TDOM Mouth Guard Scan Event This field is hidden when viewing the form2026 TDOM MOUTH GUARD SCAN EVENTPlease submit separate request form for each student. **PLEASE NOTE THAT IF YOUR ATHLETE IS IN ORTHO BRACKETS WE ARE UNABLE TO DO A CUSTOM MOUTHGUARD** This event is July 15th, 2026 from 12-6PMStudent Name:(Required) First Last Please submit separate request form for each student. **PLEASE NOTE THAT IF YOUR ATHLETE IS IN ORTHO BRACKETS WE ARE UNABLE TO DO A CUSTOM MOUTHGUARD** This event is July 15th, 2026 from 12-6PMParent/Guardian Name:(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone:(Required)Email:(Required) Student Date of Birth(Required)What town does your child attend school in?(Required) Molalla Colton Canby Oregon City Silverton Mt. Angel Other Mouthguard Color Choice(Required) Green Yellow Orange Black Orange & Black Green & Yellow Clear Is student a current patient of TDOM? :(Required) YES NO What time do you plan to arrive? (this is simply for us to plan ahead for your arrival)*Subject to appointment availability. First come, first serve.
