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230907 Recreation and Sports Advisory Committee AgendaPage 1 of 2 The Corporation of the Town of Tillsonburg Recreation & Sports Advisory Committee September 7, 2023 5:30 p.m. Council Chambers AGENDA 1. Call to Order 2. Adoption of Agenda Proposed Resolution #1 Moved by: Seconded by: THAT the Agenda as prepared for the Recreation & Sports Advisory Committee meeting of September 7, 2023, be approved. 3. Minutes of the Previous Meeting 4. Disclosures of Pecuniary Interest and the General Nature Thereof 5. General Business and Reports 5.1. RCP communications/social media – report (attached) 5.2. Summer events at park 5.3. Hall of Fame nomination frequency 5.4. Glendale Wall of Fame recommendation 5.5. Commemorative Naming Policy 5.6. Master Plan update 5.7. Community centre renovation update 5.8. Playground installation update 6. Next Meeting Page 2 of 2 [Date] 7. Adjournment The meeting adjourned at _____ p.m. Please contact the Staff Liaison listed below to gain access to this electronic meeting: Contact Margaret Puhr mpuhr@tillsonburg.ca 519-688-3009 ext.4202 Page 1 of 7 Subject: RCP Communication Report Number: RCP 23-02 Department: Recreation, Culture and Parks Department Submitted by: Andrea Greenway, Recreation Programs & Services Manager Meeting Type: Advisory Committee Meeting Meeting Date: Thursday, September 7, 2023 RECOMMENDATION A. THAT report titled RCP 23-02 Communication be received as information; and B. THAT The Recreation and Sports Advisory Committee recommend Option 2 to Council for consideration. BACKGROUND At the July 6 Recreation & Sports Advisory Committee meeting the following resolution was passed: Resolution #2 Moved by: Deb Gilvesy Seconded by: Taylor Campbell THAT the Recreation & Sports Advisory committee requests back a staff report on ways to increase communication to the public from the Recreation, Culture and Parks department when it comes to programming, events and facilities. And opportunities to further collaborate with user groups to improve partnerships and communication when it comes to successes of local organizations/teams and the promotion of events being held in Tillsonburg. Carried Options for increased communication are provided in this report. DISCUSSION The Town of Tillsonburg has one Facebook page that provides information on all corporate initiatives with the exception of Annandale NHS. The Recreation department Choose an item. Click or tap here to enter text. Page 2 of 7 has an Instagram page, however the target audience of Facebook is who we are typically trying to reach (ie: parents who sign their children up for programs). The committee has expressed concerns with the Recreation department having the ability to provide information to the public in a timely manner. The Manager of Recreation Programs & Services completed a review of how neighboring municipalities manage social media. Below are the comparators: Municipality/Organization Department Responsibility Municipal Recreation Page Municipal Corporate Page Notes City of Woodstock Corporate Communications no yes Recreation information is posted on the corporate social media page by the recreation team. There is a posting calendar provided by the communications team. Recreation staff have access to post if communications staff are unavailable. Approach is to “schedule and automate” what is known in advance and work around those (or adjust if needed) for the “responsive or urgent” needs. Choose an item. Click or tap here to enter text. Page 3 of 7 Norfolk County Corporate Communications yes yes Recreation information is posted on the recreation social media page by the corporate communications team. The recreation team provides content. Town of Aylmer Parks and Recreation yes yes Recreation staff post on the recreation social media pages. City of St. Thomas Corporate Communications no yes All posts are on the corporate page and posted by the communications team. Recreation staff provide content Strathroy-Caradoc Corporate Communications No yes All posts are on the corporate page and posted by the communications team. Recently hired an additional staff member to focus on social media and this is working very well Choose an item. Click or tap here to enter text. Page 4 of 7 City of London Corporate Communications yes yes Recreation information is posted on the recreation social media page by the corporate communications team. The recreation team provides content. Town of Ingersoll Community Services yes yes Recreation staff post on the recreation social media pages. Staff post during working hours only, no expectation to post after hours Municipality of Thames Centre Corporate Communications no yes Recreation staff provide posts including graphics, posts are forwarded to the communications team and posted when they are able In reviewing how neighboring municipalities organize their social media, it was evenly split between having a separate recreation page for disseminating information and having a corporate page that encompasses all departments. A review was also completed on social media policies for 9 municipalities. The municipalities included (note: not all of the comparators above have social media policies): • Township of Zorra Choose an item. Click or tap here to enter text. Page 5 of 7 • City of London • County of Wellington • Middlesex Centre • North Perth • Thames Centre • Haldimand County • Norfolk County • Strathroy-Caradoc Each municipality has a different staffing structure, but in all policies there are clearly defined staff roles, including management oversight of social media, social media moderators and staff who monitor social media. The management of social media is the responsibility of the communications or administration department while the moderators are appointed by managers and supervisors to produce content and post information on behalf of the municipality. All staff are responsible for following the corporate social media policy. Based on the review, the committee is presented with the following options to increase communication for the Recreation, Culture and Parks Department: Option 1: Maintain 1 corporate social media page managed by corporate communications and appoint social media moderators in each department that are responsible for creating content and posting to social media. This is currently happening informally on a trial basis for the RCP department. Option 2: Create a separate social media page for the Recreation, Culture & Parks department. This page would be managed by the RCP management team with staff appointed as moderators. The page would encompass the sharing of all Recreation, Culture and Parks information to the public. As separate Facebook page for Annandale NHS already exists, this page would be amalgamated to create one Recreation, Culture & Parks page that disseminates all department information to the public. The Recreation, Culture and Parks department has a significant amount of information to share with the community. There are a number of projects to celebrate and opportunities to engage the community. The department relies heavily on revenue generation in order to meet budget projections and there is a need to market and promote recreation programs in a timely manner. In the Community Recreation Survey that took place in June, 2022, when asked how residents learn about recreation Choose an item. Click or tap here to enter text. Page 6 of 7 opportunities in Tillsonburg, social media was the top response with just over 50% of residents receiving their information in this manner. This provides an excellent opportunity for RCP to increase communications through social media. Based on these factors, RCP staff recommend option 2 above. It is also recommended that the Town develop social media guidelines for departments to follow in order to ensure corporate standards are met. Staff will need to be assigned and trained on the social media guidelines for quality assurance. CONSULTATION RCP Director, Managers and staff, neighboring municipalities noted above, Director of Corporate Services FINANCIAL IMPACT/FUNDING SOURCE N/A CORPORATE GOALS How does this report support the corporate goals identified in the Community Strategic Plan? ☐ Lifestyle and amenities ☒ Customer service, communication and engagement ☐ Business attraction, retention and expansion ☐ Community growth ☐ Connectivity and transportation ☐ Not Applicable Does this report relate to a specific strategic direction or project identified in the Community Strategic Plan? Please indicate section number and/or any priority projects identified in the plan. Goal – The Town of Tillsonburg will strive for excellence and accountability in government, providing effective and efficient services, information, and opportunities to shape municipal initiatives. Strategic Direction – Increase opportunities and promotion for public engagement in municipal initiatives. Choose an item. Click or tap here to enter text. Page 7 of 7 Priority Project – N/A ATTACHMENTS N/A Page 1 of 18 RECREATION, HERITAGE AND PARKS Policy 9-006: Commemorative Naming Policy Approval Date: April 25, 2016 Approval Authority: Council, By-Law 4012 Effective Date: April 25, 2016 Next Scheduled Review Year: Department: Recreation, Culture and Parks Last reviewed: April 25, 2016 Revision Date/s: Schedules: POLICY STATEMENT The Town of Tillsonburg is committed to providing a fair, consistent and efficient process with respect to the commemorative naming of municipal assets, after a person, persons or family name. PURPOSE The purpose of this policy is to provide clear guidelines, a consistent evaluation framework and approval process in regards to the Commemorative Naming or Renaming of Town assets and to allow for comprehensive and open public consultation in accordance with the Town’s Public Engagement Policy. Such a process will ensure the application of key criteria in order to determine the appropriateness of a name and shall recognize the important role played by the legislative bodies involved (i.e. Committees and Council). SCOPE This Policy applies to the Commemorative Naming or Renaming of parkland, open spaces, trails, structures and public spaces after a particular individual(s),family name, business or organization. The Commemorative Naming Policy is intended to recognize the geographical, natural, Page 2 of 18 cultural, historic features and/or civic significance of properties owned by the Town, as well as to honour the outstanding achievements, distinctive services, or significant community contributions made by an individual or group. Any member of the