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UCHS SPRING BLOOD DRIVE
On St. Patrick's Day, March 17, 2017, HOSA will be hosting the Spring Blood Drive at the UCHS GYM. Come donate blood to 3 lives!
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* Indicates required question
First Name
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Your answer
Last Name
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Your answer
Student ID
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Your answer
Homeroom
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Your answer
Grade
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9th
10th
11th
12th
Age
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16
17
18
18+
Free Period or Gym Period
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Your answer
Gender
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Male
Female
Height (Pick one closes to your actual height)
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4'10
4'11
5'0
5'3
5'6 or taller
Weight
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Your answer
Email Address
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Your answer
Cell Phone Number
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Your answer
Have you traveled outside of the USA?
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Yes
No
If you left the USA, where did you go?
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N/A
Other:
Are you a senior for the Class of 2017?
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Yes
No
Did you donate at the Fall Blood Drive, last year in November 2016 ?
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Yes
No
Have you received a parent consent form?
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Yes
No
PARENT CONSENT (Pick one up from Eagle Nest or Print)
http://nybloodcenter.org/media/filer_public/2013/05/23/16yr-donate-nj-english.pdf
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