Allergy and Dietary Needs Details Form
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 18-29
June 24-July 5
July 8-19
July 22-August 2
August 9/10-21
What are your trip dates for ALP expedition?
*
June 28-July 5
July 12-July 19
July 26-August 2
Please select your allergies and/or dietary needs.
*
Peanut Allergy
Tree Nut Allergy
Dairy Allergy/Intolerance
Gluten Allergy
Celiac
Vegetarian
Vegan
Bee Allergy
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
Tree nuts allowed to be eaten.
*
Can you eat peanuts? (Main snack is trail mix with peanuts. We can 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 more beef jerky or cliff bars).
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
Can you eat chocolate with dairy? (i.e. M&M's, candy bars)
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
Do you have any questions or other information for the La Vida staff regarding your allergies or food needs?
Submit
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