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Memorial Designation Form
This form has been modified since it was saved. Please review all fields before submitting.
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.
First and Last Name
In memory of: (if applicable)
Park Location: list park plus detailed location
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.
Please choose how you would like your remaining contribution to be used:
Rose Bush at Helen S. Cuddy Memorial Rose Garden at Antioch Park
Tree to be planted in same park name plate will be located
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
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.
Text for bench plaque
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)
Text for Panel at Meadowbrook Park
Name, birth year - death year (i.e. John Son Parks 1900-2000)
Text for name plate for "In Memory Of" Plaque
Maximum of 30 characters includes spaces, name only.
If you would like an acknowledgement email sent to someone please list their email below
Relationship to person receiving acknowledgement
Leave This Blank:
Receive an email copy of this form.
This field is not part of the form submission.
* indicates a required field
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