PMEA Student Dietary Needs Form (16-17)
Please complete the form below ONLY if your child/student requires special dietary considerations. *A separate online form must be submitted for each type of fest/festival (i.e. band, chorus, jazz, orchestra), however the information will follow the student should he/she advance to additional levels (i.e. district, region, state). Should any information change from various levels, a new online form must be submitted.
**Must be completed at least four weeks prior to the start of the Fest/Festival.
A copy of this online form will be emailed to the director's email address listed on this form. Please contact the PMEA office at 1-888-919-7632 (or email email@example.com) if you do not receive the copy.
Parent/Guardian Contact Name:
Parent/Guardian Contact Email:
Parent/Guardian Contact Phone #:
Parent/Guardian Contact Phone # Type:
Student's PMEA District (please confirm your district number with your director before making a selection):
District 1: (Allegheny, Fayette, Greene, Washington, Westmoreland counties)
District 2: (Cameron, Crawford, Elk, Erie, McKean, Potter, Warren counties)
District 3: (Armstrong, Clarion, Forest, Indiana, Jefferson, Venango counties)
District 4: (Centre, Clearfield, Clinton, Fulton, Huntingdon, Juniata, Mifflin counties)
District 5: (Beaver, Butler, Lawrence, Mercer counties)
District 6: (Bedford, Blair, Cambria, Somerset counties)
District 7: (Adams, Cumberland, Dauphin, Franklin, Lancaster, Lebanon, Perry, York counties)
District 8: (Bradford, Columbia, Lycoming, Montour, Northumberland, Snyder, Sullivan, Tioga, Union counties)
District 9: (Lackawanna, Luzerne, Susquehanna, Wayne, Wyoming counties)
District 10: (Berks, Carbon, Lehigh, Monroe, Northampton, Pike, Schuylkill counties)
District 11: (Bucks, Montgomery counties)
District 12: (Chester, Delaware, Philadelphia counties)
(Check all that apply)
Vegetarian (can eat dairy products)
Vegan (no dairy products)
None of the Above
Please list food allergies below:
(Please be specific when listing - i.e. nuts, fish, fruits, peanut butter) *If none - write N/A or none in the box below.
Do you use an Epi-pen? (If so, please note that a medical administration form must be completed and submitted to PMEA)
Select an Option
Add link to the med admin form...
This is an update to the initial submission (i.e. new allergy, information was missing from the first submission, etc.)
Do Not Fill This Out