Lackawanna City School District
Lions Club Free Vision Screening Parent Letter and Decline Form
November 6, 2024
Dear Parent/Guardian,
The Lackawanna City School District is partnering with the West Seneca Lions Club to provide free vision screenings to Truman Elementary School and Martin Road Elementary School students in Prekindergarten, Kindergarten, 1st grade, and 2nd grade.
The vision screener utilized can detect the following vision conditions: near-sightedness, far-sightedness, pupil size deviation, blurred vision, unequal refractive power and eye misalignment. These conditions may lead to Amblyopia which is the leading cause of monocular blindness (blindness in one eye) in children and can cause permanent loss of vision if untreated. Amblyopia may be successfully prevented if the conditions that cause it are detected and treated early.
The Lions Club vision screening team consists of a screener and an assistant with whom the district will be working closely to ensure a smooth and efficient process that is minimally disruptive to the school day. Each screening takes just a few seconds and is performed from a distance of about three feet. There is no physical contact with the child and no eye drops are administered. Vision screenings are done in the classroom with the Teacher present.
A report will be generated and backpacked home with those students who do not pass this vision screening. All student information will be kept confidential. Please note that this is only a screening and does not constitute an examination or diagnosis of vision problems. Parents/guardians of students who do not pass this screening should take their child to be assessed by a vision care specialist.
IF YOU DO NOT WISH TO HAVE YOUR CHILD SCREENED, please complete and return the form below to your child's school by Tuesday, November 12.
Free Vision Screenings will take place on Tuesday, November 12 at Truman Elementary School and Thursday, November 14 at Martin Road Elementary School. Please contact Judy Faircloth at (716) 821-5610 ext. 4603 with any questions concerning this screening. Thank you.
Sincerely,
Truman Elementary School and Martin Road Elementary School
Lions Club Free Vision Screening Decline Form
I DO NOT wish to have a free vision screening for my child.
Print Child’s Name: ____________________________________________ Grade: _________
Child’s Classroom Teacher: _______________________________________ Room #: _________
Print Parent/Guardian Name: ________________________________ Phone #: ______________
Parent/Guardian Signature: __________________________________ Date: _____________