Dog Park Memorial Plaque Application

Contact Information

Applicant name:

Billing address:

City/Town:

Province:

Postal code:

Phone number:

Email:

Memorial Information

Plaque inscription(s):

Plaque dimensions: 6” wide by 2” high (Blue Plaque with White Printing)

Purchase Conditions

All purchases of dog park memorial plaques must adhere to the following conditions:

Installation of memorial plaques will be completed by Community Services Staff
Memorial plaque size, style and material will be determined by Community Services Staff
Plaque will be ordered by Staff and prior to installation the plaque will be approved by both Staff and the Purchaser. All ongoing maintenance of memorial plaques are the responsibility of Community Services Staff.

The cost of each memorial plaque is $30.00 ($33.90 including HST) which must be paid in full before memorial plaque installation.

Upon submission of your completed form, please call the Town of the Blue Mountains at 519-599-3131 x254 to process payment, or visit us in person at 32 Mill Street Thornbury, ON N0H 2P0 with a separate cheque payable to The Town of The Blue Mountains.

Total cost: $

I have read and understood the conditions listed above and wish to proceed with the memorial purchase as outlined in the completed application.

Date:

For Office Use Only

Application received by:

Date:

Receipt number:

Installation date: