Charity Dental Services Terms and Policies

To be considered for a for a grant from Share A Smile, simply fill out and sign both the Application and Acknowledgement of Criteria forms and fax or mail to the Share a Smile Organization. The following criteria are required to be considered for a Share A Smile dentistry grant:

1. Complete Application

2. Sign the Acknowledgement of Criteria form

3. Be examined by a participating dentist/orthodontist, who will determine in his/her sole discretion whether your teeth/bite/smile, etc. require major dental/orthodontic services to correct what the dentist/orthodontist in his/her sole discretion deems to be a severe malformation, misshapenness, or irregularity of your teeth

4. Have no dental insurance or insurance is insufficient or does not cover cosmetic work necessary, as determined by the examining participating dentist/orthodontist to correct or improve the malformation, misshapenness, or irregularity of your teeth/bite/smile, etc.

5. Will devote a minimum of two (2) years to the process, including making all the required visits to the participating dentist/orthodontist, wearing all the required equipment provided and following all instructions given

6. Agree and consent to the perpetual, non-exclusive use of your name, likeness, photograph, or any descriptive, biographical materials concerning you that you provide under this Application

7. Grant Share A Smile the right to discuss and access your dental records with the participating dentist/orthodontist throughout the application and treatment process if you are selected

8. Agree and understand that simply by submitting this Application to Share A Smile and undergoing the dental examination, you are not guaranteed to receive a grant

9. Agree and understand that Share A Smile alone has the discretion to determine whether you will receive a grant and that its determination is final and incontestable

10. Agree and acknowledge that you understand all of these criteria and the contents of the Application and that as consideration for receiving a grant, you agree to hold harmless and release from any liability, claims or damages, Share A Smile, its directors, employees, agents, volunteers and the participating dental or medical personnel that perform services on you

11. Include a picture of the child’s smile for participant evaluation purposes.

All grants are approved at the sole discretion of the Share A Smile Board of Directors and can be revoked at any time. If you are approved for a Share A Smile grant you will be required to sign a Policy and Participation Agreement Form, agreeing to adhere to the rules and guidelines of the Share A Smile program.