Vision/Hearing Opt-Out Form

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Please fill out the appropriate answers if you choose to NOT have your student screened

If you are not opting out, you do not need to submit anything

Email *

Student Last Name *

Student First Name *

Team *

Mint

Thyme

Wasabi

I would like to opt my student out of Vision Screening *

My student is already under the care of a vision specialist and/or wears corrective lenses

I would like to opt out my student for other reasons

N/A - I am opting out of Hearing screening only and understand Vision screening will still be done

I would like to opt my student out of Hearing Screening *

My student is under the care of a hearing specialist and/or wears hearing aides

I would like to opt my student out for other reasons

N/A - I am opting out of Vision screening only and understand that Hearing screening will still be done

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