George Fox University

Name(Required)

Management of food allergies and special dietary needs in our cafes is done with your safety in mind and encourages communication between you and the culinary team on campus. Filling out this form helps us to understand your individual dietary needs and create a plan with you that ensures inclusivity and the ability to maximize your meal plan.

First Last

Phone Number(Required)

What foods do you avoid to meet your dietary needs?(Required)

Please list any food (besides those listed above) that you avoid due to dietary needs:

Please list the type of gluten-avoidance:

Please list some examples of foods you like to eat to help us better prepare to serve you:

Do you carry allergy medication in case of an accidental exposure?(Required)

Yes

Do you know the common sources of, and do you avoid, the foods to which you are allergic?(Required)

Yes

I do not have food allergies. I have a dietary restriction

Please share more about your dietary restriction:

What foods are you restricted from eating?

Would you like to speak with a Bon Appétit Manager or Registered Dietician? (Required)

Yes, I would like to meet with a Manager

Yes, I would like to speak with a Registered Dietician

Is there anything else you wish to share?

Individuals with food allergies and celiac disease are considered part of a protected class under the Americans with Disabilities Act (ADA). If you have a food allergy, you are encouraged to register with the Office of Disability & Accessibility Services by visiting: https://www.georgefox.edu/offices/das/index.html

Food Allergen, Special Diet, and Nutrition Information Form