School Agreement Form
Agreement to Provide Mobile Dental Services
1. Smile Heros
Our qualified dental team visits your site to provide care to eligible students. Services include: Dental health education Oral exams Cleaning & scaling Fluoride application Fissure sealants (if needed) Personalized treatment plans Additional treatments will only be done with parent consent.
2. The School/Child Care Responsibilities
To facilitate the delivery of this service, the school agrees to:To support our visit, your team will:Confirm suitable datesPromote the program to familiesDistribute and collect consent forms (preferably 2–4 weeks before the visit)Help identify absent students for rescheduling
3. Fees & Funding
CDBS (Child Dental Benefit Schedule) provides up to $1,132 per child over 2 years (for eligible families). These students receive care at no cost. Full Treatment value is $159.65.Private health insurance: We’ll claim directly the full treatment value—families only pay the gap, if any.No Medicare/Insurance: Preventive package available for $90, which includes:Education, exam, clean, fluoride, and treatment plan
4. Consent & Privacy
Written parent/guardian consent is required for all services.We protect all personal information in line with privacy laws.Consent forms should be stored at the centre and handed to our team daily.
5. Our Dental Team
Fully qualified, insured, and child-safe professionalsStaff carry photo ID and Working with Children Checks
6. Safety, Insurance & Legal Compliance
Smile Heros complies with all health and legal regulations.We carry appropriate insurance and can provide documentation if needed.We indemnify the school/centre from any loss or issue caused by our team.
7. Cancellations
Please give at least 1 month’s notice if you need to cancel or reschedule (except in emergencies). Late changes may affect other booked centres.
8. After Our Visit
Each child receives a written Oral Care Plan.Plans are emailed to parents and the centre within one week.
9. Miscellaneous
Each party must promptly sign all documents and fulfill all reasonable requests for the efficient and professional delivery of services. These terms represent the entire agreement between the school and Smile Heros regarding the provision of services and may only be amended in writing, signed by both parties' representatives.Thank you for your cooperation and support.
Childcare Centre / School Name
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Childcare Centre / School Address
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Signature of Authorized Party
Centre Representative:
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Position/Title
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Service will commence on :
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Guidelines and Operational Procedures for Schools/Child CaresSchool/Centre Checklist
To prepare for our visit: ✅ Send and collect forms (2–4 weeks prior) ✅ Ensure 10+ kids are confirmed, or session may be cancelled ✅ Email forms if possible (for childcare) ✅ Allocate a student runner if possible
Sample Day Schedule (May change depending on the final number of confirmed kids)Morning
9:30 AM – Dental Education 10:00 AM – Check-ups BeginAfternoon 1:30 PM – Dental Education 2:00 PM – Check-ups Begin
Contact Information
If you have any questions, please contact us at:· Phone: 02 7208 8244/614 8990 4998 Email: smileheros@gmail.com
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