Park Memorial Program

Recycled Plastic Bench

Recycled Plastic Bench

The Park Memorial Program provides opportunities for applicants to donate a site furnishing or tree to beautify public spaces in memory of or dedication to an individual, significant historical event or occasion.

Please review the Park Memorial Program Policy and Appendix B – Program Agreement prior to filling out this application. Schedule A – Program Fees are currently being updated.

After reviewing these, please select the site furnishing or tree you would like to donate and choose the wording for the memorial plaque. You may submit your request using the web form below (preferred) or by printing and submitting Appendix A – Program Application.

After submission:

your application will be reviewed by Community Services Department staff
you will be contacted to discuss the details of your request including your requested location(s), installation date(s), etc
payment in full and signing of the Program Agreement is required prior to installation

Questions?

Call: (506) 432-4573

Email: recreation@sussex.ca

Form No. CS-24-001: Park Memorial Program Application

Part A – Applicant Information

Applicant Name: *

Phone *

Email *

Mailing Address: *

Mailing Address:

No P.O. Boxes

No P.O. Boxes

Mailing Address:

City

City

Province

Province

Postal Code

Postal Code

Mailing Address:

Part B – Memorial Information

Memorial Selection *

2024 prices shown

Preferred Location * Preferred Location

Preferred Installation Date *

Part C – Plaque Dedication (5″x6″)

Line 1 Line 1

Max 40 characters including spaces

Line 2

Max 40 characters including spaces. Please indicate N/A if you wish to leave blank.

Line 3

Max 40 characters including spaces. Please indicate N/A if you wish to leave blank.

Line 4

Max 40 characters per row (4). Please indicate N/A if you wish to leave blank.

Line 5 Line 5

Max 40 characters including spaces. Please indicate N/A if you wish to leave blank.

Part C – Plaque Dedication (4″x11″)

Line 1 Line 1

Max 40 characters including spaces

Line 2

Max 40 characters including spaces. Please indicate N/A if you wish to leave blank.

Line 3 Line 3

Max 40 characters including spaces. Please indicate N/A if you wish to leave blank.

Signature *

reCAPTCHA

If you are human, leave this field blank.

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