• Rugby Club Order Form

    Rugby Club Order Form

    Hello, and welcome to The Community Heartbeat Trust, the UK’s leading community defibrillator organisation. Please complete this form as fully as possible and once submitted we will get straight to work processing your request!
  • The Richmond Heavies Foundation Grant

    The Richmond Heavies Foundation Grant

    Please click/tap on the button below to select your equipment.

  • The Richmond Heavies Foundation, working with The Community Heartbeat Trust charity, is offering a free, high specification defibrillator to rugby clubs that do not have one, and cannot afford to purchase this life saving piece of equipment. Included in this defibrillator provision will be an online training session for the club members, their families and their friends.

    Equipment Covered By The Grant

    • Lifeline View Defibrillator 
    • Defib Carry Case
    • Wall Rack (If not adding a cabinet)
    • Online Training Seminar (Up to 98 participants, 60-90 minutes long)
    • Managed Solution Theft Cover
    • Delivery Cost

    If opting for the basic grant above your club will need to cover the following costs...

    • Annual Support £151.20 Annually Inc VAT or as a one off 4 year cost for £504 (No VAT incurred)

    To support the Richmond Heavies Foundation and learn about their work you can visit https://richheaviesfdn.org

    You will also need to make a commitment to carry out weekly checks on your defibrillator equipment and report this onto the WebNos governance system. On delivery you will be e-mailed a log on link to the WebNos system to activate your account. This ensures good governance, adherance to legal requirements and maintains active insurance cover on your equipment.

    To learn more about what WebNos is you can view our WhyWebNos.pdf

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  • Annual Support
  • Club Extras

    Club Extras

  • Services below are not included in the grant available and therefore will be a cost to your club.

    If you wish to place your defibrillator in a cabinet for external access please note to comply with our insurance cover the cabinet will need to be supplied by Community Heartbeat Trust direct to yourselves, these start from £450. For further information please contact us.

    If you are looking to book a face-to-face training session for up to 50 people, when this is available again post-lockdown, you can do so for £150. The sessions are about 1.5 - 2 hours in length.

     

     

  • Optional Extras
  • Lead Contact Details

    Lead Contact Details

    This person will be the central point of contact for the purposes of implementing and discussing your defibrillator project.

  • This address will be used for the purposes of posting information, paperwork and any other associated articles that relate to your defibrillator project.

  • Delivery Contact Details

    Delivery Contact Details

    This person will be the main contact and recipient for the delivery of the defibrillator equipment.
  • Is your delivery address the same as above?
  • Reporting Contact Details

    Reporting Contact Details

    These reporters will be responsible for reporting and recording checks on your defibrillator equipment.
  • Defibrillator Location

    Defibrillator Location

    Please confirm the type of location where you are going to place your defibrillator so we can ensure accurate information is provided onto the governance system.
  • Defibrillator Location*

  • If you are thinking of opening your defibrillator up for public use, should you have set opening times, you may also need to considered your area of effectiveness. This is called the activation radius and will dictate how far reaching your defibrillator will be. Each area of the country has a different radius depending on your ambulance service. For help in identifiying your radius you can visit https://www.communityheartbeat.org.uk/ambulance-service-activation-radii

  • Installation Address

    Installation Address

  • Is the installation address of the equipment the same as one of your previous addresses?
  • Keepers Address

    Keepers Address

    Location and contact persons details of where your portable unit will be kept/stored when not in use during practice or matches.
  • Is the Keepers Address of the equipment the same as one of your previous addresses?

  • e.g 12pm - 5pm or "All Day" for 24/7 access.

  • Managed Solution Agreement

    Managed Solution Agreement

  • *Please read/scroll to the bottom of the conditions. You will then be able to click agree.

    The signature fields below can be completed using your mouse or finger if on phone or tablet.

  • Signed for on behalf of the Community Heartbeat Trust

  • CHT Representative Signature
  • Terms & Conditions

    Terms & Conditions

    Please Read/scroll to the bottom of the terms outlined below and click agree otherwise you will not be able to submit.
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