Required fields are marked with asterisks (*)

Welcome

Before submitting an application, please ensure that you have read the Commemorative Trees and Benches Donation Program Policy.

Should you have any question about the assets available for donation, the terms and conditions of the program or any other aspects of the donation process, please contact 519-925-2600 ext. 261 or jkaske@shelburne.ca before making an application.

Please complete the following Town of Shelburne Commemorative Trees and Benches Program Application Form.

Personal information is protected under the Municipal Freedom of Information and Protection of Privacy Act, 1989. Personal information is collected pursuant to the Municipal Act R.S.O. 1990, Chapter M-45 as amended, S.207, and Par.28 and will be used to register program participants - Inquiries may be directed to the Clerk’s Office or (519) 925-2600.

Donor Organization Name

Donor First and Last Name

Primary Phone Number

Secondary Phone Number

Email Address

Full Address

Would you like a secondary donor listed on the application?

Yes

Location: Tell us where you would like to place the Tree, Bench or Other?

Anywhere within the Town Shelburne

A Specific location within the Town of Shelburne

Do you have any additional considerations or notes you would like to communicate to staff?

Yes

Terms and Conditions:

I have read, fully understand and agree to abide by the Commemorative Tree and Bench Dontation Program Policy and agree with the terms and conditions.

The Town reserves the right to determine the tree species, tree size, and style of bench. The Town will provide a pre-approved tree and bench list.

Items purchased, installed, or planted under this policy automatically become property of the Town of Shelburne. Donors will have no further rights, participation or involvement in the future care or maintenance of the asset.

While the donor may suggest a proposed location, the Town reserves the right to determine, limit and approve the location of installation.

The donor must purchase a plaque through the Town. The Town has a standard plaque design and must approve all wording on the plaque.

The Town will maintain the commemorative asset in the same manner as other Town trees and benches. The Town reserves the right to determine the level of maintenance required.

The Town reserves the right to relocate the asset if unforeseen circumstances arise due to its location or setting. Nothing herein shall prevent the immediate removal of any asset deemed to constitute an immediate safety concern.

Please read and check the box below, acknowledging that you have read and agree to all Terms and Conditions of the Commemorative Tree and Bench Donation Program Policy

I hereby acknowledge that I have read and agree to all Terms and Conditions of the Commemorative Tree and Bench Donation Program Policy