{"id":1377814,"date":"2025-04-15T18:24:07","date_gmt":"2025-04-15T22:24:07","guid":{"rendered":"https:\/\/fcsn.org\/?page_id=1377814"},"modified":"2025-08-13T09:27:29","modified_gmt":"2025-08-13T13:27:29","slug":"c2c-match","status":"publish","type":"page","link":"https:\/\/fcsn.org\/zh\/c2c-match\/","title":{"rendered":"Caregiver to Caregiver Match"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; use_background_color_gradient=&#8221;on&#8221; background_color_gradient_stops=&#8221;rgba(255,255,255,0.04) 0%|rgba(255,255,255,0.04) 99%&#8221; background_color_gradient_overlays_image=&#8221;on&#8221; background_image=&#8221;https:\/\/fcsn.org\/wp-content\/uploads\/2025\/04\/C2C-Website-Banner.png&#8221; min_height=&#8221;360px&#8221; custom_padding=&#8221;100px||100px||true|false&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.27.0&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#39B9BE&#8221; custom_padding=&#8221;4px||0px|||&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.27.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.27.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.0&#8243; _module_preset=&#8221;default&#8221; header_text_align=&#8221;center&#8221; header_3_text_color=&#8221;#000000&#8243; custom_padding=&#8221;||0px|||&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h1 class=\"h1-subpage\">Caregiver to Caregiver Respite Network<\/h1>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; module_class=&#8221;fcsn-page-text&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#FFFFFF&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row column_structure=&#8221;3_4,1_4&#8243; _builder_version=&#8221;4.27.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;3_4&#8243; _builder_version=&#8221;4.27.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; header_text_align=&#8221;center&#8221; header_2_text_align=&#8221;center&#8221; header_3_text_color=&#8221;#000000&#8243; custom_padding=&#8221;||0px|||&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2 class=\"fcsn-h2\" style=\"text-align: left;\">Request a Respite Care Match<\/h2>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; text_text_color=&#8221;#000000&#8243; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p><strong>Fill out the form below to get started. If you have any questions, you can also email us at <a href=\"mailto:c2cRespite@fcsn.org\">c2cRespite@fcsn.org<\/a>.<\/strong><\/p>\n<p>To change the language of this website and form, click on the language widget above.<\/p>\n<ul>\n<li>Para cambiar el idioma de este sitio web y el formulario, haga clic en el widget de idioma de arriba.<\/li>\n<li>Para alterar o idioma deste site e formul\u00e1rio, clique no widget do idioma acima.<\/li>\n<li>\u8981\u66f4\u6539\u672c\u7f51\u7ad9\u548c\u8868\u5355\u7684\u8bed\u8a00\uff0c\u8bf7\u5355\u51fb\u4e0a\u9762\u7684\u8bed\u8a00\u5c0f\u90e8\u4ef6\u3002<\/li>\n<li>Pou chanje lang nan sit ent\u00e8n\u00e8t sa a ak f\u00f2m nan, klike sou bouton lang ki anwo a.<\/li>\n<li>\u0110\u1ec3 thay \u0111\u1ed5i ng\u00f4n ng\u1eef c\u1ee7a trang m\u1ea1ng v\u00e0 bi\u1ec3u m\u1eabu n\u00e0y, h\u00e3y b\u1ea5m v\u00e0o ti\u1ec7n \u00edch ng\u00f4n ng\u1eef ph\u00eda tr\u00ean.<\/li>\n<\/ul>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_4&#8243; 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   <h2 class=\"gform_title\">C2C Respite Match Request Form<\/h2>\n                            <p class='gform_description'>The Federation for Children with Special Needs is funded by grants which require us to collect data. Our registration is confidential and used to ensure we are supporting all communities. We do not share personal information nor do we sell to third parties.<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_2'  action='\/zh\/wp-json\/wp\/v2\/pages\/1377814#gf_2' data-formid='2' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LdJN-osAAAAAGaA3QLEIzmlcFHE8ixEcZ6Q6M7Y' data-tabindex='0'><input id=\"input_82373f5ac5e09977bfd4a6856a47209b\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_82373f5ac5e09977bfd4a6856a47209b\" value=\"\"\/><\/div>\n        <div id='gf_progressbar_wrapper_2' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>4<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_25' style='width:25%;'><span>25%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_2_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_1\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_1'>First name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_2_1' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   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class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_113' id='input_2_113' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_2_7\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_7'>Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_2_7' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_8\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_8'>Town\/city in Massachusetts<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_8' id='input_2_8' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Abington' >Abington<\/option><option value='Acton' >Acton<\/option><option value='Acushnet' >Acushnet<\/option><option value='Adams' >Adams<\/option><option value='Agawam' >Agawam<\/option><option value='Alford' >Alford<\/option><option value='Allston' >Allston<\/option><option value='Amesbury' >Amesbury<\/option><option value='Amherst' >Amherst<\/option><option value='Andover' >Andover<\/option><option value='Aquinnah' >Aquinnah<\/option><option value='Arlington' >Arlington<\/option><option value='Ashburnham' >Ashburnham<\/option><option value='Ashby' >Ashby<\/option><option value='Ashfield' >Ashfield<\/option><option value='Ashland' >Ashland<\/option><option value='Athol' >Athol<\/option><option value='Attleboro' >Attleboro<\/option><option value='Auburn' >Auburn<\/option><option value='Avon' >Avon<\/option><option value='Ayer' >Ayer<\/option><option value='Back Bay' >Back Bay<\/option><option value='Baldwinville' >Baldwinville<\/option><option value='Barnstable' >Barnstable<\/option><option value='Barre' >Barre<\/option><option value='Beacon Hill' >Beacon Hill<\/option><option value='Becket' >Becket<\/option><option value='Bedford' >Bedford<\/option><option value='Belchertown' >Belchertown<\/option><option value='Bellingham' >Bellingham<\/option><option value='Belmont' >Belmont<\/option><option value='Berkley' >Berkley<\/option><option value='Berlin' >Berlin<\/option><option value='Bernardston' >Bernardston<\/option><option value='Beverly' >Beverly<\/option><option value='Billerica' >Billerica<\/option><option value='Blackstone' >Blackstone<\/option><option value='Blandford' >Blandford<\/option><option value='Bolton' >Bolton<\/option><option value='Bondsville' >Bondsville<\/option><option value='Boston' >Boston<\/option><option value='Bourne' >Bourne<\/option><option value='Boxborough' >Boxborough<\/option><option value='Boxford' >Boxford<\/option><option value='Boylston' >Boylston<\/option><option value='Bradford' >Bradford<\/option><option value='Braintree' >Braintree<\/option><option value='Brant Rock' >Brant Rock<\/option><option value='Brewster' >Brewster<\/option><option value='Bridgewater' >Bridgewater<\/option><option value='Brighton' >Brighton<\/option><option value='Brimfield' >Brimfield<\/option><option value='Brockton' >Brockton<\/option><option value='Brookfield' >Brookfield<\/option><option value='Brookline' >Brookline<\/option><option value='Buckland' >Buckland<\/option><option value='Burlington' >Burlington<\/option><option value='Buzzards Bay' >Buzzards Bay<\/option><option value='Cambridge' >Cambridge<\/option><option value='Canton' >Canton<\/option><option value='Carlisle' >Carlisle<\/option><option value='Carver' >Carver<\/option><option value='Centerville' >Centerville<\/option><option value='Charlemont' >Charlemont<\/option><option value='Charlestown' >Charlestown<\/option><option value='Charlton' >Charlton<\/option><option value='Chatham' >Chatham<\/option><option value='Chelmsford' >Chelmsford<\/option><option value='Chelsea' >Chelsea<\/option><option value='Cheshire' >Cheshire<\/option><option value='Chester' >Chester<\/option><option value='Chesterfield' >Chesterfield<\/option><option value='Chicopee' >Chicopee<\/option><option value='Chilmark' >Chilmark<\/option><option value='Chinatown' >Chinatown<\/option><option value='Clarksburg' >Clarksburg<\/option><option value='Clinton' >Clinton<\/option><option value='Cohasset' >Cohasset<\/option><option value='Colrain' >Colrain<\/option><option value='Concord' >Concord<\/option><option value='Conway' >Conway<\/option><option value='Cotuit' >Cotuit<\/option><option value='Cummaquid' >Cummaquid<\/option><option value='Cummington' >Cummington<\/option><option value='Dalton' >Dalton<\/option><option value='Danvers' >Danvers<\/option><option value='Dartmouth' >Dartmouth<\/option><option value='Dedham' >Dedham<\/option><option value='Deerfield' >Deerfield<\/option><option value='Dennis' >Dennis<\/option><option value='Dennisport' >Dennisport<\/option><option value='Devens' >Devens<\/option><option value='Dighton' >Dighton<\/option><option value='Dorchester' >Dorchester<\/option><option value='Douglas' >Douglas<\/option><option value='Dover' >Dover<\/option><option value='Dracut' >Dracut<\/option><option value='Dudley' >Dudley<\/option><option value='Dunstable' >Dunstable<\/option><option value='Duxbury' >Duxbury<\/option><option value='East Boston' >East Boston<\/option><option value='East Bridgewater' >East Bridgewater<\/option><option value='East Brookfield' >East Brookfield<\/option><option value='East Longmeadow' >East Longmeadow<\/option><option value='Eastham' >Eastham<\/option><option value='Easthampton' >Easthampton<\/option><option value='Easton' >Easton<\/option><option value='Edgartown' >Edgartown<\/option><option value='Egremont' >Egremont<\/option><option value='Erving' >Erving<\/option><option value='Essex' >Essex<\/option><option value='Everett' >Everett<\/option><option value='Fairhaven' >Fairhaven<\/option><option value='Fall River' >Fall River<\/option><option value='Falmouth' >Falmouth<\/option><option value='Fenway' >Fenway<\/option><option value='Fitchburg' >Fitchburg<\/option><option value='Florida' >Florida<\/option><option value='Forestdale' >Forestdale<\/option><option value='Foxborough' >Foxborough<\/option><option value='Framingham' >Framingham<\/option><option value='Franklin' >Franklin<\/option><option value='Freetown' >Freetown<\/option><option value='Gardner' >Gardner<\/option><option value='Georgetown' >Georgetown<\/option><option value='Gilbertville' >Gilbertville<\/option><option value='Gill' >Gill<\/option><option value='Gloucester' >Gloucester<\/option><option value='Goshen' >Goshen<\/option><option value='Gosnold' >Gosnold<\/option><option value='Grafton' >Grafton<\/option><option value='Granby' >Granby<\/option><option value='Granville' >Granville<\/option><option value='Great Barrington' >Great Barrington<\/option><option value='Green Harbor' >Green Harbor<\/option><option value='Greenfield' >Greenfield<\/option><option value='Groton' >Groton<\/option><option value='Groveland' >Groveland<\/option><option value='Hadley' >Hadley<\/option><option value='Halifax' >Halifax<\/option><option value='Hamilton' >Hamilton<\/option><option value='Hampden' >Hampden<\/option><option value='Hancock' >Hancock<\/option><option value='Hanover' >Hanover<\/option><option value='Hanscom Airforce Base' >Hanscom Airforce Base<\/option><option value='Hanson' >Hanson<\/option><option value='Hardwick' >Hardwick<\/option><option value='Harvard' >Harvard<\/option><option value='Harwich' >Harwich<\/option><option value='Hatfield' >Hatfield<\/option><option value='Haverhill' >Haverhill<\/option><option value='Hawley' >Hawley<\/option><option value='Heath' >Heath<\/option><option value='Hingham' >Hingham<\/option><option value='Hinsdale' >Hinsdale<\/option><option value='Holbrook' >Holbrook<\/option><option value='Holden' >Holden<\/option><option value='Holland' >Holland<\/option><option value='Holliston' >Holliston<\/option><option value='Holyoke' >Holyoke<\/option><option value='Hopedale' >Hopedale<\/option><option value='Hopkinton' >Hopkinton<\/option><option