Kettering Blood Drive Sign-up Request
Please complete this form if you have interest in donating blood at our next blood drive, tentatively scheduled for Tuesday, November 11, 2020. 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 timeslot 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. No student under 16 is eligible to donate. Select the time that best fits your schedule--your appointment will be as close as possible to that time.
Email address *
First Name *
Last Name *
Cell Phone Number *
Birth Date *
MM
/
DD
/
YYYY
What is your 5th Hour Room Number? *
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:
Required
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Wsdmi.org. Report Abuse