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Critical Diet Request Form

Lactose Intolerant
 Where dairy products are replaced with a soy substitute.
Rice milk and nutelex are also available options.
 
  
Full Name:
Name of Group you are attending with:
Dates of your stay:   until 
The person in charge of your group:
Your age:  Phone:


Please list in detail your dietary restrictions, either by clearly stating the limited foods you can eat, OR the restrictions on foods you cannot eat: whichever is easiest to describe your diet.  (If you require specific brands of foods, please list understanding there will be an extra cost to supply).
I am ABLE to eat:
I am UNABLE to eat:
What is the likely consequence of your diet not being met:

Mild         Serious         Potentially Fatal
Can you manage your own diet (i.e. do not need supervision in selecting foods)?    

  Yes      No

 


Please note that Camp Clayton reserves the right to advise that they are unable to provide this special diet, where on assessing the request, they are unable to meet the requirements.  This will be advised by the Chef in Charge.  

Please add any further comment and information if required.  The Chef in Charge can be contacted on 6425 1893 during their rostered hours of work (please avoid calling at meal times).

 

 

Please feel free to offer any suggestions or comments on our Website Feedback Line

For a free brochure, email us on admin@campclayton.org.au
 and provide your mailing address.

Camp Clayton - 41 Clayton Road,
PO Box 3184, Ulverstone Tasmania  7315