Strong Smiles Opt-out Thanks for letting us know your child won’t take part in Strong Smiles this year. This will make sure you don’t receive reminders from us over the coming weeks. To opt-out, please provide your child's details: Your child's name* First Name Family Name Your child's Date of Birth* DD slash MM slash YYYY HiddenYour child's ID#* This ID# was included in your QHealth message Please tell us why you've decided your child won't attend Strong Smiles* I don't want my child to receive fluoride My child is anxious about dental care My child already receives regular dental care Other Please include other reasons* Consent I understand that by submitting this form, I will be informing Darling Downs Health that I do not wish for my child to participate in Strong Smiles I understand that this means Darling Downs Health will not offer dental care to my child this year I understand Darling Downs Health may contact me next time the program offers screening at my child’s school Consent* I confirm that I have read and understand the information above, and am confirming that my child will not be participating in Darling Downs Health’s Strong Smiles dental screening session for the 2021 school year. HiddenConfirmations* I understand that by submitting this form, I will be informing Darling Downs Health that I do not wish for my child to participate in Strong Smiles I understand that this means Darling Downs Health will not offer dental care to my child this year I understand Darling Downs Health may contact me next time the program offers screening at my child’s school EmailThis field is for validation purposes and should be left unchanged.