Smile Squad Patch Order Form

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; Northern Indiana Michiana; Kentuckiana (Indiana troops only) and Southwest Indiana. If not part of an organized troop, please indicate "Juliette" in the fields below. 

Contact Information

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

Troop Information

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


Indicate the number of scouts who earned the patch:

Additional Information and Feedback

Please select what activities your troop completed from the category in the drop down menus below:

*How did your scouts’ behaviors change since earning this patch? (Check all that apply):


If you have questions, need assistance, or are interested in receiving information about the Delta Dental Foundation's oral health programs and activities, please contact Megan Schreier at