FREE IN-SCHOOL DENTAL SCREENING The Mount Vernon School District, in partnership with Smile New York Outreach, is offering every child a FREE DENTAL SCREENING. At the dental screening, a licensed dentist will check your child’s mouth and teeth. A report will be provided for your child to take home. For your ease and convenience, the in-school dentist will be back at a later date to see children needing preventive dental care including a cleaning, x-rays and sealants as necessary, or, they should be taken to their current dentist. Be sure to have your child’s mouth and teeth checked in school for FREE. Simply complete and return the permission slip below. YES, I would like my child to have a FREE DENTAL SCREENING at school. I have received the Notice of Privacy Practices on the back of this form. Child’s Name_______________________________Birth Date___________Male/Female School_________________________________________________________________ Teacher_______________________________________________Grade____________ Parent/Guardian Name____________________________________________________ Parent/Guardian Signature______________________________________Date_______