Calendar Zoom Request Form

Zoom Request Form

Once submitted, Realeyes will email a confirmation with Zoom information and will ship materials to the contact and school address below.
School Name:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County (Butler, Franklin, Summit, etc.):*
Primary Contact:*

First NameLast Name
Email*
example@example.com
Zoom Realeyes Presentations are available:
- “Sammy Safe-Eyes” for grades PreK and Kindergarten (30 minutes)
- “The Adventures of Rhet and Tina” for 1st and 2nd grades (40 minutes with 15 min Q&A)
- “The Case of Vinny Vision” for 3rd, 4th, and 5th grades (45 minutes with 15 min Q&A)
- “What’s Your EYE-Q?” for 6th, 7th, and 8th grades (45 minutes with 15 min Q&A)
- "Ask The Optometrist" - for Elementary and Middle School students - a brief lesson and the chance to ask ALL eye related questions.
Tell us about your students:

You may submit this single form for multiple grades and classes. Please indicate below:
I'm signing up the following grades with this registration form:

PreKKindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh GradeEighth Grade
Pre-K (4-5 yrs) - K # of classes
# of Classes
Total # of students:
# of students
Sammy Safe-Eyes Date & Time*
Find Dates & Times on the Realeyes Calendar, www.ooa.org/realeyes_events
1st - 2nd # of classes
# of classes
Total # of students:
# of students
The Adventures of Rhet & Tina OR Ask The Optometrist Date & Time*
Find Dates & Times on the Realeyes Calendar, www.ooa.org/realeyes_events
3rd - 5th # of classes
# of classes
Total # of students:
# of students
The Case of Vinny Vision OR Ask The Optometrist Date & Time*
Find Dates & Times on the Realeyes Calendar, www.ooa.org/realeyes_events
6th - 8th # of classes
# of classes
Total # of students:
# of students
What's You EYE-Q? OR Ask The Optometrist Date & Time*
Find Dates & Times on the Realeyes Calendar, www.ooa.org/realeyes_events.
Additional Information / Notes:
Should be Empty:

Zoom Request Form

Tell us about your students: