PacSky Dietary Restriction Notification Form
Please complete and submit this form no less than 30 days prior to your time at a Pacific Skyline Council camp in order for the necessary substitutions to be made. If this form is not received within the specified time, we cannot guarantee appropriate food substitutions. We will do our best to accommodate your needs, but some restrictions or for a person with restrictions to more than 2 types of food, we may ask you to bring your own food. Please be sure to bring your medication (e.g., Epipen)

Please complete ONE FORM PER INDIVIDUAL with a dietary restriction. ALL FIELDS ARE REQUIRED
Email address *
Camp Attending *
Arrival Date *
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Departure Date *
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Unit Type *
Unit Number *
Name of person with restriction. *
Name of parent (if individual is under 18) *
If the person with the restriction is under 18, please put the name of their parent here. If they are over 18, please put N/A
Phone Number of Individual (OR parent if individual is under 18) *
Email of individual (OR parent if individual is under 18) *
Restriction type or types (e.g., peanut allergy, vegetarian, etc.) *
If an allergy is it by? *
Select all that apply.
Required
Please explain the severity of the allergy (e.g., anaphylactic) *
Is the allergy controlled by medication? *
What is the medication? *
Symptoms experienced (e.g., vomiting) *
Substitution ideas *
Any other information you think would be useful to the food service staff at camp. *
A copy of your responses will be emailed to the address you provided.
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