Request for Self-Catered Event

Person Responsible for Event*

First Name

Last Name

Email*

Phone

Event Name

Department/Organization/Club/Team Name/etc.

Date of Event

Time of Event

Location of Event

List all goods being served

Will you prepare all items in a sanitary manner?*

Yes

Will you have a visible sign that reads, "Food was prepared at a kitchen that is not inspected by the Health Department"?*

Yes

Names of individuals preparing/serving food

Copies of Washington State Food Worker Card for individuals listed above will be on file with PLU Catering 7 days prior to event.

Yes

I have read the requirements for Food Workers, Food Safety, Garbage & Cleaning and Equipment & Fire Safety.*

Yes

I understand a $50 fee will be charged to my account if all cleanup is not complete after my event.

Account Number*