Large Gathering Notification Form – Saratoga County New York

Saratoga County Public Health Services
Large Gathering Event Notification Form
Please complete and submit the following form at least 5 days prior to the event

NYS Travel Restrictions still apply: https://coronavirus.health.ny.gov/covid-19-travel-advisory
All information entered on this form will be kept confidential

* Required field

Event Name

Event Type

Date of Event

Start Time of Event

End Time of Event

Event Location/Facility Name

Specific Room or Area Name/Description

Event Location Street Address

Event Location City/Town

Event Location Zip Code

Event Contact First Name

Event Contact Last Name

Event Contact Telephone

Event Contact Email

Room Occupancy (at 100%)

Room Occupancy (at 50%)

Unique NYS Food Service Establishment Facility Code

** Food Service Facilities must have their NY Forward Safety Plan completed and available for review **

Expected Number of Attendees

Expected Number of Event Staff

Indoor/Outdoor

Attendees must be the lower of 150 persons or 50% of venue capacity

All guests must sign in and provide full name, date of birth, address, email and phone number
Table seating chart (if applicable) must be retained
Facility must maintain this information for 28 days in the event contact tracing is required

Please refer to the NYS Forward Phase 4 "Interim Guidance for Food Services during the COVID-19 Public Health Emergency" for full explanation of requirements:
https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/Indoor_and_Outdoor_Food_Services_Detailed_Guidelines.pdf

Point of Contact for Guest List First Name

Point of Contact for Guest List Last name

Point of Contact for Guest List Telephone

Point of Contact for Guest List Email

Point of Contact for Event Staff First Name

Point of Contact for Event Staff Last Name

Point of Contact for Event Staff Telephone

Point of Contact for Event Staff Email

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 the above linked guidance and my obligation to operate this event in accordance with such guidance

By checking this box, I agree to the above statement.

Responsible Party First Name

Responsible Party Last Name

Responsible Party Type

Business Name

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