Form Center

2. AED Registration
   Thank you for taking the time to register your AED(s) with Schertz EMS and the National AED Registry.
   
   If there are any questions about this form, please contact the Community Health Coordinator at 210-619-1410.
4. AED Site Coordinator Information
6. First Name
7. Last Name
9. Email Address
10. Phone Number
14. Organization's Information
16. Organization's Name
18. Address
20. City
21. State
22. Zip Code
24. Main Phone Number
25. Fax Number
27. How many AED(s) are on site?
28. Building Type
32. AED Information
    Please complete the brand, serial number, location, and availability for each AED at your location.
    
    If you have more than four AEDs on site, please call to register.
34. AED Brand, Model & Serial Number
35. Exact AED Location
36. AED Availability

    1. 24/7
    2. Weekdays only
    3. Weekends only
38. Type of Pads
39. Battery Expiration
41. Address
42. City
43. Zip Code
47. AED Brand, Model & Serial Number
48. Exact AED Location
49. AED Availability

    1. 24/7
    2. Weekdays only
    3. Weekends only
51. Type of Pads
52. Battery Expiration
54. Address
55. City
56. Zip Code
60. AED Brand, Model & Serial Number
61. Exact AED Location
62. AED Availability

    1. 24/7
    2. Weekdays only
    3. Weekends only
64. Type of Pads
65. Battery Expiration
67. Address
68. City
69. Zip Code
73. AED Brand, Model & Serial Number
74. Exact AED Location
75. AED Availability

    1. 24/7
    2. Weekdays only
    3. Weekends only
77. Type of Pads
78. Battery Expiration
80. Address
81. City
82. Zip Code
86. Would you like more information on CPR/AED Certification Training?

    1. Yes
    2. No
88. 
Leave This Blank:


90. Submit

* indicates a required field