Blood Drive Sign-Up: Wednesday, February 05, 2020

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Please sign up to be a blood donor! We want as many signups as possible in advance. People are in need of blood every hour across our country, and the Red Cross appreciates all donations and urgently appeals for all possible volunteers. Save three lives with your donation by signing up today!

Email *

First Name *

Last Name *

Age [ON THE DAY OF THE DRIVE] *

If you are 16, you need a permission form! Go to Mrs. Heller to pick one up OR check the Bulletin Board in Marianist OUTSIDE Mrs. Stein's Office. [Students must be at least 16 on the date of the blood drive to donate. For those who area 17+ permission form not required].

16 [Permission form required]

Adult [Faculty, Staff, Parent, Community Member]

Birthdate [Format: 05/19/2000] *

The Red Cross requires this information from all donors. You will also need to have your valid ID [Drivers' License, California State ID, Passport, Military ID] with you when you donate.

YYYY

During which time of day would you prefer to donate? [Select ALL TIMES that you are available. Please note the SCHEDULE of the Day is part of the Experimental Schedule] *

2nd Period [8:50am - 9:05am]

3rd Period [9:10 - 10:15]

4th Period [10:30 - 11:35]

Lunch [11:45 - 12:25]

5th Period [12:30 - 1:35]

1st Period [1:40 - 2:00]

Required

So that we can provide the safest possible donation experience, selection criteria based on height & weight determine if you are eligible to donate. - PLEASE ANSWER THE FOLLOWING QUESTIONS TRUTHFULLY

THE CHART BELOW IS PROVIDED BY THE RED CROSS - ALL QUESTIONS ARE BASED OFF LANGUAGE USED BY THE RED CROSS

I am... *

Female

Male

If you answered that you are Male... *

I am at least 4'10"

I am 4'11"

I am 5' or taller

This question does not apply to me

If you answered that you are a Male and at least 4'10"... *

I weigh 118 lbs. or more

I weigh LESS than 118 llbs.

This question does not apply to me

If you answered that you are a Male and are 4'11"... *

I weigh 114 lbs. or more

I weigh LESS than 114 llbs.

This question does not apply to me

If you answered that you are a Male and 5' or taller... *

I weigh 110 lbs. or more

I weigh LESS than 110 lbs.

This question does not apply to me

If you answered that you are Female... *

I am at least 5'1"

I am 5'2"

I am 5'3"

I am 5'4"

I am 5'5"

I am 5'6" or taller

This question does not apply to me

If you answered that you are a Female and at least 5'1"... *

I weigh 133 lbs. or more

I weigh LESS than 133 lbs.

This question does not apply to me

If you answered that you are a Female and are 5'2"... *

I weigh 129 lbs. or more

I weigh LESS than 129 lbs.

This question does not apply to me

If you answered that you are a Female and are 5'3"... *

I weigh 124 lbs. or more

I weigh LESS than 124 lbs.

This question does not apply to me

If you answered that you are a Female and are 5'4"... *

I weigh 120 lbs. or more

I weigh LESS than 120 lbs.

This question does not apply to me

If you answered that you are a Female and are 5'5"... *

I weigh 115 lbs. or more

I weigh LESS than 115 lbs.

This question does not apply to me

If you answered that you are a Female and are 5'6" [or taller]... *

I weigh 110 lbs. or more

I weigh LESS than 110 lbs.

This question does not apply to me

The American Red Cross Offers a more effective way to donate. It is Called Power Red! [In order to donate Power Red, you must be blood types O, A-, or B-. Male donors must be 17+ and at least 5'1 and 130 lbs. Female donors must be 19+ and at least 5'5 and 150 lbs.] Are you eligible and willing to donate Power Red?

No, thanks - regular whole blood donation please! [Most common selection]

I am willing, but I don't know if I'm eligible. I'll sign up for Power Red and they can check.

Yes, I am eligible and willing! Sign me up for Power Red!

Clear selection

Emergency Contact Name of a Parent or Guardian. [To be used on the day of the drive in the case of an emergency]

Emergency Contact Number of a Parent or Guardian. [To be used on the day of the drive in the case of an emergency]

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