Food Vendor Application Form

Booth Information

* Name of booth / concession

This business will be participating at Special events
Farmers' markets

Type of set-up Mobile food premises (such as a food truck / trailer)
Temporary booth
Other, specify

Primary Owner / Operator Information

* Primary owner / operator name

* Primary owner / operator email

* Primary owner / operator phone

* Primary owner / operator mailing address

* Primary owner / operator city

Food / Menu Information

* Food items that you will typically be bringing with you to events

---

* List the name and address of all locations that will be used for food preparation before the event

Where required, inspection documentation must be provided for each location. Accepted types of documentation include:

• A routine health inspection report from your business' home / local health unit
• If your business uses a shared space (such as centralized / community kitchen), a routine health inspection report for the food premises, accompanied by proof facility use, such as an email from the owner / operator of the shared space, a facility rental agreement, or an invoice / receipt from the location's owner / operator to you related to kitchen use

Inspection documentation 1

Inspection documentation 2

---

* If you are selling any pre-packaged / pre-prepared food items, list the name and address of the manufacturing or processing facilities for these food items

Inspection documentation must be provided for each facility. Accepted types of documentation include:

• For meats and meat products, an invoice from provincially licensed meat plants or federally registered meat establishments
• For fish and fish products, an invoice from provincially licensed fish plants
• For pure honey and maple syrup products, sampling documentation for foods of plant origin, if available
• For pre-packaged food items, a copy of the Safe Food for Canadians License

Attach inspection documentation

Notice of Collection

Any personal information or personal health information submitted will be collected, used, and disclosed, where applicable, by members of Regional staff according to the Municipal Freedom of Information and Protection of Privacy Act or the Personal Health Information Protection Act. Any information you share will only be used for the intended purpose for which it was provided.

For questions or comments about privacy practices, or for more information about the administration of the Municipal Freedom of Information and Protection of Privacy Act in Niagara Region programs, see Freedom of Information and Open Government.