Request a Smile

Do you have a child, or know of a child who is battling a life threatening illness and could use a "Smile?" Meg's Smile Foundation can help by providing a special day to take them away from their illness, whether it be a gift delivered to a hospital or home, or a much needed day out and break from hospital visits and treatments. Meg's Smile Foundation is here to help provide a fun-filled day for these special children. In order for a child to be considered for a "Smile," they must live in North Carolina and/or be treated at a North Carolina hospital.

Qualifications for a Smile:

The child must have a life threatening illness.  These illnesses are progressive, malignant, and/or degenerative in nature.*

The child must be treated in a North Carolina facility and/or reside in the State of North Carolina.

Age Requirement – the child must meet the following age requirements:
•  The child must be over the age of two
•  The child must have been diagnosed with their illness prior to their 19th birthday
•  The child must have their smile fulfilled prior to their 26th birthday

* Note, Meg’s Smile Foundation, at its discretion, may request correspondence from the child’s Doctor to confirm their medical condition.

If you would like to submit a request for a child's "Smile," please fill out the application below and click "Submit."  The Meg's Smile Foundation Board of Directors will review the information and will respond to your request as quickly as we can.

Once a child has been approved for a "Smile," parents will need to fill out a Liability Release Form, which can be found at the bottom of this page. Be sure to include the names of all family and friends participating in the "Smile." 

We try to make every "Smile" special for these children. When completing the Intake Form, please be sure to write in the child's interests, what foods they enjoy, what their favorite colors are, anything that can help up create a day that will be perfect for your child!

Submit a Smile Request Online

* Indicates a Required Field

** Applicant must be a resident of NC or must be under medical treatment in NC to qualify for a Smile

We respond by email mostly, please check our response on your email. We try to respond as soon as we receive the referral. Please check your spam mail as well, sometimes it goes to that folder. We can text as well if you prefer a text response please note that in your referral form.

Applicant Information:

Medical Information (Confidential):

Additional Information:

Important Note: Unfortunately, we have been notified by Make-A-Wish (MAW) that receiving as Smile from Meg's Smile Foundation prior to receiving a wish from MAW would disqualify you from receiving a wish from MAW. If you plan to have a MAW in the future, you may want to consider waiting for a Smile until after the MAW is finalized.

** Applicant must be a resident of NC or must be under medical treatment in NC to qualify for a Smile.

Liability Release:

Participants understand that involvement in the smile may entail risk of injury or harm to the Participants and agree that this risk is fully assumed by the Participants. In addition, and in consideration of Meg's Smile Foundation considering the smile and, if it so determines, granting the smile, the Participants hereby release and agree to hold Meg's Smile Foundation harmless for, from and against any and all liability, damages and claims ("Claims") of any kind, known and unknown, which may be connected with, result from, or arise out of the consideration, preparation, fulfillment or participation in the Smile. This includes, but is not limited to, Claims involving economic loss, illness or medical condition, accidental injury or death.

Publicity Authorization:

Participants understand and agree that fulfillment of the Smile may result in publicity, whether or not Meg's Smile Foundation actively takes steps to publicize the Smile.

Publicity OK:

Participants authorize Meg's Smile Foundation to publicize the Smile and to use Participants' names, likenesses and other information about Participants and the Smile (including Smile Child's medical condition), whether embodied in photographs, videotapes, recordings or any other format (collectively, "information"), for purposes of promotion, publication, commercial advertising, or any other purpose whatsoever, now or at any time in the future. Participants understand and agree that Meg's Smile Foundation may use any such Information:

  1. in all manner and media whatsoever, whether now known or hereafter invented, including electronic and print media and the Internet;
  2. with or without Participants' names;
  3. without the payment of royalties or other compensation to anyone;
  4. without the need to notify them or to seek further approval before doing so.

This document contains information which will be kept confidential and only used or disclosed as the Foundation deems necessary so the Foundation can make a determination of Smile eligibility and to provide a personalized Smile. Sometimes it may be necessary to request additional information. Meg's Smile Foundation thanks you fortaking the time to provide this important information. If you have any questions, please contact us.

We/I confirm that the information is complete and true to the best of my knowledge. We/I authorize Meg's Smile Foundation to obtain medical information about the Child which MSF may feel necessary for consideration of the Smile. We/I understand that we/I may be required to sign a waiver at the time of the Smile Event.

Download Files:

Liability Release Form MSF
Upon approval for a "Smile" outing, parents of the "Smile" recipient will need to complete this form.