[Accepted] Wiki dev application

[center][b]Blood Donation Application Form[/b][/center]

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First time donor? [field] [small](yes/no)[/small][br]
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[u]For Repeat Donor[/u][br]
Did you encounter any problems in your last donation? [field]
[small](No problems / fainting / bruise / difficulties finding vein / other)[/small][br]
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Blood group: [field][br]
Age: [field][i]year[/i] Sex: [field] Weight: [field][i]kg[/i][br]
If more than 60-70 years old, Do you have medical certificate? [field] [small](yes/no)[/small][br]
Occupation: [field][br]
Name: [i]Mr. / Ms. / Mrs.[/i] [field] Signature: [field][br]
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[center][b]For your own safety and the safety of the patient who will receive your blood, please answer the following questions, if applicable, to the best of your knowledge:[/b][/center]

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[u]Category 1 [small](For women only)[/small][/u][br]
1. Pregnant? [field][br]
2. Do breast-feed? [field][br]
3. Gave birth or miscarriage in the last 6 months? [field][br]
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[u]Category 2[/u]
4. Had diarrhea in the last 7 days? [field][br]
5. Had major surgery in the last 6 months or minor surgery in the last 7 days?? [field][br]
6. Do you drink alcohol or others? [field][br]
7. Had a history of drug use or had you been improsoned in the last 3 years? [field][br]
8. Had a blood transfusion in the past 1 year? [field][br]
[u]Category 3[/u]
9. Have menstruation? [small](to be answered by female only)[/small] [field][br]
10. Do you feel fit enough and have enough rest last night? [field][br]
11. Did you take any medicine / antibiotics? [field][br]
12. Have you or any of your family member ever had hepatitis? [field][br]
13. Have asthma, epilepsy, chronic skin disease, chronic cough, tuberculosis, allergies, high blood pressure, heart/kidney/thyroid disease, cancer, bleeding disorder, etc? [field][br]
14. Have ear/body piercings, tattoos made or removed or acupuncture? [field][br]
15. Did you get any vaccinations in the last 2 months? [field][br]
26. Others: [field][br]
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[small]I hereby certify that I have answered the following questions truthfully and that, to the best of my knowledge, my blood is safe for donation.
I have been informed that my blood will be tested for syphilis, hepatitis B and C, as well as HIV/AIDS.
I hereby voluntarily donate blood without expecting any type of remuneration.
The blood may be given to any patient or for research purpose as deemed suitable by Aurora medical personnel.
I certify that the Aurora medical staff are not responsible for any untoward effects that may occour after this blood donation.
I shall be pleased to donate blood again.[/small]
Donor signature: [field][br]
Doctor/Staff signature: [field][br]

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[b][u]Kosher Certificate[/u][/b]

[small]This hereby certifies[/small]
[b]Aurora Civilian Kitchen[/b]
[small]
on NSS Aurora, Tau Ceti,
is under the supervision of the central rabbinate[/small]
and is found to be
[b]Kosher for Meat & Dairy[/b]
[small]
Valid until the end of the current shift
For clarifications PDA rabbi [sign]
[/small]
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[small][i]
[b]Do Not Copy[/b]
This certificate is the property of the central rabbinate and may be revoked at any time
[/i][/small]
[/center]

[center]Kosher cooking guidelines[/center]

- Don't mix meat and dairy products
- Only use whitelisted meat
- Use separate utensils and containers for meat and dairy
- Meat containers must be clearly labelled as such
- Dairy containers must be clearly labelled as such
- Maintain cleanliness
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[center]Kosher slaughtering and butchering guidelines[/center]

- Only whitelisted animals can be kosher
- The animal must not suffer during the slaughtering process
- The slaughtering must be done to the neck with a sharp, straight blade in one fluid motion
- Blood must be drained from the meat before cooking
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