Picnic Order Form
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Date Of Picnic
*
-
Month
-
Day
Year
Date
Book Your Picnic
*
How Many People will be attending
*
1
2
3
4
5
6
7
8
9
10
Does anyone have any Food Allergies?
*
Yes
No
If Yes Please Explain
Other
Select Your Picnic Vibe
*
Romantic Picnic
Baby Shower Picnic
Tailgate For 2 Picnic
Birthday Bash Picnic
Prom Picnic
Girly Gathering Picnic
Congrats You're Finally Free Picnic (Singles Rejoice)
Just Because You Deserve It Picnic
Beachy Bliss Picnic
Mountain Maverick Picnic
Adorable Add Ons
*
Flower Bouquet
Sweet Treats Board
Rose Petals
Games Basket
Teepee Tent
Insta Pix Camera
Chairs
Bunting
Guitar
Cruiser Bikes for 2
Kayaks for 2
Personal Add Ons
*
Local Personal Chef
Take-Out Special (Please indicate your Food Order from your Restaurant of Choice, and we will pickup and deliver it to your Picnic Location)
1 Hour Photoshoot
1 Hour Private Yoga Session
1 Hour Acoustic Guitar Performer
Add More Time To My Picnic
*
1 Hour Extra
2 Hours Extra
Payment Details
Please Provide Deposit via E-transfer to:
popuppicnicsvi@gmail.com
COVID-19 Liability Release Waiver Due to the outbreak of the novel Coronavirus (COVID-19), Pop Up Picnics VI and all of its subsidiaries are doing everything we can to protect you, our clients, our community and our staff. To this extent, Pop Up Picnics VI and all of its subsidiaries will be following the Center of Disease-Control (CDC) with regard to social distancing practices and sanitation. Pop Up Picnics VI Will also be adhering to Foodsafe Protocol. We ask that our clients continue to implement these sanitation and disinfection procedures. Symptoms of COVID-19 include: Fever Fatigue Dry Cough Difficulty Breathing. I agree to the following:* I, nor members of my Party, have not experienced any of the symptoms listed above within the last 14 days. I, nor members of my Party, have not travelled internationally in the last 30 days. I, nor members of my Party, have not traveled to a highly impacted area in the last 30 days. I, nor members of my Party, do not believe that we have been exposed to someone with a suspected and/or confirmed case of the Coronavirus (COVID-19). I, nor members of my Party, have not been diagnosed with the Coronavirus (COVID-19) within the last 30 days. Pop Up Picnics VI and all of its subsidiaries cannot be held liable from any exposure to the Coronavirus (COVID-19) caused by misinformation on this form or the health history provided by each client. If I take any steps to make a claim for damages against Pop Up Picnics VI and all of its subsidiaries, its agents, employees or any other released parties, I shall be obligated to pay all attorney’s fees and costs incurred as a result of such claim Pop Up Picnics VI and all of its subsidiaries is following these enhanced procedures to prevent the spread of the Coronavirus (COVID-19) Additional time will be scheduled in between client appointments to limit client contact. Each client is required to sanitize their hands upon arrival and before departure. All surfaces will be thoroughly cleaned with hospital grade disinfectant before and after each Party, according to the manufacturer’s directions. By signing below, I hereby release and agree to hold Pop Up Picnics VI and all of its subsidiaries harmless from and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses, and compensation for damages or loss to myself and/or property that may be caused by any act, or failure to act of Pop Up Picnics VI and all of its subsidiaries, or that may otherwise arise in any way in connection with any services received from Pop Up Picnics VI and all of its subsidiaries. I agree to release Pop Up Picnic VI and all of its subsidiaries from any and all liability for the unintentional exposure or harm due to the Coronavirus (COVID-19) Pop Up Picnics VI and all of its subsidiaries agrees to abide by these standards and affirms the same.
Date
*
-
Month
-
Day
Year
Date
Signature
*
Enter the message as it's shown
*
Submit
Should be Empty: