Save Your Vision Month

Save Your Vision Month

Sign up to have your class join an optometrist on a Q&A call. Once submitted, Realeyes will email a confirmation with Zoom information and will ship materials to your school. Please make sure school shipping address is accurate.
Which Zoom(s) would you like to join?
School Name:
County:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name

First NameLast Name
Email
example@example.com
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 form:
# of FIRST graders
# of SECOND graders
# of THIRD graders
# of FOURTH graders
# of FIFTH graders
# of SIXTH graders
# of SEVENTH graders
# of EIGHTH graders
# of HIGH SCHOOL STUDENTS
Additional Information or Notes
Should be Empty:

Tell us about your students