Bench Donation Program

Application/Donor *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Contact Number *

E-mail *

example@example.com

Plaque Verbiage (Please double check all spelling.)

Requested Park/Site Name:

Request Bench Location (if possible, include photos - see below)

File Upload

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Acknowledgement of Terms
The applicant/donor acknowledges that all donations to the Department of Parks, Recreation and Tourism will become property of Prince William County and the County reserves the right to remove or relocate all donated items at any time. In addition, the applicant/donor understands Parks, Recreation and Tourism will maintain the bench only for its useful lifetime. The bench will be removed when it becomes unsafe to sit on or if it is vandalized in a manner that makes it visually unacceptable. The Department of Parks, Recreation and Tourism will notify the donor when the bench must be removed and will give the original donor the opportunity to renew the gift and donate a replacement bench.