Club Preparation                 

  1. Why Vision Screening is Important for Young Children - Vision Screening overview to be used when meeting with Site Coordinators (e.g. School Nurses and Daycare Directors)

Event Preparation                    

  1. Consent Form – Every child screened needs to have a Consent Form is signed by their parent/guardian. This is customizable by each club to include name of club, screening date and contact information.
  2. Screening Results Letter Option A - Letter to be distributed to parents along with the printout of the screening results. One letter covers either a referral or no referral.
  3. Screening Results Letter Option B - Letter that can be customized to add local Optometrists and Ophthalmologists.
  4. Vision Screening Summary - Samples of screening results from the Spot - one for Screening Complete, Complete Eye Exam Recommended and Screening Flagged
  5. USB Drive Instructions - An instruction sheet for Site Coordinators on how to load the USB drive with the children to be screened.
  6. Manual Screening Sheet - Used to keep track of people screened when the USB drive approach is not able to be used. Primarily used for Public and Other Events.
  7. NH Background Check - Background Checks using State of NH forms and Instructions.
  8. Spot Usage Transfer Form - This is an agreement between a Club and the Spot Reservation Coordinator for the use of a Spot Kit. It includes a checklist of all the items contained along with the Spot (e.g. printer, ink cartridges).

Screening Event                          

  1. Screening Event Checklist – A one page summary of the key steps needing to be done for a Screening Event.
  2. Screening Event Summary - A summary of the screening event in PDF format to be filled out with the # of children screened, # referred, event, club, etc. that will be sent to the District. We have also included a Microsoft Word version that can filled in and emailed to the District.
  3. Lions Coloring Page - A file that can be printed and handed out as a reward for children that have been screened.


  1. Thank You Letter - Letter to Site Coordinators thanking them for arranging the screening(s), reminding them of following up on referrals. This is a Word verson of the Thank You Letter you can modify