GKAS February Clinic 2026 Volunteer Registration Form

GKAS February Clinic 2026 Volunteer Registration Form

St. Louis, MO February 13-14, 2026
First Name*
Last Name*
E-mail*
example@example.com
Phone Number
Are you volunteering with an Organization/Company/School?*

YesNo
If yes, please list the Organization/Company/School you are volunteering with:*
How did you hear about this volunteer opportunity?
Where you referred by an organization or colleague/friend?
Available Days*

Clinic Setup - Thursday 2/12 (5 - 8 PM)Clinic - Friday 2/13 (7 AM - 5 PM)Clinic - Saturday 2/14 (7 AM - 3 PM)Clinic Breakdown - Saturday 2/14 (12:30 - 4 PM)Other
Have you volunteered at a GKAS clinic before?*
If yes, what was your role at the previous clinic?
Preferred T-Shirt Size*
Role for this Clinic*
Dentist License Number*
If you are a Dentist, what is your area of specialty?*
If you have a dental assistant you will be working with, please provide their name(s).
If you are a Dental Resident, which school do you attend?*
If you are a Dental Resident, what area is your resident training in?*
If you are a Dental Student, which school do you attend?*
If you are a Hygienist RDH, what is your License Number?*
If you will be assisting a specific dentist, please provide the dentist's name.
If you are a Hygiene Student, which school do you attend?*
If you are a Dental Assisting Student, what school do you attend?*
What languages do you speak?*
Any Comments?
After you click Submit, you will receive an email confirmation.
Should be Empty: