March for Babies - Days of Movement Survey

March for Babies is bigger than just a walk in your community; it's a Mother of a Movement. Join the movement and invite others to step up through Days of Movement - moments in time to rally others to support the fight for moms and babies through team and individual activities. Any day can be a Day of Movement in the fight for moms and babies. Choose a day that is special to you to step up: a birthday, holiday, anniversary, favorite day of the week, or a celebration of your team’s fundraising success.

Or join us on these Days of Movement:
World Birth Defects Day, March 3
Black Maternal Health Week, April 11-17
Maternal Mental Health Month, May
Mother's Day, May 14
Father's Day, June 18

Tell us what you and your team are doing to move the March of Dimes mission forward for all families.

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* 1. Is your activation public or private? Please note public events will be shared on our website with the name and email of the point of contact. Private event information will not be shared.

Public

Private

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* 2. Please provide us your March for Babies team name.

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* 3. Who is the point of contact for the event?

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* 4. What is the email address for the point of contact?

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* 5. Please provide an address, date and time for your activation, if applicable.

Address

City

State

Zip Code

Date

Time

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* 6. Are you a member of a March of Dimes National Service Partner organization? Check all that apply

I am not a member of a National Service Partner organization

Alpha Phi Alpha Fraternity, Inc.

Chi Eta Phi

Delta Sigma Theta Sorority, Inc.

Future Business Leaders of America – Phi Beta Lambda

Gamma Sigma Sigma Sorority

General Federation of Women’s Clubs

Jack and Jill of America, Inc.

Kappa Alpha Psi Fraternity, Inc.

Kiwanis International / Key Club International

Mocha Moms

Phi Beta Sigma Fraternity, Inc.

Sigma Gamma Rho Sorority, Inc.

Sigma Sigma Sigma Sorority

Alumni Association of Spelman

The Links, Inc.

Top Ladies of Distinction – Top Teens of America, Inc.

Zeta Phi Beta Sorority, Inc.

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* 7. Please provide a description of your Days of Movement activation.

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* 8. Do you have a website URL you would like to share to provide more information about your activation?

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* 9. How many people do you estimate to participate?

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* 10. How much time do you estimate it will take to complete your Days of Movement activation?

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* 11. Why did you and your team choose to activate for Days of Movement? What does this opportunity mean to you and your team?

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* 12. Do you have a photo or logo you would like to share?

Yes

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* 13. PHOTO WAIVER AND CONSENT
By submitting this photo, I hereby grant the March of Dimes permission to use my name, likeness and/or stories, including without limitation, as depicted in photographs, videos, audio recordings and/or the Family Questionnaire, for educational, public relations, fundraising and other purposes, in any form or medium of communication now known or hereafter devised, including without limitation, print and digital media.

I represent and warrant that I am the owner of the photograph(s) and/or the video(s) described below (if applicable), and hereby grant to MOD an irrevocable, non-exclusive, royalty free license to use the photographs and/or the videos for educational, public relations, fundraising and other purposes at any time in any form or medium of communication now known or hereafter devised, including without limitation, print and digital media.

On behalf of myself and any children identified below, I hereby represent and warrant that I have the right to grant all of the rights I have given under this Waiver and Consent and I hereby waive, release and forever discharge the March of Dimes from any claims or demands in any way relating to the foregoing grant of rights.

I acknowledge I have reviewed the Photo Waiver and Consent language

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* 14. Upload your photo or logo.

Name the file with your team name and logo or photo

PNG, JPG, JPEG, GIF file types only.

Choose File

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* 15. I acknowledge I have reviewed the March of Dimes Covid policy waiver.

Yes