Meal Preference

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Name *

First

Middle

Last

Role *

Other or Sandwich

Food Safety/Diet Preference

All of this information will be kept confidential.

Are You Lactose Intolerant (Or Dairy-free) *

Are You Gluten Intolerant *

Special Diet *

None
Vegetarian
Pescatarian
Vegan
Kosher
Halal
Other

Do You Have Any Food Allergies *

None
Peanuts
All Nuts
Shellfish
Other

Do you have any other notes you would like to share about food allergies? (i.e. Severity? Do you get a reaction from proximity to the food, or only from eating it? Do you carry an epi-pen? If so, can you use the epi-pen yourself?)

Food Preference

Pizza Type *

Any
Cheese
Pepperoni
Veggie
Can’t Eat Pizza

Sandwich Ingredients

Examples: Types of breads, Meats, Cheeses, Veggies, Condiments, etc You can include things you do like and don’t like.

Mexican Food

Examples: Burrito, Taco, Quesadilla, etc. Please also specify meat and other fillings

Favorite Snacks

Favorite Drinks

Do not include energy drinks these will never be supplied to students but you are free to bring your own!

Other Notes

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Email *

Food Safety/Diet Preference

Food Preference

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