Vision care form - Quarryville Library

Vision Care Early Child Screening

Appointments for children from 6 months to 6 years to have free vision screening during the Family Place Workshop - open to all families with children in the target age group regardless of participation in Family Place or residency.

Child's Name*
First Last
Family Email*

All registration requests will be manually confirmed by our Program Manager - your appointment is not guaranteed unless you have a confirmation email.
Child's age
Choose one
Time*

: Hours

Minutes

AM/PM

Please select your first choice appointment time. Use increments of 10 minutes beginning at 11:20 am and ending at 1:30 pm. PAY ATTENTION TO AM/PM WHEN CHOOSING!
Name
This field is for validation purposes and should be left unchanged.

Vision Care Early Child Screening

Appointments for children from 6 months to 6 years to have free vision screening during the Family Place Workshop – open to all families with children in the target age group regardless of participation in Family Place or residency.

Child's Name*
First Last
Family Email*

All registration requests will be manually confirmed by our Program Manager – your appointment is not guaranteed unless you have a confirmation email.
Child's age
Choose one
Time*

: Hours

Minutes

AM/PM

Please select your first choice appointment time. Use increments of 10 minutes beginning at 11:20 am and ending at 1:30 pm. PAY ATTENTION TO AM/PM WHEN CHOOSING!
Phone
This field is for validation purposes and should be left unchanged.