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The Superhero Box Form
Would you please answer the following questions to help us understand your child’s preferences better?
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Email
*
Your email
Your name
Your answer
Your child’s name
Your answer
Pronouns
She/Her
He/Him
They/Them
Other:
Clear selection
Your child age, years
1-2
3-5
6-9
10-14
Clear selection
What school does your child attend?
Your answer
What day does your child need lunch?
Monday
Tuesday
Wednesday
Thursday
Friday
Your Child's Dietary Restrictions
Nut-Free
Soy-Free
Dairy-Free
Gluten-Free
Pork-Free
Fish-Free
Vegetarian
Egg-Free
No Dietary Restrictions
Is what you answered above
an allergy?
YES
NO
If you answered yes or no please elaborate.
Your answer
Which of the following does your child like to eat?
Grilled Salmon
Grilled Chicken Breast
Braised Brisket
Meatballs
Veggie or Meat Dumplings
Beans
Lentils
Baked Falafel
Brown Rice
White Rice
Quinoa
Couscous
Pasta with Butter
Pasta with Tomato Sauce
Pasta with Nut-Free Pesto Sauce
Mac & Cheese
Grilled Cheese
Cooked Sweet Potato
Cooked Brussel Sprouts
Cooked Cauliflower
Cooked Broccoli
Soft Boiled Eggs
Roasted Potatoes
Other:
What are some meals you like to cook or order for your child?
Your answer
Which does your child prefer?
Simpler food
Very flavorful food
Somewhere in between
Clear selection
What particular things does your child NOT like to eat?
Your answer
How strongly should we avoid these foods?
Somewhat
1
2
3
4
5
Very much
Clear selection
A copy of your responses will be emailed to the address you provided.
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