ECHO Education Event Dietary Restrictions Request Form

1.Full Name (as it appears on your ID)(Required.)

2.Phone Number(Required.)

3.Email Address(Required.)

5.Please check the boxes below to indicate your understanding.(Required.)

I understand that Paediatric Project ECHO makes every attempt to identify food(s) and ingredient(s) that may cause an allergic reaction to those with food allergies and/or accommodate those with specific dietary restrictions.

I understand that while Paediatric Project ECHO will take every reasonable precaution in an effort to accommodate my request(s), it is impossible for Paediatric Project ECHO to provide any guarantee that I will not come into contact with my listed allergen(s) and/or dietary restriction(s) during this event.

ECHO Education Event Dietary Restrictions Request Form - November 20-21, 2025