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If your child is participating in Von's Vision Day, please print off the following documents, filling out a separate form for each child. For your child to participate, they must have these forms completed and signed by a parent or guardian.

Patient History Form

Parental Consent Form (English)

Parental Consent Form (Spanish)
 
Impact


Need


Why

IMPACT

According to a 2012 study titled “The Social and Economic Impact of Poor Vision” conducted by The Boston Consulting Group and Essilor, 30% of children experience...

NEED

According to recent data collected by Von’s Vision, 38% of children in the United States need some form of vision correction. Three out of every ten children under six years old...

WHY

As a child, Von remembers times when we went to school without glasses or was made, fun of because of his glasses. Without glasses, it was impossible to see, impossible to...

ENRICH THE LIVES OF INDIVIDUALS
AND FAMILIES IN NEED.

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59 Cavalier Blvd. Suite 310 Florence, KY 41042

1-859-448-3430