Thank you for offering to be an ATTA milk donor!
Donated human milk is the gift of life and health. The WHO recommends a mothers own breastmilk for her child and donated human milk from a milk bank in the absence of the former. While we work towards building a milk bank there are still ways milk can be shared SAFELY.

Your baby is our priority. Any milk you donate should be excess of their feeding. Sharing your little one's milk may save a life today, God Bless you both.

By filling out this form you consent to the following;

To be contacted and matched to a baby or babies in need.
To have your blood sample taken for testing or to share a copy of you most recent results.
To inform ATTA of any changes in your health as soon as you become aware of it.
To receive and follow instructions on how to safely express and handle breastmilk.

You understand that:

As a human milk donor you are donating your breast milk to be used in accordance with all the common international regulations pertaining to the use of donated human milk and no money will be exchanged at any point. All information, including medical test results will be kept confidential. Depending on hospital policy if the infant is in the NICU, you may be required to take your initial tests on site. Your donated breast milk will be given to premature, low birth weight, sick or orphaned infants.  

You confirm that you are unaware of any reason why your donated breast milk should not be safe to use for these babies.

Your name, age and the name of your little one *
Date of Birth of Baby
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Phone Number *
Address and nearest landmark
Email
Where did you hear about donating breast milk?
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Have you tested positive for HIV, Hepatitis and Syphilis?
Do you have any open sores, blisters, and/or cracks around your nipple area?
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Have you received a blood transfusion in the last 12 months?
Do you regularly have more than 1 alcoholic drink in a 24-hour period?
Are you taking medication, traditional medication or receiving radio- active drugs or cytotoxins such as anti-cancer drugs? If yes please list:  
Do you use recreational or habit-forming drugs? Do you smoke? Even shisha
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Have you ever had hepatitis B or C, TB or Cytomegalovirus (CMV)?
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Have you had a sexual partner in the last 12 months who is at risk for HIV, takes habit-forming drugs, or is a haemophiliac?
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Have you had a piercing of any part of your body or a tattoo or scaring in the past 12 months?
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Is your partner okay with you donating your breast milk?
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