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- I am interested in volunteering at one or more of the following schools that is not yet scheduled.
- I am interested in applying fluoride at one or more of the following schools that is not yet scheduled.
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Format: (000) 000-0000.
- Are you over 18?*
- If the position I choose happens to be filled by another volunteer, I am still willing to attend and volunteer in other capacities.*
- MEDIA RELEASE: I hereby consent that any photographs/video/audio taken of me by Cass County Health Foundation may be used by them or assignees for the purpose of illustration, teaching, web content, or publicity in any form. NOTE: If you do not want to be photographed, please also remind the Cass County Dental Clinic employee who is present at each dental screening event.*
- By answering "Yes" below, I certify that I have completed this form accurately and on my own behalf.*
- I am interested in helping prep for Dental Screenings by coming to the clinic for the following:
- I am interested in helping prep for 2026-2027 Dental Screenings by coming to the clinic for the following:
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- Should be Empty: