Name
Is this your first time donating?
Date of Birth
In the last six months have you had any of the following?
In the last 72 hours have you taken any of the following?

Make it easy to find the nearest donation site — and sign up in the same step.

Finding a blood drive shouldn’t be the hard part. This template combines a donor intake form with a map of active drive locations, so potential donors can find the nearest site and register without ever leaving the page.

The form collects the essential pre-screening information your team needs — blood type, donation history, date of birth — while the map takes the guesswork out of where to show up. One form, two jobs done.

Why Donor Registration Works Better With a Map

Donor recruitment is time-sensitive, and friction in the signup process costs you registrations. When someone has to look up an address, open Google Maps in a new tab, and then return to the form, you risk losing them before they ever submit.

This template solves that by putting a map of your drive locations directly inside the form. Donors see the sites, pick the one most convenient for them, and complete their registration — all in one place. Their chosen location is captured cleanly in the entry, so your team knows exactly where to expect them.

Combined with the pre-screening fields, this gives coordinators meaningful data before donors even arrive at the door.

Fields in This Template

  • Name — donor’s first and last name
  • Email — for confirmation and follow-up communications
  • Phone — for day-of reminders or any questions
  • Is this your first time donating? — Yes/No to help staff prepare for first-time donors
  • Date of Birth — date picker to verify the donor meets age requirements
  • Blood Type — dropdown to help staff plan inventory
  • Map — displays active blood drive locations for donors to choose from

Getting the Most Out of This Template

Use clear, easy-to-spot marker colors for your location pins — something that stands out on the map at a glance. Each pin can include a name and description, so you can surface important details like hours or site-specific instructions right inside the form. If a site reaches capacity or changes hours, updating that information takes just a moment in the form builder.

Perfect For

  • Regional blood banks running multi-site donation drives
  • Hospitals and healthcare systems organizing community drives
  • Nonprofits coordinating donor recruitment campaigns
  • Corporate or campus blood drives with multiple collection sites
  • Emergency drives responding to urgent community blood needs

Ready to make donor registration as easy as possible? Sign up for WPForms Pro to access this template along with thousands of others, plus the full Geolocation addon and all the tools you need to run a smooth, well-organized drive.