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Whitefoord Dental Consent Form
Please complete the form below to allow your child to be screened by the Whitefoord Clinic at Toomer.
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Email
*
Your email
Student Name:
*
Your answer
Homeroom Teacher's Name:
*
Your answer
I hereby voluntarily give my consent for my child to receive dental screening conducted by a Whitefoord Dental Team Member, on February 25th, at Toomer Elementary, during the school day.
*
Yes
No
Parent Name:
*
Your answer
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