TWHC

TWHC

8th September 2019
GuardianPro will be available for mouthguard fittings this Sunday am. If you would like your child fitted please complete and bring a copy of your order form along on the day.
Wearer's Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Known Allergies
Consent

Under 18
Please note that by completing this form you are giving consent for the named child above to have a Guardianpro professional take an impression of their teeth for the purpose of the manufacturing of a mouthguard.
Parent / Guardian

First NameLast Name
Contact Email
example@example.com
Emergency Contact Number*

Area CodePhone Number
Mouthguard Options

Please see colours available and options.

Mouthguard Options*

Single Colour Mouthguard£38.00

Colour

White Mouthguard + TWHC LOGO£42.00

Glitter Gums£42.00

Colour

2 Colours 50/50£44.00

Colour 1Colour 2

2 Colour Stripe£48.00

Outer ColourCentral Stripe Colour

3 Colour Stripe £50.00

Outer Colour 1Central Stripe ColourOuter Colour 2

TWHC Match Day Mouthguard - Red/White/Red + Logo£55.00

Additional Spare Single Colour Mouthguard £28.00

Colour

Total £0.00

Privacy Statement
GuardianPro takes your privacy seriously. We will be using the information supplied solely to manufacture your child's mouthguards. We will hold all your information securely on our database which is password protected. No information will be passed on to any third parties other than working with the school to aid new supplies of mouthguards for your child.

Your information will be shared with the GuardianPro team on the fitment day. Please note that we will store your child's dental impression for one year where it will be then be disposed off. This is retained purely for reordering of replacement mouthguards.
Marketing Permission - Guardianpro will use your information to keep in touch with you, and send a replacement reminder or discount offers.*

Yes Please keep in touchNo Thanks
Should be Empty:

Consent