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If your student is participating in Von's Vision Day, please print off the following documents, filling out a separate form for each student. For your student to participate, they must have these forms completed and signed by a parent, guardian or supervisory adult for the student's organization. Blank copies of the documents below will always be provided at check-in to be filled out and signed on site.

Patient History Form

Parental Consent Form (English)

Parental Consent Form (Spanish)

COVID-19 Waiver

Please email Michael Lusk at michael.lusk@prolanthropy.net with any questions.
 

SPECIAL THANKS TO OUR PRESENTING SPONSORS

Hero Practice Services
Subaru | Schomp

FOR PROUDLY SUPPORTING

Von Miller's A Night to Take Flight

ENRICH THE LIVES OF INDIVIDUALS
AND FAMILIES IN NEED.

COPYRIGHT © 2021. VON’S VISION FOUNDATION. ALL RIGHTS RESERVED | REFUND POLICY | PRIVACY

59 Cavalier Blvd. Suite 310 Florence, KY 41042

1-859-448-3430