ALL KIDS SCHOOL-BASED DENTAL PROGRAM CONSENT FORM 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in the 'Name of School' and 'Teacher' fields. Ensure you print clearly in ink for legibility.
3. Provide your child's legal name, birth date, address, gender, city/zip code, and home phone number in the designated sections.
4. Indicate whether your child qualifies for free or reduced meals and if they are enrolled in the Medicaid/All Kids program. If applicable, include the recipient ID number.
5. If your child has private dental insurance, fill out all relevant insurance information including the company name, address, plan number, and employee details.
6. Answer the medical history questions by circling 'YES' or 'NO' for each condition listed. This is crucial for ensuring appropriate care.
7. Finally, sign and date the form as a parent or guardian to authorize dental services. Make sure to review all entries before submission.

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