Name *

First Name

Last Name

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Phone Number

(###)

###

####

Secondary Phone Number

(###)

###

####

Vendor Type

Farm

Artisan

Prepared Foods

Food Truck

What are your booth needs? Check all that apply

Power Source

Access to Vehicle

Are you registered to participate in the MA Farmers' Market Nutrition Program (FMNP)? (Farms and Apiaries only)

Yes

No

Are you registered to participate in the MA Healthy Incentives Program (HIP)? (Farms only)

Yes

No

Are the items that you will be offering one of the following?

USDA Certified Organic

Sustainable Practices

None of the above

Requested Market Dates

Dates you plan on attending the market. Select all that apply. Please note that you may not be able to participate in all that you select.

June 1

June 8

June 15

June 22

June 29

July 6

July 13

July 20

July 27

August 3

August 10

August 17

August 24

August 31

September 7

September 14

September 21

September 28

October 5

(Possible October 12 date)

Sturbridge Farmers Market - Waiver *

I, the undersigned, do hereby consent to my participation in the Sturbridge Farmers Market program of the Town of Sturbridge. I also agree to forever release the Town of Sturbridge, and all their employees, agents, board members, volunteers and any and all individuals and organizations assisting or participating in the Town of Sturbridge’s, Sturbridge Farmers Market ("the Releasees") from any and all claims, rights of action and causes of action that may have arisen in the past, or may arise in the future, directly or indirectly, from personal injuries to myself or property damage resulting from my participation in the Town of Sturbridge’s, Sturbridge Farmers Market. I also promise, to indemnify, defend, and hold harmless the Releasees against any and all legal claims and proceedings of any description that may have been asserted in the past, or may be asserted in the future, directly or indirectly, arising from personal injuries to myself or property damage resulting from participation in the Town of Sturbridge’s, Sturbridge Farmers Market. I further affirm that I have read this Consent and Release Form and that I understand the contents of this Form. I understand that my participation is voluntary and that I am free to choose not to participate in said programs. By clicking the box below, I affirm that I have decided to participate in the Town of Sturbridge’s, Sturbridge Farmers Market as a Vendor with full knowledge that the Releasees will not be liable to anyone for personal injuries and property damage that I may suffer in Town of Sturbridge’s, Sturbridge Farmers Market.

I have read and agree to all of the terms listed above.

Sturbridge Farmers Market - Acknowledgement of Receipt of Rules and Guidelines *

A copy of the rules and guidelines for the market can be found at: https://www.sturbridge.gov/recreation/pages/sturbridge-farmers-market By checking the box below you acknowledge that you have read and agree to abide by the Sturbridge Farmers Market's Rules and Guidelines. I understand that failure to follow these policies may exclude my participation in the market.

I have read and agree to all of the terms listed above.

Sturbridge Farmers Market - Insurance Requirement *

The Town of Sturbridge requires that ALL vendors participating in the Sturbridge Farmers Market hold their own liability insurance to participate. An Insurance Certificate Naming the Town as an Additional Insured for general liability with limits of $1,000,000 Occurrence and $2,000,000 General Aggregate MUST be submitted to the Town of Sturbridge. Failure to provide this document will result in a rejection of the application. For more information on this requirement please contact the Town at 508-347-2500 ext. 1411. Insurance documentation should be sent to sturbridgefarmersmkt@gmail.com.

I have read the above statement and agree to provide the Town of Sturbridge with a copy of my Insurance Certificate.