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Applicant information and Dedication type

Please complete the form below, indicating the donor's contact information and dedication type of interest. Details relating to plaque wording, maintenance and repair and payment information can be found on the webpage and page two of this form.

Personal information requested on this form is collected under the authority of the Municipal Act, 2001, S.O. 2001, c.25, and will be used to assist City staff in making a decision on this Work.  Questions regarding this collection should be forwarded to the Director of Environment and Parks Services, 265 Lexington Crt, Waterloo ON N2J 4A8, 519-886-2310 x30237.