To register, please take the time to fill out the information below, after the second page you will be directed to a new page for your payment.  On the PayPal logon screen you can either log into your PayPal account or scroll down to pay by credit card.

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Type of Health Department Permit: 

IMPORTANT - You MUST register with the Thomas Jefferson Area Health District at least 1 month prior to Old Farm Day.  For details, application and instructions, call 434-972-6259 or go to http://www.vdh.virginia.gov/thomas-jefferson/tjhd-administration/.

A copy of your liability insurance certificate is required by April 1.  Please email an image to

SPACE NEEDS AND FEES (RAIN OR SHINE, NO REFUNDS)

Enter dimensions for truck/trailer (include ropes or pegs)

SPACE FEES:  (you will be redirected to a new page for your selection and payment via credit card through PayPal after you submit this form on the second page).

Up to 20 x 20 space (includes 4 admission tickets) - $80

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Space larger than 20 x 20 (includes 5 admission tickets) - $120

Extra Admission tickets - $5 each ($8 at gate)

(all workers must have tickets.  Children under 12 are free)​

LIABILITY DISCLAIMER - must be signed below.  Under Virginia law, there is no liability for an injury to or death of a participant in an agritourism activity conducted at the agritourism location if such injury or death results from te inherent risks of the agritourism activity.  Inherent risks of agritourism activities include, among others, risks of injury ionherent to land, equipment, and animals, as well as the potential for you to act in a negligent manner that may contribute to your injury or death.  You are assuming the risk of participating in this agritourism activity.  We agree to abide by this space agreement and will make certain all helpers with our space are informed of the guidelines as well.

A copy of your liability insurance certificate is required by April 1. 

Please email an image to

Use your mouse or finger to sign on the line above