Daily Wellness Questionnaire for Japhet School Attendance
Between 6 AM and 8 AM Monday-Friday, a parent or designated adult guardian must fill out this form before coming to school (or before entering Before-school Care). The results will be read by a Japhet School faculty or staff member, bound by a confidentiality agreement.

Systematic reporting is paramount for the safety and well-being of all students, faculty, and staff. Please take the time to answer these questions carefully and accurately.

Your email address and today's date and time are automatically captured by this survey.
Email address *
What is your child's LAST name? (one form per child) *
What is your child's FIRST name? *
What is your child's class? *
Will your child attend school today? *
If your child is staying home today for any reason, explain.
The mask my child is wearing today has been sterilized since its last use, or is a brand-new mask. *
What was your child's temperature this morning? Answer digitally as XX.X or type "absent today" *
Does your child have any of these new, unexplained symptoms? If you answer YES to any of these questions, please stay home and contact your healthcare provider. Contact the school for re-entry qualifications. *
No
Yes
Cough
Shortness of breath
Sore throat
Loss of taste or smell
Diarrhea
Nausea
Vomiting
Rash
Congestion
Has your child or anyone in your immediate household been exposed to someone diagnosed with COVID-19 in the last 14 days? If the answer is YES, please stay home and contact the school for re-entry qualifications. *
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