Share Your Little Love Story

Share Your Little Love Story

We love hearing stories from milk recipients and donor moms about their experience with the Northwest Mothers’ Milk Bank! Please take a moment to share your story and photos.
Name

First NameLast Name
How are you involved with NWMMB?

I am a Milk DonorMy little one received Donor Milk as a RecipientMy baby received donor milk thru Evie's Fund (NWMMB Community Care Program)We are both a Milk Donor and Milk RecipientI am a Healthcare Provider
We appreciate you sharing your story! We often like to feature stories locally. It's helpful to know your city, state, and zip code.
Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Share Your Story

Milk Donor
Donor Number
Email*
example@example.com
What are two reasons why you decided to donate breast milk?
How did donating milk affect your relationship with your own baby and/or as a mother?
What is one thing you wish other mothers would know about your experience of donating milk?
We love baby photos! If you'd like, please upload a photo of your child and/or your experience donating milk.

Browse Files

Cancelof
Browse Files

Cancelof
Thank you for sharing your story! Please fill out the subsequent photo and minor releases so we can share your story.

Share Your Story

Recipient
Parent's Name

First NameLast Name
Recipient's Name*

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
How did you first hear about the Northwest Mothers Milk Bank?
In what ways did receiving donor milk help your baby?
How did you feel about being able to provide human donor milk to your baby?
What would you like to share with other mothers who are thinking about receiving and/or donating breast milk?
We love baby photos! If you'd like, please upload any photos of your baby and/or your experience.

Browse Files

Cancelof
Browse Files

Cancelof
Thank you for sharing your story! Please fill out the subsequent photo and minor releases so we can share your story.

Share Your Story

Donor & Recipient
Parent's Name

First NameLast Name
Recipient's Name

First NameLast Name
Email*
example@example.com
Donor Number
Phone Number

Area CodePhone Number
How did you first hear about the Northwest Mothers Milk Bank?
In what ways did receiving donor milk help your baby?
How did you feel about being able to provide human donor milk to your baby?
In what ways did receiving donor breast milk for your little one inspire you to then donate your own milk?
What would you like to share with other mothers who are thinking about receiving and/or donating breast milk?
We love baby photos! If you'd like, please upload any photos of your baby and/or your experience.

Browse Files

Cancelof
Browse Files

Cancelof
Thank you for sharing your story! If you upload photos, please fill out the subsequent photo and minor releases so we can share your story.

Share Your Story

Recipient of Evie's Fund
Parent's Name

First NameLast Name
Recipient's Name*

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
How did you first hear about the Northwest Mothers Milk Bank?
How did you hear about Evie's Fund?
Tell us about your baby and your experience.
Information such as diagnosis, your hospital experience, your breastfeeding experience are wonderful to learn about!
In what way did having access to human donor milk make a difference for your baby?
What would you like to share with other mothers who are thinking about receiving and/or donating breast milk?
We love baby photos! If you'd like, please upload any photos of your baby and/or your experience.

Browse Files

Cancelof
Browse Files

Cancelof
Thank you for sharing your story! Please fill out the subsequent photo and minor releases so we can share your story.

Publicity Release
Please read and complete Northwest Mothers Milk Bank's Publicity Release form. A Notice of Privacy Practices is available for review HERE.
- I consent the use of my name, likeness, and any personal statements I may provide to be used by Northwest Mothers Milk Bank (NWMMB) and/or Human Milk Banking Association of North America (HMBANA) in connection with promotional, education, editorial and/or fundraising services and activities.
- I consent and authorize NWMMB and/or HMBANA to use my likeness in a photograph, video, or other digital media, in any and all of NWMMB and/or HMBANA's publications, including but not limited to print or web-based publications. NWMMB and/or HMBANA may copy, edit, enhance, crop, or otherwise alter photo/media in any way.
- I waive the right to review or approve the released materials.
- I understand that I will receive no payment from NWMMB or HMBANA for use of likeness, photographs, or personal statements.
Please check this box to continue:*

I consent to the terms of the NWMMB Publicity Release.
Name*

First NameLast Name
Donor Number
Email*
example@example.com
Phone Number

Area CodePhone Number
Signature*

Clear
Date*

MonthDayYear

FOR MINORS under the age of 18, a parent or guardian should review and sign.

I am the parent or legal guardian of the child or children listed below and hereby irrevocably and unconditionally agree to all the terms of the Publicity Release on my child(ren)’s behalf.
Please check this box to continue:

I consent to the terms of the NWMMB Publicity Release on behalf of my child(ren).
Name(s) of Child(ren)

First NameLast Name
Parent / Guardian Name

First NameLast Name
Parent / Guardian Signature

Clear
Date

MonthDayYear
INTERNAL USE ONLY

Response sentUsed on social mediaUsed in newsletterOther
Should be Empty:

Share Your Story