Perpich Center Visitor Health Screening Questionnaire (COVID-19)
In an effort to prevent the spread of COVID-19 and reduce the risk of exposure to Perpich Center for Arts Education (PCAE) workforce, students and visitors, we are asking all visitors who wish to enter Perpich buildings to complete the following screening questionnaire on the day of your visit, prior to being authorized entry.

If you are part of a group, each individual member visiting Perpich needs to complete their own Health Screening Questionnaire.

You are not legally required to answer the screening questions; however, if you do not answer the screening questions, you will not be permitted to enter Perpich Center buildings.
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Visitor Name: *
Visitor Phone Number:     ###-###-#### *
Visitor Email: *
Family/Visitor Company/Organization: *
Name of Perpich Host (who are you here to see?): *
The first question asks about whether you’ve recently had COVID-19 symptoms.  These symptoms may appear 2-14 days after you are exposed to the virus that causes COVID-19.  Symptoms include: Fever of 100.4 degrees Fahrenheit or above or possible fever-like symptoms such as alternating chills and sweating. Frequent cough (not a chronic cough or your normal seasonal allergies). Trouble breathing, shortness of breath, or severe wheezing. Muscle or body aches that are not exercise related. Sore throat. New loss of smell or taste. Headache. Congestion or runny nose. Nausea or vomiting. Diarrhea. -------  Have you had any of the above symptoms within the past 48 hours? *
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