Harmony Park Personalized Brick
Please complete the details of this order form to reserve your personalized brick to be permanently included in the Kyrene de la Paloma Harmony Park. Bricks are $100 each.
Email address *
Your Full Name *
Your answer
Your Child's/Children's Full Name(s) *
Your answer
Your Child's/Children's Teacher(s)
Your answer
Phone number *
Your answer
Preferred contact method *
Required
Brick message samples (family name, years at Paloma, special quote or message)
How many lines of text do you want on your brick? There is a maximum of 3 lines, 20 characters (including spaces) per line. *
Text for Brick Line 1 (max 20 characters including spaces) *
Your answer
Text for Brick Line 2 (max 20 characters including spaces)
Your answer
Text for Brick Line 3 (max 20 characters including spaces)
Your answer
Payment Options: *
Questions and comments
Your answer
A copy of your responses will be emailed to the address you provided.
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