PARENTAL/GUARDIAN CONSENT

For 16 and 17 year-old-blood Donors

Name of the Donor: _____________________________________________

Relationship with the Donor: _____________________________________________
Name of the Parent/Guardian: _____________________________________________
Contact No: _____________________________________________

I, hereby confirm that I am the Parent/Guardian of the above named. I give may
permission for him/her to donate blood and give on behalf of him/her the same consents
as those required under _______. I declare the representations and information
required to be provided by my child/ward under the _________ to be true and, accurate
and complete. I will bear full responsibility for this consent and declaration.
I shall not hold the College or its representatives liable for any untoward incident that
may occur as a consequence of the blood donation.
I certify that I am the person referred to in the above and that all the entries are read
and well understood by me.

_____________________________ ____________________________
Signature of the Parent/Guardian Date of Consent