2014 Chili for Charity Cook-off September 20, 2014 River Front

2014 Chili for Charity Cook-off
September 20, 2014
River Front – Downtown Yorkville
Cook’s Registration
Complete form below and mail with check to:
CHILI FOR CHARITY, PO Box 399, Yorkville IL 60560
Cooking rules and more info can be
viewed at www.chilicharity.org.
ALL CONTRIBUTIONS ARE TAX DEDUCTIBLE
Make Checks Payable to: SVDP-Chili For Charity
Single Chili Entry: Free! includes 10 admission tickets
Business Chili $100 includes 20 admission tickets
Non-profit, Fire, Police, Knights Council : Free! includes 10 admission tickets
Note : All entrants must obtain a Temporary Food Permit for $30.00 from the Kendall County Health Dept available
online:
http://health.co.kendall.il.us/Environmental/Epay.html
Cook’s Name or Team’s Name: ___________________________________________________
Address___________________________________________
City _____________________ State____ Zip _______
Phone_________________________ E-mail____________________________________________
Chili Category (select one or two)
Hot
Mild
Chili Name:__________________________________
Additional Tickets $3 each) ____________________
Total Fee Enclosed ___________________________
Cook’s Waiver: My signature acknowledges that I have read and understand the rules as displayed on the website and
agree to abide by all of these rules. I acknowledge that no one will be allowed to leave early due to limited site access. I
waive any and all claims I may have against CFC, it’s officers, directors, representatives, or any other individual, firm or
organization affiliated therewith,resulting in whole or part from my participation in the 2013 CFC Cook-off. I hereby grant
full permission to CFC, to any photographs, video tapes, live broadcasts, motion pictures, recordings or any other record
of this event for any legitimate purpose.
Date:
_______________
Signature:
_________________________________
Disclaimer
The Knights of Columbus, God’s Divine Mercy Council #14463(KofC) and St Vincent DePaul, St Patrick Conference ( SVDP) reserves the right to refuse
any sponsorship, cooks entry, donation or any in-kind contribution from any individual or organization that does not reflect or represent the beliefs or
mission statement of the KofC, SVDP or of the Roman Catholic Church. The submission of an application with payment for said sponsorships or
donation does not constitute an acceptance. All donations or sponsorships shall be reviewed by the executive bodies of the KofC and SVDP. Any
monies submitted by any individual or organization who the executive body deems inappropriate or who fail to reflect the beliefs or mission statements of
the KofC or SVDP and/or the Roman Catholic Church will be refunded to the submitter and the donation or sponsorship shall be refused. Submission of
a donation or sponsorship request to the Chili Cook Off represents an acceptance of these terms and conditions.
If any questions please contact Robert Skidmore 630-660-8923
KENDALL COUNTY HEALTH DEPARTMENT
811 W. JOHN ST., YORKVILLE, IL 60560
FOR OFFICE USE ONLY
PERMIT #__________________ DATE ISSUED ________________ APPROVED BY:_______________
(630) 553-9100, Ext. 8026
FAX (630) 553-9603
PAYMENT REC’D $___________BB___ CASH &5(',7 CHECK#________________
INVOICE #________________ RISK : TYPE 3 TYPE 2 TYPE 1 NP
www.kendallhealth.org
TEMPORARY FOOD EVENT PERMIT APPLICATION
PLEASE NOTE: BAKE SALE FUNDRAISERS ARE SUBJECT TO DIFFERENT REGULATIONS. PLEASE CALL REGARDING THESE REGULATIONS.
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NAME OF VENDOR: ________________________________________________________________________________________
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NAME OF EVENT:____________________________________________ LOCATION:____________________________________
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EVENT CORRDINATOR:_______________________________________ PHONE:_______________________________________
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DATE(S) OF EVENT:___________________________________________SET UP TIME:___________________________________
PAGE NUMBERS BELOW CORRESPOND TO THE KENDALL COUNTY TEMPORARY FOOD ESTABLISHMENT GUIDELINES - PLEASE USE AS A REFERENCE
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MENU ITEMS: ______________________________________________________________________________________________
__________________________________________________________________________________________
HOT HOLD EQUIPMENT: _________________________________________________________________________________
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COLD HOLD EQUIPMENT:
(p. 1) _______________________________________________________________________________________________________
FOOD PREPARED BY:
VENDOR ONSITE
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FOOD ESTABLISHMENT: ______________________________________
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DESCRIPTION OF HANDWASH FACILITIES: (p. 2) (HAND SANITIZER ONLY IS NOT A SUBSTITUTE FOR PROPER HAND WASHING)
SPIGOT TYPE THERMOS, SOAP, PAPER TOWELS, WASTEWATER CATCH BUCKET
HARD PLUMBED HANDSINK IN THE FOOD PREP AREA
N/A - PREPACKAGED FOODS ONLY
RAW PRODUCE PREPARATION ON SITE: (p. 3) NO
YES IF YES, PLEASE SELECT ONE OF THE FOLLOWING
PRODUCE WASHED ON SITE AT DEDICATED PRODUCE WASHING STATION
PRODUCE WASHED AT LICENSED FOOD SERVICE ESTABLISHMENT
METHOD OF UTENSIL CLEANING AND SANITIZING: (p. 2)
WASH, RINSE, SANITIZE BINS (PROPER SANITIZER CONCERTRATION REQUIRED)
EXTRA UTENSILS (ALL UTENSILS MUST BE WASHED, RINSED AND SANITIZED IN A LICENSED FACILITY BEFORE THE EVENT)
METHOD OF INSECT AND DUST PROTECTION: (p. 4)
COVERED/PREWRAPPED FOODS ONLY
ELECTRIC FANS (BLOWING ACROSS OPEN FOOD PRODUCT)
TENTS OR BUILDING WALLS (DUST PROTECTION)
NON-REFUNDABLE FEES (PLEASE SEE BACK OF APPLICATION FOR RISK CATEGORY EXAMPLES)
RISK TYPE 3: HIGH RISK FOODS REQUIRING TEMPERATURE CONTROL AND PREPARATION ($80.00)
RISK TYPE 2: MEDIUM RISK FOODS REQUIRING TEMPERATURE CONTROL AND PREPARATION ($50.00)
RISK TYPE 1: SHELF STABLE FOODS ($30.00)
NON-PROFIT ORGANIZATIONS ($30.00)
***LATE FEE TO BE ASSESSED IF APPLICATION IS SUBMITTED WITHIN 48 HOURS OF THE START OF THE EVENT***
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NAME OF APPLICANT: (PRINT) ___________________________________________________________ PHONE: _____________________
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ADDRESS: (STREET,CITY,ZIP) ________________________________________________________ DATE: _____________________
SANITARIAN COMMENTS: __________________________________________________________________________________
___________________________________________________________________________________________________________
IF MAILING PAYMENT - MAKE CHECK PAYABLE TO “KCHD”
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