Weddings & Catered Events Affirmation Form
Instructions: This form applies to in-person catered events in non-residential settings that are attended by more than 100 persons indoor, and 200 persons outdoor. The owner/operator of the event venue and/or the event organizer (“Responsible Party”) should fill out this form in its entirety. The Responsible Party must affirm that the event will abide by the New York State Guidelines that are in place on the event date by signing the Attestation at the end of this document. The completed form must be submitted to Hamilton County Public Health at least five (5) days in advance of the event.

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Email *
Name of Responsible Party: *
Telephone Number: *
Name of Event: *
Address at which above Event is taking place: *
Description of Event Location (eg: indoors/outdoors, which room(s) within the facility) *
Event Date: *
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Start time: *
Time
:
End Time: *
Time
:
Expected Number of Attendees: *
Expected Number of Staff: *
***This event must abide by all the guidelines promulgated by the State of New York in Section I(D) “In-Person and Catered Events” of the Interim Guidance for Food Services:https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/Indoor_and_Outdoor_Food_Services_Detailed_Guidelines.pdf 
ATTESTATION:
 I hereby affirm under penalty of perjury that the above information is true and complete to the best of my knowledge, and that the event listed will abide by the Guidance referenced above. I understand that all such attestations are subject to investigation and verification and that a material misstatement or fraud may result in penalties including the closure of the event facility by Hamilton  County.
Signature of Responsible Party: (Electronic Signature; please type name of Responsible Party) *
Date Signed: *
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A copy of your responses will be emailed to the address you provided.
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