RESET.01 Dietary Requirements Form
We want every part of your RESET.01 experience to feel thoughtful and comfortable.Please complete the dietary form before the retreat so that all allergies, dietary restrictions and meal preferences can be provided to the culinary team in advance.
Date:
*
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Personal Information
Name
First Name
Last Name
Phone Number:
*
Format: (000) 000-0000.
Email:
*
example@example.com
Dietary Requirements (check all that apply)
No Dietary Restrictions
Vegan (No meat, poultry, fish, dairy, eggs, honey, or animal-derived ingredients.)
Vegetarian (No meat, poultry, or seafood.)
Gluten-Free (Requires meals free from wheat, barley, rye, and gluten-containing ingredients.)
Celiac Disease (Requires a strict gluten-free diet. Even small amounts of gluten or cross-contamination may cause a serious reaction.)
Lactose-Free (Avoids foods containing lactose (milk sugar). Dairy alternatives are preferred.)
Food Allergies (check all that apply)
Peanuts
Tree Nuts
Dairy
Eggs
Soy
Fish
Shellfish
Sesame
Other
Please provide details:
Additional Dietary Preferences or Medical Requirements
Cross-Contamination
Do you require precautions to avoid cross-contamination?
Yes
No
If yes, please specify:
Emergency Contact (Optional)
Name:
Relationship:
Phone Number:
Format: (000) 000-0000.
Declaration
I confirm that the information provided above is accurate and complete. I understand that while every reasonable effort will be made to accommodate my dietary requirements, I have disclosed all relevant dietary restrictions, allergies, and medical conditions.
Signature:
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: