RED HILL LUTHERAN SCHOOL

K-3 Vision Screening Permission Form

K-3 Vision Screening Permission Form

Your RHLS K-3 child has the opportunity to get a free vision screening with the California-Hawaii Elks Major Project. The California-Hawaii Elks Major Project is a non-profit organization that offers free vision screening to children throughout California. The purpose of this screening is to identify children who may be at risk for undetected vision abnormalities.

The Vision Screening Program consists of the following for each child:
♦ assessment of visual acuity and external eye health
♦ evaluation of the ability of the two eyes to work together
♦ observation of the muscular ability of the eyes to follow, fixate and maintain binocular vision.
There is no cost to the school or child for participation in this vision screening.

To take advantage of this free screening, permission is needed from the child’s legal guardian. Results will be provided to the legal guardian.

Who: The California-Hawaii Elks Major Project (a non-profit organization)
Why: To evaluate the ability of the two eyes to work together and observe the muscular ability of the eyes to follow, fixate and maintain binocular vision.
When: March 21, 22 and 23 (9:15 a.m. – 11:30 a.m.)
Where: Conveniently scheduled on campus during your child’s regular school day

Completed By

Address
City
State/Province
Zip/Postal

Student Information

Authorization Information

Sending

Red Hill Lutheran School | 13200 Red Hill Avenue, Tustin, CA 92780 | 714-544-3132