Volunteer Form

Yes, I am interested in volunteering with Healthy Smiles of Spartanburg.

Name:   *
Address:   *
City:   *
State:   Zip:   *
Phone:  
Email:  
Please check one of the following, if applicable:
  I am a Registered Dental Hygienist
  I am a Certified Dental Assistant
  I am a dentist
  Other:
I am interested in volunteering in the following area(s):
  Presenting dental health education in schools, daycares, etc.
  Distributing dental health information at health fairs and other community events
  Assisting with school-based dental screenings
  Providing oral health care services for low-income children
  Other:
In general, the days/times that I am available to volunteer are:
S M T W T F S
Varied Schedule:
I am interested in volunteering:
  As needed and available
  Monthly
  Quarterly
  Twice per year
  Other:
Comments: