{"id":7090,"date":"2021-12-02T10:15:24","date_gmt":"2021-12-02T18:15:24","guid":{"rendered":"https:\/\/immigrantservices.ca\/?page_id=7090"},"modified":"2024-03-05T12:30:44","modified_gmt":"2024-03-05T20:30:44","slug":"childmindregistration-form","status":"publish","type":"page","link":"https:\/\/immigrantservices.ca\/vi\/childmindregistration-form\/","title":{"rendered":"Childminding Registration form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"7090\" class=\"elementor elementor-7090\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6895c523 e-flex e-con-boxed e-con e-parent\" data-id=\"6895c523\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6ac5eb84 elementor-widget elementor-widget-heading\" data-id=\"6ac5eb84\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Childminding Registration form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-471e50d7 e-con-full e-flex e-con e-parent\" data-id=\"471e50d7\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-52e9b3cd elementor-icon-list--layout-inline elementor-align-center elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"52e9b3cd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items elementor-inline-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item elementor-inline-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/immigrantservices.ca\/vi\">\n\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">CHILDMIND PROGRAM<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item elementor-inline-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-chevron-right\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Childminding Registration form<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-50c87f3b e-flex e-con-boxed e-con e-parent\" data-id=\"50c87f3b\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-22989c5e elementor-widget elementor-widget-jet-headline\" data-id=\"22989c5e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"jet-headline.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"jet-headline jet-headline--direction-horizontal\"><span class=\"jet-headline__part jet-headline__first\"><span class=\"jet-headline__label\">REGISTERATION<\/span><\/span><span class=\"jet-headline__space\">&nbsp;<\/span><span class=\"jet-headline__part jet-headline__second\"><span class=\"jet-headline__label\">FORM<\/span><\/span><\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-114d6434 elementor-widget elementor-widget-formidable\" data-id=\"114d6434\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"formidable.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<link rel='stylesheet' id='formidable-css' href='https:\/\/immigrantservices.ca\/wp-content\/plugins\/formidable\/css\/formidableforms.css?ver=9102249' media='all' \/>\n<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_41_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_pro_form  frm_logic_form \" id=\"form_dropinformchildmind\" >\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Childminding Program<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"41\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_41\" id=\"frm_hide_fields_41\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"dropinformchildmind\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_41\" name=\"frm_submit_entry_41\" value=\"ef18846751\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/vi\/wp-json\/wp\/v2\/pages\/7090\" \/><div id=\"frm_field_689_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first frm_two_col\">\r\n    <div  id=\"field_58gau_label\" class=\"frm_primary_label\">Immigration Status ( Choose One)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_58gau_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_689-0\">\t\t\t<label  for=\"field_58gau-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[689][]\" id=\"field_58gau-0\" value=\"Visitor Visa\"  data-frmlimit=\"1\"  data-invmsg=\"Immigration Status ( Choose One) is invalid\"   \/> Visitor Visa<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_689-1\">\t\t\t<label  for=\"field_58gau-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[689][]\" id=\"field_58gau-1\" value=\"Student\"  data-frmlimit=\"1\"  data-invmsg=\"Immigration Status ( Choose One) is invalid\"   \/> Student<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_689-2\">\t\t\t<label  for=\"field_58gau-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[689][]\" id=\"field_58gau-2\" value=\"Work Permit\"  data-frmlimit=\"1\"  data-invmsg=\"Immigration Status ( Choose One) is invalid\"   \/> Work Permit<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_689-3\">\t\t\t<label  