Dear Parent/Guardian,

These screenings are performed by your child’s school nurse throughout their academic career. Annually K, 2, 4, 6, and 8 graders are given both hearing and vision screenings. If you choose to opt-in, please sign the bottom of this form.

Benefits of School Hearing Screening

School-age hearing screenings are an integral tool in identifying children with hearing loss who were not identified at birth, lost to follow-up, or who developed hearing loss later. Without mandated routine hearing screenings in schools, students with unilateral, less severe, or late-onset hearing loss may not be identified or will be misdiagnosed and managed. Efforts to provide consistent protocols, screener training, and follow-up through school age will help ensure that children with hearing loss are identified and managed in a timely manner, thereby minimizing negative academic consequences.

Benefits of School Vision Screening

Vision impairments in children are common and uncorrected vision problems can impair child development, lead to behavior problems in the classroom, interfere with early literacy and learning, and lead to permanent vision loss. Early detection and treatment are critical. Additionally, visual functioning is a strong predictor of academic performance in school-age children and vision disorders of childhood may continue to affect health and well-being throughout adulthood.

I have read and understood the benefits of School Health Screenings. I do wish to have my child participate in School Health Screenings at this time.