Special Diet and Allergy Information

Please complete this form if your Scout has a special diet due to allergies or religious requirement.

Participant's Name * First Last
Participant's Age *

Participant's age at time of camp attendance.
Unit Number *
Council Name *
Council Name *
Week of Camp *
Reason for Special Diet *

Reason for Special Diet Allergy Religious Other Other
Nature of the Special Diet *

Please describe the allergy or special need. What is the Scout not permitted to consume? What are acceptable alternatives?
Emergency Contact information
In-camp Leader Name * First Last
Who will be the adult contact at camp?
In-camp leader phone number * - ### - ### ####
Parent or Guardian Name * First Last
Parent of Guardian Phone number * - ### - ### ####
Parent's email *

For confirmation the form was submitted
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If possible, please upload an picture of your Scout to help our food services staff.