Holiday Lake 4-H Dietary Needs Information Form for Horizons Unlimited
Please fill out the form below as accurately as possible so that we can best accommodate you during your time here with us during the Horizons Unlimited event.
Participant Name
*
First Name
Last Name
Please select all dietary restrictions and/or allergies that effect you.
*
Alpha Gal (No mammal meat)
No Pork (no byproducts)
No Beef (no byproducts)
Vegetarian
Gluten Free
Wheat Allergy
Lactose Intolerant
Dairy Allergy
Egg Allergy
Peanut Allergy
Tree nut Allergy
Sesame Allergy
Soy Allergy
Shellfish Allergy
Seafood Allergy
Other
Please explain the severity of dietary needs and allergies. **For example, describe your sensitivity to your allergen ( airborne, trace cross contamination, etc.) or if lactose intolerant, please specify tolerance for dairy products (milk, butter, cheeses, cooked dairy, etc.)
*
Please give as much detail as possible
Please indicate your preference for accommodations needed for your diet: ***NOTE: We will make all reasonable efforts to accommodate you, however, there are instances where we may not be able to provide alternatives for your needs.*
*
YES, please provide as many substitutions as possible to meet my dietary needs. I will eat the food prepared for the event.
NO, do not provide substitutions for my dietary needs. I will eat the food prepared for the event and AVOID MY ALLERGENS ON MY OWN.
NO, do not provide substitutions for my dietary needs. I will BRING MY OWN FOOD to accommodate my diet.
Please indicate whether you'd like to be contacted with information regarding the event menu and available substitutes specific to your needs:
*
YES, please contact me with details for the menu and subsitutes
NO, there is no need to contact me with more information
Other
In case we have questions for you, please provide your E-mail
*
example@example.com
In case we have questions for you, please provide your Phone Number
*
Please select all meals you WILL be attending
*
Thursday Dinner
Friday Breakfast
Friday Lunch
Friday Dinner
Saturday Breakfast
Saturday Lunch
Saturday Dinner
Sunday Breakfast
Please provide any additional information or requests that you'd like to communicate to the Kitchen Staff. Thank you!
Submit
Should be Empty: