Smile Squad Materials Order Form

Contact Information

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Address where you would like the materials sent:
(Please note: Materials cannot be sent to PO boxes.)

The free patch program for Girl Scouts is currently only available to girls in the following councils: Central Indiana; Heart of Michigan; Michigan Shore to Shore; North East Ohio; Southeastern Michigan and Southwest Indiana. If not part of an organized troop, please indicate "Juliette" in the fields below. 

Troop Information

(Please note: If requesting for multiple troops, list all troop numbers.)

Indicate the number of scouts in your troop: 

Activity Materials


If you have questions or need assistance, contact Lisa Ermak at

If you are interested in receiving information about the Delta Dental Foundation's oral health programs, field trip grants and activities, email Megan Schreier at