Garden Bench Form

Thank you for your decision to contribute a garden bench at the Healing Garden. Please complete the form below. If you would like to submit an anonymous contribution on behalf of a donor’s family, please contact us at legacy@life-source.org.

A map of available Garden Benches can be viewed here.

Please note names will be engraved on the Memorial Wall in late June or early July of 2024. An event will also be held at LifeSource on August 3rd for families with loved ones’ inscriptions engraved in 2024. Click here for more details.

Garden Bench Application

Your Name*
This bench inscription is being made:*
- in honor of
- in memory of
Name of individual being recognized*
Relationship to individual being recognized*
Are you the legal next of kin?*
- Yes
- No, but I have received the legal next of kin’s permission for the engraving.
Name of legal next of kin (for confirmation)*
Inscription (limit to 90 characters)*
Write your message in the space provided. Any symbol or punctuation, such as a comma, period or dash, will be considered one character. Text will be centered on the bench and may fill up to three lines.
Confirmation*
- Checking this box confirms my approval for the inscription. It will be inscribed on a garden bench as entered above.

Payment
Name*
First Last
Billing Address*
Street Address Address Line 2 City State ZIP Code

To help protect your credit card, this information must match the billing address on file with your credit card company.
Email*
Enter Email Confirm Email
Phone*
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Garden Bench*
Price:
Additional Contribution (optional)
CAPTCHA

Garden Bench Application

Payment