St John Heart Grant

Application form

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As part of the application form you will be required to answer first aid questions. Please click here for a list of the questions you will be required to answer. We recommend you have the responses to the questions prior to beginning the application process. The application contact person will be the only contact throughout the process.

To begin the application process please read and acknowledge the Terms and Conditions below

I hereby verify that the organisation I have submitted an application on behalf of [hereby referred to as “my organisation”] is either a not-for-profit sporting or a community group and is an incorporated association or has a similar accountability structure defined by the WA Department of Commerce.
If successful, my organisation will not under any circumstances on-sell the defibrillator or any of the associated components to any third parties at any stage.
If the defibrillator is used on a casualty, I understand that St John WA will cover the replacement costs of the pads, however, it is the obligation of my organisation to pay for the ongoing expenses to maintain the defibrillator.
I confirm that I have sought permission from the appropriate Shire, Council, Committee or Building Owner to install the external cabinet and defibrillator.
Before the defibrillator and cabinet is installed, my organisation agrees to undertake and pass an initial St John Safe assessment, as well as passing an annual St John Safe assessment.
I understand that the defibrillator must be located on the exterior of the relevant building so it can be accessed by the general public and that it will be registered as part of the St John WA Community First Responder network.
If successful in this grant, my organisation will contribute $249 (this includes the customer contribution of $200 towards the defibrillator and external cabinet and a freight cost of $49)
Payment of the $249 is required to be paid by credit card.
I understand that insurance cover for the defibrillator and cabinet is the responsibility of my organisation.

**St John WA reserves the right to close applications before this date dependent on the volume of applicants.

A tick on all the T&C’s above is required before the application opens the next page.
(please note: this application form may not work using Internet Explorer)

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