The Eye Doc
Free vision screenings will be offered to all students at Democracy Prep Agassi Campus by The Eye Doc and Optica 2020 on Tuesday, May 17, 2022. To confirm registration, please fill out the below form and return to the front office by Monday, May 16.

Vision screening of a student's eyes will not take the place of a professional eye examine or by an eye care provider. The purpose of school vision screening is to assist in detecting vision problems that may affect the student’s ability to be successful in class.

No student will be screened without the signed and completed consent form below. Each individual student needs his/her own consent form. If you have questions about the consent form, please contact Democracy Prep Agassi Campus at dpac_info@democracyprep.org. Please follow the link below for a pdf copy of the form. If you would like a physical copy please come to the front office at your convenience.

https://drive.google.com/file/d/1D7_afiwY4UYzRf5RH23q8Cym07-VTnwX/view?usp=sharing

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Se ofrecerán exámenes de visión gratuitos a todos los estudiantes en la escuela, Democracy Prep Agassi Campus por The Eye Doc y Optica 2020 el 17 de Mayo del 2022. Para confirmar el registro, complete el siguiente formulario y devuélvalo a la oficina antes del Lunes, 16 de Mayo.

El examen visual de los ojos de un estudiante no sustituirá a un examen ocular profesional realizado por un profesional de la vista. El propósito del examen de la vista en la escuela es ayudar a detectar problemas de la vista que puedan afectar a la capacidad del estudiante para tener éxito en clase.

No se examinará a ningún estudiante sin un formulario de consentimiento firmado y completado. Cada estudiante necesita su propio formulario de consentimiento. Si tiene preguntas sobre el formulario de consentimiento, póngase en contacto con Democracy Prep Agassi Campus. Siga el link para obtener el formulario de concentimiento. Porfavor llenelo y entregelo a la oficina principal.

https://drive.google.com/file/d/1D7_afiwY4UYzRf5RH23q8Cym07-VTnwX/view?usp=sharing
 
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Parent First and Last Name // Nombre y Apellido del Padre/Madre
Scholar First and Last Name. // Nombre y Apellido de Estudiante
Parent email address/Correo electronico de padre
Scholars Grade. // Estudiante Grado
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Does your child have medical insurance?/Tiene su estudiante seguro medico?
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