Special Needs Form

SLC Registration Forms -- Special Needs Form

Please complete this form by March 28 if your student has a special need such as a dietary restriction or physical/medical condition that requires a certain accommodation (ie. handicap accessibility, low floor, etc.). Create one student per form. Please provide as much information as possible regarding the requirements, especially as it relates to food restrictions.

Student Name *

Chapter Name *

Adviser Name *

Adviser Email *

Parent Name *

Parent Emergency Phone Number *

Dietary Restriction

Special meals can be provided by the convention center for Kosher, Gluten Free, Vegan, Dairy Free, etc. Please state the type of restriction and be specific as to the types of food they CAN and CANNOT eat. Our regular breakfast menu will include yogurt, breakfast pastries, cereal, milk, juices, eggs, bacon or sausage, fresh fruit, French toast, breakfast potatoes. Our regular dinner menu will include salad choices, rolls and butter, vegetables, a selection of starches (either rice, pasta, or potato), entrees consisting of chicken and beef, and a dessert with water and soda available.

Medical/Physical Needs

Please state any special needs to accommodate a physical or medical restriction (ie. handicap-accessible room, use of a wheelchair on site, etc.)

If you are human, leave this field blank.