public or Town Council may submit a nomination application for the Commemorative Naming or Renaming of a parkland, open space, trail, structure or public building/room. This Policy is not intended to address: Individual naming dedications such as for park benches or tree program memorials; Naming of Town-owned facilities leased to commercial tenants; Naming of Town Buildings that provide core services (i.e. Town Hall, Fire Services, Police Services, EMS). This restriction does not apply to the courtyards, squares, gardens, lawns, etc. or indoor components of these buildings (wings, halls, auditoriums, galleries, lounges, lobbies, boardrooms, etc.). GENERAL This Policy shall be administered by the Director of Recreation, Culture and Parks; This Policy shall be referred to as the “Commemorative Naming Policy”; This Policy shall come into force and effect on the date adopted. AUTHORITY The authority for the Commemorative Naming Policy shall be by the approval of the Council of the Town of Tillsonburg. DEFINITIONS Commemorative Names Reserve List: Names submitted that qualify, but may not be chosen by the Committee for a particular asset, will be added to a list and can be considered for future assets (Names will be kept on the Commemorative Names Reserve List for 5 years). Commemorative Naming Committee (CNC): Shall be comprised of one member of the Museum, Culture, Heritage and Special Awards Committee, Parks Beautification and Cemeteries Committee as well as the Sport and Recreation Committee, one member of Council, Town Clerk, Commissionaire of Economic Development and the Director of Recreation, Culture & Parks (or Designates). Meetings will be held in-camera, in accordance with Section 239 (2)(b) of the Municipal Act, “personal matters about an identifiable individual, including municipal or local board employees”. Matrix Rating System: Shall be comprised of weighted questions to assist Committee Members in the analyzation and determination of qualified/appropriate names for Town assets (attached as Appendix 'A' of this Policy). Page 3 of 18 Other Open Spaces: Valleys, forests/woodlots, watercourses (lakes, rivers), utility features such as storm- water management areas, downtown squares, and plazas. Parkland: Refers to land dedicated by the Town for use as a public park or for recreational purposes. All parkland designations are defined within the Town of Tillsonburg’s Parks, Recreation, and Cultural Strategic Master Plan and Zoning Bylaw. For commemoration purposes, the term municipal park shall include other components, such as sporting fields contained within a larger park. Public Buildings: Town owned public buildings and their outdoor service areas (pools, arenas, parking garages, recreation centre, facility yards, plazas, courtyards, squares, gardens, lawns, etc.), as well as their indoor components (wings, halls, auditoriums, galleries, lounges, lobbies, boardrooms, etc.). Public Consultation Process: The two-way exchange of information between The Town and the public before decisions are made. It is an open and accountable process allowing individuals and groups to participate in the decision-making process of naming Town owned assets. Statistical information on comments received under consultation will be provided to individuals other than staff, upon request. However, specifics and written comments received will be available only to the Committee and Town Council. Trails: An off-road Recreational path system or Pedestrian walkway which may be made of Limestone, Asphalt, packed earth, woodchips, granular surface or other material, for use by walkers, cyclists, snowshoers, cross-country skiers, etc. Submitting an Application Applicants are required to submit a completed Commemorative Naming Application Form (attached as Appendix 'B' of this Policy), the sworn Affidavit Forms (attached as Appendix 'C' of this Policy) along with the required supporting documentation when requesting the Commemorative Naming or Renaming of a municipal property. Background information and/or biographical information (if named after an organization or an individual) shall demonstrate the significance of the proposed name to the community. It is recommended that the applicant include letters of support for the request, including documentation by the individual being honoured or their legal representative. A petition may also be included in the event that a request is being made for the renaming of a municipal property. The commemorative naming process for parkland, open spaces, trails, structures and public buildings, may differ from application to application depending on the circumstances surrounding the request/requirement for naming. Application Criteria Page 4 of 18 When an Application Form is submitted, at least one of the following criteria shall apply: The nominated individual has demonstrated excellence, courage or exceptional service to the citizens of the Town of Tillsonburg, the Province of Ontario and/or Canada; The nominated individual has provided extensive community service and has an extraordinary community service record; The nominated individual has worked to foster equality and reduce discrimination; The nominated individual is a current Town of Tillsonburg employee, and has made an outstanding contribution to the Town of Tillsonburg unrelated