Smile Squad Patch Order Form

To be completed by troop leader.

(required) indicates a required field.

Contact Information
Mailing Information

Enter the address to which you'd like patches shipped. Materials cannot be shipped to PO boxes.

Council Information

The Smile Squad Patch Program is currently available to Girl Scouts of Western Oklahoma. To get started, enter your troop information below. If you are not part of an organized troop, enter ‘Juliette’ in the Troop Number field.

If you're requesting materials for multiple troops, list all troop numbers.

Enter the number of scouts who earned the patch.

Enter the number of scouts who earned the patch.

Enter the number of scouts who earned the patch.

Enter the number of scouts who earned the patch.

Enter the number of scouts who earned the patch.

Enter the total number of scouts who earned the patch.

Activity Information

Using the check boxes below, select the activities your troop completed from each curriculum category.

Discover (required)
Connect (required)
Take Action (required)
Feedback

Your feedback helps us learn about what's working and where we can make improvements!

Behavior Changes

How have your scouts' behaviors changed since earning the patch? (required)

Check all that apply.

Badge Outcomes

Did your scouts earn a badge as part of completing the Smile Squad Patch Program? (required)

Check all that apply.

Questions?

For questions about Delta Dental of Oklahoma Foundation’s oral health education programs, please contact Teri Bachhofer at tbachhofer@DeltaDentalOK.org.