Special Dietary Needs Form
User Manual: Special-Dietary-Needs-Form
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Pennsylvania Dutch Council Boy Scouts of America Camp Mack Summer Camp Special Dietary Needs Form The Pennsylvania Dutch Council, Boy Scouts of America, strives to serve its campers nutritious meals which meet or exceed all applicable requirements and standards. The variety of foods available at meals is usually adequate to suit the nutritional needs of most campers. In order to meet the needs of participants who have special dietary requirements due to allergies, food intolerances, or other health issues, as well as those who follow alternate diets for ethical or religious reasons, it is necessary to obtain as much information as possible prior to arrival at camp. Please be as specific as possible regarding exact nature and severity of any allergy or intolerance. This information is necessary to determine whether the individual can simply avoid eating certain foods, whether we need to assess all ingredients in every food, or whether offending foods can or cannot be stored or served where they may contact the individual or things he or she may eat. Additionally, extra time may be required to obtain special foods such as gluten-free bread or vegan entrees. While the Pennsylvania Dutch Council attempts to provide meals which meet these special needs as much as possible, it is still the responsibility of the individual to avoid those foods which he or she is unable to eat. In some rare cases, it may be necessary for the camper to bring some food items, which can then be prepared by the camp staff. Name: _____________________________________________________ Unit: _____________ Dates of attendance at camp: _____________________________________________________ Contact Name for Further Information if Needed: _____________________________________ Relationship to Camper: ________________________ Phone: ___________________________ Food Allergies? YES NO What are they: _________________________________________________________________ How severe is the Allergy? MODERATE STRONG SEVERE Other information we may need to know about these allergies? __________________________ ______________________________________________________________________________ ______________________________________________________________________________ Other Special Diet? Vegetarian Vegan Diabetic Other: __________________ Signature (Parent/Guardian if form for Scout): ______________________ Date: _____________ Please return this form attached to your BSA Medical Form. Forms turned during Camp check-in upon arrival will be accepted but provisions may not be available. Pennsylvania Dutch Council 630 Janet Ave. Suite B-114, Lancaster, PA 17601 www.padutchbsa.org
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