value='Hubbardston' >Hubbardston<\/option><option value='Hudson' >Hudson<\/option><option value='Hull' >Hull<\/option><option value='Huntington' >Huntington<\/option><option value='Hyannis' >Hyannis<\/option><option value='Hyannisport' >Hyannisport<\/option><option value='Hyde Park' >Hyde Park<\/option><option value='Ipswich' >Ipswich<\/option><option value='Jamaica Plain' >Jamaica Plain<\/option><option value='Jefferson' >Jefferson<\/option><option value='Kingston' >Kingston<\/option><option value='Lakeville' >Lakeville<\/option><option value='Lancaster' >Lancaster<\/option><option value='Lanesborough' >Lanesborough<\/option><option value='Lawrence' >Lawrence<\/option><option value='Lee' >Lee<\/option><option value='Leicester' >Leicester<\/option><option value='Lenox' >Lenox<\/option><option value='Leominster' >Leominster<\/option><option value='Leverett' >Leverett<\/option><option value='Lexington' >Lexington<\/option><option value='Leyden' >Leyden<\/option><option value='Lincoln' >Lincoln<\/option><option value='Littleton' >Littleton<\/option><option value='Longmeadow' >Longmeadow<\/option><option value='Lowell' >Lowell<\/option><option value='Ludlow' >Ludlow<\/option><option value='Lunenburg' >Lunenburg<\/option><option value='Lynn' >Lynn<\/option><option value='Lynnfield' >Lynnfield<\/option><option value='Magnolia' >Magnolia<\/option><option value='Malden' >Malden<\/option><option value='Manchester by the Sea' >Manchester by the Sea<\/option><option value='Mansfield' >Mansfield<\/option><option value='Marblehead' >Marblehead<\/option><option value='Marion' >Marion<\/option><option value='Marlborough' >Marlborough<\/option><option value='Marshfield' >Marshfield<\/option><option value='Martha&#039;s Vineyard' >Martha&#039;s Vineyard<\/option><option value='Mashpee' >Mashpee<\/option><option value='Mattapan' >Mattapan<\/option><option value='Mattapoisett' >Mattapoisett<\/option><option value='Maynard' >Maynard<\/option><option value='Medfield' >Medfield<\/option><option value='Medford' >Medford<\/option><option value='Medway' >Medway<\/option><option value='Melrose' >Melrose<\/option><option value='Mendon' >Mendon<\/option><option value='Merrimac' >Merrimac<\/option><option value='Methuen' >Methuen<\/option><option value='Middleborough' >Middleborough<\/option><option value='Middlefield' >Middlefield<\/option><option value='Middleton' >Middleton<\/option><option value='Milford' >Milford<\/option><option value='Millbury' >Millbury<\/option><option value='Millis' >Millis<\/option><option value='Millville' >Millville<\/option><option value='Milton' >Milton<\/option><option value='Mission Hill' >Mission Hill<\/option><option value='Monroe' >Monroe<\/option><option value='Monson' >Monson<\/option><option value='Montague' >Montague<\/option><option value='Monterey' >Monterey<\/option><option value='Montgomery' >Montgomery<\/option><option value='Mount Washington' >Mount Washington<\/option><option value='Nahant' >Nahant<\/option><option value='Nantucket' >Nantucket<\/option><option value='Natick' >Natick<\/option><option value='Needham' >Needham<\/option><option value='New Ashford' >New Ashford<\/option><option value='New Bedford' >New Bedford<\/option><option value='New Braintree' >New Braintree<\/option><option value='New Marlborough' >New Marlborough<\/option><option value='New Salem' >New Salem<\/option><option value='New Seabury' >New Seabury<\/option><option value='Newbury' >Newbury<\/option><option value='Newburyport' >Newburyport<\/option><option value='Newton' >Newton<\/option><option value='Norfolk' >Norfolk<\/option><option value='North Adams' >North Adams<\/option><option value='North Andover' >North Andover<\/option><option value='North Attleboro' >North Attleboro<\/option><option value='North Brookfield' >North Brookfield<\/option><option value='North End' >North End<\/option><option value='North Reading' >North Reading<\/option><option value='Northampton' >Northampton<\/option><option value='Northborough' >Northborough<\/option><option value='Northbridge' >Northbridge<\/option><option value='Northfield' >Northfield<\/option><option value='Norton' >Norton<\/option><option value='Norwell' >Norwell<\/option><option value='Norwood' >Norwood<\/option><option value='Oak Bluffs' >Oak Bluffs<\/option><option value='Oakham' >Oakham<\/option><option value='Orange' >Orange<\/option><option value='Orleans' >Orleans<\/option><option value='Osterville' >Osterville<\/option><option value='Otis' >Otis<\/option><option value='Otis Air Force Base' >Otis Air Force Base<\/option><option value='Oxford' >Oxford<\/option><option value='Palmer' >Palmer<\/option><option value='Paxton' >Paxton<\/option><option value='Peabody' >Peabody<\/option><option value='Pelham' >Pelham<\/option><option value='Pembroke' >Pembroke<\/option><option value='Pepperell' >Pepperell<\/option><option value='Peru' >Peru<\/option><option value='Petersham' >Petersham<\/option><option value='Phillipston' >Phillipston<\/option><option value='Pittsfield' >Pittsfield<\/option><option value='Plainfield' >Plainfield<\/option><option value='Plainville' >Plainville<\/option><option value='Plymouth' >Plymouth<\/option><option value='Plympton' >Plympton<\/option><option value='Princeton' >Princeton<\/option><option value='Provincetown' >Provincetown<\/option><option value='Quincy' >Quincy<\/option><option value='Randolph' >Randolph<\/option><option value='Raynham' >Raynham<\/option><option value='Reading' >Reading<\/option><option value='Readville' >Readville<\/option><option value='Rehoboth' >Rehoboth<\/option><option value='Revere' >Revere<\/option><option value='Richmond' >Richmond<\/option><option value='Rochester' >Rochester<\/option><option value='Rockland' >Rockland<\/option><option value='Rockport' >Rockport<\/option><option value='Roslindale' >Roslindale<\/option><option value='Rowe' >Rowe<\/option><option value='Rowley' >Rowley<\/option><option value='Roxbury' >Roxbury<\/option><option value='Royalston' >Royalston<\/option><option value='Russell' >Russell<\/option><option value='Rutland' >Rutland<\/option><option value='Sagamore' >Sagamore<\/option><option value='Salem' >Salem<\/option><option value='Salisbury' >Salisbury<\/option><option value='Sandisfield' >Sandisfield<\/option><option value='Sandwich' >Sandwich<\/option><option value='Saugus' >Saugus<\/option><option value='Savoy' >Savoy<\/option><option value='Scituate' >Scituate<\/option><option value='Seekonk' >Seekonk<\/option><option value='Sharon' >Sharon<\/option><option value='Sheffield' >Sheffield<\/option><option value='Shelburne' >Shelburne<\/option><option value='Sherborn' >Sherborn<\/option><option value='Shirley' >Shirley<\/option><option value='Shrewsbury' >Shrewsbury<\/option><option value='Shutesbury' >Shutesbury<\/option><option value='Somerset' >Somerset<\/option><option value='Somerville' >Somerville<\/option><option value='South Boston' >South Boston<\/option><option value='South Chatham' >South Chatham<\/option><option value='South Dennis' >South Dennis<\/option><option value='South End' >South End<\/option><option value='South Hadley' >South Hadley<\/option><option value='Southampton' >Southampton<\/option><option value='Southborough' >Southborough<\/option><option value='Southbridge' >Southbridge<\/option><option value='Southwick' >Southwick<\/option><option value='Spencer' >Spencer<\/option><option value='Springfield' >Springfield<\/option><option value='Sterling' >Sterling<\/option><option value='Stockbridge' >Stockbridge<\/option><option value='Stoneham' >Stoneham<\/option><option value='Stoughton' >Stoughton<\/option><option value='Stow' >Stow<\/option><option value='Sturbridge' >Sturbridge<\/option><option value='Sudbury' >Sudbury<\/option><option value='Sunderland' >Sunderland<\/option><option value='Sutton' >Sutton<\/option><option value='Swampscott' >Swampscott<\/option><option value='Swansea' >Swansea<\/option><option value='Taunton' >Taunton<\/option><option value='Templeton' >Templeton<\/option><option value='Tewksbury' >Tewksbury<\/option><option value='Thorndike' >Thorndike<\/option><option value='Three Rivers' >Three Rivers<\/option><option value='Tisbury' >Tisbury<\/option><option value='Tolland' >Tolland<\/option><option value='Topsfield' >Topsfield<\/option><option value='Townsend' >Townsend<\/option><option value='Truro' >Truro<\/option><option value='Tyngsborough' >Tyngsborough<\/option><option value='Tyringham' >Tyringham<\/option><option value='Upton' >Upton<\/option><option value='Uxbridge' >Uxbridge<\/option><option value='Vineyard Haven' >Vineyard Haven<\/option><option value='Wakefield' >Wakefield<\/option><option value='Wales' >Wales<\/option><option value='Walpole' >Walpole<\/option><option value='Waltham' >Waltham<\/option><option value='Ware' >Ware<\/option><option value='Wareham' >Wareham<\/option><option value='Warren' >Warren<\/option><option value='Warwick' >Warwick<\/option><option value='Washington' >Washington<\/option><option value='Watertown' >Watertown<\/option><option value='Wayland' >Wayland<\/option><option value='Webster' >Webster<\/option><option value='Wellesley' >Wellesley<\/option><option value='Wellfleet' >Wellfleet<\/option><option value='Wendell' >Wendell<\/option><option value='Wenham' >Wenham<\/option><option value='West Boylston' >West Boylston<\/option><option value='West Bridgewater' >West Bridgewater<\/option><option value='West Brookfield' >West Brookfield<\/option><option value='West End' >West End<\/option><option value='West Newbury' >West Newbury<\/option><option value='West Roxbury' >West Roxbury<\/option><option value='West Springfield' >West Springfield<\/option><option value='West Stockbridge' >West Stockbridge<\/option><option value='West Tisbury' >West Tisbury<\/option><option value='West Yarmouth' >West Yarmouth<\/option><option value='Westborough' >Westborough<\/option><option value='Westfield' >Westfield<\/option><option value='Westford' >Westford<\/option><option value='Westhampton' >Westhampton<\/option><option value='Westminster' >Westminster<\/option><option value='Weston' >Weston<\/option><option value='Westport' >Westport<\/option><option value='Westwood' >Westwood<\/option><option value='Weymouth' >Weymouth<\/option><option value='Whately' >Whately<\/option><option value='Whitman' >Whitman<\/option><option value='Wilbraham' >Wilbraham<\/option><option value='Williamsburg' >Williamsburg<\/option><option value='Williamstown' >Williamstown<\/option><option value='Wilmington' >Wilmington<\/option><option value='Winchendon' >Winchendon<\/option><option value='Winchester' >Winchester<\/option><option value='Windsor' >Windsor<\/option><option value='Winthrop' >Winthrop<\/option><option value='Woburn' >Woburn<\/option><option value='Woods Hole' >Woods Hole<\/option><option value='Worcester' >Worcester<\/option><option value='Worthington' >Worthington<\/option><option value='Wrentham' >Wrentham<\/option><option value='Yarmouth' >Yarmouth<\/option><option value='Yarmouthport' >Yarmouthport<\/option><option value='Other City in MA' >Other City in MA<\/option><option value='Other City out of state' >Other City out of state<\/option><option value='Unknown' >Unknown<\/option><option value='' ><\/option><\/select><\/div><\/div><div id=\"field_2_9\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_9'>Zip code<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_2_9' type='text' value='' class='medium' maxlength='5'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_15\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_15'>Your preferred pronouns<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_15' id='input_2_15' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected'><\/option><option value='he\/him\/his' >he\/him\/his<\/option><option value='she\/her\/hers' >she\/her\/hers<\/option><option value='they\/them\/theirs' >they\/them\/theirs<\/option><\/select><\/div><\/div><div id=\"field_2_86\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_86'>Best phone number to reach you<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_86' id='input_2_86' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Cell Phone' >Cell Phone<\/option><option value='Home Phone' >Home Phone<\/option><option value='Work Phone' >Work Phone<\/option><\/select><\/div><\/div><div id=\"field_2_87\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_87'>Cell Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_87' id='input_2_87' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_88\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_88'>Home Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_88' id='input_2_88' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_89\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_89'>Work Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_89' id='input_2_89' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_2_99\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I agree to receive text messages.