Lions of Michigan Foundation - KidSight - Vision Screening

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Lions of Michigan Foundation - KidSight - Vision Screening - Participation Consent Form

Worldwide, the leading cause of reduced vision in children is an unidentified need for them to wear glasses. Our vision screening program is designed to quickly and accurately identify treatable causes of vision loss in young children in a noninvasive and low stress environment. However, a vision screening is not a diagnosis of a problem, and it is not a substitute for an examination by an eye care professional. Participation in our vision screening program is voluntary, and no fees are charged.

Event Name or Screening Site: *

Event Location: City *

Screening Participant: First Name *

Screening Participant: Last Name *

Screening Participant: Date of Birth *

YYYY

Number of Family Members Participating in Screening *

My Child

My Child and Additional Family Members

Myself (Participants 18 Years-old or Older)

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