NOTE: Please download and read the following rules and guidelines of the Five Hills Public Health Service prior to filling out your form. The Moose Jaw Homegrown Market will not accept any food vendors without approval from Five Hills Health Region prior to the first market you attend.

Five Hills Health Region Farmers Market Guidelines

Application (*) For Vendor To Sell Food At Farmer's Market

Name

First Name

Last Name

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Phone Number Residence

(###)

###

####

Phone Number Business

(###)

###

####

Type of Food Sold:

Please be as specific as you can and list ALL products

Processed At: (Land location or street and town)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of Market where I sell food:

Do I sell food at any other farmer's market?

If yes, Where (If No, please type N/A)

Additional Info - if required

Vendor Electronic Signature

Date

YYYY

I have received, read and understand the information contained in this guideline.

I have read the Five Hills Public Health Guidelines and Regulations as provided

**FOR OFFICE USE ONLY ** Please do not fill this out, you can now SUBMIT your application

Approval for the above vendor to operate at the Moose Jaw Homegrown Farmer's Market has been granted subject to the following conditions:

Conditions Determined by FHHR Public Health Officer

Local Authority Signature

Approval Date

YYYY