Seckman High School Procedures for Giving Blood

SECKMAN HIGH SCHOOL PROCEDURES FOR GIVING BLOOD -

SIGNATURES REQUIRED ON THIS FORM – EVEN IF YOU ARE 18!

Your Name: ______Phone ______Blood Drive Date: Nov. 29, 2012

Donation Time / Hour: ______/ ______Teacher that hour:______

Dear Parent and Student:

We cannot tell you how much we appreciate your donation! Please read over the following procedures for donating blood at SeckmanHigh School:

1.ON THE DAY YOU GIVE BLOOD, you must eat breakfast, lunch and dinner. If you don’t usually eat, then eat anyway. If you have not eaten, then DO NOT donate blood. Snacks will be available at the blood drive to ensure you have something in your stomach, but do not count on these snacks to fill you.

2.If you pass out / lose consciousness at ANY TIME after giving blood (both immediately or later, before leaving school), a parent or responsible adult MUST PICK YOU UP, even if you have driving privileges. This is for your safety and the safety of others on the road.

3.We will contact this person in the event that you pass out after giving blood. Please provide this person’s phone number and make sure they are available at the time you would need a ride (after full day attendance, half-day attendance, after-school activities, etc.)

4.If you should pass out, your name will go on a list. Your name will be checked off when that person comes to pick you up. If they CANNOT come to pick you up at that time, you must wait until they can. Therefore you may want to have a BACKUP PLAN in place. Remember, it is your health, your life and possibly someone else’s life. Being patient and waiting just a little while could mean the difference between life and death.

5.If you should become nauseated or dizzy after donating (but do not pass out), your parent will be notified and MUST BE CONTACTED before you will be allowed to drive yourself home.

SIGN THIS TO SHOW YOU UNDERSTAND ALL OF THE ABOVE PROCEDURES:

PARENTS - PRINT______PHONE ______

PARENTS - SIGN______

CONTACT NAME / PHONE # IN CASE YOU PASS OUT AND NEED A RIDE:

Name______Phone______

DONOR SIGNATURE: ______

Note to parents: Alcohol consumption within a 12-hour period after giving blood is strenuously discouraged.

These procedures will be followed. They are put in place to protect you and those around you. If you choose not to abide by these procedures, we will invalidate your donation time and send you back to class.