CONSENT FORM

At State Schools’ Relief (SSR), we believe that clear vision is the gateway to learning and a brighter future for Victorian students. The Glasses for Kids program is part of our commitment to ensuring that young learners in Victoria can see the world with clarity and participate fully in their education.

What is Glasses for Kids

We provide free in-school vision screening, further testing, and glasses (if required) to targeted Foundation (Prep) to Year 3 students. Our program is funded by the Victorian State Government and proudly managed and delivered by State Schools’ Relief.

Is my child eligible to participate? 

Any child in Foundation (Prep) to Year 3 (up until age 10 in a specialist school) can participate! You do not need to have a healthcare card. Students who already have glasses can also still particpate! 

Do I need to pay anything?

No. This is a free service for all participating students, provided by State Schools' Relief with support from the Victorian State Government.

Why should my child participate? 

Getting glasses through the Glasses for Kids program can help your child see better. This makes it easier for them to learn, read, and play at school. Good vision helps children do their best in class and feel more confident every day.

Can I complete a paper consent form? 

Yes; if you require a paper consent form, please request one from your school. 

Who can provide consent?

Parents or carers may complete this form and provide consent for the initial screening and testing.

Need assistance?

For more information, or if you need help filling in the form:

Email: info@glassesforkids.com.au
Visit: glassesforkids.com.au
Phone: (03) 8769 8400 



Need more information?

Read the detailed Information for Families Guide on the Glasses for Kids website.

Click here


Privacy and Information Handling

The personal and health information collected through this process will be held by your child’s school, State Schools’ Relief and the relevant Program partners (optometrists) who conduct and supervise the screening and testing of your child.

The information collected is used for the purpose of administering and providing the services of the Program. This Consent Form will be shared with the appropriate school and Department of Education staff, staff within SSR and the Program partners optometrists, who require such information to facilitate your child receiving services provided through the Program, or otherwise when permitted or required by law. If required, you can request access to the information collected about your child for the Program by contacting your child’s school in the first instance.

The department, SSR and its relevant Program partners will handle your and your child’s personal and health information (including this form) in accordance with the Privacy and Data Protection Act 2014, the Health Records Act 2001, and the department’s privacy policies.

The department’s privacy policies can be found here: https://www.education.vic.gov.au/Pages/privacy.aspx


The Department of Education (the department), which includes all Victorian government schools, and central and regional offices, is providing funding to State Schools’ Relief (SSR) which is a charitable non-government organisation, to manage and deliver the Glasses for Kids program (the Program) at 770 targeted schools between 2024 and 2027.

Your consent is needed for your child to participate in the Program.


School Details

Student Details

If you do not have a Medicare card, you may still participate in the Glasses for Kids program.

  • All participating students will receive free initial vision screening.

  • GFK program partners require your Medicare number if your child requires an eye test.

  • Eye testing may be bulk billed through Medicare and limits apply as to the frequency of bulk-billed eye tests.


e.g. 04/2025

Parent/Carer Details

Confirm School

Please go back and select the correct school.

Eye health questionnaire

If yes, please supply your school with their current prescription to give to Glasses for Kids program staff
Browse

Consent to take part in Glasses for Kids

In giving consent, have enough information and I understand the following:

  • I confirm that I have read the Information for Families.

  • I understand that an optometrist may need to clarify or discuss further details with me and I have provided my phone number.

  • I authorise and consent to my child receiving free initial vision screening and if needed, testing and glasses by a registered optometrist at school through the Program.

  • I consent to the optometrist conducting a comprehensive eye test that may be bulk billed to Medicare. I authorize the optometrist to assign the Medicare benefit on behalf of my child and I acknowledge that there may be limitations to how frequently these eye tests can be billed to Medicare.

  • I understand that if glasses are required, my child will select these on the day from SSR’s range of frames.These will be delivered to the school after the visit. If this pair of glasses is lost or broken within 12 months after our visit, we will replace this pair of glasses free of charge.

  • I understand that the range of lenses provided by SSR are limited, and that I may request a copy of the lens prescription and/or any other relevant prescription that is prescribed by the optometrist.

  • I understand that the services performed by the Glasses for Kids program is not a replacement for routine eye care.  


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