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COVID-19 Daily Entry Health Questionnaire

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Please complete the form below. Required fields marked with an asterisk *

Contact Information

In the past 24  hours or longer period if noted, have you experienced any of the following:

Nasal Congestion/Runny Nose*
Answer Required
Fever (100.0 or higher)*
Answer Required
Sore Throat*
Answer Required
Chills (with or without repeated shaking)*
Answer Required
Shortness of Breath or Fatigue*
Answer Required
Excessive or Continual Coughing*
Answer Required
Diarrhea*
Answer Required
Muscle or Body Aches*
Answer Required
New loss of taste or smell*
Answer Required
Close contact with someone diagnosed with COVID-19 or presumed to have COVID-19 within the last 10 days*
Answer Required
Traveled on any flight or on any cruise*
Answer Required

Acceptance

Acceptance [You understand Jewish Academy of Orlando (JAO) has taken the recommended precautions to keep all students, teachers and staff members safe and healthy from the transmission of COVID-19. JAO cannot make any guarantees about the transmission of any illness, and you agree to maintain appropriate physical distance from others while on campus and to follow all safety guidelines.]*
Answer Required

Thank you for your help and cooperation!