Vision Opt-Out Consent Forms
Pursuant to California Education Code (EC) Section 49455.5, our school has entered into a Memorandum of Understanding with a nonprofit eye examination provider to provide eye examinations to our pupils. These eye examinations are supplemental to, and do not replace, the vision screenings required by EC Section 49455. An on-site free eye examination by licensed health care professionals may be provided at your child’s school. The on-site eye examinations are noninvasive and provided exclusively for the purpose of providing eyeglasses, if advised. Participating in a school screening has many benefits:
• You do not need to take time off from work.
• No missed school days or workdays.
• Free eye examination by a licensed professional.
• Free prescription eyeglasses.
If your child is screened and found to have urgent problems, your child will be sent home with a letter. If you receive a letter, it is important that you take your child to an eyecare provider for an evaluation. If you want your child to participate in the eye examinations for his/her grade, no further action is required.
If you DO NOT want your child to participate in the on-site eye examinations, please download the PDF Opt-out Consent letter and return it to your child’s school.
A Guide for Vision Screening in California Public Schools
Vision Services Parent Opt-Out Consent Form
Health Services &
Ron Tanimura, Ed.D
333 S. Beaudry Ave.,
29th Fl. Los Angeles, CA 90017
P: (213) 202-7584
Fax: (213) 580-0559