Mobile Vision Bus Request Form

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    • Fieldset

      • Volunteers Trained To Use Screening Equipment

      • Licensed Professional on Site for Screening

    • Mobile Vision Bus Requirements For Vision Screening

      1. A level location to park the Mobile Vision Bus
      2. A Room or Space for Registering Clients
      3. Access to a restroom
      4. A fee of $150.00 will be charged to the use of the Bus
      5. At least one Director from the LS&TF will need to be on-site
      6. Volunteers (6-10) from the Lions Club(s) requesting the Clinic
      7. The Lions Club(s) requesting the clinic should have at least one licensed professional (Optometrist or Ophthalmologist) on site for the screening. If the club needs the LS&TF to furnish these Doctors, the club will pay $50.00 per hour for each Doctor required with a minimum of $200.00 per Doctor per Clinic

      Mobile Vision Bus Requirements For Publicity/Public Relations

        1. The request must come from a Lion in Good Standing who is a member of a club in Good Standing within the area that encompasses Lions District 2-X1
        2. A fee of $150.00 will be charged for use of the Bus
        3. Driver for PR Purposes $100.00 or The Lion or Lions Club is responsible for obtaining and making sure the Driver is covered under an Insurance Policy
        4. Returning the Bus with the same amount of DIESEL as when it left the lot or they will be billed for the amount necessary to replace the fuel used
        5. Bus returned in the same condition as it left the lot. Any damages will be the responsibility of the Lion or Lions Club. (Current Deductible on policy is $5000.00

      Restrictions on Use

        1. The Bus must not be used to transport Individuals (Driver and a Co-Driver are the only people allowed on Bus during transportation)
        2. The unit is intended for the use of Lions District 2-X1. It cannot be used outside of District 2-X1 unless approved by the LS&TF Board of Driectors
        3. AT NO TIME SHOULD EQUIPMENT BE REMOVED FROM THE BUS

      • Certification

    • I Certify that what is entered above is true to the best of my ability and that I have read and understand the Instructions above.
     

    Verification