All the forms used for OKS are listed below by the chapter in the OKS Manual where they are referenced.

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