Kettering Blood Drive - Become a Donor!

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Please complete this form if you have interest in donating blood at our next blood drive, scheduled for Friday, November 10, 2023. The drive will begin at 7:20a and conclude at 1:30p. If you are 17+ years old, you will be automatically given a donor time-slot in our system and can expect an email confirming. Please check for an email the day prior to the drive, to fill out the survey of information ahead of the drive. If you are 16, please see Mr. Burlingame, Room 105, for the necessary form to complete your registration. Students under the age of 16 are ineligible to donate. Select the time that best fits your schedule--your appointment will be as close as possible to that time.

Schedule for 2023-2024:

Friday, November 10, 2023
Friday, March 1, 2024

Email *

First Name *

Last Name *

Cell Phone Number *

Birth Date *

YYYY

Grade Level *

What is your 5th Hour Room Number? *

Have you donated with us before? *

Yes

No, I am a new donor.

Best time of day for your appointment *

Times are approximate and are based on the drive status--they are not guaranteed. You will receive a pass by a member of Student Council, at the time of your actual appointment.

Alternate time for appointment

Times are approximate and are based on the drive status--they are not guaranteed. You will receive a pass by a member of Student Council, at the time of your actual appointment.

I certify that I am of eligible age for donation on the drive date. *

Please check all that apply:

I certify that I am a student at Waterford Kettering High School

I certify that I am 17 years or older and would like an appointment.

I certify that I am 16 years old and will obtain and return the completed/signed form (Room 105) before the date of the drive.

I certify that I have read the full instructions at the top of this page and my responses are valid, factual and I am of legal age to donate blood.

Required

A copy of your responses will be emailed to the address you provided.

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