School of Sport
AGREEMENT TO HAVE BLOOD DRAWN BY VENUPUNCTURE AND /OR
SKIN PUNCTURE
I, the undersigned, voluntarily agree to allow blood to be drawn from me by
venupuncture and/or skin puncture.
I understand that the blood will be used only for laboratory classes, research or testing
and that no more than _______________ will be drawn at any one time.
I have not:
i)
ii)
iii)
iv)
v)
vi)
vii)
suffered from Hepatitis
suffered from jaundice
received blood transfusions
received blood products
undergone dialysis treatment
been refused as a blood donor
I am not in a recognised risk group for HIV infection
I hereby exempt The University of Ulster from all responsibility for any adverse
effects arising from the blood collection.
I am aged 18 years or over.
Signed ________________________________________
Date
___________________