Defibrillator loan request

Required fields are marked with asterisks (*)

Public Access Defibrillator (PAD) Loaner Request

The Public Access Defibrillator Loaner program allows the general public to borrow an automated external defibrillator (AED), at no cost, for short-term community and family events within the city of Guelph and county of Wellington.

Primary contact

This person will be responsible for receiving the required training in advance of the event and will be responsible for the AED unit while on loan.

Primary contact name

Main phone

Primary contact street address

City

Postal code

Secondary contact

Secondary contact name

Main phone

Event information

Event name

Event address

City

Postal code

Event start date

Event start time

Event end date

Event end time

Below, please request the dates you would like to check out and return the unit. Check out and returns are available Monday to Friday between 7:30 a.m. and 4:30 p.m.

Requested check out date

Requested return date

Does the venue have an automated external defibrillator (AED) on site already?

Yes

Where at the venue will the loaned public access defibrillator (PAD) be kept during your event?

Event website, if available

Estimated attendance

What type of event is this?

Community, school or church

Company

Family

Sport or athletic

Event with guests at risk for cardiac arrest

Other

Describe why having an automated external defibrillator (AED) is important for this event.

Have you received a public access defibrillator (PAD) on loan from Guelph Wellington Paramedic Service before?

Yes

How did you hear about Guelph Wellington Paramedic Service's defibrillator loaner program?

Personal information is being collected and will be used for the purpose of managing the Public Access Defibrillator Loaner program.

Personal information, as defined by Section 2 of the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA), is collected under the authority of the Municipal Act, 2001, and in accordance with the provisions of MFIPPA.

If you have questions about this program, please contact Guelph-Wellington Paramedic Service at pad@guelph.ca.

If you have questions about the collection, use or disclosure of this personal information please contact the City’s Information and Access Coordinator at 519-822-1260 extension 2349 or email privacy@guelph.ca.