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2. APPLICATION PROCESS

   Dedicating a memorial in honor of a loved one or a civic group on a public park feature is a meaningful way to acknowledge and support the significant role of the Powhatan County parks system in our community. Your donation will contribute to the maintenance of the County Parks system while celebrating a special person or civic group.

   1. Review the Memorial Policy, guidelines, and costs.

   2. Identify an available location.

   3. Your request will be reviewed by staff within 60 days. 

   4. If approved you will be invoiced for the amount owed.

   5. A plaque will be ordered and installed by County staff.

4. CONTACT INFORMATION
6. First Name*
7. Last Name*
9. Street Address*
11. City*
12. State*
13. Zip*
15. Phone Number*
16. Email Address*
18. REQUEST INFORMATION
20. DISCLAIMER

    Submission of a park memorial request requires the express permission of the family of the individual being memorialized. By completing this request, you confirm that you have obtained consent from the family to proceed. The Parks and Recreation Department reserves the right to verify permissions before approving any memorial installation.

22. Name of Individual/Organization:*
23. Significant Area of Contribution:*
    -- Select One --EducationGovernmentPublic ServiceScienceHuman BettermentCommunity OutreachOther
25. Dedication Type:*
    -- Select One --PlaqueBenchPicnic Table Tree DonationEngraved BrickPlayground EquipmentRockDonation to Park Improvements/Infrastructure
26. Location*
    -- Select One --Fighting Creek ParkTurner ParkVillage ParkVillage Sports ComplexPocahontas Landmark CenterTrails
27. Specific area within park location:
29. Plaque Inscription*
31. Special Notes:
33. Thank you for your application!

    Your request will be reviewed by the Parks and Recreation Director and presented to the Parks and Recreation Advisory Commission for approval at the next regular scheduled meeting. Requests may take up to 60 days for approval and up to 12-18 months for installation. For additional questions or information contact the Parks and Recreation Department at (804) 598-5275 or email parksandrec@powhatanva.gov.

Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field