1.Do you have any food allergies?

Yes

No

2.If so, what are they?

3.Are they airborne or by consumption?

Airborne

Consumption

4.Are they life-threatening or require medical attention?

Yes

No

5.If yes, do you carry an epi pen or other anaphylaxis aid?

Yes

No

6.Do you have any accessibility requirements?

Yes

No

7.If so, what are they? Please explain in detail much as you are comfortable with and suggest some solutions to help you during the meetings.

Auditory

Physical

Speech

Visual

Other

8.Councillor Name: