COVID-19 Large Gathering Event Notification Form

Location Contact

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

Event Organizer Contacts

Responsible Party

The responsible party submitting this form must affirm below that all applicable current NYS COVID-19 Executive Orders and Guidance will be followed.

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 the Ulster County Department of Health to ensure compliance with all provisions of the guidance.