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2. Food Waiver Request

   This form can only be completed by applicants or organizers of events that have 99 attendees or less who are bringing in their own food. Groups using a licensed and insured caterer do not need to fill out this form. This food waiver request must be completed in its entirety. Incomplete requests will not be permitted and may delay the approval of your event.

4. Event Information
6. First Name*
7. Last Name*
9. Address1*
11. Address2
13. City*
14. State*
15. Zip*
17. Contact Phone Number*
18. Event Date*
    Event Date
19. Number of Attendees*
21. Event Description*
22. City Facility Requested*
24. Food Waiver*

    1. I agree to the following:

    A licensed and insured caterer MUST be used for all food SERVED at your event. A copy of your insured caterer's license must be on file ONE (1)) month prior to your event. If a caterer is not used, this waiver must be completed, signed, and submitted to Leisure Services at least thirty (30) days prior to your event date. If a caterer is not utilized, the food must be served from furnished trays (Publix, etc.).

    However, the City of Cocoa (the "City") recognizes that occasionally events have special circumstances in which catering options do not meet the needs of the event. These special circumstances may include certain non-profit charity functions running fundraising events and private groups having a "potluck" party wherein the group members bring in food to share with other group members. In such cases, the City MAY permit the Organization to serve Non-Catered Food (where individual members of the Organization bring in a food item). Under no circumstances will the City allow events consisting of greater than one hundred (100) people to serve Non-Catered Food.

    If the City allows the Organization to provide Non-Catered Food, the Organization hereby warrants and confirms that the information contained within, to the best of the Organization's knowledge, is true and correct, and further certifies that the Organization and each individual bringing in Non-Catered Food has read the USDA food and safety inspection service flier, 7 Food Safety Steps for Successful Community Meals, which accompanies this form. Furthermore. if the City allows the Organization to provide Non-Catered Food, the Organization agrees to indemnify the City (as described below).

    UNDER NO CIRCUMSTANCES MAY THE ORGANIZATION BRING IN ALCOHOL, OTHER THAN AS DESCRIBED IN THE CITY OF COCOA FACILITY USE APPLICATION AND AGREEMENT.

26. NON-CATERED FOOD INDEMNIFICATION/HOLD HARMLESS AGREEMENT*

    1. I agree to the following:

    The Applicant/Organization agrees to and will at all times indemnify, save and hold the City, and its officers, employees, attorneys, and agents through all appellate proceedings harmless from any and all liability, claims, demands, disputes, damages, costs, attorneys' fees and expenses, incurred by the City and its officers, employees, attorneys, and agents as a result, directly or indirectly, resulting from the preparation and/or service of any food or beverage at the event by the Applicant/Organization and its members, guests, visitors, spectators, and participants.

    By signing below, the Applicant/Organization understands and agrees to use the information included in the 7 Food Safety Steps for Successful Community Meals flier to help ensure safe preparation and handling of food at the event. The Applicant/Organization understands and agrees that the completion of this application shall not be binding until accepted by the City of Cocoa's City Manager or his/her designee.

28. Signature*

    By typing my name in this form, I affirm the accuracy of the information provided in this waiver. I understand that this constitutes a legal signature and confirms that I agree to the above terms. I understand that I am electing not to have food at my event that is provided by a caterer as is required by City of Cocoa ordinance and I am accepting full responsibility for the food that is being served at my event.

29. Date*
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit Submit and Print

* indicates a required field