Biannual Clinic Events
Spreading the Smiles
Learning to Smile
Summer Health Fairs
Support and Collaborations
Stats and Results
Summer Health Fair Statistics
Letters of Thanks & Support
Volunteer at Clinic Information
Dr. Volunteer Supplies
Patient Information for the Biannual Clinic Event
Health History and Consent (English & Spanish) On-line Form
Health History and Consent Paper Form
Health History and Consent Paper Form (Spanish)
Patient Information for Smile Factories
Patient Information for Tiny Smiles
Annual Fund Drive
Sponsor a Child
Contributions of supplies, materials, and equipment
Volunteer Sign-up Form
February 7 & 8, 2014
If you signed up before October 2010 you may call to register for the upcoming clinic.
Call 636-39Smile (636-397-6453)!
St. Louis, MO - Give Kids A Smile - Event Form
Personal Email Address
This section does not apply to me.
Dental Office or Organization Information
Dental Office or Organization
I am a returning volunteer
Clinic Set Up
Thursday: February 6, 2014 | 4:30 P.M. – 8:00 P.M.
Clinic Break Down
Saturday: February 8, 2014 | 12:30 P.M. - 4:00 P.M.
Friday: February 7, 2014 7:00 A.M. – 4:30 P.M.
Saturday: February 8, 2014 7:00 A.M. – 3:00 P.M.
SELECT A POSITION:
(3 hours of continuing education credits will be issued per
each full day
Student, Pre-Dental Student
Dental Assistant, Dental Assistant Student
Dental Hygienist, Dental Hygiene Student
Nurse, Nursing Student
Physician, Medical Student
Audiologist, Audiology Student
Dietary and Nutrition
AMBASSADOR: (all other workers)
Please bring your own Dental Assistant if possible. (Each volunteer will need to sign up individually)
Please fill-in all your information below that
Professional License Number
Any information that would help assign you in our clinic
Please be aware that you are volunteering for a Give Kids A Smile clinic at St. Louis University in Missouri.
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