Black Mamas Bail Out Fund
Thank you for your interest in our Black Mamas Bail Out. Black Mothers in Power (BMIP) & Wilmington Freedom Alliance (WFA) will raise money to bail out Black mamas & Black Trans women for Mother's Day and throughout the year. 100% of the funds will be used for bail. Please complete this form if you (or someone you know) is a Black mom and/or Black Trans Woman that would like to request help posting bail. By filling out this form, you agree to have us contact you. The information will only be used to determine whether the bail fund can provide bail assistance. Please note that completing this form does not guarantee help with posting bail.
Your Contact Information
Full Name
Phone
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Email
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Relationship to Recipient:
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If you are working with the recipient in a professional capacity please list the name of your affiliated organization:
Recipient's Information
Recipient's Full Name
Race or Ethnicity:
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Asian or Asian American
American Indian, Alaska Native, or Indigenous
Black or African American
Hispanic, Latino/a/x, or Latin American
Multiracial or Multi-ethnic
Native Hawaiian or Pacific Islander
White
Gender
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Male
Female
Non-Binary
Trans
Date of birth
Is the recipient, a parent or caregiver to children?
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Yes
No
To your knowledge, is the recipient currently pregnant?
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Yes
No
Date of Arrest
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Details of Arrest
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Bail Amount
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$
Where is the client being held?
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Does the person have any other open cases?
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Yes
No
I'm not sure
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