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_99'>\n\t\t\t<div class='gchoice gchoice_2_99_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_99' type='radio' value='Yes'  id='choice_2_99_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_99_0' id='label_2_99_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_99_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_99' type='radio' value='No'  id='choice_2_99_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_99_1' id='label_2_99_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_129\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_129'>Select your age group<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_129' id='input_2_129' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='18-24' >18-24<\/option><option value='25-34' >25-34<\/option><option value='35-44' >35-44<\/option><option value='45-54' >45-54<\/option><option value='55-64' >55-64<\/option><option value='65 or Above' >65 or Above<\/option><option value='Prefer Not to Answer' >Prefer Not to Answer<\/option><\/select><\/div><\/div><div id=\"field_2_110\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_110'>How did you hear about this program?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_110' id='input_2_110' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Agency' >Agency<\/option><option value='Friend' >Friend<\/option><option value='Flyer' >Flyer<\/option><option value='FCSN Staff' >FCSN Staff<\/option><option value='Website' >Website<\/option><option value='Other' >Other<\/option><option value='College\/university' >College\/university<\/option><\/select><\/div><\/div><div id=\"field_2_111\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_111'>Name of Agency<\/label><div class='ginput_container ginput_container_text'><input name='input_111' id='input_2_111' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_112\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_112'>Other way you heard about the program<\/label><div class='ginput_container ginput_container_text'><input name='input_112' id='input_2_112' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_10\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_10'>Your race<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_10' id='input_2_10' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Caucasian\/White' >Caucasian\/White<\/option><option value='African-American\/Black' >African-American\/Black<\/option><option value='American Indian\/Native American\/Alaskan Native (*Specify)' >American Indian\/Native American\/Alaskan Native (*Specify)<\/option><option value='Asian' >Asian<\/option><option value='Native Hawaiian\/Pacific Islander (*Specify)' >Native Hawaiian\/Pacific Islander (*Specify)<\/option><option value='Two or more races' >Two or more races<\/option><option value='Undisclosed' >Undisclosed<\/option><\/select><\/div><\/div><div id=\"field_2_11\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_11'>Are you Hispanic\/Latino?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_11' id='input_2_11' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Hispanic or Latino' >Hispanic or Latino<\/option><option value='Not Hispanic or Latino' >Not Hispanic or Latino<\/option><option value='Undisclosed' >Undisclosed<\/option><\/select><\/div><\/div><div id=\"field_2_12\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_12'>Your ethnicity<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_12' id='input_2_12' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='African American' >African American<\/option><option value='African\u00a0(*specify country)' >African\u00a0(*specify country)<\/option><option value='Albanian' >Albanian<\/option><option value='American' >American<\/option><option value='Armenian' >Armenian<\/option><option value='Brazilian' >Brazilian<\/option><option value='Cambodian \/ Khmer' >Cambodian \/ Khmer<\/option><option value='Canadian' >Canadian<\/option><option value='Cape Verdean' >Cape Verdean<\/option><option value='Caribbean Islander (*specify island)' >Caribbean Islander (*specify island)<\/option><option value='Chinese' >Chinese<\/option><option value='Colombian' >Colombian<\/option><option value='Cuban' >Cuban<\/option><option value='Dominican' >Dominican<\/option><option value='English' >English<\/option><option value='Filipino' >Filipino<\/option><option value='French' >French<\/option><option value='German' >German<\/option><option value='Greek' >Greek<\/option><option value='Guatemalan' >Guatemalan<\/option><option value='Haitian' >Haitian<\/option><option value='Indian \/Asian Indian' >Indian \/Asian Indian<\/option><option value='Irish' >Irish<\/option><option value='Italian' >Italian<\/option><option value='Japanese' >Japanese<\/option><option value='Korean' >Korean<\/option><option value='Mexican, Mexican American, Chicano' >Mexican, Mexican American, Chicano<\/option><option value='Middle Eastern (*specify country)' >Middle Eastern (*specify country)<\/option><option value='Native American' >Native American<\/option><option value='Polish' >Polish<\/option><option value='Portuguese' >Portuguese<\/option><option value='Puerto Rican' >Puerto Rican<\/option><option value='Russian' >Russian<\/option><option value='Salvadoran' >Salvadoran<\/option><option value='Scottish' >Scottish<\/option><option value='Swedish' >Swedish<\/option><option value='Ukrainian' >Ukrainian<\/option><option value='Vietnamese' >Vietnamese<\/option><option value='Unknown' >Unknown<\/option><option value='Undisclosed' >Undisclosed<\/option><option value='Other or (*specify)' >Other or (*specify)<\/option><\/select><\/div><\/div><div id=\"field_2_119\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_119'>Other Ethnicity<\/label><div class='ginput_container ginput_container_text'><input name='input_119' id='input_2_119' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_13\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_13'>Primary Language<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_13' id='input_2_13' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected'><\/option><option value='American Sign Language' >American Sign Language<\/option><option value='Chinese' >Chinese<\/option><option value='English' >English<\/option><option value='Haitian Creole' >Haitian Creole<\/option><option value='Portuguese' >Portuguese<\/option><option value='Spanish' >Spanish<\/option><option value='Korean' >Korean<\/option><option value='Vietnamese' >Vietnamese<\/option><option value='Other Language' >Other Language<\/option><\/select><\/div><\/div><div id=\"field_2_98\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_98'>Chinese Dialect<\/label><div class='ginput_container ginput_container_select'><select name='input_98' id='input_2_98' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Cantonese' >Cantonese<\/option><option value='Mandarin' >Mandarin<\/option><option value='Other Chinese Dialect' >Other Chinese Dialect<\/option><\/select><\/div><\/div><div id=\"field_2_91\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_91'>Other Primary Language<\/label><div class='ginput_container ginput_container_text'><input name='input_91' id='input_2_91' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_43\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_43'>Household structure<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_43' id='input_2_43' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected'><\/option><option value='Single' >Single<\/option><option value='Married' >Married<\/option><option value='Divorced' >Divorced<\/option><option value='Domestic Partnership' >Domestic Partnership<\/option><option value='Widowed' >Widowed<\/option><option value='Separated' >Separated<\/option><option value='Living with significant other' >Living with significant other<\/option><option value='Living with extended family' >Living with extended family<\/option><\/select><\/div><\/div><div id=\"field_2_92\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_92'>My respite language preference is<\/label><div class='ginput_container ginput_container_select'><select name='input_92' id='input_2_92' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='my primary language' >my primary language<\/option><option value='English only' >English only<\/option><option value='either primary language or English' >either primary language or English<\/option><\/select><\/div><\/div><div id=\"field_2_14\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_14'>Additional languages spoken<\/label><div class='ginput_container ginput_container_select'><select name='input_14' id='input_2_14' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected'><\/option><option value='American Sign Language' >American Sign Language<\/option><option value='Chinese' >Chinese<\/option><option value='English' >English<\/option><option value='Haitian Creole' >Haitian Creole<\/option><option value='Portuguese' >Portuguese<\/option><option value='Spanish' >Spanish<\/option><option value='Vietnamese' >Vietnamese<\/option><option value='Korean' >Korean<\/option><option value='Other Language' >Other Language<\/option><\/select><\/div><\/div><div id=\"field_2_118\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_118'>Other Additional Language spoken<\/label><div class='ginput_container ginput_container_text'><input name='input_118' id='input_2_118' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_19\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_19'>I am looking to<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_19' id='input_2_19' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected'><\/option><option value='I want to receive respite' >I want to receive respite<\/option><option value='I want to provide respite' >I want to provide respite<\/option><option value='I want to receive and provide respite' >I want to receive and provide respite<\/option><\/select><\/div><\/div><fieldset id=\"field_2_133\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you a<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_133'>\n\t\t\t<div class='gchoice gchoice_2_133_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_133' type='radio' value='Parent\/Caregiver'  id='choice_2_133_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_133_0' id='label_2_133_0' class='gform-field-label gform-field-label--type-inline'>Parent\/Caregiver<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_133_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_133' type='radio' value='Student\/Professional'  id='choice_2_133_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_133_1' id='label_2_133_1' class='gform-field-label gform-field-label--type-inline'>Student\/Professional<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_135\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Student\/Professional<\/h3><\/div><fieldset id=\"field_2_137\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_137'>\n\t\t\t<div class='gchoice gchoice_2_137_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_137' type='radio' value='Currently enrolled as a fulltime student'  id='choice_2_137_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_137_0' id='label_2_137_0' class='gform-field-label gform-field-label--type-inline'>Currently enrolled as a fulltime student<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_137_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_137' type='radio' value='Part-time student'  id='choice_2_137_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_137_1' id='label_2_137_1' class='gform-field-label gform-field-label--type-inline'>Part-time student<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_137_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_137' type='radio' value='Student\/Professional'  id='choice_2_137_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_137_2' id='label_2_137_2' class='gform-field-label gform-field-label--type-inline'>Student\/Professional<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_137_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_137' type='radio' value='Professional'  id='choice_2_137_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_137_3' id='label_2_137_3' class='gform-field-label gform-field-label--type-inline'>Professional<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_139\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are you an international student?