Monroe County Department of Public Health
Large Gathering Event Notification Form

Responsible Party

Responsible Party is the operator of the food service site, or another party as may be designated by the operator who shall be responsible for meeting NYS standards.

Event Information

NOTE: For indoor events up to 250 attendees and outdoor events up to 500 attendees, this form DOES NOT need to be submitted


Please refer to the New York State Department of Health “Interim Guidance for Food Services During the COVID-19 Public Health Emergency” for a full explanation of requirements. This guidance is posted on the Monroe County Department of Public Health website.


I am the Responsible Party for the 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 the Event may be subject to inspection by the Monroe County Department of Public Health to ensure compliance with all provisions of the guidance.

I understand that it is my responsibility to submit a full list of Event attendees, including their full names, dates of birth, addresses, phone numbers and email addresses, to [email protected] within 48 hours following the end of the Event, and maintain a record of the aforementioned sign-in data for a minimum period of 28 days.