Donor Agreement Form

Call Now (540) 338-7387

Download and Print, or fill out electronically below
Download and Print

  • Please type name
  • BENEFITS: I understand that my dog’s initial visit will consist of an evaluation and blood typing. Blood testing is to ensure that my dog is in excellent health and will be performed at the first donation. I understand that after fulfilling his/her obligations to the BRVBB my dog will be eligible to receive one unit of red blood cells or plasma at a discounted rate should medical or surgical circumstances arise which warrant its use (elective procedures excluded). I understand that this eligibility is non-transferable to other dogs. I also understand that the discounted rate will be at BRVBB’s discretion. If your dog is needing emergency blood, please do not delay in seeking medical treatment for your pet but please contact the blood bank immediately so that we can negotiate replacement of any blood products used for our donors. OBLIGATIONS: I agree to schedule 5-7 donations during the next 12 months. I understand that requests for donations will be at least 5 weeks apart. I understand that a minimum of 5 donations per year are necessary for my dog to be eligible for the benefits described above. I understand that BRVBB and its staff cannot function as the ”veterinarian” for my pet. I am obligated to remain current with my regular veterinarian’s health and vaccination schedule, including heartworm prevention. Please note that there may be times during the year where we will need to reschedule due to weather, emergency, illness, or lack of donors to cover our travel. This will be no fault of our donors.

    TRAVEL OBLIGATIONS: I understand that it is one of my benefits to have the BRVBB staff travel to my area to complete my dogs’ donor obligations. I understand that the corresponding obligation is to make every attempt within reason to make my dog available on the days that the BRVBB staff is scheduled into my area. I must notify the BRVBB donor staff of any absence or illness. Please notify us at the earliest possible convenience so that we may condense our schedule or schedule someone else in your place.

    LIABILITY: I understand that if my dog, without provocation, attacks or injures any person or other animal who is acting peaceably in any place where the person or animal may lawfully be, I am personally liable in damages to the person or dog so attacked or injured to the full amount of the injury sustained.

    PUBLICITY RELEASE: I agree to allow my pets “first name” and photos to be used to help publicize the awareness of BRVBB in positive advertising and events. ( initials).