PARENT OBJECTION TO PHYSICAL EXAMINATION OR VISUAL EVALUATION
(For School Admission)
I am the parent or guardian of the following children who are enrolling in the beginner grade or seventh grade in _________ Public Schools, or who are transferring from out of state into any grade in ___________ Public Schools:
Child No. 1: _____________________________
Child No. 2: _____________________________
I understand that state law requires that the school be provided with: (1) evidence of a physical examination by a physician, physician's assistant, or nurse practitioner and (2) for school year 2006-07 and each school year thereafter, a visual evaluation by a physician, a physician assistant, an advanced practice registered nurse, or an optometrist. The physical examination and visual evaluation is required to be completed within six months prior to the entrance of the child into the beginner grade and the seventh grade or, in the case of a transfer from out of state, to any other grade. The visual evaluation is to consist of testing for amblyopia, strabismus, and internal and external eye health, with testing sufficient to determine visual acuity. No such physical examination or visual evaluation shall be required of any child whose parent or guardian objects in writing.
I hereby object in writing to the:
____ physical examination
____ visual evaluation
(check one or both)
for the above named child(ren). I will not hold _________ Public Schools responsible for any injury or harm caused by or relating to such refusal to obtain a physical examination of visual evaluation for the above named child(ren).
