Restart a Heart - School sign up form

Name of your school*

Address line 1*

Address line 2

Town*

Region

Postcode

Country

County

Lead contact (the name of the person dealing with and organising the event at your school) Please note that this person must be at the event on the day).*

What is the lead contact's job title?*

What is the lead contact's mobile phone number?*

What is the lead contact's landline phone number?*

What is the lead contact's email address?*

Please provide the name of the back-up contact person for the school*

What is your preferred teaching time?*

AM
PM
All day

Expected numbers of students to be trained on the day (we need to know so we can provide enough support)*

Expected number of sessions to be run on the day (each session is for 35 children maximum).*

We will need you to supply one member of teaching staff per session. I confirm a minimum of one member of teaching staff will attend each session *

We would like to take photos for the media on the day. Does your school give photographic consent? *

Yes
No
Not sure

Do your pupils have any special requirements, such as special needs, behavioural problems, other? Please advise below. *

Do you have any other comments, questions, or concerns?

Does your school currently have a British Heart Foundation Call Push Rescue pack with 35 mannequins? You MUST have ordered the kit from the BHF before completing this form*

Yes my school already has a kit
There's no kit yet but we've applied for one from the British Heart Foundation

I consent to having this website store my submitted information so they can respond to my request to take part in this event. This data will be held until the event has taken place and concluded. *

As a protection against spam, please type the letters and/ or numbers you see: *