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Vision and Hearing Screening Opt-Out Form
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Vision and Hearing Screening Opt-Out Form
I understand that by completing this form, I am choosing to opt-out of a vision and hearing screening for the 2020-2021 school year.
Student Legal Name (First Name, Last Name) *
*
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Student ID
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Student Grade
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Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Parent Name (First Name, Last Name)
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Parent Email or Phone Number
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This form was created inside of Fairfax County Public Schools.
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