for=\"field_58gau-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[689][]\" id=\"field_58gau-3\" value=\"Permanent Resident\"  data-frmlimit=\"1\"  data-invmsg=\"Immigration Status ( Choose One) is invalid\"   \/> Permanent Resident<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_689-4\">\t\t\t<label  for=\"field_58gau-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[689][]\" id=\"field_58gau-4\" value=\"Canadian Citizen\"  data-frmlimit=\"1\"  data-invmsg=\"Immigration Status ( Choose One) is invalid\"   \/> Canadian Citizen<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_689-5\">\t\t\t<label  for=\"field_58gau-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[689][]\" id=\"field_58gau-5\" value=\"Other\"  data-frmlimit=\"1\"  data-invmsg=\"Immigration Status ( Choose One) is invalid\"   \/> Other<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_699_container\" class=\"frm_form_field frm_section_heading form-field  frm12 frm_first\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Enter the Permanent Resident Number<\/h3>\r\n\r\n\r\n<div id=\"frm_field_704_container\" class=\"frm_form_field form-field  frm_top_container frm4 frm_first\">\r\n    <label for=\"field_k5d4z\" id=\"field_k5d4z_label\" class=\"frm_primary_label\">Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_k5d4z\" name=\"item_meta[704]\" value=\"\"  data-sectionid=\"699\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_705_container\" class=\"frm_form_field form-field  frm_top_container frm4 horizontal_radio\">\r\n    <div  id=\"field_aqll_label\" class=\"frm_primary_label\">Relationship (Choose one)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_aqll_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_705-699-0\">\t\t\t<label  for=\"field_aqll-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[705][]\" id=\"field_aqll-0\" value=\"Father\"  data-sectionid=\"699\"  data-frmlimit=\"1\"  data-invmsg=\"Relationship (Choose one) is invalid\"   \/> Father<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_705-699-1\">\t\t\t<label  for=\"field_aqll-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[705][]\" id=\"field_aqll-1\" value=\"Mother\"  data-sectionid=\"699\"  data-frmlimit=\"1\"  data-invmsg=\"Relationship (Choose one) is invalid\"   \/> Mother<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_705-699-2\">\t\t\t<label  for=\"field_aqll-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[705][]\" id=\"field_aqll-2\" value=\"Child\"  data-sectionid=\"699\"  data-frmlimit=\"1\"  data-invmsg=\"Relationship (Choose one) is invalid\"   \/> Child<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_693_container\" class=\"frm_form_field form-field  frm_top_container frm4\">\r\n    <label for=\"field_5n5di\" id=\"field_5n5di_label\" class=\"frm_primary_label\">Permanent Resident Number\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_5n5di\" name=\"item_meta[693]\" value=\"\"  data-sectionid=\"699\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<\/div>\n<div id=\"frm_field_605_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first frm_two_col\">\r\n    <div  id=\"field_u77rb_label\" class=\"frm_primary_label\">Care Needed For (Choose One)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_u77rb_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_605-0\">\t\t\t<label  for=\"field_u77rb-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[605][]\" id=\"field_u77rb-0\" value=\"LINC\"  data-invmsg=\"Care Needed For (Choose One) is invalid\"   \/> LINC<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_605-1\">\t\t\t<label  for=\"field_u77rb-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[605][]\" id=\"field_u77rb-1\" value=\"Drop-In CLBPA (Language Assessment)\"  data-invmsg=\"Care Needed For (Choose One) is invalid\"   \/> Drop-In CLBPA (Language Assessment)<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_605-2\">\t\t\t<label  for=\"field_u77rb-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[605][]\" id=\"field_u77rb-2\" value=\"Drop-In Settlement\"  data-invmsg=\"Care Needed For (Choose One) is invalid\"   \/> Drop-In Settlement<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_605-3\">\t\t\t<label  for=\"field_u77rb-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[605][]\" id=\"field_u77rb-3\" value=\"Drop-In Digital Literacy (Computer Classes)\"  data-invmsg=\"Care Needed For (Choose One) is invalid\"   \/> Drop-In Digital Literacy (Computer Classes)<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_605-4\">\t\t\t<label  for=\"field_u77rb-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[605][]\" id=\"field_u77rb-4\" value=\"Drop-In WE( Women Empowerment)\"  data-invmsg=\"Care Needed For (Choose One) is invalid\"   \/> Drop-In WE( Women Empowerment)<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_605-5\">\t\t\t<label  for=\"field_u77rb-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[605][]\" id=\"field_u77rb-5\" value=\"Zoom Activity\"  data-invmsg=\"Care Needed For (Choose One) is invalid\"   \/> Zoom Activity<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_605-7\">\t\t\t<label  for=\"field_u77rb-7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[605][]\" id=\"field_u77rb-7\" value=\"Drop-In Workshop\"  data-invmsg=\"Care Needed For (Choose One) is invalid\"   \/> Drop-In Workshop<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_605-6\">\t\t\t<label  for=\"field_u77rb-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[605][]\" id=\"field_u77rb-6\" value=\"Comfort Play Teach\"  data-invmsg=\"Care Needed For (Choose One) is invalid\"   \/> Comfort Play Teach<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_605-8\">\t\t\t<label  for=\"field_u77rb-8\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[605][]\" id=\"field_u77rb-8\" value=\"Park Pop Up\"  data-invmsg=\"Care Needed For (Choose One) is invalid\"   \/> Park Pop Up<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_605-9\">\t\t\t<label  for=\"field_u77rb-9\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[605][]\" id=\"field_u77rb-9\" value=\"Christmas Tea Party\"  data-invmsg=\"Care Needed For (Choose One) is invalid\"   \/> Christmas Tea Party<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_605-10\">\t\t\t<label  for=\"field_u77rb-10\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[605][]\" id=\"field_u77rb-10\" value=\"Drop-In Employment\"  data-invmsg=\"Care Needed For (Choose One) is invalid\"   \/> Drop-In Employment<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_651_container\" class=\"frm_form_field  frm_html_container form-field\">This form is intended to travel with a child in the event KIS staff must leave the facility with a child.<\/p>\n<p>In the event of an emergency, KIS staff will keep this information and consent forms to access emergency medical treatment based upon the first aid and emergency information provided<\/p><\/div>\n<div id=\"frm_field_635_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n    <div  id=\"field_9atbe_label\" class=\"frm_primary_label\">Child's Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <fieldset aria-labelledby=\"field_9atbe_label\">\n\t<legend class=\"frm_screen_reader frm_hidden\">\n\t\tChild&#039;s Name\t<\/legend>\n\n\t<div  class=\"frm_combo_inputs_container\" id=\"frm_combo_inputs_container_635\" data-name-layout=\"first_last\">\n\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_635-first_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-first  frm6\"\n\t\t\t\tdata-sub-field-name=\"first\"\n\t\t\t>\n\t\t\t\t<label for=\"field_9atbe_first\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tFirst\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_9atbe_first\" value=\"\" name=\"item_meta[635][first]\" autocomplete=\"given-name\" data-reqmsg=\"Child&#039;s Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Child&#039;s Name is invalid\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_635_first_desc\">First<\/div>\t\t\t<\/div>\n\t\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_635-last_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-last  frm6\"\n\t\t\t\tdata-sub-field-name=\"last\"\n\t\t\t>\n\t\t\t\t<label for=\"field_9atbe_last\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tLast\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_9atbe_last\" value=\"\" name=\"item_meta[635][last]\" autocomplete=\"family-name\" data-reqmsg=\"Child&#039;s Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Child&#039;s Name is invalid\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_635_last_desc\">Last<\/div>\t\t\t<\/div>\n\t\t\t\t<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_638_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_9wlsj\" id=\"field_9wlsj_label\" class=\"frm_primary_label\">Child photo \r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"hidden\"  data-invmsg=\"File Upload is invalid\" aria-invalid=\"false\"   name=\"item_meta[638]\"  value=\"\" data-frmfile=\"638\" \/>\n\n<div class=\"frm_dropzone frm_single_upload frm_clearfix\" id=\"file638_dropzone\" role=\"group\" >\n\t<div class=\"fallback\">\n\t\t<input type=\"file\" name=\"file638\" id=\"field_9wlsj\"\n\t\t\t data-invmsg=\"File Upload is invalid\" aria-invalid=\"false\"  \t\t\t\/>\n\t\t\t\t<div