BLOOD DONOR REGISTRATION FORM

Name
Sex	Male Female
Date of Birth
Age
Guardian's Name
Occupation
Organization
Address for communication:
Telephone
Mobile No
Email
Blood Group
Have you donated previously?	Yes No
If yes, how many occasions
When last

I understand that:-

Blood donation is a totally voluntary act and no inducement or remuneration has been offered. Donation of Blood! Components are a medical procedure and that by donating voluntarily; I accept the risks associated with this procedure.

My blood will be tested for Hepatitis B/C, Malaria parasite, HIV / AIDS and venereal diseases in addition to any other screening tests required to ensure blood safety.

I prohibit any information provided by me or about my donation to be disclosed to any individual or government agency without my prior permission

BLOOD SAFETY BEGINS WITH A HEALTHY DONOR.

I Agree