‘Not Around Us’ Campaign - Donegal

Expression of interest in Tobacco/Vape Free Donegal signage with commitment.

In submitting this form you are confirming that your organisation/group is committed to promoting smoke free outdoor spaces to contribute to the denormalisation of smoking/vaping for children and young people and to helping provide an environment where it is easier for those who smoke to quit and stay quit.

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* 1. Name of Group or Organisation

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* 2. Which of the following best describes your organisation/group?

Not-for-profit organisation/group with outside space(s) where children and young people are likely to be

School with outside space(s) where children and young people are likely to be

Early Years Service with outside space(s) where children and young people are likely to be

Other (please specify)

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* 3. Not Around Us signage is required for the following property (please include organisation/ group name, address and Eircode)

Organisation/Group Name

Address

Address 2

Address 3

County

Eircode

Email Address

Phone Number

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* 4. Where do you propose to securely attach the signage on your property?

Front/Back Entrance

Car Park

School Gates

Other (please specify)

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* 5. Signage Specification (please indicate preferred signage type)

Permanent, sized 300mm by 400mm, 12-gauge aluminum, reflective, pre-drilled for rivet fixing (e.g. for walls).

A5 window sticker

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* 6. Please indicate number of signs required.
Signage is subject to availability. Distribution will be on a first come first served basis.

Other (please specify)

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* 7. I agree that we (organisation/group) are responsible for all signage located on our property and the secure fixing of same by a suitably qualified person and acknowledge that Donegal County Council and its partners are not responsible for any injury or damage caused by inadequate installation or maintenance of the signage on our property.

Agree

Disagree

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* 8. I acknowledge that I have read Donegal County Council's Data Protection Statement and consent to providing the requested data. Donegal County Council Data Protection Statement

Agree

Disagree

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* 9. Signed (Please print name)

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* 10. Date

Date

‘Not Around Us’ Campaign - Donegal

Expression of interest in Tobacco/Vape Free Donegal signage with commitment.

Question Title

* 1. Name of Group or Organisation

Question Title

* 2. Which of the following best describes your organisation/group?

Question Title

* 3. Not Around Us signage is required for the following property (please include organisation/ group name, address and Eircode)

Question Title

* 4. Where do you propose to securely attach the signage on your property?

Question Title

* 5. Signage Specification (please indicate preferred signage type)

Question Title

* 6. Please indicate number of signs required.Signage is subject to availability. Distribution will be on a first come first served basis.

Question Title

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* 8. I acknowledge that I have read Donegal County Council's Data Protection Statement and consent to providing the requested data. Donegal County Council Data Protection Statement

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* 9. Signed (Please print name)

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* 10. Date

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* 6. Please indicate number of signs required.
Signage is subject to availability. Distribution will be on a first come first served basis.