Vision Exam Waiver Form 7.100 F20

Illinois law requires that proof of an eye examination by an optometrist or physician / eye doctor (such as an ophthalmologist) who provides eye examinations be submitted to the school no later than October 15 of the year the child is first enrolled or as required by the school for other children.

The examination must be completed within one year prior to the first day of the school year the child enters the Illinois school system for the first time. The parent of any child who is unable to obtain an examination must submit this waiver form to the school, indicating one of the following reasons:

  • Child is enrolled in medical assistance/ALL KIDS, but we are unable to find a medical doctor who performs eye examinations or an optometrist in the community who is able to examine my child and accepts medical assistance/ALL KIDS.
  • Child does not have any type of medical or vision/eye care coverage, child does not qualify for medical assistance/ALL KIDS, there are no low-cost vision/eye clinics in our community that will see my child, and I have exhausted all other means and do not have sufficient income to provide my child with an eye examination.
  • Other undue burden or a lack of access to an optometrist or to a physician who provides eye examinations
  • Vision Exam Waiver Form 7.100 F20