Memorial Program Online Application

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Memorial Bench 

You must fill out this form in one single session, please allow yourself enough time to do so.

Please correct the field(s) marked in red below:

Application Form for Park Memorial Program 

Review the Park Memorial Program Policy prior to filling out this application.  Select the site furnishing or tree you would like to donate and choose the wording for the memorial plaque.

The Parks and Trails Supervisor will contact you to arrange a meeting to discuss your application and select a suitable location for your memorial.

Questions? 

Call: 668-8325

Email: parks@whitehorse.ca  

Mailing Address: 2121 – 2nd Avenue Y1A 1C2  

Location: 4061 – 4th Avenue (Sport Yukon Building)

Name of Official Donor(s)
Dedicated to
Contact Person
Mailing Address
Postal Code
Daytime Phone
Cell
Email 
Select donation (2017 Prices - including GST)
 *
Select donation (2017 Prices - including GST)
Requested Location

Plaque Dedication (20 words or less)

Application Date
PARK MEMORIAL PROGRAM AGREEMENT

This Park Memorial Program Agreement is made between the City of Whitehorse and the donor. 

Both parties agree to the following responsibilities:

The Donor shall be responsible for:

  1. Donation payment to the City of Whitehorse prior to purchase and installation.
  2. Assume expenses related to any commemoration or dedication ceremony.
  3. Identify and hold harmless, the City of Whitehorse, its agents, servants and employees from and against all actions, suits, proceedings, or judgements taken against the City based on the construction and installation of all amenities undertaken by the City, unless such action, suit, proceeding or judgement was due to the negligent acts or omissions of the City of Whitehorse, its employees, agents or servants.

The City shall be responsible for:

  1. The purchase and installation of the agreed upon site furnishing or tree to City department standards.
  2. Any damage or repairs to any existing equipment or to the site due to installation of the site furnishing or tree, and clean up of construction debris after installation.
  3. Retain all the manufacture warranties and ensure that guarantees are carried out as required.
  4. Identify and hold harmless the donor, his/her agents, servants and employees from and against all actions, proceedings or judgements taken against the donor based on the construction and installation of the amenities undertaken by the City, unless such action, suit, proceeding or judgement was due to the negligent act or omission of the donor, their employees, agents or servants.

In lieu of signatures 

The person who has completed this online application has read and understood the Park Memorial Program Agreement:
  1. To receive a copy of your submission, please fill out your email address below and submit.
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