Not Around Us - Expression of Interest Form

On behalf of insert group/ organisation name here* I can confirm that:

1. We are a not-for-profit organisation/group, school or early years' service in Galway City or County with outside space(s) where children and young people are likely to be.

2. We are committed to promoting smoke free outdoor spaces to help provide an environment where it is easier for those who smoke to quit and stay quit and to help denormalise smoking for the next generation.

3. We would like to have Not Around Us signs for the following property (please include organisation/ group name, address and Eircode)*

4. We commit to securely attaching the signage in the following locations at this property (e.g. in the car park/ front and back entrances/ school gates etc.) *

If there is more than one property, please give details for each.

5. We agree that we are responsible for all signage located on our property and their secure fixing by a suitably qualified person. Healthy Galway City, Galway CYPSC and their partners are not responsible for any injury or damage caused by inadequate installation or maintenance of the signage on our property.

Signage Specification*

	Quantity
1. Permanent, sized 300mm by 400mm, 12-gauge aluminium, reflective, pre-drilled for rivet fixing (e.g. for walls).
2. Permanent, sized 300mm by 400mm, 12-gauge aluminium, reflective, with clamp & rail system (e.g. for railings).

*If your property is not suitable for installation of fixed signage please get in touch regarding alternative options.

Signed*

Print name

Date*

Role in Organisation/Group*

Email*

Contact Number*

Signage is subject to availability. Distribution will be on a first come first served basis.

For more information, contact Ashling Jennings, Healthy Galway City Coordinator, on 085 8217547 or email healthygalway@gcp.ie.