Special Diet Request Form EVENT INFORMATIONEvent Date* MM slash DD slash YYYY Additional Dates?If your event includes more than one meal service and/or dates, please describe here: Event Name* SPECIAL DIET REQUESTEDPlease let us know the nature of the special dietary accommodation you are requesting.I am requesting:*VEGAN DIETVEGETARIAN DIETNON-MEDICAL Ingredient Avoidance (i.e.: gluten free, dairy free)MEDICAL DIET (i.e.: allergy, Celiac)MORE THAN ONE SPECIAL DIETVEGAN DIETVegan options are made with only plant based foods. I am requesting a VEGAN DIET VEGETARIAN DIETFor a vegetarian diet, please let us know the foods you DO consume.I DO consume: FISH EGG DAIRY SOY OTHER If "other," please explain:AVOIDANCE DIETUse this section to select the food ingredient(s) you AVOID. Please understand that we treat all selected ingredients as allergy. We will not distinguish between allergy, intolerance, and preference. I AVOID: (please select all that apply) WHEAT GLUTEN DAIRY SOY FISH SHELLFISH EGG PEANUT TREENUT OTHER If "other," please explain:ADDITIONAL INFORMATIONI have:* SEVERE FOOD ALLERGY and carry an epinephrine auto-injector (i.e. EpiPen, AuviQ). CELIAC DISEASE Both CELIAC DISEASE and SEVERE FOOD ALLERGY Neither celiac or severe food allergy Would you like to provide us with additional information? YES NO Provide additional information here.Use this section to provide common foods you avoid and your usual substitutions.*Click on the plus sign (+) to add additional items.Food AvoidedUsual Substitution ATTENDEE INFORMATIONName* First Last Email* Phone*Contact Preference Email Phone I am an adult, requesting the above accommodations for myself.*EWU Dining and Catering Services strongly suggests that the event attendee fills out this form for themselves. Yes No, I am the event planner completing form for an adult attendee. (discouraged) No, I am a parent/legal guardian completing form for a minor. FOOD ALLERGY/INTOLERANCE DISCLAIMERFood Allergy/Intolerance Disclaimer: EWU Dining Services makes effort to identify ingredients that may cause allergic reactions for those individuals with food allergies and other food ingredient related reactions. However, there is always a risk of contamination and the possibility that the manufacturer of the commercial foods we use could change the formulation at any time and without notice. Additionally, the foods we prepare without gluten ingredients are not certified Gluten Free. Consumers concerned about food ingredients should be aware of these risks.AGREE AND CONTINUEBy clicking Agree and Continue, I hereby:*State that I have read and understand the Food Allergy/Intolerance Disclaimer and give consent for Dining and Catering Services to communicate with me regarding my submitted special diet request form. Agree and Continue Δ