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_139'>\n\t\t\t<div class='gchoice gchoice_2_139_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_139' type='radio' value='Yes'  id='choice_2_139_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_139_0' id='label_2_139_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_139_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_139' type='radio' value='No'  id='choice_2_139_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_139_1' id='label_2_139_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_140\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >International students are required to have CPT\/OPT card to participate in the respite experience. We will ask you to provide a copy to us after your intake call. If you have any questions, please reach out to the International Programs office at your school.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_140'><div class='gchoice gchoice_2_140_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_140.1' type='checkbox'  value='I consent'  id='choice_2_140_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_140_1' id='label_2_140_1' class='gform-field-label gform-field-label--type-inline'>I consent<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_141\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_141'>What majors\/minors\/certificates are you pursuing?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_141' id='input_2_141' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_143\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_143'>Please describe past experience, if any, working with people with disabilities.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_143' id='input_2_143' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_2_144\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_144'>Please describe past experience, if any, working with people without disabilities (e.g., babysitting, summer camp, nursing home).<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_144' id='input_2_144' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_2_136' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_2' class='gform_page' data-js='page-field-id-136' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_96\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Child\/Youth Information<\/h3><\/div><div id=\"field_2_20\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_20'>Child&#039;s first name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_2_20' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_21\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_21'>Child&#039;s last name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_2_21' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_28\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_28'>Child&#039;s gender<\/label><div class='ginput_container ginput_container_select'><select name='input_28' id='input_2_28' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected'><\/option><option value='Female' >Female<\/option><option value='Male' >Male<\/option><option value='Unspecified' >Unspecified<\/option><\/select><\/div><\/div><div id=\"field_2_120\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_120'>Child&#039;s date of birth (mm\/dd\/yyyy)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_120' id='input_2_120' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_2_120_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_2_120_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_120' class='gform_hidden' value='https:\/\/fcsn.org\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_2_34\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_34'>Child&#039;s Primary Language<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_34' id='input_2_34' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected'><\/option><option value='American Sign Language' >American Sign Language<\/option><option value='Chinese' >Chinese<\/option><option value='English' >English<\/option><option value='Haitian Creole' >Haitian Creole<\/option><option value='Portuguese' >Portuguese<\/option><option value='Spanish' >Spanish<\/option><option value='Vietnamese' >Vietnamese<\/option><option value='Korean' >Korean<\/option><option value='Other Language' >Other Language<\/option><\/select><\/div><\/div><div id=\"field_2_40\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_40'>Your relationship to child<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_40' id='input_2_40' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected'><\/option><option value='Parent' >Parent<\/option><option value='Adoptive parent' >Adoptive parent<\/option><option value='Foster parent' >Foster parent<\/option><option value='Grandparent' >Grandparent<\/option><option value='Sibling' >Sibling<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_2_125\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_125'>Child&#039;s Other Language<\/label><div class='ginput_container ginput_container_text'><input name='input_125' id='input_2_125' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_115\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_115'>Other Relationship<\/label><div class='ginput_container ginput_container_text'><input name='input_115' id='input_2_115' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_30\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_30'>Child&#039;s race<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_30' id='input_2_30' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected'><\/option><option value='Caucasian\/White' >Caucasian\/White<\/option><option value='African-American\/Black' >African-American\/Black<\/option><option value='American Indian\/Native American\/Alaskan Native (*Specify)' >American Indian\/Native American\/Alaskan Native (*Specify)<\/option><option value='Asian' >Asian<\/option><option value='Native Hawaiian\/Pacific Islander (*Specify)' >Native Hawaiian\/Pacific Islander (*Specify)<\/option><option value='Two or more races' >Two or more races<\/option><option value='Undisclosed' >Undisclosed<\/option><\/select><\/div><\/div><div id=\"field_2_31\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_31'>Is your child Hispanic\/Latino?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_31' id='input_2_31' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Hispanic or Latino' >Hispanic or Latino<\/option><option value='Not Hispanic or Latino' >Not Hispanic or Latino<\/option><option value='Undisclosed' >Undisclosed<\/option><\/select><\/div><\/div><div id=\"field_2_32\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_32'>Child&#039;s ethnicity<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_32' id='input_2_32' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='African\u00a0(*specify country)' >African\u00a0(*specify country)<\/option><option value='African American' >African American<\/option><option value='Albanian' >Albanian<\/option><option value='American' >American<\/option><option value='Armenian' >Armenian<\/option><option value='Brazilian' >Brazilian<\/option><option value='Cambodian \/ Khmer' >Cambodian \/ Khmer<\/option><option value='Canadian' >Canadian<\/option><option value='Cape Verdean' >Cape Verdean<\/option><option value='Caribbean Islander (*specify island)' >Caribbean Islander (*specify island)<\/option><option value='Chinese' >Chinese<\/option><option value='Colombian' >Colombian<\/option><option value='Cuban' >Cuban<\/option><option value='Dominican' >Dominican<\/option><option value='English' >English<\/option><option value='Filipino' >Filipino<\/option><option value='French' >French<\/option><option value='German' >German<\/option><option value='Greek' >Greek<\/option><option value='Guatemalan' >Guatemalan<\/option><option value='Haitian' >Haitian<\/option><option value='Indian \/Asian Indian' >Indian \/Asian Indian<\/option><option value='Irish' >Irish<\/option><option value='Italian' >Italian<\/option><option value='Japanese' >Japanese<\/option><option value='Korean' >Korean<\/option><option value='Mexican, Mexican American, Chicano' >Mexican, Mexican American, Chicano<\/option><option value='Middle Eastern (*specify country)' >Middle Eastern (*specify country)<\/option><option value='Native American' >Native American<\/option><option value='Polish' >Polish<\/option><option value='Portuguese' >Portuguese<\/option><option value='Puerto Rican' >Puerto Rican<\/option><option value='Russian' >Russian<\/option><option value='Salvadoran' >Salvadoran<\/option><option value='Scottish' >Scottish<\/option><option value='Swedish' >Swedish<\/option><option value='Ukrainian' >Ukrainian<\/option><option value='Vietnamese' >Vietnamese<\/option><option value='Unknown' >Unknown<\/option><option value='Undisclosed' >Undisclosed<\/option><option value='Other or (*specify)' >Other or (*specify)<\/option><\/select><\/div><\/div><div id=\"field_2_124\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_124'>Child&#039;s Other Ethnicity<\/label><div class='ginput_container ginput_container_text'><input name='input_124' id='input_2_124' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_107\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_107'>Your child&#039;s primary diagnosis<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_107' id='input_2_107' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='ADD' >ADD<\/option><option value='ADHD' >ADHD<\/option><option value='Allergies' >Allergies<\/option><option value='Anxiety' >Anxiety<\/option><option value='Apraxia' >Apraxia<\/option><option value='Asperger&#039;s Syndrome' >Asperger&#039;s Syndrome<\/option><option value='Autism' >Autism<\/option><option value='Behavioral Concerns' >Behavioral Concerns<\/option><option value='Bipolar Disorder' >Bipolar Disorder<\/option><option value='Blind \/ Vision Impairment' >Blind \/ Vision Impairment<\/option><option value='Cancer' >Cancer<\/option><option value='Cardiac Condition' >Cardiac Condition<\/option><option value='Cerebral Palsy' >Cerebral Palsy<\/option><option value='Child Died' >Child Died<\/option><option value='Cleft Lip \/ Palatte' >Cleft Lip \/ Palatte<\/option><option value='Complex Medical Needs' >Complex Medical Needs<\/option><option value='Deaf-Blind' >Deaf-Blind<\/option><option value='Deaf \/ Hearing Impairment' >Deaf \/ Hearing Impairment<\/option><option value='Depression' >Depression<\/option><option value='Developmental Delay' >Developmental Delay<\/option><option value='Down Syndrome' >Down Syndrome<\/option><option value='Dyslexia' >Dyslexia<\/option><option value='Failure to Thirive' >Failure to Thirive<\/option><option value='Feeding \/ GI Issues' >Feeding \/ GI Issues<\/option><option value='Feeding Tube' >Feeding Tube<\/option><option value='Genetic -' >Genetic -<\/option><option value='Gross Motor Delay' >Gross Motor Delay<\/option><option value='Growth Disorder' >Growth Disorder<\/option><option value='Intellectual disability' >Intellectual disability<\/option><option value='Learning Disability' >Learning Disability<\/option><option value='Luekemia' >Luekemia<\/option><option value='Mental Health' >Mental Health<\/option><option value='Metabolic Disorder' >Metabolic Disorder<\/option><option value='Mitochondrial Disease' >Mitochondrial Disease<\/option><option value='Muscular Dystrophy' >Muscular Dystrophy<\/option><option value='Nonverbal Communication' >Nonverbal Communication<\/option><option value='Nonverbal Learning Disability' >Nonverbal Learning Disability<\/option><option value='Other -' >Other -<\/option><option