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.

Participants understand that involvement in the smile may entail a 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.

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.

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 that 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 provide a personalized Smile. Sometimes it may be necessary to request additional information. Meg's Smile Foundation thanks you for taking 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.