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





Questions?

If you have questions or need assistance, contact Lisa Ermak at lermak@deltadentalmi.com.

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 mschreier@deltadentalmi.com.