New Submission

Event Location Section

Event Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Date of Event*field type date
Starting Time of Event*field type time
Ending Time of Event*field type time
Event Location/Facility Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Location/Facility Street Address*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Location/Facility City*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Location/Facility State*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Location/Facility Zip*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Location Contact First Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Location Contact Last Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Location Contact Phone Number*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Location Contact Email*field type email
Room or Area Name / Description*field type multi line
Event Typefield type drop-down
Enter Other Type of Eventfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Venue Typefield type drop-down
Room / Area Listed Capacity (at 100%)*field type number
Number of Attendeesfield type number
Number of Stafffield type number
Event Location Additional Details*field type multi line
Please describe how you will verify vaccination or a recent negative COVID test.*field type multi line

Event Organizers Section

Event Contacts

	First Namefield type single line	Last Namefield type single line	Phonefield type single line	Emailfield type email
1×	First Namefield type single line Input blocked. Maximum character limit of 4000 characters reached.	Last Namefield type single line Input blocked. Maximum character limit of 4000 characters reached.	Phonefield type single line Input blocked. Maximum character limit of 4000 characters reached.	Emailfield type email	×
2×	First Namefield type single line Input blocked. Maximum character limit of 4000 characters reached.	Last Namefield type single line Input blocked. Maximum character limit of 4000 characters reached.	Phonefield type single line Input blocked. Maximum character limit of 4000 characters reached.	Emailfield type email	×

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Event Guest Sign In Responsible Party

	First Namefield type single line	Last Namefield type single line	Phonefield type single line	Emailfield type email
1×	First Namefield type single line Input blocked. Maximum character limit of 4000 characters reached.	Last Namefield type single line Input blocked. Maximum character limit of 4000 characters reached.	Phonefield type single line Input blocked. Maximum character limit of 4000 characters reached.	Emailfield type email	×

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Additional Event Specific Information

Will there be music at the event?*field type radio button
Will there be music at the event?YesNo
Will there be dancing at the event?*field type radio button
Will there be dancing at the event?YesNo
Will there be food at this event?*field type radio button
Will there be food at this event?YesNo
Manner of food service*field type radio button
Manner of food serviceServed to patronsBuffetOther

Submission Section

Responsible Party
I am the responsible party for the business, organization or event listed. I have reviewed all applicable New York State interim guidance for event activities and operations during the COVID-19 public health emergency and I affirm that I have read and understand my obligation to operate this event in accordance with such guidance.
I understand that my event may be subject to inspection by Tompkins County Environmental Health to ensure compliance with all provisions of the guidance.
I affirm that all applicable current NYS COVID-19 Executive Orders and Guidance will be followed.
*field type checkbox
By checking this box, I agree to the above statements.
Responsible Party First Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Responsible Party Last Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Responsible Party Phone Number*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Responsible Party Email*field type email
Responsible Party Association with Event (organizer, facility, operator, etc.)*field type multi line
Signature*field type signature
Submission Date*field type date
Date will be captured on form submission

Tompkins County COVID-19 Large Gathering Event Notification Form

Event Location Section

Event Organizers Section

Event Contacts

Event Guest Sign In Responsible Party

Additional Event Specific Information

Submission Section