Allergy Notification Form
This form should be completed of you have any allergies or food intolerances so we can know how prepare the food for the evening.
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Does you have any food allergies or intolerances?
*
Yes
No
Please select your food allergies below.
If you ticked any of the above boxes please provide further details of the nature of the allergy/intolerance:
*
Does you need to carry an EpiPen or autoinjector?
*
Yes
No
Full Name of Emergency Contact
*
First Name
Last Name
Phone Number Emergency Contact
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date
*
-
Month
-
Day
Year
Date
Signature
*
Submit
Submit
Should be Empty: