La Vida Expeditions Food Form: Allergy and Dietary Needs Details
Please fill this form out at least two weeks prior to your expedition so that we can prepare your food.
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@gordon.edu
Please select from the categories below:
*
I am attending as a Gordon College Student
I am attending with the Adirondack Leadership Program
I am attending as part of a group (Church, Corporate, etc)
I am attending with Compass
I am a La Vida staff member
What is the name of the group or organization?
What are your trip dates for your College Expedition?
*
May 17-28
July 7-July 18
July 21-August 1
August 8/9-20
What are your trip dates for ALP expedition?
*
June 27-July 4
July 11-July 18
In regular day-to-day, I would describe my appetite as
*
Lower than average
Average
Higher tha average
When doing more strenuous activity, I would describe my appetite as
*
Lower than average
Average
Higher than average
Please select your allergies and/or dietary needs.
*
No Allergies
Tree Nut Allergy
Peanut Allergy
Dairy Allergy/Intolerance
Gluten Allergy
Celiac
Vegetarian
Vegan
Other
Which tree nuts are you allergic to?
*
Are there any tree nuts you can eat? If yes, list below.
Does your allergy cause an anaphylactic reaction?
*
Yes
No
Please describe your last reaction and include dates.
*
Do you carry an EpiPen for your allergy?
*
Yes
No
Is this precautionary or have you had to use it?
*
Used before
Precautionary
Are you affected by airborne allergens?
Yes
No
Are you affected by touching the allergen?
Yes
No
Are you affected by cross-contamination?
Yes
No
Are you comfortable being on a patrol where other students are eating nuts/nut products?
Yes
No
Can you eat foods processed in a facility that produces nuts (as long as nuts aren't in the ingredients list; i.e. M&M's, certain granola bars/cereal)?
Yes
No
Can you eat some types of tree nuts as a replacement?
Yes
No
Please List tree nuts allowed to be eaten.
*
Can you eat peanuts? (Main snack is trail mix with peanuts. We will do a modified version if necessary).
Yes
No
Can you eat peanut butter? This is the main source of protein for lunches. If not, we'll need to find an alternative (sometimes sun butter).
Yes
No
Can you have food that lists milk as one of the last ingredients?
Yes
No
Can you have lactose free dairy? (i.e. lactose-free ice cream, Parmesan/sharp cheddar cheese, butter)
Yes
No
Other
Can you eat chocolate with dairy? (i.e. M&M's)
Yes
No
Can you eat food items that say "may contain wheat"?
Yes
No
Can you eat food items that don't specify it's gluten-free, but there is no wheat in the ingredients? (i.e. oats, granola, etc.)
Yes
No
Lunches are family style: meaning everyone shares the same jars of PB and use the same knife to spread PB on crackers. Are you okay if that knife is also used for your crackers?
Yes
No
Is there anything you would like to clarify or add for the La Vida staff about your allergies or dietary needs? Do you have any questions? This may include whether your solo fast could be affected by a dietary or medical condition.
Submit
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