Vision Screening Package

 

On line Vision Screening Kit Lion District A-16

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Vision Screening Pamphlet

File Name: Vision-Screening-Pamphlet.pdf

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Startup info

File Name: Vision Screening Start Up Kit Lion District A-16.pdf

Paperwork filled out just before screening day

File Name: Paperwork done before the screening day.pdf

Certificate of Insurance (DDSB 2024-2025)

File Name: Certificate-Of-Insurance-District-A16-various-DDSB-annual-24-25.pdf

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You will need to print a copy for each school

 

Letter to the Principal - Version 1

File Name: Letter to the Principal - Version 1.pdf

Letter to the Principal - Version 2

File Name: Letter to the Principal - Version 2.pdf

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You will need to print multiple copies of the forms below

 

Permission form for principal and parents to sign

File Name: Vision and Hearing Permission Form.pdf

Permission form for Durham Catholic District School Board

File Name: Durham Catholic District School Board - Consent Form.pdf

 

Student Individual Report form

File Name: Vision Screening Report Form.pdf

Summary sheet for sharing of student results with school staff

File Name: Vision Screening Summary - Approved for Sharing.pdf

 Summary sheet of student info NOT shared with staff

File Name: Vision Screening Summary - NOT Approved for Sharing.pdf

Declaration form for volunteers

File Name: 2017-2018 DDSB Offence Declaration for service providers.pdf