Food Allergy Form

(Please note your form session will expire after 15 minutes.)

Use this form to indicate food allergies including: fish, shellfish, tree nuts, peanuts, milk, eggs, wheat, and soy. At the bottom of this form you can also indicate whether you use an Epi-pen or wear a Medic Alert bracelet. Please fill out all required fields and descriptions of your allergies.

Student Name:

Phone:

Email:

Fish Allergies - Which fish?

Fish Allergies - How severe? (Ingest/inhale/on contact.)

Shellfish Allergies - Which shellfish?

Shellfish Allergies - How severe? (Ingest/inhale/on contact.)

Tree Nuts - Which nuts?

Tree Nuts - How severe? (Ingest/inhale/on contact.)

Peanuts - How severe? (Ingest/inhale/on contact.)

Milk - How severe? (Ingest/inhale/on contact.)

Is it a milk allergy or an intolerance?

Eggs - How severe? (Ingest/inhale/on contact.)

Wheat - Do you have a Wheat Allergy or Celiac Disease?

Sesame - How severe? (Ingest/inhale/on contact.)

Soy - How severe? (Ingest/inhale/on contact.)

Other allergens - How severe? (Ingest/inhale/on contact.)

Food Allergy Disclaimer
Gettysburg College Dining Services makes every attempt to identify ingredients that may cause allergic reactions for those with food allergies. Every effort is made to instruct our food production staff on the severity of food allergies. In addition, we label items with possible allergen-containing ingredients; however, there is always a risk of contamination. There is also a possibility that manufacturers of the commercial foods we use could change the formulation at any time, without notice. Customers concerned with food allergies need to be aware of this risk. Dining Services will not assume any liability for adverse reactions to foods consumed, or items one may come in contact with while eating at any College establishment. Students with food allergies are encouraged to contact Dining Services 717-337-6326 for additional information and/or support.