UW-Stout Food Permit
Permit for Selling, Giving Away or Serving Food or Refreshments on University Property in
Association with Meetings, Social Gatherings and Special Events.
Please Print
Confirmation #__________
Location food/beverage will be at:
_________
Individual/Sponsoring Organization/Department:
Contact Person:
Address:
City:
State/Zip Code:
Phone (home):
Phone (work):
Phone (cell):
Address:
City:
State/Zip Code:
Phone (home):
Phone (work):
Phone (cell):
Reservation Date:
Reservation Time:
Room:
Applicant’s Name:
Caterer/Restaurant:
(source of food/beverage)
Type and amount of Food/Beverage Served:
Phone:
The applicant does hereby agree to hold harmless and indemnify the Board of Regents of the University of
Wisconsin System, its officers, agents and employees, from any and all liability, loss, damages, costs, or
expenses which are sustained, incurred, or required arising out the actions of this event.
The applicant does hereby agree to the “Policy for Safe Service of Food of Refreshments on University
Property in Association with Meetings, Social Gatherings, and Special Events.”
The applicant agrees that all information is correct. The applicant also agrees to provide all required
equipment for maintaining correct food temperatures, and for serving the food or beverage and for cleanup
and proper disposal of refuse/garbage.
Applicant’s Signature:
Date:
This permit must be submitted to the building supervisor of the area the food will be served at least ten (10)
business days before the event takes place.
Approved
;
Disapproved: ______
Signature of Bldg. Supervisor or Designee:
Date:
You must have this approved permit present during all food service.
Updated: 06/02/03