Healthy Smiles Event Registration
Please complete one registration per child.
Child's name:
*
First Name
Last Name
Suffix
Child's age:
*
Child's school:
*
Please pre-register for one event date.
*
Saturday, February 1st (9am - 1pm)
Saturday, February 15th (9am - 1pm)
Parent or Guardian's Name: (Must be present day of event):
*
First Name
Last Name
Suffix
Contact phone number:
*
Submit
Should be Empty: