Food Allergy And Religious Dietary Information Form printable pdf download

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:

YES

(Please check one)

What are they: _____________________________________________________________________________

How severe is the Allergy:

MODERATE

STRONG

SEVERE

(Please choose one)

Any other information we need to know? ________________________________________________________

__________________________________________________________________________________________

Religious Needs:

YES

(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

Food Allergy And Religious Dietary Information Form