Parental Consent Blood Donation - California

Community Hospital of the Monterey Peninsula Document Number: BDQ 301.02aD v2
Monterey, CA 93940 Effective Date: 01/22/09
Blood Center
Blood Center
Parental Consent Blood Donation
This form is required for blood donation by persons 16 years of age who have not yet
reached the age of legal majority as defined by the laws of the state of California.
PLEASE HAVE A PARENT OR GUARDIAN COMPLETE THIS FORM IN BLACK INK
I do hereby give my consent for (donor’s full name), __________________________, at his
or her discretion, to donate to Community Hospital of the Monterey Peninsula Blood Center
on (date)_____________________.
__________________________________________ _____________________
Signature of Parent or Guardian Date
Donor’s Age: Donor’s Date of Birth:
_______________________________________________________________________
Address
_________________________________________________________________________( )___________________________
City State Zip Phone
LAST MINUTE REMINDERS
Present this consent at the time of donation.
Bring a picture I.D. (driver’s license or student identification card).
Bring (or remember) your social security number.
Eat a good meal and drink plenty of water before and after giving blood.
Bring your friends to give blood too!
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