JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Fall Blood Drive Donor Sign Ups
Date: November 6
Hours: 8:30am-2:00pm
NOTE: We are limited in how many students can sign up for the blood drive. Spots will be reserved on a first come first serve basis. All other students will be placed on a waiting list.
Requirements:
- Be the appropriate weight (see
www.phsservicelearning.org
or
https://stanfordbloodcenter.org/
for more details )
- Be free of cold and flu symptoms
- Must be at least 16 years old or older: ALL 16 YEAR OLDS must fill out a PERMISSION SLIP (You can print out a permission slip from Stanford -
https://stanfordbloodcenter.org/wp-content/uploads/2021/03/05-F-X1-Form-Consent-for-Minor-to-Donate-Blood-v15.0.pdf
OR a hardcopy from from Mr Burrell in P4). All permission slips must be turned into Mr Burrell by October 23).
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Please type your first name here
*
Your answer
Please type your last name here
*
Your answer
What is your birthday (Be sure the year is correct)
*
MM
/
DD
/
YYYY
What year are you in school
*
Senior
Junior
Sophomore
Your cell phone number (We use Remind.com for updates regarding the blood drive). Please enter the number with no spaces/slashes/or dashes. For example, 4085356310.
*
Your answer
Your email address (Please use an email that you check frequently. We often need to get other information from you for the donation.)
*
Your answer
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of San José Unified School District.
Report Abuse
Forms