Food Allergy And Religious Dietary Information Form


Food Allergy and Religious Dietary Information Form
The Food Services Program Area at Hawk Mountain Scout Reservation is committed to insuring that your Scout
has the best meals that we can provide. We understand that many children are allergic to foods that we use every
day in the kitchen or that they may follow dietary guidelines of their religion.
If your Scout has any allergies to food or follows dietary guidelines of their religion, please complete the form
below. This form is very important to the Food Services Program Area. In order for your Scout to have adequate
food, we need to be aware of any dietary needs. It is also very important for us to know if the Scout has a severe
allergy, so that we may do everything that we are able to ensure the Scout does not come in contact with that
particular food. Please take the time to answer the few questions below.
You also have the option of providing your Scout’s meals. If this is chosen, the meal costs ($2.75-Breakfast;
$4.00- Lunch; $5.25-Dinner) will be deducted from the camper fee. (These costs are a revision from previously
published costs (2015) based on 2016 projected food costs.)
Sign and return the form no later than two weeks prior to your Scout’s camping week. Forms given on Sunday of
that week of camp will be accepted but provisions may not be available. This form is required in advance so
food can be purchased to assist the needs of the Scout. Mail the form to Hawk Mountain Council, ATTN: Food
Services Program Area, 5027 Pottsville Pike, Reading, PA 19605.
NAME: _________________________________________
TROOP/PACK: ________
Date/Week attending camp: ________________________
Food Allergies:
(Please check one)
What are they: _____________________________________________________________________________
How severe is the Allergy:
(Please choose one)
Any other information we need to know? ________________________________________________________
Religious Needs:
(Please circle one)
What can we do to help? _____________________________________________________________________
I choose
do not choose (Please choose one) to provide meals for my Scout. (If you choose to provide
meals for your Scout, please contact David Muldowney at 570.581.3116 for reduced camper fee pricing.)
Parent/Guardian Signature ______________________________________________ Date _____________
Phone Number ____________________ E-mail _______________________________________________
Revised 5/10/2016


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