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AED Registration

2. AED Registration
   Thank you for taking the time to register your AED(s) with Schertz EMS and the National AED Registry. <br> <br> If there are any questions about this form, please contact the Community Health Coordinator at 210-619-1410.

   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. <br> <br> If you have more than four AEDs on site, please call to register.

    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. 1. Receive an email copy of this form.
91. Email address

    This field is not part of the form submission.

92. Submit

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