Support as 🩸 Donor – Sickle Cell Warriors Aid Initiative

🩸Blood Donation Registration Form🩸

This form is for individuals willing to donate blood🩸to support persons living with Sickle Cell Disease (SCD) through the Sickle Cell Warriors Aid Initiative (SCWAI). Your willingness to donate can save lives. All information provided will be treated with strict confidentiality.

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Full Name *

First

Last

Phone Number *

Email *

Name State available

Gender *

Male
Female

Date Of Birth *

DD/MM/YYYY

Blood Group *

Genotype *

Have you donated blood before? *

Yes
No

Date of last blood donation

DD/MM/YYYY

Are you currently in good health? *

Yes
No

Do you have any chronic medical condition? *

Yes
No

If yes, please specify:

Country of Residence *

State of Residence *

City / Town *

Residential Address *

House number, street.

Are you available for emergency donation if contacted? *

Yes
No

Consent

I confirm that the information provided is accurate, and I consent to being contacted by SCWAI regarding blood donation opportunities.