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THE POWER TO SAVE LIVES IS IN YOUR BLOOD: DONATE TODAY, HEARTBEAT HEROES!
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DATA PRIVACY AND NON-DISCLOSURE AGREEMENT

I hereby acknowledge that, in accordance with the Data Privacy Act of 2012, I have been provided with the written notification below on my rights as a Data Subject (each, a "Right"), to with: i. to learn whether information and/or personal data are being or have been processed. 

Also, I hereby acknowledge the attached guidelines of Philippine Red Cross Youth - Quezon City Blood Letting 2023 and pledge to support this activity to help the most vulnerable.
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PERSONAL INFORMATION 
Last Name, First Name Middle Initial 
Ex. Dela Cruz, Juan S.
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Address 
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Year Level and Section 
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Full Name of School
Ex. Polytechnic University of the Philippines - Quezon City Campus 
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Age
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Birthdate
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Gender
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How many times have you donated? 
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Contact Number 
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