Please print and mail this form

Freedom Playground Brick Paver Form
www.HaverfordFreedomPlayground.org

Help maintain Freedom Playground by buying a brick at the entrance of the playground!
Please share this special opportunity with friends and family. It makes a great gift!
Your name or message will be engraved in your paver.

4" x 8" Brick Paver - $75 (2 lines @ 15 characters per line Maximum)
Please fill out your request in the spaces boxes below

(one letter, number, space or punctuation per space)

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8" x 8" Brick Paver - $125 (5 lines @ 15 characters per line Maximum)
Please fill out your request in the spaces boxes below

(one letter, number, space or punctuation per space)

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Include this form with your check made payable to Freedom Playground and mail to:
Freedom Playground, c/o Ann Phillips, 2628 Wendy Rd, Havertown, PA 19083
Name:____________________________________________________
Address: ___________________________________________________
Telephone _________________________________________________
Email: ____________________________________________________
Freedom Playground Committee appreciates your support! 
Please note that we are not a 501(c)3 so your donation is not tax-deductable.  For more information

on giving or if you would like to make a major gift requiring a tax deduction, please email

info@haverfordfreedomplayground.org or call Ann at 610-577-5228.  Freedom Playground is located

at 9000 Parkview Drive, Haverford, PA at the Community Parkat Haverford Reserve.  The playground

is owned and operated by Haverford Township. The Freedom Playground Committee is an all-volunteer

group formed to fund raise,build and help maintain Freedom Playground.  Form dated 05-5-15.