Please complete this application form if you are interested in becoming a volunteer for March of Dimes Canada. Once you complete the form, click the submit button at the bottom.

Personal Information

Emergency Contact Information

Areas/Programs of Interest


March of Dimes Canada is committed to creating an inclusive environment that accommodates all individuals. Please let us know below if you require accommodations.

Publicity Waiver & Volunteer Agreement

I grant MODC permission to use any photographs, videotape images or other visual representations taken of me during my volunteer service, and to use my name, image, comment(s) and information regarding my volunteer role and activities.

Select YES if you agree to allowing MODC to use photographs or videotaped images of you taken during the course of your volunteer involvement.

Please read the following information carefully;

At March of Dimes Canada (MODC) the privacy and dignity of consumers, donors, volunteers and staff will be respected. The mission, vision and values of MODC will be followed in accordance with the organization’s policies.

As a volunteer, I may have access to information and documents relating to consumers, donors, volunteers and staff that are private and confidential. All records are the property of MODC and will be treated as confidential material; everyone within MODC should exercise care and caution in order to protect and maintain total confidentiality. MODC has adopted practices and

procedures, in line with the Personal Information Protection and Electronic Documents Act(PIPEDA).

I agree not to make any statements, written or verbal, or cause or encourage others to make any statement, written or verbal, that defame, disparage or in any way criticize the personal or business reputation, practices, or conduct of the organization, their employees, directors, and volunteers. I acknowledge and agree that this includes; statements, written or verbal, made to

anyone, including but not limited to, the news media, any board of directors or advisory board of directors, competitors, strategic partners, vendors, employees and volunteers (past and present), donors and consumers.