value='PDD' >PDD<\/option><option value='Prematurity' >Prematurity<\/option><option value='PTSD' >PTSD<\/option><option value='Reactive Attachment Disorder' >Reactive Attachment Disorder<\/option><option value='Schizophrenia' >Schizophrenia<\/option><option value='Scoliosis' >Scoliosis<\/option><option value='Seizure Disorder' >Seizure Disorder<\/option><option value='Sensory Integration' >Sensory Integration<\/option><option value='Speech delays' >Speech delays<\/option><option value='Spina Bifida' >Spina Bifida<\/option><option value='Stroke' >Stroke<\/option><option value='Technology Dependent' >Technology Dependent<\/option><option value='Traumatic Brain Injury' >Traumatic Brain Injury<\/option><option value='Undiagnosed or Unknown' >Undiagnosed or Unknown<\/option><option value='Aicardi Syndrome' >Aicardi Syndrome<\/option><option value='AIDS' >AIDS<\/option><option value='Albright Hereditary Osteodystrophy' >Albright Hereditary Osteodystrophy<\/option><option value='Angelman Syndrome' >Angelman Syndrome<\/option><option value='Apert Syndrome' >Apert Syndrome<\/option><option value='Aplastic Anemia' >Aplastic Anemia<\/option><option value='Arthritis' >Arthritis<\/option><option value='Arthrogryposis' >Arthrogryposis<\/option><option value='Asthma' >Asthma<\/option><option value='Auditory Processing Delay' >Auditory Processing Delay<\/option><option value='Beckwith-Wiedemann Syndrome' >Beckwith-Wiedemann Syndrome<\/option><option value='Biliary Atresia' >Biliary Atresia<\/option><option value='Bronchial Pulmonary Dysplasia (BPD)' >Bronchial Pulmonary Dysplasia (BPD)<\/option><option value='Cat Cry Syndrome (Cri-du-Chat)' >Cat Cry Syndrome (Cri-du-Chat)<\/option><option value='CDG Type 1X' >CDG Type 1X<\/option><option value='Charge Syndrome' >Charge Syndrome<\/option><option value='Cortical Vision Impairment (CVI)' >Cortical Vision Impairment (CVI)<\/option><option value='Chromosomal Disorder' >Chromosomal Disorder<\/option><option value='Cystic Fibrosis' >Cystic Fibrosis<\/option><option value='Cytomegalovirus (CMV)' >Cytomegalovirus (CMV)<\/option><option value='Dandy-Walker Syndrome' >Dandy-Walker Syndrome<\/option><option value='Diabetes' >Diabetes<\/option><option value='DiGeorge Syndrome' >DiGeorge Syndrome<\/option><option value='Diplegia' >Diplegia<\/option><option value='Diamond Blackfan Anemia' >Diamond Blackfan Anemia<\/option><option value='Diaphragmatic Hernia' >Diaphragmatic Hernia<\/option><option value='Dravet Syndrome (SMEI)' >Dravet Syndrome (SMEI)<\/option><option value='Dwarfism' >Dwarfism<\/option><option value='Ehlers-Danlos Syndrome' >Ehlers-Danlos Syndrome<\/option><option value='Encephalopathy' >Encephalopathy<\/option><option value='Epstein&#039;s Syndrome' >Epstein&#039;s Syndrome<\/option><option value='Erb&#039;s Palsy (Brachial Plexis Injury)' >Erb&#039;s Palsy (Brachial Plexis Injury)<\/option><option value='Executive Function Disorder' >Executive Function Disorder<\/option><option value='Fetal Alcohol Syndrome (FAS)' >Fetal Alcohol Syndrome (FAS)<\/option><option value='FG Syndrome' >FG Syndrome<\/option><option value='Fine Motor Delay' >Fine Motor Delay<\/option><option value='Fragile X Syndrome' >Fragile X Syndrome<\/option><option value='Hearing Impairment' >Hearing Impairment<\/option><option value='Hirschprungs Disease' >Hirschprungs Disease<\/option><option value='Hydrops-Fetalis' >Hydrops-Fetalis<\/option><option value='Hypogammaglobulinemia' >Hypogammaglobulinemia<\/option><option value='Immune Deficency' >Immune Deficency<\/option><option value='Joubert Syndrome' >Joubert Syndrome<\/option><option value='Kabuki Syndrome' >Kabuki Syndrome<\/option><option value='Klinefelter Syndrome 47XXY' >Klinefelter Syndrome 47XXY<\/option><option value='Limb Difference' >Limb Difference<\/option><option value='Maple Syrup Urine Disease' >Maple Syrup Urine Disease<\/option><option value='Marfan Syndrome' >Marfan Syndrome<\/option><option value='Mobius Syndrome' >Mobius Syndrome<\/option><option value='Mosaic Down Syndrome' >Mosaic Down Syndrome<\/option><option value='Mosaic Turner Syndrome' >Mosaic Turner Syndrome<\/option><option value='Mowat Wilson Syndrome' >Mowat Wilson Syndrome<\/option><option value='Mucopolysaccharidosis' >Mucopolysaccharidosis<\/option><option value='No Diagnosis' >No Diagnosis<\/option><option value='Neurological' >Neurological<\/option><option value='Oppositional Defiant Disorder (ODD)' >Oppositional Defiant Disorder (ODD)<\/option><option value='Orthopedic Condition' >Orthopedic Condition<\/option><option value='Pfeiffer Syndrome' >Pfeiffer Syndrome<\/option><option value='Phenylketonuria (PKU)' >Phenylketonuria (PKU)<\/option><option value='Pierre Robin Syndrome' >Pierre Robin Syndrome<\/option><option value='Prader-Willi Syndrome' >Prader-Willi Syndrome<\/option><option value='Rett Syndrome' >Rett Syndrome<\/option><option value='Ricketts' >Ricketts<\/option><option value='Russell-Silver Syndrome' >Russell-Silver Syndrome<\/option><option value='Selective Mutism' >Selective Mutism<\/option><option value='Sleep Disorder' >Sleep Disorder<\/option><option value='Sickle Cell Disease' >Sickle Cell Disease<\/option><option value='Single Lung and Kidney' >Single Lung and Kidney<\/option><option value='Spinal Muscular Atrophy' >Spinal Muscular Atrophy<\/option><option value='Substance Abuse' >Substance Abuse<\/option><option value='Tay-Sachs Disease' >Tay-Sachs Disease<\/option><option value='Torticollis' >Torticollis<\/option><option value='Transplant' >Transplant<\/option><option value='Trecher Collins Syndrome' >Trecher Collins Syndrome<\/option><option value='Tourette Syndrome' >Tourette Syndrome<\/option><option value='Tuberous Sclerosis' >Tuberous Sclerosis<\/option><option value='Twin-To-Twin Transfer' >Twin-To-Twin Transfer<\/option><option value='Vacterl Syndrome' >Vacterl Syndrome<\/option><option value='Velocardiofacial Syndrome (VCFS) 22q11' >Velocardiofacial Syndrome (VCFS) 22q11<\/option><option value='Vocal Cord Paralysis' >Vocal Cord Paralysis<\/option><option value='Vision Impairment' >Vision Impairment<\/option><option value='Williams Syndrome' >Williams Syndrome<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_2_109\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_109'>Your child&#039;s secondary diagnosis<\/label><div class='ginput_container ginput_container_select'><select name='input_109' id='input_2_109' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='ADD' >ADD<\/option><option value='ADHD' >ADHD<\/option><option value='Allergies' >Allergies<\/option><option value='Anxiety' >Anxiety<\/option><option value='Apraxia' >Apraxia<\/option><option value='Asperger&#039;s Syndrome' >Asperger&#039;s Syndrome<\/option><option value='Autism' >Autism<\/option><option value='Behavioral Concerns' >Behavioral Concerns<\/option><option value='Bipolar Disorder' >Bipolar Disorder<\/option><option value='Blind \/ Vision Impairment' >Blind \/ Vision Impairment<\/option><option value='Cancer' >Cancer<\/option><option value='Cardiac Condition' >Cardiac Condition<\/option><option value='Cerebral Palsy' >Cerebral Palsy<\/option><option value='Child Died' >Child Died<\/option><option value='Cleft Lip \/ Palatte' >Cleft Lip \/ Palatte<\/option><option value='Complex Medical Needs' >Complex Medical Needs<\/option><option value='Deaf-Blind' >Deaf-Blind<\/option><option value='Deaf \/ Hearing Impairment' >Deaf \/ Hearing Impairment<\/option><option value='Depression' >Depression<\/option><option value='Developmental Delay' >Developmental Delay<\/option><option value='Down Syndrome' >Down Syndrome<\/option><option value='Dyslexia' >Dyslexia<\/option><option value='Failure to Thirive' >Failure to Thirive<\/option><option value='Feeding \/ GI Issues' >Feeding \/ GI Issues<\/option><option value='Feeding Tube' >Feeding Tube<\/option><option value='Genetic -' >Genetic -<\/option><option value='Gross Motor Delay' >Gross Motor Delay<\/option><option value='Growth Disorder' >Growth Disorder<\/option><option value='Intellectual disability' >Intellectual disability<\/option><option value='Learning Disability' >Learning Disability<\/option><option value='Luekemia' >Luekemia<\/option><option value='Mental Health' >Mental Health<\/option><option value='Metabolic Disorder' >Metabolic Disorder<\/option><option value='Mitochondrial Disease' >Mitochondrial Disease<\/option><option value='Muscular Dystrophy' >Muscular Dystrophy<\/option><option value='Nonverbal Communication' >Nonverbal Communication<\/option><option value='Nonverbal Learning Disability' >Nonverbal Learning Disability<\/option><option value='Other -' >Other -<\/option><option value='PDD' >PDD<\/option><option value='Prematurity' >Prematurity<\/option><option value='PTSD' >PTSD<\/option><option value='Reactive Attachment Disorder' >Reactive Attachment Disorder<\/option><option value='Schizophrenia' >Schizophrenia<\/option><option value='Scoliosis' >Scoliosis<\/option><option value='Seizure Disorder' >Seizure Disorder<\/option><option value='Sensory Integration' >Sensory Integration<\/option><option value='Speech delays' >Speech delays<\/option><option value='Spina Bifida' >Spina Bifida<\/option><option value='Stroke' >Stroke<\/option><option value='Technology Dependent' >Technology Dependent<\/option><option value='Traumatic Brain Injury' >Traumatic Brain Injury<\/option><option value='Undiagnosed or Unknown' >Undiagnosed or Unknown<\/option><option value='Aicardi Syndrome' >Aicardi Syndrome<\/option><option value='AIDS' >AIDS<\/option><option value='Albright Hereditary Osteodystrophy' >Albright Hereditary Osteodystrophy<\/option><option value='Angelman Syndrome' >Angelman Syndrome<\/option><option value='Apert Syndrome' >Apert Syndrome<\/option><option value='Aplastic Anemia' >Aplastic Anemia<\/option><option value='Arthritis' >Arthritis<\/option><option value='Arthrogryposis' >Arthrogryposis<\/option><option value='Asthma' >Asthma<\/option><option value='Auditory Processing Delay' >Auditory Processing Delay<\/option><option value='Beckwith-Wiedemann Syndrome' >Beckwith-Wiedemann Syndrome<\/option><option value='Biliary Atresia' >Biliary Atresia<\/option><option value='Bronchial Pulmonary Dysplasia (BPD)' >Bronchial Pulmonary Dysplasia (BPD)<\/option><option value='Cat Cry Syndrome (Cri-du-Chat)' >Cat Cry Syndrome (Cri-du-Chat)<\/option><option value='CDG Type 1X' >CDG Type 1X<\/option><option value='Charge Syndrome' >Charge Syndrome<\/option><option value='Cortical Vision Impairment (CVI)' >Cortical Vision Impairment (CVI)<\/option><option value='Chromosomal Disorder' >Chromosomal Disorder<\/option><option value='Cystic Fibrosis' >Cystic Fibrosis<\/option><option value='Cytomegalovirus (CMV)' >Cytomegalovirus (CMV)<\/option><option value='Dandy-Walker Syndrome' >Dandy-Walker Syndrome<\/option><option value='Diabetes' >Diabetes<\/option><option value='DiGeorge Syndrome' >DiGeorge Syndrome<\/option><option value='Diplegia' >Diplegia<\/option><option value='Diamond Blackfan Anemia' >Diamond Blackfan Anemia<\/option><option value='Diaphragmatic Hernia' >Diaphragmatic Hernia<\/option><option value='Dravet Syndrome (SMEI)' >Dravet Syndrome (SMEI)<\/option><option value='Dwarfism' >Dwarfism<\/option><option value='Ehlers-Danlos Syndrome' >Ehlers-Danlos Syndrome<\/option><option value='Encephalopathy' >Encephalopathy<\/option><option value='Epstein&#039;s Syndrome' >Epstein&#039;s Syndrome<\/option><option value='Erb&#039;s Palsy (Brachial Plexis Injury)' >Erb&#039;s Palsy (Brachial Plexis Injury)<\/option><option value='Executive Function Disorder' >Executive Function Disorder<\/option><option value='Fetal Alcohol Syndrome (FAS)' >Fetal Alcohol Syndrome (FAS)<\/option><option value='FG Syndrome' >FG Syndrome<\/option><option value='Fine Motor Delay' >Fine Motor Delay<\/option><option value='Fragile X Syndrome' >Fragile X Syndrome<\/option><option value='Hearing Impairment' >Hearing Impairment<\/option><option value='Hirschprungs Disease' >Hirschprungs Disease<\/option><option value='Hydrops-Fetalis' >Hydrops-Fetalis<\/option><option value='Hypogammaglobulinemia' >Hypogammaglobulinemia<\/option><option value='Immune Deficency' >Immune Deficency<\/option><option value='Joubert Syndrome' >Joubert Syndrome<\/option><option value='Kabuki Syndrome' >Kabuki Syndrome<\/option><option value='Klinefelter Syndrome 47XXY' >Klinefelter Syndrome 47XXY<\/option><option