Facility E-Form | Teeth On Wheels

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Visit Infomation
Electricity access?*
A standard power point is required and needs to be in a 15 metre reach from our parking location
Best place for us to park out dental clinic?*
Please keep in mind we can’t drive/park undercover (clinic is 4 meters high) and parking should be in a safe place for children and staff to come to and from our clinic
Best place for us to enter with our dental clinic?*
Please keep in mind we can’t drive/park undercover (clinic is 4 meters high). If we need to drive through a gate this is locked, please let us know who the best point of contact is to open the gate
Photo of Parking Spot/ Electricity access / entry point*
Drop files here or

Max. file size: 128 MB.
Childcare Start Time:*
School Start Time:*
Childcare Finish Time:
School Finish Time:
Children's Lunch Time:*
(eg. 11-11.30am)
Children's Nap Time:*
(eg. Toddler Room-11-11.30am)
Children's Recess Time: (please keep in mind we work through recess)*
Latest time for Teeth On Wheels’ staff to leave:*
Time for Teeth On Wheels’ staff to Arrive:*
School Assembly:*
(eg: Mondays at 9:00am)
If we required to send out 2 dental clinics could your facility facilitate this? (2x power points, and 2x parking spaces required)
- Yes
- No
Please list any further information given by staff at the facility:

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To ensure a smooth running process please upload your school documents*
- Term Calendar - Specialist Timetable - Evacuation Plan - School Map (with classrooms/grade location clearly visible)
Drop files here or

Accepted file types: jpg, gif, png, pdf, worddocument, Max. file size: 128 MB.
Signature*
Date Signed
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

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