Student Athlete Mouthguard Clinic

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Please fill out the following information. Please remember to prepay for your mouthguard using this link. This will cover the supplies. Students will receive a confirmation email once they have registered and paid. The deadline to sign up is Thursday 2/1/24.

Please note: Unfortunately, we will not be able to make a mouthguard if you currently have braces.

First and Last Name: *

Student ID *

What sport(s) do you play? *

Do you have any allergies? If yes, to what? *

Choose a date below: *

Monday February 5 (week 1)

Tuesday February 6 (week 1)

Monday February 12 (week 2)

Tuesday February 13 ( week 2)

Required

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