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Please fill out the following form to help us understand your physical condition.

Please select any of the dietary requirements below and state the total number of people it applies to in your group. If you have none, please set the number to 0: 


Nut Allergy

Gluten free




Lactose Intolerance


▪ I can confirm that I have received individual information from every participant which allows them the receive catering at Mount Cook Adventure Centre
▪ I can confirm that the information I have provided is correct and complete. I will inform Mount Cook Adventure Centre as soon as possible if there are any changes to this

PRIVACY NOTICE: This form will be kept securely and will be destroyed after 6 months if no incidents occurred during your stay. If an incident has been recorded, we may hold this data for up to 7 years (up to 20 years for U16’s)

Thanks for submitting!


This form must be completed by the assigned group leader on behalf of all guests who are having catering provided by Mount Cook. The purpose of this form is to provide catering suitable for all attendees dietary requirements.

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