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.
*First Name:
*Last Name:
*Email:
*Phone:
*Street Address:
*City:
*State:
*ZIP code:
*Council:
*Troop Number:
*What day did your troop complete the Smile Squad Girl Scout Patch Curriculum?:
Indicate the number of scouts who earned the patch:
Daisies:
Brownies:
Juniors:
Cadettes:
Seniors/Ambassadors:
Total Number of Girls:
*How did you hear about our Smile Squad Patch Program?:
Other:
*Discover:
*Connect:
*Take Action:
*How satisfied were you with the educational component related to this patch?:
*How valuable do you think this information is in your scouts’ lives?:
*What activity from the curriculum was the most meaningful for your troop?:
*How did your scouts’ behaviors change since earning this patch? (Check all that apply):
*Did your scouts earn a badge as part of earning this patch?:
Do you have any additional feedback to share?:
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 mschreier@deltadentalmi.com.