Sight and Hearing Screening Program
The Lions Club of Lancaster County has an outreach program to provide initial vision and hearing screenings for children here at school. We are partnering with them to screen all CA students with your permission. If you would like your child's vision and hearing screened on December 6th, please complete the permission form by December 1st. Information regarding your child's screening will be forwarded to you so that you can pursue additional interventions if necessary.
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The undersigned is the parent or legal guardian of a student at Chesapeake Academy, Irvington, VA. Permission is given by this form for the Lancaster County Lions Club on December, 6 2023, at a time scheduled by the Academy, to conduct (1) an eye screening using the SPOT Pediavision from WelchAllyn and (2) a hearing screening to determine if further medical examinations are required of my child for sight-or hearing -related difficulties.   *
Does your child wear glasses?
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Please sign your child's name/grade below. *
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