Dietary Accommodations Form

Dining Services

Conference Information

Camp/Conference Attending

Beginning Date

To What is the end date?

Participant Information

Participant Name

Participant Age

Participant Phone:

Participant Email

Food Allergy or Restriction

Dairy
Soy
Eggs
Peanuts
Tree Nuts
Fish
Shellfish
Wheat (non-celiac)
Sesame
Celiac Disease

Other allergy or condition requiring a special diet

What types of contact will cause a reaction:

trace,
cross-contact
actual ingestion of food

Does the participant understand the food allergy and what needs to be done to manage it?

Yes
No

Is there any other information you would like to share to help us meet the participant's needs?

Parent/Guardian Information

Parent or Guardian Name (if participant is under 18 years of age):

Relationship to Participant:

Parent/GuardianCellPhone

Parent/Guardian Home Phone

Parent/Guardian Email:

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Dining Resources

RESOURCES

STUDENT AFFAIRS

PO Box 641066 | Lighty 360

Dining Services, PO Box 641726 , Pullman, WA, 99164-1726 Email Phone: 509-335-5498

Log into your UREC Account here

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