Special Needs Request Form

Please note the following management policies:

•  Flowers – client’s responsibility. Please arrange delivery at least three hours prior to the event.
• Entertainment – client’s responsibility. Kevin’s reserves the right to control volume of music and amplification systems.
• Decorations – client’s responsibility. NO glitter. Nothing taped or tacked to walls or ceilings. Confetti permitted with $50 cleanup fee.
• Food/Beverage – all items must be prepared and presented by our staff. Special requests for bar service require advanced notice and additional charge.

Name
Address
City
State
Zip
Phone
Email
How did you hear about us?	Newspaper Radio TV Channel 18 Flyer Other
If you checked other, please specify:
Event Information:	Wedding Anniversary Birthday Graduation Business Shower Other
First choice of date is:
Second choice of date is:
Scheduled arrival time is:
Are you having cocktails?	Yes No
Are you having Hors d'oeuvres?	Yes No
Scheduled meal time is:
Total number of expected guests is:
The requested type of service is?	Banquet Dinner Buffet Family Style
Please check all that apply:	Tablecloth Linen Napkins Sound Systems Special Menus Setup Assistance
Comments, special requests or arrangements:
Security code	Reload Image
Verify code

Note: Please print this page and bring it with you for faster service or feel free to fax it to (717) 453-7622. We look very forward to helping make your next event a very special one!