School Dental Screening Non-Participation Form

School dental screenings are optional. Each year you don't want your child to participate in the dental screenings, you must contact us one of the following ways:

Complete the form below
Call 905-688-8248 or 1-888-505-6074 ext. 7399

If you do not want your child to participate in the school dental screening, complete this form before the screening day. If your child switches schools during the school year, it's your responsibility to notify us.

* = Required

Student Information

* Student first name

* Student last name

* Parent / guardian first name

* Parent / guardian last name

* Phone
xxx-xxx-xxxx

* Parent / guardian email

* Student date of birth

* School

* Current grade

Personal Information and Privacy

Any personal information or personal health information submitted in writing will be collected, used and disclosed by members of Regional Council and Regional staff in accordance with the Municipal Freedom of Information and Protection of Privacy Act or the Personal Health Information Protection Act, where applicable.

Freedom of Information

Any information you share will be used only for the intended purpose for which it was provided. If you have any questions, email foi@niagararegion.ca or call 905-980-6000 ext. 3779.

Public Health

Dental Health

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