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2021 Celebrate Purcellville Registration

  1. About Celebrate Purcellville 2021

    The Purcellville Parks and Recreation Advisory Board and the Town of Purcellville are co-hosting a week-long event called Celebrate Purcellville from October 4 - 10, 2021. The event encourages people to visit businesses and organizations in Purcellville and enjoy the historical and cultural aspects of town. It will include a passport program in which participating businesses and organizations will be listed (only businesses and organizations within Town are eligible to sign up). People will show their Celebrate Purcellville Passport in participating businesses/organizations to be stamped. On October 10, 2021, people will turn in their Celebrate Purcellville Passport for a chance to win a prize. Also on October 10, there will be live music, food, drink, and activities in Dillon’s Woods. To participate in Celebrate Purcellville, businesses and organizations must complete the application, meet the requirements, and agree to the participation rules. Participation is FREE! 

  2. Business/Organization Category*
  3. Is your business or organization physically located in the Town of Purcellville?*

    Only businesses and organizations inside the incorporated limits of Town are eligible to participate in Celebrate Purcellville.

  4. For businesses: does you business have a current Town of Purcellville business license?*
  5. For non-profit organizations: is your organization IRS tax-exempt and have a 501c designation?*
  6. Is your business/organization open to the public?*
  7. If your business/organization is open to the public, will you extend your hours on Friday, October 8 to 7 p.m. (if you usually closer earlier)?*
  8. If your business/organization is not open to the public (i.e. home based or other reason), would you like to have a 10x10 space in Dillon's Woods on Sunday, October 10 from noon to 5 p.m.?*

    Spaces in Dillon's Woods are only available for eligible businesses/organizations that do not have a location that is open to the public. I understand and agree that I will provide my own table, chairs, canopy with anchors if I choose to have a space in Dillon's Woods, and that I will be responsible for my own loading, unloading, set up, and clean up. 

  9. Check off which of the specials listed below you will offer to those who present you with the passport from October 4 - 10, 2021:*
  10. I will donate an item to be given as a prize for those who participated in the Celebrate Purcellville Passport program.*
  11. How did you hear about the event?*
  13. My business/organization will participate in Celebrate Purcellville from October 4 - 10, 2021*
  14. We will display a flyer, which will be provided, in the business/organizations to indicate that we are participating in Celebrate Purcellville.*
  15. We will stamp the Celebrate Purcellville passports to visitors who present them to us during the week of October 4 - 10, 2021.*
  16. We will have a special offer to give to those who present their Celebrate Purcellville passports from October 4 - 10, 2021*
  17. We will help promote Celebrate Purcellville on our website and/or social media.*
  18. I understand that the Town will have a Celebrate Purcellville web page where all of the participating businesses and organizations will be listed with their logo, address, web or Facebook address, and listing of the special offer available to those who present their Celebrate Purcellville Passport.*
  19. I understand the the Town of Purcellville will create a Celebrate Purcellville Passport that can be picked up at designated locations and that can be downloaded and printed by people who would like to use it. *
  20. Celebrate Purcellville Participation Waiver and Release Form

    The individual signing below verifies that he/she is legally authorized to bind and act on behalf of the participating business or organization. The business/organization, including all of its employees, agents, and other representatives, hereby agrees to hold harmless and to indemnify, defend and protect the Town of Purcellville and its Council Members, employees, agents, volunteers, and other representatives against any and all claims, losses, damages and liabilities whatsoever to persons or property incurred as a result of the actions of the participating business/organization. This release is intended to discharge the Town of Purcellville, Virginia, and their respective volunteers, officers, employees, sponsors, and agents from any and all liability arising out of or connected in any way with my participation in said activity, even though that liability may arise out of negligence or carelessness on the part of the Town of Purcellville their volunteers, officers, employees, agents, participants, or attendees.  I understand that the terms herein are contractual and not a mere recital, this instrument is legally binding, and I have signed this document of my own free will.   Further, I agree that photographs, pictures, slides, movies or videos may be taken of me and my minor children in connection with my participation in these events or activities without compensation from anyone, and I consent to the use of these photographs, pictures, slides, movies or videos for any legal purpose. I have fully informed myself of the contents of this liability waiver, release, discharge, and assumption of risk. 

    This Waiver, Release, Discharge, and Assumption shall in no way be limited by any financial responsibility or insurance requirements of the Town of Purcellville, and shall survive the termination of this registration form.

  21. By checking this box, I agree to the participation waiver and release.*
  22. Once your application has been approved, we will follow up with an email to confirm your participation.
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  24. This field is not part of the form submission.