Donor Registration

Shivagiri, Vijayapur
Blood Donation Initiative

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Complete the steps below to register as a blood donor with Shivagiri, Vijayapur.

Personal

Contact & Blood

ID, Medical & Consent

Full Name*

Gender*

Date of Birth*

Occupation (optional)

Select Camp you are registering for*

Mobile Number*

Alternate Phone (optional)

Address*

Area / Locality

City / Village*

State

Pincode

Country

Blood Group*

Last Donation Date (if any)

Approx. No. of Past Donations

Aadhaar Number

Other ID Type

Other ID Number

Emergency Contact Name*

Emergency Contact Number*

Basic Medical Information (self-declaration)

Any chronic illness?

If Yes, briefly specify

On regular medication?

If Yes, briefly specify

Any known allergies?

If Yes, briefly specify

Donation Preferences

Willing to donate

Whole Blood

Platelets

Plasma

Preferred days

Preferred time

Eligibility Confirmation

Please confirm that you meet the basic eligibility criteria:

Age between 18–65 years & minimum 45 kg weight
No fever / infection / major illness currently
No alcohol in last 24 hours
Last blood donation at least 3 months ago

I have read the eligibility conditions and confirm that I am fit to donate blood.

Communication & Consent

Preferred communication channel*

SMS

Phone Call

Preferred language

I agree to receive SMS/WhatsApp/Email reminders about blood donation camps and urgent blood requirements from Shivagiri Trust.

I have read and agree to the terms and privacy policy.

Your unique Donor ID and QR code will be generated after you submit the form.

Shivagiri Blood Initiative

Committed to saving lives through organized blood donation camps and community service. Join our mission to make a difference.

Quick Links

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Camps
Contact

Services

Blood Donation
Volunteer Registration
Emergency Blood
Health Checkups

Contact Info

Shivagiri, Vijayapur, Karnataka
+91 98765 43210
info@shivagiriblood.org
24/7 Emergency Support

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