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CHS Winter Percussion Food Planning Questionnaire
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* Indicates required question
Email
*
Your email
Student Name & Last Name
*
Your answer
Allergies
I have food allergies
*
Yes
No
I carry medication (Benadryl, EpiPen, etc.) for my food allergy. *(Allergies are a physiological reaction, NOT just a strong dislike).
*
Yes
No
List ALL food allergies
Your answer
Restrictions
I can eat anything, no restrictions.
*
Yes
No
I am completely lactose intolerant (unable to digest dairy at all).
*
Yes
No
I am vegetarian, but not vegan (eggs & dairy products are acceptable).
*
Yes
No
I am vegan (no animal products at all).
*
Yes
No
I require gluten-free food.
*
Yes
No
I am diabetic and need to control my blood sugar level.
*
Yes
No
I will eat the following foods:
Poultry
*
Yes
No
Beef
*
Yes
No
Dairy products (milk, cheese, ice cream, etc.)
*
Yes
No
Please check here if you plan to bring your own food and you DO NOT plan to eat the food provided.
Please check here
Anything else we should know about your dietary needs?
Your answer
Parent or Guardian Name & Last Name
*
Your answer
Parent or Guardian 1 Cell Phone #: (___) ___ - ____
*
Your answer
Parent or Guardian 2 Cell Phone #: (___) ___ - ____
*
Your answer
Please check here to allow the Food Coordinator to contact you. Please provide the best contact numbers for the parent(s) and student so the Food Coordinator may contact you with questions.
Please check here
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