylaxisNot Applicable

Anything else that you would like us to be aware of as we prepare for your stay at Pioneer Camp