Memorial Bench Application

August 11, 2025

Open Burn Fire Ban in Middlesex County

No open-air burning is permitted in Middlesex County until further notice.

Middlesex County Fire Chiefs have declared an open-air fire ban. There will be no open-air burning permitted in Middlesex County until further notice.

Campfires are permitted but must be fully extinguished after use and must comply with all municipal by-laws.

This fire ban is being imposed due to the extreme dryness of all vegetation in the area and shall remain in effect until further notice.

No burn permits will be issued until the ban is lifted.

Required fields are marked with asterisks (*)

Memorial Bench

Please complete the following information to begin your application for a memorial bench and leave a lasting legacy

Notice of Collection of Personal Information

Personal information on this form is collected under the legal authority of Municipal Act, 2001. This information is collected and maintained for the purpose of sending out electronic mail billing. Questions or concerns about the collection of this information can be directed to the Clerk at 4305 Hamilton Road, Dorchester ON N0L 1G3, Phone: 519-268-7334 ext 254 or clerk@thamescentre.on.ca

Full Name

Street Number

Street Name

City/Town

Province

Phone Number

Email Address

Bench Location

Wording for Dedication Plaque

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