Old Farm Day Food Vendor Application

Deadline - April 1, 2020

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.

Will you offer any: (we will identify in our handout)

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/.

Dept of Health Permit*

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

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

Space Needs*

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

POWER NEEDS

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).

Space Fees*

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

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)​

TASTING GARDEN: (Open Air)  Bring your own tent/canopy, table, chairs.  Bring long, outdoor rated extension cord if you want electricity.  There is an outdoor outlet on the back of Haden House.  Six (6) tickets will be provided for associates working in your booth.  If you need more, you may purchase extra tickets on the next pages.

We will be demonstrating or have a display board for educating the public.  Please describe:

$5 each ($8 at gate) (all workers must have tickets.  Children under 12 are free)​

LIABILITY DISCLAIMER

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 space@oldfarmday.org

Your Signature

Use your mouse or finger to sign on the line above