Special Diet Request Form for Summer Conferences

Food Allergy/Intolerance Disclaimer: UR Dining Services makes effort to identify ingredients that may cause allergic reactions for those individuals with food allergies and other food ingredient related reactions. However, there is always a risk of contamination and the possibility that the manufacturer of the commercial foods we use could change the formulation at any time and without notice. Additionally, the foods we prepare without gluten ingredients are not certified Gluten Free. Consumers concerned about food ingredients should be aware of these risks. It is the responsibility of each individual with severe food allergies to carry with them an epinephrine auto-injector at all times.

Form must be completed and submitted at least two weeks before your arrival to campus.

*Required

Preferred Method of Communication: *
Meal period of first meal needed: *
Meal period of last meal needed: *
I am requesting more information about the following diet: Non-medical ingredient avoidance.
Check the following that apply:
If you have a medically diagnosed food allergy, please select the foods that you have to avoid:
I am an adult, requesting the above accommodations for myself: *