Food Allergy/Aversion and Ingredient Exception Request

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Class ingredients may contain or come into contact with wheat, eggs, nuts and milk. We cannot guarantee that ingredients are free of common allergens. We are not able to make exceptions within 48 hours of any class or event

What is the date of the event that you are referencing in this form?
*

YYYY

Are you allergic to any of the following ingredients? Select all that apply
*

Please enter the product number

Gluten

Dairy (i.e. cow's milk, butter, heavy cream, cheese, etc.)

Eggs

Fish

Shellfish

Tree Nuts

Peanuts

Soy Products

Sesame

Other:

Required

I cannot have these ingredients because of a: *

Minor allergy

Major allergy

Personal preference

Minor aversion

Major aversion

Religious or philosophical reason

Required

If applicable, will you have an epipen with you when you attend this event?

Yes

Clear selection

Your name *

Phone number *

E-mail *

Preferred contact method *

Phone

Required

Questions and comments

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