Public Access Defibrillator
Application From.

Apply.

We need your help! Jay’s Aim is trying to establish the areas most in need of a defibrillator in South-West England. If you would like to apply for a defibrillator for your sports club, place of education or other area where you exercise or socialise, please get in touch with us using the form.

Your Name

First Name

Last Name

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Site Name

Please provide the name of your community, School, College, University, Sports Club or Business.

Phone Number

Nearest public access defibrillator ?

How close is your nearest public access defibrillator at present?

Site Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Size of Site

How many people use the site each week?

Accessibility

Is the site accessible to members of the public 24/7 and do you have a suitable location to put a public access cabinet with mains electricity?

Yes

Why your site?

Please explain why you feel your site would be a good venue for a public access defibrillator?

Maintenance

Do you have somebody at the club/school who could complete a monthly online check of the public access defibrillator?

Yes

CPR & Defibrillator

We offer free basic CPR and defibrillator training to all venues that we provide a public access defibrillator to. Is this something you would be interested in?

Yes

Fundraising

If required would you be able to provide/fundraise a contribution towards the cost of the equipment?

Yes

Public Access Defibrillator Application From.

Apply.

JAY’S AIM.

Public Access Defibrillator
Application From.