District 27-B2 Vision Screening Mission: “To provide vision screening to the youth of our community for those who do not have access to pediatric eye screening programs. Our goal is to identify vision issues early enough in a child’s life to assist in correcting vision for life” In pursuit of our ongoing campaign against blindness, the Lions have adopted the use of Autorefractor cameras to help diagnose eye problems at a much younger age. The Autorefractor sometimes called a Photorefractor camera uses infrared imaging to diagnose many common eye conditions so our children can be treated for these conditions.
The following is a guide to various forms, documents, and presentations that can be used to assist you in providing vision screening services. To ensure that you are using the latest version of these files, please download them from this site before each usage or screening.
New updated forms are here. This page is a work in progress until all changes are made to update this page.
FORMS
OPT-OUT - OPTIONAL
Some Schools before school starts offier Opt-Out forms for varies activities. If your school does this you can supply them with this form. They keep track who will not be screened though the signed forms. Day Care or School Opt Out
PERMISSION FORM
If the School does not offer Opt-Out forms as an option you need to use a Vision Screening Permission Form - Download This is an editable file.
RESULT FORMS
After you are done screening you need to send your reports in. There are 2 forms to choice from. Both are acceptable. Please follow the forms directions on what to do with them once they are complete.
Vision Screening Report Form - Short
Vision Screening Report Form - Long
VOLUNTEERS
It is important that the screener knows what they can and cannot do. The Volunteer Code of Conduct is useful for this. Also, the Volunteer Confidentiality Agreement also explains what information needs to remain private.
Volunteer Code of Conduct Volunteer Confindentiality Agreement
OTHER FORMS
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