value='Limb Difference' >Limb Difference<\/option><option value='Maple Syrup Urine Disease' >Maple Syrup Urine Disease<\/option><option value='Marfan Syndrome' >Marfan Syndrome<\/option><option value='Mobius Syndrome' >Mobius Syndrome<\/option><option value='Mosaic Down Syndrome' >Mosaic Down Syndrome<\/option><option value='Mosaic Turner Syndrome' >Mosaic Turner Syndrome<\/option><option value='Mowat Wilson Syndrome' >Mowat Wilson Syndrome<\/option><option value='Mucopolysaccharidosis' >Mucopolysaccharidosis<\/option><option value='No Diagnosis' >No Diagnosis<\/option><option value='Neurological' >Neurological<\/option><option value='Oppositional Defiant Disorder (ODD)' >Oppositional Defiant Disorder (ODD)<\/option><option value='Orthopedic Condition' >Orthopedic Condition<\/option><option value='Pfeiffer Syndrome' >Pfeiffer Syndrome<\/option><option value='Phenylketonuria (PKU)' >Phenylketonuria (PKU)<\/option><option value='Pierre Robin Syndrome' >Pierre Robin Syndrome<\/option><option value='Prader-Willi Syndrome' >Prader-Willi Syndrome<\/option><option value='Rett Syndrome' >Rett Syndrome<\/option><option value='Ricketts' >Ricketts<\/option><option value='Russell-Silver Syndrome' >Russell-Silver Syndrome<\/option><option value='Selective Mutism' >Selective Mutism<\/option><option value='Sleep Disorder' >Sleep Disorder<\/option><option value='Sickle Cell Disease' >Sickle Cell Disease<\/option><option value='Single Lung and Kidney' >Single Lung and Kidney<\/option><option value='Spinal Muscular Atrophy' >Spinal Muscular Atrophy<\/option><option value='Substance Abuse' >Substance Abuse<\/option><option value='Tay-Sachs Disease' >Tay-Sachs Disease<\/option><option value='Torticollis' >Torticollis<\/option><option value='Transplant' >Transplant<\/option><option value='Trecher Collins Syndrome' >Trecher Collins Syndrome<\/option><option value='Tourette Syndrome' >Tourette Syndrome<\/option><option value='Tuberous Sclerosis' >Tuberous Sclerosis<\/option><option value='Twin-To-Twin Transfer' >Twin-To-Twin Transfer<\/option><option value='Vacterl Syndrome' >Vacterl Syndrome<\/option><option value='Velocardiofacial Syndrome (VCFS) 22q11' >Velocardiofacial Syndrome (VCFS) 22q11<\/option><option value='Vocal Cord Paralysis' >Vocal Cord Paralysis<\/option><option value='Vision Impairment' >Vision Impairment<\/option><option value='Williams Syndrome' >Williams Syndrome<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_2_36\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_36'>Other diagnoses<\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_2_36' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_2_100\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I am the legal guardian of the child mentioned in this application.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_100'>\n\t\t\t<div class='gchoice gchoice_2_100_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_100' type='radio' value='Yes'  id='choice_2_100_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_100_0' id='label_2_100_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_100_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_100' type='radio' value='No'  id='choice_2_100_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_100_1' id='label_2_100_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_101\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >My child uses assistive technology\/AT device to communicate.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_101'>\n\t\t\t<div class='gchoice gchoice_2_101_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_101' type='radio' value='Yes'  id='choice_2_101_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_101_0' id='label_2_101_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_101_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_101' type='radio' value='No'  id='choice_2_101_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_101_1' id='label_2_101_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_101_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_101' type='radio' value='Unsure'  id='choice_2_101_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_101_2' id='label_2_101_2' class='gform-field-label gform-field-label--type-inline'>Unsure<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_102\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >My child has a service\/emotional support animal.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_102'>\n\t\t\t<div class='gchoice gchoice_2_102_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_102' type='radio' value='Yes'  id='choice_2_102_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_102_0' id='label_2_102_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_102_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_102' type='radio' value='No'  id='choice_2_102_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_102_1' id='label_2_102_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_122' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_122' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_3' class='gform_page' data-js='page-field-id-122' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_45\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Areas of family and personal expertise<\/h3><\/div><div id=\"field_2_78\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_78'>Please briefly describe your caregiving experience.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_78' id='input_2_78' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_2_47\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Birth related experiences<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_47'><div class='gchoice gchoice_2_47_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.1' type='checkbox'  value='Failure to thrive'  id='choice_2_47_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_47_1' id='label_2_47_1' class='gform-field-label gform-field-label--type-inline'>Failure to thrive<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_47_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.2' type='checkbox'  value='Infant death'  id='choice_2_47_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_47_2' id='label_2_47_2' class='gform-field-label gform-field-label--type-inline'>Infant death<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_47_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.3' type='checkbox'  value='NICU'  id='choice_2_47_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_47_3' id='label_2_47_3' class='gform-field-label gform-field-label--type-inline'>NICU<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_47_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.4' type='checkbox'  value='Prematurity'  id='choice_2_47_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_47_4' id='label_2_47_4' class='gform-field-label gform-field-label--type-inline'>Prematurity<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_47_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.5' type='checkbox'  value='Triplets'  id='choice_2_47_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_47_5' id='label_2_47_5' class='gform-field-label gform-field-label--type-inline'>Triplets<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_47_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.6' type='checkbox'  value='Twins'  id='choice_2_47_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_47_6' id='label_2_47_6' class='gform-field-label gform-field-label--type-inline'>Twins<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_47_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.7' type='checkbox'  value='Twin-to-twin transfusion syndrome'  id='choice_2_47_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_47_7' id='label_2_47_7' class='gform-field-label gform-field-label--type-inline'>Twin-to-twin transfusion syndrome<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_47_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.8' type='checkbox'  value='Postpartum depression'  id='choice_2_47_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_47_8' id='label_2_47_8' class='gform-field-label gform-field-label--type-inline'>Postpartum depression<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_47_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.9' type='checkbox'  value='None of the above'  id='choice_2_47_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_47_9' id='label_2_47_9' class='gform-field-label gform-field-label--type-inline'>None of the above<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_51\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Mobility equipment<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_51'><div class='gchoice gchoice_2_51_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.1' type='checkbox'  value='Accessible home'  id='choice_2_51_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_51_1' id='label_2_51_1' class='gform-field-label gform-field-label--type-inline'>Accessible home<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_51_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.2' type='checkbox'  value='Accessible vehicle'  id='choice_2_51_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_51_2' id='label_2_51_2' class='gform-field-label gform-field-label--type-inline'>Accessible vehicle<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_51_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.3' type='checkbox'  value='Ankle-foot orthoses (AFOs)'  id='choice_2_51_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_51_3' id='label_2_51_3' class='gform-field-label gform-field-label--type-inline'>Ankle-foot orthoses (AFOs)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_51_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.4' type='checkbox'  value='Gait trainer'  id='choice_2_51_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_51_4' id='label_2_51_4' class='gform-field-label gform-field-label--type-inline'>Gait trainer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_51_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.5' type='checkbox'  value='Hoyer Lift'  id='choice_2_51_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_51_5' id='label_2_51_5' class='gform-field-label gform-field-label--type-inline'>Hoyer Lift<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_51_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.6' type='checkbox'  value='Supramalleolar orthoses (SMOs)'  id='choice_2_51_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_51_6' id='label_2_51_6' class='gform-field-label gform-field-label--type-inline'>Supramalleolar orthoses (SMOs)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_51_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.7' type='checkbox'  value='Stander'  id='choice_2_51_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_51_7' id='label_2_51_7' class='gform-field-label gform-field-label--type-inline'>Stander<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_51_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.8' type='checkbox'  value='Walker'  id='choice_2_51_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_51_8' id='label_2_51_8' class='gform-field-label gform-field-label--type-inline'>Walker<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_51_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.9' type='checkbox'  value='Wheelchair'  id='choice_2_51_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_51_9' id='label_2_51_9' class='gform-field-label gform-field-label--type-inline'>Wheelchair<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_51_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.11' type='checkbox'  value='None of the above'  id='choice_2_51_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_51_11' id='label_2_51_11' class='gform-field-label gform-field-label--type-inline'>None of the above<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_52\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Adaptive therapies<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_52'><div class='gchoice gchoice_2_52_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.1' type='checkbox'  value='ABA therapy'  