NOTICE: It is necessary to register your consent for your student to receive an eye exam at school. We are a 501(c)(3) For-Service organization providing school optometry services in Washington State. Completing this consent form does not guarantee we will be able to see your student during our upcoming event. We will do our best to see all students who register, but we will prioritize students according to need as determined in consultation with the school nurse. Once we have seen students flagged by the nurse as a concern for vision issues impacting education, we will fill our remaining capacity on a first-come, first-serve basis. If there are more students than we can serve on an event day we will try to arrange future event days to meet the need. Also be aware that we prioritize uninsured, Medicaid, and Apple Health students who do not have access to eye care elsewhere. If you have a vision insurance plan other than Medicaid or Apple Health, we must fully confirm eligibility before providing services. We strive to serve all children in need and use philanthropic funding to support eye exams and eyeglasses for uninsured students. If your child has Medicaid, Apple Health, or some other vision insurance access we do need to use these available benefits to provide services. Your consent is required for your student to receive an eye exam. If you do not consent, your student will not receive an eye exam, or eyeglasses. Please enter the required information and read the consent form carefully. Once we receive your request for services we will let you know if it is possible to provide services at this event or a later event when scheduled. If you do not agree to the terms of the consent form, please do not proceed. Thank you.