class=\"frm_clearfix \"><\/div>\n\t<\/div>\n\t<div class=\"dz-message needsclick\">\n\t\t\t\t<svg  viewBox=\"0 0 18 18\" class=\"frmsvg frm-svg-icon\">\n\t<path viewBox=\"0 0 18 18\" fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M8.2 4v8a.8.8 0 001.5 0V4l2.1 2.2A.7.7 0 1013 5L9.5 1.7a.7.7 0 00-1.1 0L5.1 5.2a.8.8 0 001 1l2.1-2zm7.6 4.3c.4 0 .7.3.7.7v6.8c0 .4-.3.7-.8.7H2.3a.8.8 0 01-.8-.8V9A.8.8 0 013 9v6h12V9c0-.4.3-.8.8-.8z\"><\/path>\n<\/svg>\t\t<span class=\"frm_upload_text\"><button type=\"button\" aria-label=\"Child photo . Click to upload. Maximum file size: 67.11MB\">Click to upload<\/button><\/span>\n\t\t<span class=\"frm_compact_text\"><button type=\"button\" aria-label=\"Child photo . Choose File. Maximum file size: 67.11MB\">Choose File<\/button><\/span>\n\t\t<div class=\"frm_small_text\">\n\t\t\t<p>Maximum file size: 67.11MB<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\t\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_602_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first horizontal_radio\">\r\n    <div  id=\"field_wei1y_label\" class=\"frm_primary_label\">Gender\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_wei1y_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_602-0\">\t\t\t<label  for=\"field_wei1y-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[602][]\" id=\"field_wei1y-0\" value=\"Male\"  data-frmlimit=\"1\"  data-invmsg=\"Gender is invalid\"   \/> Male<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_602-1\">\t\t\t<label  for=\"field_wei1y-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[602][]\" id=\"field_wei1y-1\" value=\"Female\"  data-frmlimit=\"1\"  data-invmsg=\"Gender is invalid\"   \/> Female<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_602-2\">\t\t\t<label  for=\"field_wei1y-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[602][]\" id=\"field_wei1y-2\" value=\"Other\"  data-frmlimit=\"1\"  data-invmsg=\"Gender is invalid\"   \/> Other<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_758_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n    <label for=\"field_u14cz\" id=\"field_u14cz_label\" class=\"frm_primary_label\">Date of Birth\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_u14cz\" name=\"item_meta[758]\" value=\"\"  maxlength=\"10\" placeholder=\"yyyy\/mm\/dd\" data-reqmsg=\"Date of Birth cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_694_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm12 frm_first\">\r\n    <div  id=\"field_ieegk_label\" class=\"frm_primary_label\">Guardian's Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/div>\r\n    <fieldset aria-labelledby=\"field_ieegk_label\">\n\t<legend class=\"frm_screen_reader frm_hidden\">\n\t\tGuardian&#039;s Name\t<\/legend>\n\n\t<div  class=\"frm_combo_inputs_container\" id=\"frm_combo_inputs_container_694\" data-name-layout=\"first_last\">\n\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_694-first_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-first  frm6\"\n\t\t\t\tdata-sub-field-name=\"first\"\n\t\t\t>\n\t\t\t\t<label for=\"field_ieegk_first\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tFirst\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_ieegk_first\" value=\"\" name=\"item_meta[694][first]\" data-reqmsg=\"Guardian&#039;s Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Guardian&#039;s Name is invalid\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_694_first_desc\">First<\/div>\t\t\t<\/div>\n\t\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_694-last_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-last  frm6\"\n\t\t\t\tdata-sub-field-name=\"last\"\n\t\t\t>\n\t\t\t\t<label for=\"field_ieegk_last\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tLast\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_ieegk_last\" value=\"\" name=\"item_meta[694][last]\" data-reqmsg=\"Guardian&#039;s Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Guardian&#039;s Name is invalid\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_694_last_desc\">Last<\/div>\t\t\t<\/div>\n\t\t\t\t<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_613_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n    <label for=\"field_ie1gq\" id=\"field_ie1gq_label\" class=\"frm_primary_label\">Phone\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_ie1gq\" name=\"item_meta[613]\" value=\"\"  maxlength=\"10\" data-reqmsg=\"Phone cannot be blank.