Dietary Needs Questionnaire

This form should be completed ONLY for campers who have dietary restrictions due to severe or life-threatening allergies or other major dietary needs. We will use this information to determine the best and safest ways we can meet your child’s needs.

This form is not required for campers with lesser food sensitivities and/or common dietary restrictions, such as those who have minor sensitivities to gluten or dairy or who follow a vegan/vegetarian diet. That information will be collected at another time.

Please complete this form only once per camper. If additional information is necessary, our staff will reach out to you prior to accepting your online camper registration.

Camper First and Last Name

Parent Name

First Name

Last Name

Phone Number

Which of our programs is your child planning to attend?

What is the reason for your child's dietary restriction?

Select all necessary dietary restrictions below:

Gluten

Dairy

Peanuts/Other Nuts

Seafood

Eggs

Soy

Other (Explain fully in the box below.)

For each of the boxes checked above, describe your child's reaction if exposed to the restricted food. Include how often these reactions have occurred in the past.

For each of the boxes checked above, describe the necessary treatment for the reaction. Include how well your child responds to the treatment.