id='choice_2_52_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_52_1' id='label_2_52_1' class='gform-field-label gform-field-label--type-inline'>ABA therapy<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_52_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.2' type='checkbox'  value='Adapted physical education\/APE'  id='choice_2_52_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_52_2' id='label_2_52_2' class='gform-field-label gform-field-label--type-inline'>Adapted physical education\/APE<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_52_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.3' type='checkbox'  value='Feeding therapy'  id='choice_2_52_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_52_3' id='label_2_52_3' class='gform-field-label gform-field-label--type-inline'>Feeding therapy<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_52_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.4' type='checkbox'  value='Hippotherapy'  id='choice_2_52_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_52_4' id='label_2_52_4' class='gform-field-label gform-field-label--type-inline'>Hippotherapy<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_52_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.5' type='checkbox'  value='Occupational therapy\/OT'  id='choice_2_52_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_52_5' id='label_2_52_5' class='gform-field-label gform-field-label--type-inline'>Occupational therapy\/OT<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_52_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.6' type='checkbox'  value='Physical therapy\/PT'  id='choice_2_52_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_52_6' id='label_2_52_6' class='gform-field-label gform-field-label--type-inline'>Physical therapy\/PT<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_52_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.7' type='checkbox'  value='Speech therapy'  id='choice_2_52_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_52_7' id='label_2_52_7' class='gform-field-label gform-field-label--type-inline'>Speech therapy<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_52_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.8' type='checkbox'  value='None of the above'  id='choice_2_52_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_52_8' id='label_2_52_8' class='gform-field-label gform-field-label--type-inline'>None of the above<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_53\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Vision<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_53'><div class='gchoice gchoice_2_53_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.1' type='checkbox'  value='Blind'  id='choice_2_53_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_53_1' id='label_2_53_1' class='gform-field-label gform-field-label--type-inline'>Blind<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_53_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.2' type='checkbox'  value='Cortical Visual Impairment (CVI)'  id='choice_2_53_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_53_2' id='label_2_53_2' class='gform-field-label gform-field-label--type-inline'>Cortical Visual Impairment (CVI)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_53_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.3' type='checkbox'  value='Eye surgery'  id='choice_2_53_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_53_3' id='label_2_53_3' class='gform-field-label gform-field-label--type-inline'>Eye surgery<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_53_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.4' type='checkbox'  value='Glasses\/contact lenses'  id='choice_2_53_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_53_4' id='label_2_53_4' class='gform-field-label gform-field-label--type-inline'>Glasses\/contact lenses<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_53_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.5' type='checkbox'  value='Moderate visual impairment'  id='choice_2_53_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_53_5' id='label_2_53_5' class='gform-field-label gform-field-label--type-inline'>Moderate visual impairment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_53_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_53.6' type='checkbox'  value='None of the above'  id='choice_2_53_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_53_6' id='label_2_53_6' class='gform-field-label gform-field-label--type-inline'>None of the above<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_50\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nutrition related experiences<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_50'><div class='gchoice gchoice_2_50_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.1' type='checkbox'  value='Fed by others'  id='choice_2_50_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_1' id='label_2_50_1' class='gform-field-label gform-field-label--type-inline'>Fed by others<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_50_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.2' type='checkbox'  value='Feeding pump'  id='choice_2_50_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_2' id='label_2_50_2' class='gform-field-label gform-field-label--type-inline'>Feeding pump<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_50_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.3' type='checkbox'  value='Fundoplication'  id='choice_2_50_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_3' id='label_2_50_3' class='gform-field-label gform-field-label--type-inline'>Fundoplication<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_50_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.4' type='checkbox'  value='GJ-tube'  id='choice_2_50_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_4' id='label_2_50_4' class='gform-field-label gform-field-label--type-inline'>GJ-tube<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_50_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.5' type='checkbox'  value='G-tube'  id='choice_2_50_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_5' id='label_2_50_5' class='gform-field-label gform-field-label--type-inline'>G-tube<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_50_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.6' type='checkbox'  value='Naso-Gastric tube'  id='choice_2_50_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_6' id='label_2_50_6' class='gform-field-label gform-field-label--type-inline'>Naso-Gastric tube<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_50_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.7' type='checkbox'  value='Reflux'  id='choice_2_50_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_7' id='label_2_50_7' class='gform-field-label gform-field-label--type-inline'>Reflux<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_50_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.8' type='checkbox'  value='Special diets'  id='choice_2_50_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_8' id='label_2_50_8' class='gform-field-label gform-field-label--type-inline'>Special diets<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_50_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.9' type='checkbox'  value='Swallowing issues'  id='choice_2_50_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_9' id='label_2_50_9' class='gform-field-label gform-field-label--type-inline'>Swallowing issues<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_50_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.11' type='checkbox'  value='TPN'  id='choice_2_50_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_11' id='label_2_50_11' class='gform-field-label gform-field-label--type-inline'>TPN<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_50_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_50.12' type='checkbox'  value='None of the above'  id='choice_2_50_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_50_12' id='label_2_50_12' class='gform-field-label gform-field-label--type-inline'>None of the above<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_54\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Hearing<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_54'><div class='gchoice gchoice_2_54_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.1' type='checkbox'  value='Atresia'  id='choice_2_54_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_54_1' id='label_2_54_1' class='gform-field-label gform-field-label--type-inline'>Atresia<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_54_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.2' type='checkbox'  value='Bilateral hearing loss'  id='choice_2_54_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_54_2' id='label_2_54_2' class='gform-field-label gform-field-label--type-inline'>Bilateral hearing loss<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_54_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.3' type='checkbox'  value='Cochlear implants'  id='choice_2_54_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_54_3' id='label_2_54_3' class='gform-field-label gform-field-label--type-inline'>Cochlear implants<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_54_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.4' type='checkbox'  value='Conductive hearing loss'  id='choice_2_54_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_54_4' id='label_2_54_4' class='gform-field-label gform-field-label--type-inline'>Conductive hearing loss<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_54_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.5' type='checkbox'  value='Deaf blindness'  id='choice_2_54_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_54_5' id='label_2_54_5' class='gform-field-label gform-field-label--type-inline'>Deaf blindness<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_54_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.6' type='checkbox'  value='Hard of hearing'  id='choice_2_54_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_54_6' id='label_2_54_6' class='gform-field-label gform-field-label--type-inline'>Hard of hearing<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_54_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.7' type='checkbox'  value='Hearing aids'  id='choice_2_54_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_54_7' id='label_2_54_7' class='gform-field-label gform-field-label--type-inline'>Hearing aids<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_54_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.8' type='checkbox'  value='Microtia'  id='choice_2_54_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_54_8' id='label_2_54_8' class='gform-field-label gform-field-label--type-inline'>Microtia<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_54_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.9' type='checkbox'  value='Mixed hearing loss'  id='choice_2_54_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_54_9' id='label_2_54_9' class='gform-field-label gform-field-label--type-inline'>Mixed hearing loss<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_54_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.11' type='checkbox'  value='No hearing loss'  id='choice_2_54_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_54_11' id='label_2_54_11' class='gform-field-label gform-field-label--type-inline'>No hearing loss<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_54_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.12' type='checkbox'  value='Sensorineural hearing loss'  id='choice_2_54_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_54_12' id='label_2_54_12' class='gform-field-label gform-field-label--type-inline'>Sensorineural hearing loss<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_54_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.13' type='checkbox'  value='Unilateral hearing loss'  id='choice_2_54_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_54_13' id='label_2_54_13' class='gform-field-label gform-field-label--type-inline'>Unilateral hearing loss<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_54_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_54.14' type='checkbox'  