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April 5 Blood Drive
You must be 17 years old to give blood!!
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Middle Name
Your answer
Last Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Are you at least 17 years old?
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Yes
No
Do you weigh at least 110 pounds?
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Yes
No
What is a number that we can text your permission slip to?
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Your answer
What is your preferred time to give blood? (Understand that we will try our best to accommodate your preference.)
*
Choose
8:30am
8:45am
9:00am
9:45am
10:00am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
1:00pm
Telephone number of Parent or Guardian (if under 18):
*
Your answer
Do you understand that if you are 17 years old that you must bring a signed permission slip from home to be able to donate blood? You may download this from Mrs. Webb's website (
https://lmwebb.weebly.com/blood-drive-permission-form.html
) or pick one up from 19 West. You must also bring your ID the day of the drive.
Do you understand this information?
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Yes
No
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