\" aria-required=\"true\" data-invmsg=\"Phone is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_614_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_i0r5g\" id=\"field_i0r5g_label\" class=\"frm_primary_label\">Email\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_i0r5g\" name=\"item_meta[614]\" value=\"\"  data-invmsg=\"Email is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_600_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <div  id=\"field_nhcgn_label\" class=\"frm_primary_label\">Address\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <fieldset aria-labelledby=\"field_nhcgn_label\">\n<legend class=\"frm_screen_reader frm_hidden\">\n\tAddress<\/legend>\n<div class=\"frm_combo_inputs_container\">\n<div id=\"frm_field_600-line1_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_nhcgn_line1\" class=\"frm_screen_reader frm_hidden\">\n\t\tAddress\t<\/label>\n\t\t<input type=\"text\" id=\"field_nhcgn_line1\" value=\"\" name=\"item_meta[600][line1]\"  data-invmsg=\"Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-line1\" \/>\n\t<\/div>\n<div id=\"frm_field_600-line2_container\" class=\"frm_form_field form-field \">\n\t<label for=\"field_nhcgn_line2\" class=\"frm_screen_reader frm_hidden\">\n\t\tAddress\t<\/label>\n\t\t<input type=\"text\" id=\"field_nhcgn_line2\" value=\"\" name=\"item_meta[600][line2]\"  data-invmsg=\"Address is invalid\" class=\"frm_optional\" aria-invalid=\"false\"   autocomplete=\"address-line2\" \/>\n\t<\/div>\n<div id=\"frm_field_600-city_container\" class=\"frm_form_field form-field frm_third frm_first\">\n\t<label for=\"field_nhcgn_city\" class=\"frm_screen_reader frm_hidden\">\n\t\tCity\t<\/label>\n\t\t<input type=\"text\" id=\"field_nhcgn_city\" value=\"\" name=\"item_meta[600][city]\"  data-invmsg=\"Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level2\" \/>\n\t<div class=\"frm_description\">City<\/div><\/div>\n<div id=\"frm_field_600-state_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_nhcgn_state\" class=\"frm_screen_reader frm_hidden\">\n\t\tState\/Province\t<\/label>\n\t\t<input type=\"text\" id=\"field_nhcgn_state\" value=\"\" name=\"item_meta[600][state]\"  data-invmsg=\"Address is invalid\" aria-invalid=\"false\"   autocomplete=\"address-level1\" \/>\n\t<div class=\"frm_description\">State\/Province<\/div><\/div>\n<div id=\"frm_field_600-zip_container\" class=\"frm_form_field form-field frm_third\">\n\t<label for=\"field_nhcgn_zip\" class=\"frm_screen_reader frm_hidden\">\n\t\tZip\/Postal\t<\/label>\n\t\t<input type=\"text\" id=\"field_nhcgn_zip\" value=\"\" name=\"item_meta[600][zip]\"  data-invmsg=\"Address is invalid\" aria-invalid=\"false\"   autocomplete=\"postal-code\" \/>\n\t<div class=\"frm_description\">Zip\/Postal<\/div><\/div>\n<\/div>\n<\/fieldset>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_695_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_4uvrs\" id=\"field_4uvrs_label\" class=\"frm_primary_label\">Alternate Contact\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_4uvrs\" name=\"item_meta[695]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_618_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_bp999\" id=\"field_bp999_label\" class=\"frm_primary_label\">Relationship to you\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_bp999\" name=\"item_meta[618]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_611_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_65vsq\" id=\"field_65vsq_label\" class=\"frm_primary_label\">Physician Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_65vsq\" name=\"item_meta[611]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_619_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_wasue\" id=\"field_wasue_label\" class=\"frm_primary_label\">Phone\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_wasue\" name=\"item_meta[619]\" value=\"\"  maxlength=\"10\" data-invmsg=\"Phone is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_620_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_tl3mr\" id=\"field_tl3mr_label\" class=\"frm_primary_label\">Dentist\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_tl3mr\" name=\"item_meta[620]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_621_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_9r2yp\" id=\"field_9r2yp_label\" class=\"frm_primary_label\">Phone\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_9r2yp\" name=\"item_meta[621]\" value=\"\"  maxlength=\"10\" data-invmsg=\"Phone is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_759_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <label for=\"field_re3ge\" id=\"field_re3ge_label\" class=\"frm_primary_label\">Care Card Number\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"number\" id=\"field_re3ge\" name=\"item_meta[759]\" value=\"\" data-invmsg=\"Care Card Number is invalid\" aria-invalid=\"false\"   