Pok-O-MacCready Outdoor Education Center - Making Learning Natural!
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Special Dietary Needs Form

We know how important hearty meals are for students and chaperones who spend all day outside.  Therefore, we do our best to provide delicious, accessible meals to meet everyone’s needs.  Please use this form to tell us of any dietary restrictions you or your child has so we can better provide balanced meals during your group’s visit.  In order for us to fully meet everyone’s needs during your trip, please complete this form at least 2 weeks before your groups’ arrival date.

Please DO NOT use this form to inform us of food likes or dislikes.  We make every effort to serve meals that everyone will be able to enjoy… and many of our students find themselves liking foods they never expected to like!  If you are concerned about a severely picky eater, please contact the chef through other methods.

Name:

 Student

 Teacher

 Chaperone

* Parent Contact (for students):

* Contact phone number:

* Contact e-mail address:

School/Group:

Grade (students only):

Sex:

 * We will only use this contact information if we need clarification about the information provided, or to respond to questions included below.

Religious/Moral Restrictions
Given the size of our staff and kitchen, and the diverse needs of our clients, we cannot promise to serve truly halal or kosher food.  We will do our best to meet the needs of observant students in multiple ways, however.  Please check all that will apply during your/your student’s stay at Pok-O.

Vegetarian – eggs and dairy are ok

Vegetarian – dairy is ok, no eggs

Vegan – no meat, eggs, or dairy

No Pork

No meat and dairy in the same meal (a vegetarian option will be provided for the meal)

Other

Additional Information:

Food Intolerances (NOT Allergies)

Lactose Intolerance

Cannot have milk

Cannot have ice cream

Cannot have cheese or other cultured dairy products

CAN eat the following dairy products in the following amounts:

Gluten Intolerance

Cannot eat wheat, rye, or barley

Cannot eat oats

Other Intolerance(s):

Additional information, including severity of food intolerance(s) and any clarifications:

Food Allergies (NOT Intolerances)

Peanuts

Other Nuts

Walnuts

Almonds

Cashews

Pecans

Sesame Seeds

Dairy

Eggs

Shellfish

Fish

Soy

Wheat

Other

Additional information, including reactions and severity (especially if anaphylaxis) and any clarifications:

Additional comments or questions for the chef:

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Contact Us!
ph: (518) 963-7967
fax: (518) 963-4165
PO Box 397
1391 Reber Rd
Willsboro, NY 12996
 


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