Dining Experience
To best prepare for your arrival, please complete this form if you have any allergies or dietary restrictions at least one week in advance. Our culinary team has planned the menu to accommodate general gluten-free and dairy-free needs. If you have a specific medical condition or severe allergy, please specify in the form below.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Dining Location
*
Purdy Dining Room
Hill Dining Hall
Please select the week(s) that you will be here.
*
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7
Week 8
Week 9
Gender
*
Male
Female
Age
*
Allergy/Dietary Restrictions: Select all that apply.
Gluten/Wheat
Dairy
Eggs
Seafood
Shellfish
Tree Nuts
Soy
Peanuts
Sesame
Vegan
Other
From the categories above, please name the specific allergy/dietary restriction.
Other Allergies: Select all that apply.
Alliums
Nightshades
Seed Oil
Red Meat
MSG
Coconut
Legumes
Certain Fruits
From the categories above, please name the specific allergy/dietary restriction.
If you selected "other," name the allergy/dietary restriction.
Specific Medical Conditions or Severe Allergies
Select the severity.
Airborne
Anaphylactic
Cross-contact
Other
If you selected "other," name it below.
Please describe your medical condition or severe allergy.
Do you have any concerns about cross contamination? If so, please explain.
Disclaimer
We strive to accommodate all dietary restrictions and food allergies with care and attention. However, due to the high-volume nature of our kitchens and the set structure of our daily menu, the variety of available meal options may be limited depending on the specific dietary needs indicated. While we make every reasonable effort to provide safe and suitable meals, we appreciate your understanding that accommodations are made within the capabilities of our facilities and staffing. Our goal is to serve you well while maintaining excellence in food service for all our members.
Provide your signature.
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