Tell Us Your KidSight Story

You can empower other parents to take action when they receive a KidSight referral – just by sharing your experience! Complete the story questionnaire below to get started.

Your Child's KidSight Screening
Tell us about your experience with the KidSight vision screening program. (i.e. how old was your child at their screening and after screening what was their diagnosis/treatment)?
What is your child like? How would you describe him/her? What does he/she like to do?
What materials did you receive from KidSight and what role did they play in your follow-up care?
How did you feel when you received the KidSight referral? Is there a particular moment or memory that stands out?
Have you noticed any changes at home or at school since you child began their vision treatment?
What would you say to parents of kids who get referred by a KidSight screening or what would you want other parents to know that you learned from this experience?
How do you think this story would be different if KidSight didn’t provide free vision screenings at your child’s daycare/school?
Your Contact Information
Name
First Last
Phone
Email
Do you have a photo of your child in their glasses that we can use with the story?
Accepted file types: jpg, png, pdf, Max. file size: 50 MB.
You can also email photo(s) to mstephenson@kid-sight.org
Photo Release*
- Yes
The undersigned hereby irrevocably consents to and authorizes the use by KidSight, its officers and employees, of the undersigned’s image, voice, likeness and/or story as follows: KidSight shall have the right to photograph, publish, re-publish, adapt, exhibit, perform, reproduce, edit, modify, make derivative works, distribute, display or otherwise use or reuse the undersigned’s image, voice, likeness and/or story in connection with any product, service or program in all markets, media or technology now known or hereafter developed in KidSight’s products, services or program for the promotion of KidSight’s programs, as long as there is no intent to use the image, voice, likeness and/or story in a disparaging manner. KidSight may exercise any of these rights itself or through any successors, transferees, licensees, distributors or other parties, commercial or nonprofit. The undersigned acknowledges receipt of good and valuable consideration in exchange for this Release, which may simply be the opportunity to represent KidSight in its promotional and advertising materials as described above. The undersigned understands likenesses captured may be used as stated herein for an indefinite period.

Tell Us Your KidSight Story

Your Child's KidSight Screening

Your Contact Information