Apply for An AED - Chino Valley Fire

APPLY FOR AN AED

Please complete the form below to be considered for an AED.

Name *

First

Last

Business or Establishment's Name

Type of Business or Establishment *

Email Address *

Phone Number *

Business or Establishment Address *

Address Line 1

Address Line 2

City

State

Zip Code

*Must be within the Chino Valley (Chino or Chino Hills)

Are you willing to place a wall-mounted AED in an easily visible and accessible area within your business or establishment? *

Are you willing to receive free training for most or all of your staff? *

Are you willing to complete a free cardiac emergency response plan? *

Are you and your staff willing to sign up for the free PulsePoint phone app? *

The pulse point phone app notifies you when a life saving emergency is happening near your, so you can render immediate aid to a victim.

Reason your business/establishment qualifies to receive a donated AED and training? *