to and outside of his/her job responsibilities, capacity and duties as a Town employee; The nominated individual is a former employee of the Town of Tillsonburg and is to be recognized for his/her exceptional service unrelated to and outside of his/her job responsibilities, capacity and duties as a former Town employee; The nominated individual has made a significant financial contribution to parkland, an open space, trail, structure or public building, and the contribution significantly benefits the community that the municipal property serves (i.e. the project may not have been otherwise possible without the financial assistance); The nominated name has a geographical, natural, cultural, historical or civic significance to the community, Town of Tillsonburg, Province of Ontario or Canada. *Out of respect to the deceased, no proposal for the Naming or Renaming of municipal property shall be considered by the Naming Committee within ninety (90) days of the death of the person for whom the naming request is being made. Renaming The Commemorative Naming Committee will consider renaming an existing Municipal Asset after receiving a submission from a private individual or organization, or direction from Council to undertake the Commemorative Naming process as outlined herein. Recognizing that established names contribute significantly to community identity and pride, proposals to rename existing municipal property, must be predicated by exceptional circumstances. Existing names will not be changed without consideration of: The historical significance of the existing name; The impact on the individual or organization associated with the existing name; The cost and impact of changing existing signage, rebuilding community recognition and updating records (data bases, letterhead, promotional materials, etc.). Processing of Application The following section sets out the procedures for the selection and approval of a Commemorative name. Applications received requesting the Commemorative Naming of municipal assets, shall be forwarded to the Commemorative Naming Committee for consideration. The Naming Page 5 of 18 Committee will utilize an established Matrix Rating System (refer to Appendix ‘A’ of this Policy) when evaluating applications. As part of the approval process, a preliminary investigation of the commemorative name will be conducted to ensure that the name has not been used in the past and that the nomination is meritorious in nature. Processing the application involves confirmation of criteria, reference checks (if applicable), discussion with the applicant and the applicable Town departments, initial meeting of the Commemorative Naming Committee (CNC), public consultation, compiling consultation results and a reconvening meeting of the CNC for final decision. Public notice in regards to the application(s) received, shall be provided in accordance with the Town of Tillsonburg’s Notice Policy. Notice shall be made in the local newspaper and on the Town of Tillsonburg website as part of the Public Consultation Process for a (60) sixty-day period. A copy of the notice shall also be provided to applicable Town departments. The notice shall include: An invitation for public comments in regards to the proposed name(s) of the Town asset(s), as provided for by the Commemorative Naming Committee; Directions on how comments can be submitted to the Town for consideration; Directions on where further information can be found regarding the Commemorative Naming Program (i.e. Commemorative Naming Policy and accompanying forms, etc.); The date on which a report will be scheduled for consideration by Town Council. Public Consultation Public consultation is required as the issue of commemorative naming of municipal property directly affects citizens and provides identity to the communities in which they live. Through public consultation at the community and Town-wide level, residents will be able to ensure they maintain a strong connection to their communities and will be able to gain a better understanding of the individual(s)/family who has been nominated for commemoration. Public consultation shall be undertaken in accordance with the size and scope of the specific municipal property being named. Consultation may consist of formal written notification of the proposed name to affected community associations, applicable interest groups and Town of Tillsonburg Advisory Committees (where appropriate). Advertisements may be placed in the local newspapers, where appropriate, and on the Town’s website. Statistical information on comments received under consultation will be provided to individuals other than the Commemorative Naming Committee, upon request. However, specifics and written comments received will only be available to the Committee and Town Council. Town staff will provide the final decision on a proposal to individuals who submit a Page 6 of 18 comment under the public consultation component, and provide a copy of the Commemorative Naming policy and information sheet, when necessary. Evaluation Process The CNC shall reconvene to review the public consultation results and departmental comments. When a name is recommended for approval, an In-camera report to the appropriate Standing Committee and Council is prepared containing the CNC’s recommendation. First