Blood Bank of Hawaii COLF001 Rev. 5 Page 1 of 1
Parent/Legal Guardian Consent
Parents must review the Parent/Legal Guardian Consent Information
located on our website at www.BBH.org prior to signing this form.
If you have any questions about the blood donation process or the
Parent/LegalGuardian Consent Information, please call the Collections
Department of Blood Bank of Hawaii at 845-9966 (Oahu) or 800-372-9966
(Neighbor Islands). On behalf of the patients we serve, we thank you for your
support of your teenager’s wish to selflessly save lives in Hawaii.
I represent that I am the parent or legal guardian of the minor donor
indicated below and have the authority to sign this consent. I have reviewed
and understand the current Parent/Legal Guardian Consent Information
located at www.BBH.org on the date of my signature below. I authorize and
give permission for the minor donor indicated below to donate blood and for
that blood donation to be tested, as explained in the Parent/Legal Guardian
Consent Information.
The following must be completed in blue or black ink.
______________________________ _________________________________________
Parent/Legal Guardian Name (Print) Signature of Parent/Legal Guardian Date
______________________________ _________________________________________
Minor Donor’s Legal Name (Print) On day of donation, I can be reached at this phone number
