Valentine Blood Donation Special for Children

Join us in saving lives through voluntary blood donation

Registration Form

Help us save lives by joining the Valentine Blood Donation Special for Children

Personal Information

First Name *

Last Name *

Date of Birth *

Age *

Age Category *

Gender *

Phone Number (WhatsApp Preferred) *

Email Address *

Residential Area/Community *

Donation Details

Blood Group

Preferred Donation Location *

Have you donated blood before? *

Health & Eligibility Screening

Have you been diagnosed with or treated for any chronic illness (e.g., HIV, Hepatitis B/C, heart disease, cancer)? *

YesNo

Have you had surgery, a blood transfusion, or major illness in the past 6 months? *

YesNo

Are you currently pregnant or breastfeeding? (For female participants) *

YesNoNot applicable

Are you willing to undergo standard blood screening as required by National Safe Blood Services? *

YesNo

Consent & Declaration

I confirm that the information provided is true and accurate to the best of my knowledge. *

I voluntarily consent to donate blood and to undergo the necessary screening procedures. *

I understand that final eligibility will be determined by medical professionals on the day of donation. *

Empowering communities to save lives through blood donation.