consideration by the Naming Committee will be given to those Names that are representative of the geographical, natural, cultural, or historical features and/or the civic significance of the municipal property to which the name will be applied. Second consideration by the Naming Committee will be given to those Names that fall under at least one of the following criteria: The nominated individual has demonstrated excellence, courage or exceptional service to the citizens of the Town of Tillsonburg, the Province of Ontario and/or Canada; The nominated individual has provided extensive community service and has an extraordinary community service record; The nominated individual has worked to foster equality and reduce discrimination; The nominated individual is a current Town of Tillsonburg employee, and has made an outstanding contribution to the Town of Tillsonburg unrelated to and outside of his/her job responsibilities, capacity and duties as a Town employee; The nominated individual is a former employee of the Town of Tillsonburg and is to be recognized for his/her exceptional service unrelated to and outside of his/her job responsibilities, capacity and duties as a former Town employee; The nominated individual has made a significant financial contribution to parkland, an open space, trail, structure or public building, and the contribution significantly benefits the community that the municipal property serves (i.e. the project may not have been otherwise possible without the financial assistance); The nominated name has a geographical, natural, cultural, historical or civic significance to the community, Town of Tillsonburg, Province of Ontario or Canada. Page 7 of 18 Council Approval The Commemorative Naming Committee will prepare and send a report to Council outlining the proposed name for each Town asset and the reasons why the name was chosen (i.e. analysis against the criteria). Upon Committee and Council approval, implementation of the approved commemorative name is undertaken. This involves final notification to the nominee, preparation of an official letter signed by the Mayor, and an official unveiling ceremony for the nominee and family with the presentation of a plaque to be erected at the site, indicating the name as well as its significance for commemoration. New Development of Municipal Property Building and Planning Services, will notify the Town Clerk when the new development of municipal parkland, an open space, trail, structure or public building occurs and provide information regarding the specific project and the applicable time frame for construction, Town ownership, and, if applicable, information with respect to proposed names for the development. The Town Clerk or designate may convene a meeting of the Commemorative Naming Committee as required to discuss and name all new municipal properties which have been identified as requiring a name, or to discuss a recommended commemorative name. The Committee shall review the approved list of names eligible for consideration to determine if there is an appropriate name for the identified project, or undertake necessary steps to solicit proposed names. If a commemorative name is selected for the project from the Commemorative Names Reserve List, or a name is recommended through another means, the public consultation process will commence for (60) sixty days. The Commemorative Naming Committee will request comment from the Museum, Heritage, Culture and Special Awards Committee, Parks, Beautification and Cemeteries Committee, Sports and Recreation Committee and the Economic Development Committee regarding the proposed name. The Commemorative Naming Committee will reconvene to review public comment and develop a final recommendation. Council Approval The Commemorative Naming Committee will prepare and send a report to Council outlining the proposed name for each Town asset and the reasons why the name was chosen (i.e. analysis against the criteria). After Council approval, staff will initiate the implementation of the approved Names on official documents, construction and permanent signage and plan/implement the appropriate protocols (e.g. dedication ceremony). Page 8 of 18 Commemorative Names Reserve List Maintenance and Use A name may be submitted that is not site or venue specific. In this regard, the application will undergo the same process with respect to the criteria evaluation and investigation process included within this policy. Staff will discuss possible options with the nominator and the suitability. If a site or/and geographic location is not determined through these discussions, the name is placed on the Commemorative Names Reserve List (for municipal properties) maintained by the Town Clerk, and the Street Names Reserve List maintained by Building Services. The Commemorative Naming Committee will meet to review the Name Reserve List, new submissions and complete the Matrix Rating for each completed submission. They will also appoint a member to verify the accuracy of the proposed names for each asset, using reference documents including atlases, other official municipal/civic publications and local historians/contacts. In accordance with Council direction, historical names will be given precedence. Otherwise, there shall be no prioritization system of commemorative names on the list. Nominators are free to designate the name for use in a parkland, open space, trail, structure or public building, at the time of nomination if they chose. The List shall be made available on request to any interested party, although the results of the investigations of the naming requests shall remain confidential. A commemorative name may be used for parkland, open space, trail, structure or public building only once. If the nominator wishes that a nominated commemorative name be associated with a particular municipal property, it shall be noted on the Commemorative Names Reserve List. Length of Naming Rights 1. If the parkland, open space, trail, structure or public building is named after a person(s). The name will remain for the lifespan of the facility. 