Each person receiving a mouthguard requires a form
Mouthguard Clinic will be held on September 23rd, 2018. Please select your preferred appointment time for that day
Please enter the age of the person receiving the mouthguard
5 and under
20 and up
Please enter your email address
A reminder email of the appointment time will be emailed prior to the Mouthguard Clinic.
How did you hear about us?
SMHA - Email
SMHA - Website
SMF - Email
SMF - Website
Word of Mouth
ASHL - Email from Captain
Came here last year
Please note: Mouthguard pick-up will be during the EVENING of September 25, 2018. Pick-up time will be between 5pm and 730pm
I have read and understand this form.
A copy of your responses will be emailed to the address you provided.
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