Parental Consent Form

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Information for Parents and Students
“What You Need To Know About Donating Blood”
Thank you for your interest in becoming a blood donor. Your donation is a lifesaving gift, and we want to make sure it is a
pleasant and rewarding experience. Please read this document before beginning the donation process. Be sure to share this
information with your parent(s) or guardian(s) and have them sign the permission slip below. This is required for ALL student
donors. The entire donation process takes approximately one hour, and each unit of blood will be separated into components
that can help save three lives. We encourage you to ask the blood center staff any questions you have about giving blood.
There are THREE steps to the donation process:
STEP ONE - The Medical Evaluation
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Review your medical history.
Perform a brief physical exam (blood pressure, temperature, and pulse).
Take a few drops of blood from your finger to measure your hematocrit (iron level)
STEP TWO - The Blood Donation
The blood collection technician will:
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Use only new, sterile, disposable equipment for each step of the donation process.
Draw one unit (pint) of blood – usually takes about 7-10 minutes.
Clean and bandage your arm.
STEP THREE - Following Donation
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Read the donor instructions, and be sure to take them with you when you leave.
Spend 15 minutes in the refreshment area drinking juice and eating crackers or cookies, provided by the blood center.
Make sure you are feeling well before you leave. If you are not feeling well, inform one of our staff members.
During and after blood donation, most feel fine. Occasionally, a donor may experience weakness, dizziness or fainting. Such
cases can often be avoided by EATING A WELL BALANCED MEAL and DRINKING FLUIDS WITHIN FOUR HOURS PRIOR TO
DONATING. In other cases, a donor may experience some tenderness, bruising, bleeding, or infection at the site where the
needle was inserted. Remember, since all equipment is new and sterile, it is not possible to contract any disease from donating
blood.
In order to donate blood, donors must have photo identification.
Basic Donor Guidelines:
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At least 17 years of age.
Must weigh at least 110 pounds.
No Tattoos or piercings with in the last year.
No colds, sore throat, or flu symptoms for at least 3 days prior to donation.
Must have eaten a well-balanced meal, including plenty of fluids (3-4 hours prior)
High School Blood Drive
Parental Consent Form
(please complete in Blue or Black Ink)
Your child has expressed interest in donating blood at an upcoming blood drive. Because one blood
donation can be separated into three (3) components, your child has the potential to save three (3) lives
with a single donation or to contribute to science. Blood donation is a safe procedure using single use
sterile supplies.
We hope that you support and encourage your child’s decision to donate blood. He or she is showing civic
responsibility, maturity and a sense of community pride by donating blood. Your child’s blood will be
tested for all Food and Drug Administration (FDA) required tests.
According to the guidelines at your child’s school, we ask that you please complete this parental consent
form and give it to your child who will present it when he or she registers to donate blood. In addition to
the parental consent form, your child will need to bring documentation and/or a picture I.D. that includes
his/her full name and his/her date of birth.
I, ________________, give my consent for ______________________, to
(print parent’s name)
(print students first name, middle initial and last name)
donate blood on ______________________. I understand that my son/daughter must
( Date of Blood Drive)
bring the signed parental consent form to the blood drive.
Student’s Date of Birth: ___/___/___
Age:_______ MM
Parents Signature:________________________
Relationship to Student:________________________
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