Dear JTED Parents and Guardians:

Thank you to those of you who sent in your completed COVID-19 Parental Acknowledgment and Disclosure forms. We've been informed that people are having difficulty with the fillable PDF form. We apologize for any inconvenience this may have caused. If you have not submitted your form, or if you've been notified that we did not receive your form correctly, please follow the steps below on or before Friday, Oct. 9:

  1. Download and print the form by clicking the blue button below.
  2. If you do not have access to a printer, email Amanda Simeza asimeza@pimajted.org - you may select the orange button below to open an email to her. Request to have a blank form mailed to you. Please include your student's name and your home address in the email.
  3. A parent/guardian must initial each of the numbered statements on the form to verify they understand and agree to abide by the information provided.
  4. The parent/guardian must complete the bottom portion of the form, including adding their signature.
  5. Scan the document or take a photo of both pages side by side with your phone. Free scanner Apps are available for smart phones. Please see the sample form below.
  6. Email the pdf or jpg image to asimeza@pimajted.org You may click on the purple button below to open an email to her. Include your student's name in the subject line and make sure your completed form is attached.
  7. All forms are due by Friday, Oct. 9.
Sample Form
sample form completed