Oral Health Photo Contest
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2020 Share Your Smile With Alabama Submission Form
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Note: This contest is open for children living in Alabama either enrolled and attending third grade, or 8 to 10 years of age being home-schooled. Be sure you have read the Official Contest Rules before submitting your photo.

* Student's Name

* Student's Birthdate

* How did you hear about the "Share Your Smile with Alabama" contest?

* Name of School

* Name of Homeroom Teacher

If homeschooled,

check here  

* What county do you reside in?

* Legal parent or guardian Name

* Legal parent or guardian email address
Example: janedoe@nowhere.com

* Legal parent or guardian phone number(s)
Format the phone number(s) as follows: 1112221234 no dashes or letters will be accepted in this field.

Is child in foster care?
If yes, the social worker responsible for the child must sign