Free Dental Sealant Permission Slip Form
Multnomah County School Dental Sealant Program

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Your child's school has been chosen to participate in the Multnomah County School Dental Sealant Program. Dental Sealants are coatings put on the back of the teeth, and are a quick and easy way to prevent cavities. The screening, sealants and follow up care are FREE, and done by dental care professionals.
Name of Student: (Last, First, Preferred name)
Student's Date of Birth (mm/dd/yy)
You child's grade
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