Dental Exam Waiver Form 7.100 F8

This form must be filled out by parents or guardians seeking a waiver of the required school dental exam for their student. The form must provide the reason why the child is exempt:

  • Enrolled in the free and reduced lunch program and is not covered by private or public dental insurance (Medicaid/All Kids).
  • Enrolled in the free and reduced lunch program and is ineligible for public insurance (Medicaid/All Kids).
  • Enrolled in Medicaid/All Kids, but we are unable to find a dentist or dental clinic in our community that is able to see my child and will accept Medicaid/All Kids.
  • Does not have any type of dental insurance, and there are no low-cost dental clinics in our community that will see my child.

Dental Exam Waiver Form 7.100 F8