Memorials and Donations Application

Create a tribute while giving back to your community.

Bloomington is home to 97 parks and thousands of acres of green space. Now you can help improve a park while also memorializing a loved one or honoring a milestone occasion. Dedicate a park bench, bicycle rack or tree as a memorial or meaningful acknowledgement of a birthday, anniversary, new baby, graduation or other life event.

Your gift will become a valuable enhancement to be enjoyed by park guests for many years to come!

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Applicant First Name

Applicant Last Name

Organization Name (if applicable)

Street

Unit / Apt. # (if any)

City/Town

State/Province

ZIP/Postal Code

Phone

Email

Donation/Improvement

Park Bench

Tree

(2-inch diameter or 5-foot evergreen)

Bike Rack

Monetary

Other (please specify)

Park Requested

In what park do you want the memorial placed?

Specific Location

What specific location within the park do you want the memorial placed?

Plaque Inscription (if applicable)

In Memory of

In Honor of

Donated by

Who is being recognized?

Indicate who the memorial is in memory of, honor of or donated by.

Signature

Typing your name constitutes your signature and acknowledgement that you have read, understand and agree to be bound by the City of Bloomington Parks and Recreation Department's Donation and Memorial Policy. Donations and/or memorials to Bloomington Parks and Recreation are considered outright and unrestricted donations. Bloomington Parks and Recreation does not guarantee permanency of the accepted donation. If a memorial must be relocated or removed, department staff will attempt to notify the donor in writing at the address shown on this form. Bloomington Parks and Recreation will maintain and perform reasonable repairs to the donation for ten years following installation. Donations may be tax deductible, please consult an accountant. The donor understands and agrees with the conditions set forth in this policy and agrees to pay City any donation funds within one week of notification of approval.

Date Signed and Submitted

Math question (8 + 7 =)

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Please take notice that any data received by the City as the result of submitting this form will be classified as government data pursuant to the Minnesota Government Data Practices Act, Minnesota Statutes Chapter 13. Under the Data Practices Act, some or all of this data is classified as public data, including your name, address, email address, phone number, and other personal information provided by you. Public data is available to anyone requesting it and consists of all data furnished via this Web form. Please be advised that the correspondence will be added to the public record. The purpose and intended use of the information collected through this form is to obtain public input and data in support of City activities and services. You have the right to refuse to submit this form. If you choose not to submit this form, you will need to contact the City by another means if you wish to provide the information collected by the form.

The City of Bloomington does not discriminate against or deny the benefits of its services, programs, or activities to a qualified person because of a disability. To make a request for a reasonable accommodation, ask for more information, or to file a complaint, contact the Community Outreach and Engagement Division, City of Bloomington, 1800 West Old Shakopee Road, Bloomington, MN 55431- 3027; 952-563-8733, MN Relay 711.

Memorials and Donations Application

Create a tribute while giving back to your community.

INSTRUCTIONS

Contact Information

Parks and Recreation Department