2. If the parkland, open space, trail, structure or public building is named after a company or organization due to significant contribution to the community the name will remain for the lifespan of the facility or until the company or organization is no longer in operation. 3. If the parkland, open space, trail, structure or public building is named after a company or organization, due to a financial contribution to the project. The naming rights will remain for a period of 20 years or until the company or organization is no longer in operation. After the 20 year period the company or organization may make a financial contribution to extend the naming rights. At this point if the company or organization no longer wishes to continue, the naming rights will be opened to other companies or organizations. Page 9 of 18 Page 10 of 18 SCHEDULE A THE CORPORATION OF THE TOWN OF TILLSONBURG MUNICIPAL PROPERTY AND BUILDING COMMEMORATIVE NAMING SCHEDULE A: Matrix Rating System - For Use By The Commemorative Naming Committee ASSET: PROPOSED NAME: Check one (1) box for each criteria met. When complete, add and total at the bottom (5= excellent, 1 = poor). NO. Criteria RATE WEIGHTING 5 4 3 2 1 (rate x weighting number) 1 Civic significance 5 2 Geographical or Natural significance 5 3 Cultural or Historic significance 5 4 Demonstrated excellence, courage or exceptional service to 3 5 Demonstrated excellence, courage or exceptional service to 3 6 Has worked to foster equality and reduce discrimination 2 7 Has risked or given his/her life to save or protect others 2 8 Other - creativity and/or originality of the proposed 1 9 Have no other Town owned asset designations (multiple 1 TOTAL: Page 11 of 18 SCHEDULE B APPLICATION FORM COMMEMORATIVE NAMING OF A MUNICIPAL STREET, PARKLAND, OPEN SPACE, TRAIL, STRUCTURE & PUBLIC BUILDING A. NOMINATOR’SINFORMATION *A COMMEMORATIVE NAME MAY BE USED ONLY ONCE IN THE TOWN OF TILLSONBURG SUBSEQUENT REQUESTS WILL BE DENIED Name (Individual or Organization): Mailing Address: Telephone: Home Work E-mail: Affiliation to Nominee: B. NOMINEE’S INFORMATION (NAME TO BE COMMEMORATED) Name: Mailing Address: Date of Birth: Telephone: Home Work E-mail: Page 12 of 18 E. APPLICABLE CRITERIA (SELECT ONE)  The nominated individual has demonstrated excellence, courage or exceptional service to the citizens of the Town of Tillsonburg, the Province of Ontario and/or Canada.  The nominated individual has provided extensive community service and has an extraordinary community service record.  The nominated individual has worked to foster equality and reduce discrimination.  The nominated individual is a current Town of Tillsonburg employee, and has made an outstanding contribution to the Town of Tillsonburg unrelated to and outside of his/her job responsibilities, capacity and duties as a Town employee.  The nominated individual is a former employee of the Town of Tillsonburg and is to be recognized for his/her exceptional service unrelated to and outside of his/her job responsibilities, capacity and duties as a former Town employee.  The nominated individual has made a significant financial contribution to municipal parkland, open space, trail, structure or public building and the contribution significantly benefits the community that the municipal property serves (i.e., the project may not have otherwise been possible without the financial assistance).  The nominated name has geographical, natural, cultural, historical or civic significance to the community, Town of Tillsonburg, Province of Ontario or Canada. C. NOMINATOR’SINFORMATION *A COMMEMORATIVE NAME MAY BE USED ONLY ONCE IN THE TOWN OF TILLSONBURG SUBSEQUENT REQUESTS WILL BE DENIED Name (Individual or Organization): D. NOMINEE’S INFORMATION (NAME TO BE COMMEMORATED) Name: Page 13 of 18 F. RATIONALE FOR NOMINATION AND ATTACHED BACKGROUND INFORMATION RELATED TO THE CRITERION CHOSEN, WHICH SUBSTANTIATES ALL CLAIMS MADE: INCLUDE COPIES OF NEWSPAPER ARTICLES, CERTIFICATES, AWARDS, LETTERS OF SUPPORT OR COMMENDATION, SERVICE RECORDS, PICTURES, ETC. Please note all information provided below and/or attached to this Application Form will form part of the Commemorative Naming Application Form and will therefore be released to the public in any public notices/advertisements produced, public Agenda and Minutes, Committee discussions/meetings and Reports which may go forward to Council. Page 14 of 18 G. PLEASE INDICATE WHAT YOU WOULD LIKE THE NAME USED FOR (PLEASE CHECK ONE):  Street  Parkland  Open Space  Trail  Structure  