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Memorial Designation Form

  1. Fill out and submit the form below. Upon receipt, we will notify you and confirm the information. Payment can be made in person with a check made payable to JCPRD and dropped off or mailed to 7900 Renner Road, Shawnee Mission, KS 66219. Attention: Cindy Lawrence PGC. Payment can also be made by phone with a Visa, Mastercard or Discover.
  2. Memorial Nameplate
    Includes a bronze nameplate with your loved ones' name installed on our "In Memory Of" plaque located in Antioch Park, Heritage Park, Shawnee Mission Park or Tomahawk Hills Golf Course.
  3. Please choose how you would like your remaining contribution to be used:
  4. Contour Bench and Bench Plaque*
    Donor's purchase includes a contour bench (with backrest) made of resin wood slats. This bench will be placed in the park of your choice. The location within the park can be requested but will have to be approved by the park manager. A bronze plaque will be installed on the backrest of the bench. *Bench and plaque not available in Meadowbrook Park
  5. Memorial Panel at Meadowbrook Park
    Your purchase includes engraving of your loved one's name, birth year and death year on a panel located on the Memorial Wall at Meadowbrook Park.
  6. Up to 45 characters per line, includes spaces. 3 line maximum. If listing dates, only birth year and death year allowed (i.e. 1900-1999)
  7. Name, birth year - death year (i.e. John Son Parks 1900-2000)
  8. Maximum of 30 characters includes spaces, name only.
  9. Leave This Blank:

  10. This field is not part of the form submission.