Purely Picnics VA
Picnic Request Form
Email *
First Name *
Last Name *
Date of Birth *
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Mobile Phone Number *
Preferred Picnic Date (must be 48 hrs in advance) *
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Back-up Picnic Date *
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Requested Time *
Package Description
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Traditional Picnic Package: Number of Adults
Clear selection
Number of Children 10 years and up
Clear selection
Select a Theme *
Picnic Locations (location requests also accepted) Note: you do not have to contact the location-we do everything for you. *
À La Carte Items - Will be delivered to your picnic
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Custom Letter Board: Please provide your special message here. (10 words or less, if possible) *
Tell us about your special event! What are you celebrating and how can we make this a perfect picnic for you?
How did you hear about us?
Additional Questions or Comments? Leave a note here or email us at purelypicnicsva@gmail.com
To submit this form, please click the submit button below. Once submitted, please close your browser to avoid re-submission. You will receive a confirmation email from Purely Picnics VA within 24 hours of your request. Please email us at purelypicnicsva@gmail.com with any questions or to check the status of your reservation. We look forward to planning your ultimate picnic experience!
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