Public Building H. IS THERE APARTICULAR STREET/PARKLAND/OPEN SPACE/TRAIL/STRUCTURE/OR PUBLIC BUILDING WHICH YOU WOULD LIKE THE NAME USED FOR?: 1st choice 2nd choice Property’s Current Identification, Address or Location Information: I. RENAMING: (Please note that before a Renaming Application is accepted, the nominator must have written permission from the family or next of kin―if this application results in a request to displace an existing commemorative name [person, persons, or family]): Does the property currently have a name? If so, provide current name, details and rationale for the proposed renaming of this property. J. ADDITIONAL INFORMATION: (ADD INFORMATION AS NEEDED) 1 The nominee or a representative on their behalf (next of kin, solicitor, notary public, etc.) must provide consent to this nomination. K. INVESTIGATION AND REFERENCE CHECKS REQUIRED A Criminal Reference Check* (CRC) for the nominee is required as part of this process. It is necessary for the nominee to obtain the CRC. The nominee must provide the Clerk’s Office with a copy of the processed CRC provided by Police Services together with the completed Application Form. To obtain a CRC, contact the Ontario Provincial Police Service at 519-688-6540. (Note: If the nominee is deceased, it is not possible to obtain a CRC, but the next of kin must complete the section below and submit an Affidavit of the next of kin). In addition to the above, a sworn affidavit* (issued separately) must be provided to the Town Clerk’s Office. The affidavit provides information with respect to Outstanding Offence Convictions or infractions under a Federal or Provincial statute. Please note that an outstanding conviction or infraction under any of the above may result in the disqualification of an application. Confirmation that the information has been collected through the above investigations will be presented at the public Commemorative Nominating Committee meeting at the time of its consideration of the application – but any details of the results of the clearance checks will only be discussed with Committee Members In-Camera. CONSENT1 Does the nominee consent to a CRC and providing the information to the Town? Yes No Does the nominee or nominator consent to a Provincial Offences Act Check? Yes No Does the nominee or nominator consent to providing the sworn affidavit to the Town? Yes No Does the nominee or nominator consent to the release of the status of the clearance checks? Yes No * Any fees associated with the Criminal Reference Check and/or the sworn affidavit are the responsibility of the applicant. Nominator’s Signature Date Nominee’s Signature Date 2 The nominee or a representative on their behalf (next of kin, solicitor, notary public, etc.) must provide consent to this nomination. L. CONSENT TO THE RELEASE OF INFORMATION PROVIDED IN SECTIONS C- J IN WHOLE OR IN PART The information collected on this form will be used as part of the Commemorative Naming Process. Personal information on the form, attached to the form or subsequently submitted to be included or attached to the Application Form, and all subsequent information collected as a result of the research and the staff investigation of the person’s information, and subsequently found on websites, in local archived materials, in newspapers articles, as a result of a public consultation process, etc., will be used by Town staff and will be made available to the members of the Commemorative Naming Committee, the public, the Mayor’s Office and Elected Officials―except the contact information collected in Sections A and B . Nominator’s Signature Date Nominee’s Signature2 Date SCHEDULE C MUNICIPAL COMMEMORATIVE NAMINGPROGRAM TO BE COMPLETED BY THE NOMINEE AFFIDAVIT OF ___________________________ (Nominee) I,_________________________, of the Town of Tillsonburg, in the Province of Ontario, MAKE OATH AND SAY: 1. I have never been convicted of an offence as set out in a Federal Statute. 2. I do not have any outstanding convictions or infractions as set out in the Provincial Offences Act and/or any Town of Tillsonburg Municipal By-laws. 3. I make this Affidavit in support of the Application Form for the Commemorative Naming Policy, Town of Tillsonburg, and for no improper purpose. __________________________ (Nominee) SWORN BEFORE ME at the Town of Tillsonburg, in the Province of Ontario, this day of , 20 __________________________ A Commissioner, etc. MUNICIPAL COMMEMORATIVE NAMINGPROGRAM TO BE COMPLETED BY THE NOMINATOR OR NEXT OF KIN TO THE NOMINEE (APPLICABLE IF THE NOMINEE IS DECEASED) AFFIDAVIT OF ___________________________ (Nominator Or Next of Kin) I, __________________________, of the Town of Tillsonburg, in the Province of Ontario, MAKE OATH AND SAY THAT TO THE BEST OF MY KNOWLEDGE, 1. Was never convicted of an offence as set out in a Federal Statute. 2. Does not have any outstanding convictions or infractions as set out in the Provincial Offences Act and/or any Town of Tillsonburg Municipal By-laws. 3. I make this Affidavit in support of the Application Form for the Commemorative Naming Policy, Town of Tillsonburg, and for no improper purpose. __________________________ (Nominator or Next Of Kin) SWORN BEFORE ME at the Town of Tillsonburg, in the Province of Ontario, this day of , 20 __________________________ A Commissioner, etc.