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2. Thank you for contacting the Health Department for your temporary food event. 

    

   We ask that the information below be submitted to us for review during the planning process for all events involving food. 

   Please note that this form must be submitted first and DOES NOT replace the temporary food permit application if one is necessary. 

4. First Name*
5. Last Name*
7. Email Address*
8. Phone Number*
10. Address of Event*
12. City
13. State
14. Zip Code
16. Date& Time of Event*
    Date& Time of Event

    Date& Time of Event
18. What proposed food(s) will be provided? Please select all that apply.*

    1. Coffee / Tea
    2. Other Beverages
    3. Baked Goods ( If so please specify below) :
    4. Bagels / Donuts
    5. Pizza
    6. Salad
    7. Pre-Packaged foods ( if so please specify below)
    8. Other ( If so please specify below)
20. Please provide the specifics on the provided item(s):
22. Is this a Catered event, or will the food be delivered or picked up? *
24. Please enter the Name and Address of establishment the food will be bought from? *
26. City*
27. State*
28. Zip Code*
30. When during the event will the food be available?*
32. Does the food need to be kept hot or cold? What is the plan to keep the food at temperature?*
34. Additional Comments

36. Please submit this completed form to the Health Department at least 2 weeks prior to the day of the event. Once the information is reviewed, the Health Department will determine if any permit is needed.   

     

Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field