Emily's Smile Boxes Request Form
-We ship boxes to all of the United States and can ship to other countries depending on funding
-Boxes are for ages 2-14 years old
-Sibling boxes are sent if funds allow
-Please allow up to 14 business days for delivery
-Boxes are better shipped to a relative to drop at a hospital verses shipping direct to a hospital
-If you do not receive a box we did not receive your request so please reach out again thank you!
Email address *
What is your name?
What is the recipient of the "Smile Boxes" full name?
What is the address including state and zip code of the recipient? *
How old is the recipient?
Please include any other information you would like us to know.
If you are filling out multiple requests for siblings include ages and names below if they need a box as well. Thank you! (If funds allow we ship to siblings. Otherwise the boxes are packed to share)
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