STEM CAMP - DIETARY RESTRICTION FORM

  • What is the best phone number to contact attendee's parent/guardian?
  • What is the best email address to contact attendee's parent/guardian?
  • Which Summer Camp will you be attending?
  • Please describe the type of dietary restriction in detail.
  • Please select all that apply. Shift+Click to select multiple.
  • If you selected "Other" [above] please explain.
  • What is the severity of the allergy? i.e. anaphylactic
  • What are the symptoms experienced by participant? i.e. vomiting
  • Is allergy controlled by medication? Yes/No, if yes, what medication(s) are prescribed?
  • If medication is prescribed, will participant have medication(s) at camp? If yes, what is the prescribed dosage?
  • What are some substitution ideas?
  • Is there any other information you can provide that would be useful to our Food Service Staff to ensure for an awesome week at camp?
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