Automatic External Defibrillator ApplicationIf your nonprofit is interested in having a life-saving AED device to support its clients and staff in the event of an emergency, fill out and submit the form, and I will be in touch! Organization Name Person of contact * First Name Last Name Pronouns Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * Website http:// Tell me about your organization's mission * What populations do you support? * How will your organization benefit from this device? Do you have staff trained in AED use and CPR? Consider training all staff or at least having one working at all times. How many AEDs does your organization require? * Please keep in mind that the American Heart Association recommends AEDs be brought to an emergency within 3 minutes. If you already have AEDs try to consider locating them centrally & visibly and doing test runs to see if/how many more you may need. How did you hear about Heartfelt Harmonies? Please confirm that you will be able to share this donation on social media. * All of our funding comes from community fundraising & awareness, sharing donations helps us continue making change! Yes No Please confirm that you will be able to maintain donated AEDs. * AEDs are very important pieces of equipment, and I want to ensure they don't fall into unusable states. AEDs have pads and batteries that expire, please ensure these can be replaced when needed and that the condition of the AED is checked monthly to be functional. I have a partnership with AED365, a company that has made a simple way to keep tabs on AEDs if that is of interest to you. Yes No Please express the need for this device. We aim to support organizations who could not otherwise afford these devices, please offer a small explanation of your financial situation. Please agree to our Terms & Conditions * Terms and Conditions 1. Register the AED with the manufacturer, with Local EMS, with AEDRegistry.org, & with AED365 (a partnership with a free AED maintenance program). 2. Assure the AED will be accessible, properly stored, well sign posted, and maintained. (Heartfelt Harmonies can assist with cost barrier to replacements of pads & batteries) 3. Assure staff will be trained and cardiac response plan will be in place. Cardiac Response Plan ideas: Project ADAM/Heart Safe Schools 4. Promote the donation and Heartfelt Harmonies Charity through social media, newsletter, etc. 5. Inform Heartfelt Harmonies Charity if the AED was used in an emergency. Agree Thank you! Someone from Heartfelt Harmonies will be in touch soon! Please keep in mind that we currently have a high demand for AEDs and will be attempting to meet these needs as soon as possible, thank you for your patience.