min=\"0\" max=\"9999999999\" step=\"any\" \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_622_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n    <label for=\"field_m6u43\" id=\"field_m6u43_label\" class=\"frm_primary_label\">Is Child fully Immunized\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_m6u43\" name=\"item_meta[622]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_753_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_my6tg\" id=\"field_my6tg_label\" class=\"frm_primary_label\">Last Date of Tetanus Shot\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_my6tg\" name=\"item_meta[753]\" value=\"\"  maxlength=\"10\" placeholder=\"yyyy\/mm\/dd\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_627_container\" class=\"frm_form_field form-field  frm_top_container frm3 frm_first\">\r\n    <label for=\"field_qtf00\" id=\"field_qtf00_label\" class=\"frm_primary_label\">Child's Weight\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_qtf00\" name=\"item_meta[627]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_628_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n    <label for=\"field_ieoqu\" id=\"field_ieoqu_label\" class=\"frm_primary_label\">Child's Height\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_ieoqu\" name=\"item_meta[628]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_629_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n    <label for=\"field_172yg\" id=\"field_172yg_label\" class=\"frm_primary_label\">Eye Color\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_172yg\" name=\"item_meta[629]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_626_container\" class=\"frm_form_field form-field  frm_top_container frm3\">\r\n    <label for=\"field_bge11\" id=\"field_bge11_label\" class=\"frm_primary_label\">Hair Color\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_bge11\" name=\"item_meta[626]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_631_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_z0r25\" id=\"field_z0r25_label\" class=\"frm_primary_label\">Other distinguishing features\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_z0r25\" name=\"item_meta[631]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_625_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <label for=\"field_vo81q\" id=\"field_vo81q_label\" class=\"frm_primary_label\">Alergies: if yes, list all; give symptoms; procedures\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[625]\" id=\"field_vo81q\" rows=\"5\"  data-invmsg=\"Alergies: if yes, list all; give symptoms; procedures is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_754_container\" class=\"frm_form_field form-field  frm_top_container frm12 frm_first\">\r\n    <label for=\"field_is199\" id=\"field_is199_label\" class=\"frm_primary_label\">Start Date\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_is199\" name=\"item_meta[754]\" value=\"\"  maxlength=\"10\" placeholder=\"yyyy\/mm\/dd\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_643_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first frm_two_col\">\r\n    <div  id=\"field_kyzv2_label\" class=\"frm_primary_label\">Days Attending Childmind\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_kyzv2_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_643-0\">\t\t\t<label  for=\"field_kyzv2-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[643][]\" id=\"field_kyzv2-0\" value=\"Monday\"  data-frmlimit=\"5\"  data-invmsg=\"Days Attending Childmind is invalid\"   \/> Monday<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_643-1\">\t\t\t<label  for=\"field_kyzv2-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[643][]\" id=\"field_kyzv2-1\" value=\"Tuesday\"  data-frmlimit=\"5\"  data-invmsg=\"Days Attending Childmind is invalid\"   \/> Tuesday<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_643-2\">\t\t\t<label  for=\"field_kyzv2-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[643][]\" id=\"field_kyzv2-2\" value=\"Wednesday\"  data-frmlimit=\"5\"  data-invmsg=\"Days Attending Childmind is invalid\"   \/> Wednesday<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_643-3\">\t\t\t<label  for=\"field_kyzv2-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[643][]\" id=\"field_kyzv2-3\" value=\"Thursday\"  data-frmlimit=\"5\"  data-invmsg=\"Days Attending Childmind is invalid\"   \/> Thursday<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_643-4\">\t\t\t<label  for=\"field_kyzv2-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[643][]\" id=\"field_kyzv2-4\" value=\"Friday\"  data-frmlimit=\"5\"  data-invmsg=\"Days Attending Childmind is