• Location: Canopy Austin - 916 Springdale Rd, Austin, TX 78702

    Date: Saturday, August 29th

    Drop off: 9:50 AM

    Pick up: 12:00 PM

    Attire: Something you do not mind getting paint on

    Please drop off your child at Canopy Austin. An Austin Smiles staff will be outside to direct them into the building where the painting session will be held.

     **Light snacks will be provided** 

  • Personal Information

  • Date of Birth of Child*
     / /
  • Gender/Genero:
  • Are you Hispanic or Latino?*
  • What is your race? Select one or more of the following:*

  • Emergency Contact Details

  •  -

  • Care Information

  • Does your child have any allergies?*
  • Will your child need to attend with an attendee?*

  • I hereby knowingly assume the risk of injury, harm and loss assoicated with Create a Smile event, including any injury, harm and loss caused by the negligence, fault or conduct of any kind on the part of the Released Parties.

  • Date:
     / /

  • Photo Release Form

  • I grant Austin Smiles representatives and employees the right to take photographs of my child during Create A Smile with Laura Clay. I authorize the team members to use and publish the photographs in print and/or electronically.

    I agree that Austin Smiles may use such photographs of my child with or without their name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content (Facebook). 

    I have read and understood the above:

  • Date:
     / /
  • Should be Empty: