Children's Culinary Assessment Form - THE HEALING CONNECTIVE

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Please fill out the below form to the best of your knowledge to help our team better understand your children’s specific needs. This helps us to understand your dietary needs while also providing us with further information about your kitchen.

Your Name: *

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Email: *

Phone Number: *

Spouse/Partner's Name: *

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Last

Children's Names and Ages: *

Address: *

Property Gate Code/Secondary Name & Number For Entrance

If you are in a gated/secured location that requires an access code or additional name please provide that here.

How many people will be eating these meals?

How often will you require services & which days? *

Monday
Tuesday
Wednesday
Thursday
Friday

Which meals will you be requiring?

Breakfast
Lunch
Dinner
Snacks

Please provide necessary details about your children's eating habits if necessary.

How would you like these meals packaged? Often, onene snack and/or meal option will be eaten during the class by the children.

Pre-portioned individual (stored in fridge)
Family-style (you determine the portion)
1 snack or entire meal served immediately

All items will be organized based on freshness. This means a dressing will be in a separate container from a salad to ensure the meal holds well.

Do you have any allergies? Please indicate in detail in next question. *

Child Anaphylactic Allergies – Severe
Adult Anaphylactic Allergies – Severe
Child – Food Sensitivities
Adult – Food Sensitivities

Please do not hesitate to note sensitivities so that we are aware of your specific needs/preferences.

Allergies – Please indicate which adult or child has these allergies if applicable. Please note any and all details to ensure allergen safety. We are allergen-aware and take a personal approach to allergen-safety. *

Please type N/A if necessary.

Your childrens favorite snacks & main courses.

Please type N/A if necessary.

Are there any foods your children dislike? Please confirm below.

Please provide any details about dietary restrictions or foods/products that you and your family avoid.

Please list any favorite products/brands your children enjoy most or product preferences/notes:

Children's favorite Miami/Fort Lauderdale based restaurants:

What are your children's favorite types of cuisines?

Please fill out based on each individual child’s preference with name/age.

Do you own any of the following: *

Vitamix
Food processor
LARGE/MEDIUM Cutting Boards
Sheet Trays/Cookie Trays
Glass Storage Containers (of various sizes for a family of your size for a weeks worth of food)
Mixing Bowls
Grater
Gas Stovetop
Electric Stovetop
Measuring Cups
Measuring Spoons
Cast Iron Pan
Grill
Ice Cream Maker
Metal Frozen Pop Molds

We are a Covid-19 vaccinated team (as of Feb 2021) and ask for our clients to disclose their status for safety purposes. *

Our (adult) household is vaccinated.
Our (adult) household is NOT vaccinated.
Our children ARE vaccinated.
A few of our children are vaccinated but not all.
Our children are NOT vaccinated.
Our on-site staff ARE vaccinated.
Our on-site staff is NOT vaccinated.
I do not wish to disclose this information and understand this could alter services being rendered.

This information will be kept private. We believe in vaccination choice and doing what is right for your specific health needs. However, due to our elevated risk, we reserve the right to refuse to provide services to unvaccinated households.

If you will have unvaccinated guests or workers in your home on a day that we are cooking do you agree to provide us with these details when possible? *

Certainly, we understand this cannot always occur with last-minute plans/appointments.

If anyone on our team is exposed to covid-19 we will notify your family immediately. May we ask the same of you? *

Yes, I will notify The Cooking Collaborative.
No.

If you require outdoor shoes to come off while inside for sanitary reasons please let us know below. *

This is not necessary in our home.
Yes, this is necessary in our home.

We kindly ask to wear shoes inside. However we will gladly purchase inside shoes to wear in your home! Please inquire if necessary.

We accept credit card payments, cash, zelle, ACH, and venmo payments. If you choose credit card payments in our secure system you agree to a 3% transaction fee. *

By agreeing to any of the above you understand we are required to charge necessary taxes to our services.

Please list any additional comments, details, or concerns. We look forward to serving you!

Feel free to be as detailed as possible! The more information we receive the better prepared we are to serve you and your family!

Please agree or deny the following for safety purposes. We understand that this is a time for parents to have personal time and/or work time. We do not require parents to be in the kitchen during classes. *

Yes, I agree to be home – you agree to be at home during culinary classes or nearby within a 10 minute drive in case of an emergency were to occur.
No, I do not agree to be home – However, an on-site staff member (nanny, housekeeper, estate manager) will be home if an emergency were to occur.
If another child (outside of your own) is added to the class we ask you to make this section known to the parent. We limit classes to 5 students if any of the children are under 5.

The Cooking Collaborative makes safety our top priority when working with little ones. We will do everything in our power to ensure safety in every way that we can. However, if an emergency were to occur we would like to know all of the above & below to ensure safety measures are known and available to our team members. By checking either option you release liability from The Cooking Collaborative, LLC from fault if an emergency were to occur.

Primary Emergency Contact & Number (Other than yourself) *

Please provide name & primary phone number.

Secondary Emergency Contact & Number *

Please provide name & primary phone number.

Please type your name which serves as an agreement that you have read this assessment and all answers are accurate. *

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Thank you & We look forward to serving you!

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