SSSF Registration — Black Dental Students & Pre-Dents #BDSPDS

Black Dental Students & Pre-Dents in partnership with the University of Missouri Kansas City School of Dentistry’s Office of Student Programs and chapters of the Student National Dental Association and the Hispanic Student Dental Association presents
"Shaping Smiles, Shaping Futures"

Our joint event, is designed to foster interest and enthusiasm for the dental profession among underrepresented minority students in grades 6-12. We believe that by providing them with hands-on experiences and exposure to the world of dentistry, we can inspire a new generation of diverse dental professionals.

All of our organizations are committed to increasing the representation of minority students in dentistry and creating a supportive community for their academic and professional growth. We aim to promote and nurture diversity within the field of dentistry while providing a platform for networking and professional development.

REGISTRATION IS REQUIRED, SPOTS ARE LIMITED.

📅 Date: Saturday, November 09, 2024
🕘 Time: 8:30 AM - 1:00 PM
📍 Location: UMKC School of Dentistry, 650 E. 25th St, Kansas City, MO

Join us for an exciting journey into the world of dentistry! This free event is designed for underrepresented minority 6th-12th graders interested in exploring the dental profession. Get hands-on experience, meet dental professionals, and discover the rewarding careers that shape smiles and futures. A light breakfast and lunch will be provided. Students under 18 years old are required to be accompanied by an adult.

Please complete the registration form below to secure your spot by Saturday, November 2, 2024! We look forward to inspiring the dentists, dental hygienists, and dental scientists of tomorrow!

If you have any questions please do not hesitate to reach out w/questions at: BlackDentalStudents@gmail.com

SECTION 1: Participant information

Participant's Name

First Name

Last Name

Participant's Unisex T Shirt Size

Participant's Age

Participant's Current Grade

Please list the school the participant is currently enrolled at.

Do not use acronyms.

Participants Phone Number (Optional)

(###)

###

####

Participant's Email (Optional)

SECTION 2: Parent/Guardian Information

Parent/Guardian's Name

First Name

Last Name

Parent/Guardian's Phone Number

(###)

###

####

Parent/Guardian's Email

Who will be accompanying the participant throughout the event? *All participants under 18 years old, must be accompanied by an adult.*

If another adult, other than the Parent/Guardian will be accompanying the participant. Please List their First Last Name and Phone Number below.

SECTION 3: Participant Medical Information

Please list any allergies or medical conditions (i.e. allergies to latex, medical conditions that might affect participation) - if not applicable list 'none'.

Please list any dietary restrictions the participation may have. - if not applicable list none

*please note there is no guarantee all restrictions will be accommodated with our light breakfast and lunch.*

SECTION 4: Photography & Consent

Please read the Photography & Consent outlined below and respond with your preference.

I understand and agree that photographs and/or video recordings may be taken during the "Shaping Smiles, Shaping Futures" Dental Career Exploration Event for promotional, educational, and informational purposes. These photographs and recordings may be used in various forms of media, including but not limited to websites, social media, brochures, and presentations. By attending this event, I grant permission for my (or my child's) likeness and voice to be used in such materials without further notice or compensation. I understand that this consent extends to all images and recordings taken during the event. If I do not wish to grant this consent, I will inform event organizers by selecting no below and at the registration desk on the day of the event. I understand and consent to the use of photographs and video recordings as described above.

SECTION 5: Terms & Conditions

By registering for the "Shaping Smiles, Shaping Futures" Dental Career Exploration Event, you agree to the following terms and conditions:

Liability Waiver: Participants and their parents/guardians (if applicable) understand and acknowledge that participation in this event involves certain inherent risks. Event organizers, UMKC, and its affiliated organizations shall not be held liable for any injuries, accidents, or property damage that may occur during the event. Code of Conduct: All participants are expected to conduct themselves in a respectful and responsible manner throughout the event. Disruptive or inappropriate behavior may result in removal from the event without refund. Changes to Event Details: Event organizers reserve the right to make changes to the event schedule, activities, or location as necessary. Participants will be notified of any significant changes. Privacy Policy: Personal information collected during registration will be used solely for event-related communication and will not be shared with third parties. Photography and Consent: Participants agree to the use of photographs and video recordings as outlined in the provided Photography and Consent section. Emergency Procedures: In the event of an emergency during the event, participants and their parents/guardians (if applicable) agree to follow the instructions provided by event staff and medical professionals.