Family Application

Thank you for your interest in receiving a cake for your family through Icing Smiles.  If you have not already done so, please review our answers to Frequently Asked Questions for Families to familiarize yourself with how to Receive A Smile and ensure your family is eligible.

Child's Name *
Child's Name
Please select one option from the drop down menu.
Have we served your family before? *
Address *
Address
Phone *
Phone
Date of Celebration *
Date of Celebration
Please enter the town/city of the event.
Day and Year of Child's Birth *
Day and Year of Child's Birth
Have your read and agree to the Family FAQ's? *
By submitting this, I acknowledge that my cake request is at least four (4) weeks away unless my child is terminal or hospitalized. *
Please note that dietary restrictions can only be accommodated for the child the cake is being requested for.
Please select one option from the drop down menu.
Are you requesting your dream cake? *
Do we have your permission to release this information to our baking partners? *
Do we have your permission to use your story and pictures when marketing our service? *
Do you authorize a liaison to act on your behalf? *
Liaison phone number:
Liaison phone number:
Evidence of eligibility: (details can be found at Family FAQs) *