invalid\"   \/> Friday<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_646_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_6ulqd\" id=\"field_6ulqd_label\" class=\"frm_primary_label\">Time\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_6ulqd\" name=\"item_meta[646]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_647_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_ivo0z\" id=\"field_ivo0z_label\" class=\"frm_primary_label\">Person Authorised to pick up your Child\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_ivo0z\" name=\"item_meta[647]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_648_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_rmh5o\" id=\"field_rmh5o_label\" class=\"frm_primary_label\">Person Not Authorised to pick up your child (A copy of legal custody orders are required in order to detain pickup by the parent)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input  type=\"text\" id=\"field_rmh5o\" name=\"item_meta[648]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"   \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_650_container\" class=\"frm_form_field  frm_html_container form-field\">The Kamloops Immigrant Services (KIS) Childminding Program policy is to notify a parent or guardian in the event a child is ill or needs medical attention. In such case, if we cannot reach you immediately and the child needs immediate medical help, we will take the child to the nearest emergency centre. We will take this consent form to the emergency centre. It serves as your consent to have your child treated by emergency services.<br \/>\nI authorize the staff at the KIS to call a physician, take my child to the nearest emergency centre or summon an ambulance for emergency medical aid should they feel this is required and I cannot be contacted. If such an emergency should arise, I shall be notified as immediately as possible.<\/p>\n<p>I, ................................................................understand that in order to use the Childminding Services at KIS while I am attending LINC, settlement services and\/or workshops, I must not leave the premises without my child for ANY reason. 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autocomplete=\"off\" value=\"\"  style=\"width:400px\" maxlength=\"150\" class=\"auto_width\" aria-invalid=\"false\"   \/>\n\t\t<\/div>\n\n\t\t<canvas class=\"pad\" data-fieldid=\"603\" data-fieldname=\"item_meta[603]\" width=\"396\" height=\"150\"><\/canvas>\n\t\t<div class=\"clearButton\"><a href=\"#clear\">Clear<\/a><\/div>\n\n\t\t<input type=\"hidden\" name=\"item_meta[603][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_757_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n    <label for=\"field_aeok9\" id=\"field_aeok9_label\" class=\"frm_primary_label\">Date\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_aeok9\" name=\"item_meta[757]\" value=\"\"  maxlength=\"10\" placeholder=\"yyyy\/mm\/dd\" data-invmsg=\"Date is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_978_container\" class=\"frm_form_field form-field  frm_none_container frm12 frm_first\"><div  id=\"field_ts8d3\" class=\"frm-g-recaptcha\" data-sitekey=\"6Lcz1pApAAAAAKDT0hdcUztSLkXkl3KyjqPEG9kZ\" data-size=\"invisible\" data-theme=\"light\"><\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_1227_container\" class=\"frm_form_field form-field \">\n\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Submit<\/button>\r\n\r\n<\/div>\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_1239_container\">\n\t\t\t<label for=\"field_ivvi8\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_ivvi8\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[1239]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" 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[&hellip;]<\/p>\n","protected":false},"author":25,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_mo_disable_npp":"","_price":"","_stock":"","_tribe_ticket_header":"","_tribe_default_ticket_provider":"","_tribe_ticket_capacity":"0","_ticket_start_date":"","_ticket_end_date":"","_tribe_ticket_show_description":"","_tribe_ticket_show_not_going":false,"_tribe_ticket_use_global_stock":"","_tribe_ticket_global_stock_level":"","_global_stock_mode":"","_global_stock_cap":"","_tribe_rsvp_for_event":"","_tribe_ticket_going_count":"","_tribe_ticket_not_going_count":"","_tribe_tickets_list":"[]","_tribe_ticket_has_attendee_info_fields":false,"footnotes":"","_tec_slr_enabled":"","_tec_slr_layout":"","_wp_rev_ctl_limit":""},"class_list":["post-7090","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ 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