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PARENTAL/GUARDIAN CONSENT FORM
For sixteen and seventeen year old blood donors

1. Donating blood is one of the kindest and most generous acts that one human being can do for another. Blood cannot be manufactured. It has to come from one human being to save the life of another. Thanks to blood donors, thousands of accident victims and those who need major surgery are alive today.

2. Any healthy person between the age of 18 and 60 years can give blood. Those who are 16 & 17 may also give if they have their parental / guardian consent (Please see below).

3. The small amount of blood one gives does not have any adverse effect on one's health. It is a simple and painless procedure. Donors will be medically examined by the attending Medical Officer before they are accepted as blood donors.

4. The Bloodbank @ HSA, which supplies blood to all government and private hospitals, needs your support. Please take a step forward and be a blood donor. On behalf of the patients in the hospitals who will directly benefit from your donation, we would like to thank you for your generous act.

Centre for Transfusion Medicine
The Bloodbank @ H.S.A.
11 Outram Road, Health Sciences Authority
Tel : 220-0183 / Fax : 223-8508

 

__________________________has my permission to donate blood and meets the basic criteria (Name of donor)                          listed below. I will bear total responsibility for this consent.
Donor NRIC No.:

Parent/Guardian Name:

Parent/Guardian Signature:

Date of Consent:

School Name:

Parent/Guardian Contact No:.

Parent/Guardian NRIC No.:


In order to donate blood, donors must have:
¨ NRIC or other photo identification showing date of birth
¨ Signed Centre for Transfusion Medicine's Parental/Guardian consent form.

Basic blood donor requirements:
¨ At least 16 years of age on the date of the blood donation.
¨ Weighs at least 45 kg.
¨ Eat a well-balanced meal, including plenty of fluids (avoid caffeine), 3-4 hours prior to your donation.
¨ No colds, sore throat or flu symptoms (specific medications and other diseases will be evaluated by the attending medical officer).
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