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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. Tree and Nameplate

    Your contribution will allow park staff to choose the best tree species to be planted at the optimal time in the park of your choice. Location determined by park manager. A nameplate with one line of type will be placed on a plaque located in one of the following: Antioch, Heritage or Shawnee Mission parks or Tomahawk Hills Golf Course.

  3. Rosebush and Nameplate

    Your contribution will allow park staff to purchase and care for a rose bush to be planted in the Helen S. Cuddy Memorial Rose Garden in Antioch Park. A nameplate, with one line of type of your choice, will be placed on the plaque in Antioch Park.

  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 50 characters per line, includes spaces. 3 line maximum. Dates should be listed as years only.

  7. name, birth year - death year

  8. maximum of 30 characters includes spaces, names only.

  9. Leave This Blank:

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