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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
Answer Required
Muscle or Body Aches*
Answer Required
New loss of taste or smell*
Answer Required

We would ask that if you are symptomatic (Like any other flu-type communicable illness) that you keep your child home until symptoms relieve.


In addition, please contact the front office at [email protected] notifying personnel of your child’s absence. Students may return to school once they are symptom free without the aid of medication for 24 hours.

Note: Students will be welcome to pivot to remote learning as they are able. Please allow one day for teachers to gather materials and devices. Pick up of the items will be available by afternoon dismissal.  


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!