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 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 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