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.
Your Full Name
Your Child's/Children's Full Name(s)
Your Child's/Children's Teacher(s)
Preferred contact method
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)
Text for Brick Line 2 (max 20 characters including spaces)
Text for Brick Line 3 (max 20 characters including spaces)
Invoice from us (you can then send in check or cash to school)
Pay via PayPal (you will have the option to go to our PayPal account after you submit this form)
Questions and comments
A copy of your responses will be emailed to the address you provided.
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