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Give Kids A Smile Program Planning Toolbox

Have you planned an access to care event in the past or is this a new activity for you? The keys to success are organization, planning, execution, publicity, and evaluation. This GKAS Program Planning Toolbox is an excellent resource to assist you in planning your event whether it is your first time or if you are a veteran program coordinator. The guides, forms, letters and other informative materials in this section provide a step-by-step timetable to guide you through planning, implementing, and promoting your GKAS event. For answers to additional questions, visit our GKAS FAQ page.

Planning and Promotion Guide

Get step-by-step information to assist you in planning and promoting your GKAS event. The clickable table of contents quickly directs you to the section you need.

Program Planning and Promotion Guide (PDF)

Community Coalition-Building and Identifying Qualified Children for GKAS (PDF)

Continuity of Care Planning Guide

This resource guide provides valuable information on how to find families who are uninsured and refer them to insurance application assistance, so that they may receive ongoing dental care following the GKAS event.

Continuity of Care Planning Guide (PDF)

Legal Insurance and Risk Management Considerations Guide

As with any access to care program, GKAS raises legal, insurance and risk management considerations. The following provides guidance on how to manage this aspect.

Legal, Insurance and Risk Management Considerations Guide (PDF)
The Ethics of Temporary Charitable Events (ADA white paper, 2015) (PDF)

Notice of Privacy Practices

This notice describes how a patient's health information may be used, disclosed and how to obtain access to this information.

Sample Forms

Private Practices Acknowledgement Form

This form acknowledges that the Notice of Privacy Practices was provided and read by the patient.

Sample Private Practices Acknowledgement Form (English) (PDF)
Sample Private Practices Acknowledgement Form (Spanish) (PDF)

ADA Caries Risk Assessment Forms

Download Instructions (PDF)
Caries Form (Patients Ages 0-6 Years) (PDF)
Caries Form (Patients Over 6 Years) (PDF)

Waiver and Permissions Forms

Sample Dental Examination Waiver Form (English) (PDF)

Sample Dental Examination Waiver Form (Spanish) (PDF)

Photo/Video Consent Release Form (PDF)

Sample Letters

Sample House Resolution (PDF)
Sample House Resolution Letter (PDF)
Sample Invitation Letter to Elected Officials (PDF)
Sample Invitation Letter (English) (PDF)
Sample Invitation Letter (Spanish) (PDF)

Education Resources

Good oral health is an important part of overall health. For healthy teeth tips, download and print education handouts to distribute at your event, or access fun and educational videos to play for children and caretakers in your waiting area.


Tips for Healthy Teeth (English & Spanish) (PDF)


GKAS waiting room video (PDF)

Website Links

Access oral-health information for the public and ADA Find-A-Dentist

Brought to you by the American Dental Association
Visit the Ad Council's children's oral health website