Memorial Bench Request Form

Memorial Bench Request Form

Contact Information

Your first name*

Your last name*

Applicant's email*

Your mailing address*

Your primary phone number*

Phone

Your preferred language

Select

Memorial Bench Information

Bench type*

Please select which bench type you would like to reserve for your memorial.

Select

Name of person being honored*

Plaque inscription*

Please write the text you wish to be engraved on the memorial plaque. You may include up to 3 lines of 100 characters or less. Click here for an online character counting tool. A proof will be sent to you to confirm your request.

Bench Location

Please describe your 1st, 2nd, and 3rd choice of memorial bench location. Include the park or trail name.

When possible, we will reserve your most preferred location.

1st location choice*

2nd location choice

3rd location choice

What else would you like to share about your memorial bench request?

Memorial Bench Agreements

Please check each box below to confirm that you agree to each of the terms below.

I am aware that memorial bench orders are processed twice per year (in January and June) and installed by the end of February and August, pending availability of materials.*

I am aware that the fees for a refurbished bench is $2,500 and includes the cost to repair an existing bench and install a recognition plaque. Fees cover the installation of a plaque, materials, and basic maintenance for a ten-year period, starting on the date of installation.*

I am aware that the fees for a new bench is $5,000 and includes the bench, plaque with inscription, delivery/installation on a concrete pad, a confirmation letter and installation photo. A proof of the plaque will be provided for review and approval before production. Fees cover the installation of a plaque and bench, materials, and basic maintenance of the bench for a ten-year period, starting on the date of installation.*

I am aware THPRD will not pay for the replacement of a damaged plaque. I may purchase a new plaque for $350 should the need arise.*

I am aware that benches become property of THPRD once they are installed or refurbished. THPRD may not replace a bench if it is irreparably damaged by an act of god, such as tree fall, flood, or landslide. When the bench reaches its 10-year term, the purchaser will have an opportunity to renew the bench dedication for $2,500 or have the plaque removed and returned at no cost to the purchaser. If the purchaser chooses to renew the bench dedication after its initial 10-year term, THPRD will continue to maintain the bench for up to ten additional years or until it is deemed unsafe or unusable, whichever comes first.*

Memorial plaques must follow THPRD’s Policy 4.01.04, which in part states that the district reserves the right to remove, at the district’s expense, a memorial or tribute if the person(s) for whom the memorial or tribute was erected is revealed to not or no longer align with the district’s values.*

I am aware that payment must be received before a location is secured and a bench/plaque is ordered.*

Please submit your full name which we will use as a form of signature to confirm that you've read the above agreements.*

Send me a copy of my responses

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