value='None of the above'  id='choice_2_54_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_54_14' id='label_2_54_14' class='gform-field-label gform-field-label--type-inline'>None of the above<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_48\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Medical care<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_48'><div class='gchoice gchoice_2_48_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.1' type='checkbox'  value='Catheterization'  id='choice_2_48_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_48_1' id='label_2_48_1' class='gform-field-label gform-field-label--type-inline'>Catheterization<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_48_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.2' type='checkbox'  value='Colostomy'  id='choice_2_48_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_48_2' id='label_2_48_2' class='gform-field-label gform-field-label--type-inline'>Colostomy<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_48_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.3' type='checkbox'  value='ECMO\/life support'  id='choice_2_48_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_48_3' id='label_2_48_3' class='gform-field-label gform-field-label--type-inline'>ECMO\/life support<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_48_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.4' type='checkbox'  value='Genetic testing'  id='choice_2_48_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_48_4' id='label_2_48_4' class='gform-field-label gform-field-label--type-inline'>Genetic testing<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_48_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.5' type='checkbox'  value='Home health aid'  id='choice_2_48_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_48_5' id='label_2_48_5' class='gform-field-label gform-field-label--type-inline'>Home health aid<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_48_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.6' type='checkbox'  value='IV\/Central lines'  id='choice_2_48_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_48_6' id='label_2_48_6' class='gform-field-label gform-field-label--type-inline'>IV\/Central lines<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_48_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.7' type='checkbox'  value='Neurosurgery'  id='choice_2_48_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_48_7' id='label_2_48_7' class='gform-field-label gform-field-label--type-inline'>Neurosurgery<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_48_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.8' type='checkbox'  value='Nursing'  id='choice_2_48_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_48_8' id='label_2_48_8' class='gform-field-label gform-field-label--type-inline'>Nursing<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_48_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.9' type='checkbox'  value='PCA services'  id='choice_2_48_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_48_9' id='label_2_48_9' class='gform-field-label gform-field-label--type-inline'>PCA services<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_48_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.11' type='checkbox'  value='Service\/emotional support animal'  id='choice_2_48_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_48_11' id='label_2_48_11' class='gform-field-label gform-field-label--type-inline'>Service\/emotional support animal<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_48_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.12' type='checkbox'  value='Shunt'  id='choice_2_48_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_48_12' id='label_2_48_12' class='gform-field-label gform-field-label--type-inline'>Shunt<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_48_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.13' type='checkbox'  value='Sleep apnea monitor'  id='choice_2_48_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_48_13' id='label_2_48_13' class='gform-field-label gform-field-label--type-inline'>Sleep apnea monitor<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_48_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.14' type='checkbox'  value='Supplemental oxygen'  id='choice_2_48_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_48_14' id='label_2_48_14' class='gform-field-label gform-field-label--type-inline'>Supplemental oxygen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_48_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.15' type='checkbox'  value='Tracheotomy'  id='choice_2_48_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_48_15' id='label_2_48_15' class='gform-field-label gform-field-label--type-inline'>Tracheotomy<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_48_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.16' type='checkbox'  value='Vagal nerve stimulator'  id='choice_2_48_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_48_16' id='label_2_48_16' class='gform-field-label gform-field-label--type-inline'>Vagal nerve stimulator<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_48_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.17' type='checkbox'  value='Ventilator'  id='choice_2_48_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_48_17' id='label_2_48_17' class='gform-field-label gform-field-label--type-inline'>Ventilator<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_48_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_48.18' type='checkbox'  value='None of the above'  id='choice_2_48_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_48_18' id='label_2_48_18' class='gform-field-label gform-field-label--type-inline'>None of the above<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_49\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Emotional health<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_49'><div class='gchoice gchoice_2_49_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.1' type='checkbox'  value='Aggression'  id='choice_2_49_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_49_1' id='label_2_49_1' class='gform-field-label gform-field-label--type-inline'>Aggression<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_49_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.2' type='checkbox'  value='Anxiety'  id='choice_2_49_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_49_2' id='label_2_49_2' class='gform-field-label gform-field-label--type-inline'>Anxiety<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_49_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.3' type='checkbox'  value='Bereavement'  id='choice_2_49_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_49_3' id='label_2_49_3' class='gform-field-label gform-field-label--type-inline'>Bereavement<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_49_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.4' type='checkbox'  value='Bolting'  id='choice_2_49_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_49_4' id='label_2_49_4' class='gform-field-label gform-field-label--type-inline'>Bolting<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_49_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.5' type='checkbox'  value='Compulsive behavior'  id='choice_2_49_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_49_5' id='label_2_49_5' class='gform-field-label gform-field-label--type-inline'>Compulsive behavior<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_49_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.6' type='checkbox'  value='Defiance'  id='choice_2_49_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_49_6' id='label_2_49_6' class='gform-field-label gform-field-label--type-inline'>Defiance<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_49_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.7' type='checkbox'  value='Depression (child)'  id='choice_2_49_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_49_7' id='label_2_49_7' class='gform-field-label gform-field-label--type-inline'>Depression (child)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_49_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.8' type='checkbox'  value='Depression (parent)'  id='choice_2_49_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_49_8' id='label_2_49_8' class='gform-field-label gform-field-label--type-inline'>Depression (parent)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_49_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.9' type='checkbox'  value='Hospitalization'  id='choice_2_49_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_49_9' id='label_2_49_9' class='gform-field-label gform-field-label--type-inline'>Hospitalization<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_49_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.11' type='checkbox'  value='Hyperactivity'  id='choice_2_49_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_49_11' id='label_2_49_11' class='gform-field-label gform-field-label--type-inline'>Hyperactivity<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_49_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.12' type='checkbox'  value='Impulsivity'  id='choice_2_49_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_49_12' id='label_2_49_12' class='gform-field-label gform-field-label--type-inline'>Impulsivity<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_49_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.13' type='checkbox'  value='Residential services'  id='choice_2_49_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_49_13' id='label_2_49_13' class='gform-field-label gform-field-label--type-inline'>Residential services<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_49_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.14' type='checkbox'  value='Self-harm'  id='choice_2_49_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_49_14' id='label_2_49_14' class='gform-field-label gform-field-label--type-inline'>Self-harm<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_49_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.15' type='checkbox'  value='Sibling supports'  id='choice_2_49_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_49_15' id='label_2_49_15' class='gform-field-label gform-field-label--type-inline'>Sibling supports<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_49_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.16' type='checkbox'  value='Social skills group'  id='choice_2_49_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_49_16' id='label_2_49_16' class='gform-field-label gform-field-label--type-inline'>Social skills group<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_49_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.17' type='checkbox'  value='Social anxiety'  id='choice_2_49_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_49_17' id='label_2_49_17' class='gform-field-label gform-field-label--type-inline'>Social anxiety<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_49_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.18' type='checkbox'  value='Toileting challenges'  id='choice_2_49_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_49_18' id='label_2_49_18' class='gform-field-label gform-field-label--type-inline'>Toileting challenges<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_49_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.19' type='checkbox'  value='Trauma\/PTSD'  id='choice_2_49_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_49_19' id='label_2_49_19' class='gform-field-label gform-field-label--type-inline'>Trauma\/PTSD<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_49_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.21' type='checkbox'  value='None of the above'  id='choice_2_49_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_49_21' id='label_2_49_21' class='gform-field-label gform-field-label--type-inline'>None of the above<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_55\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Education<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_55'><div class='gchoice gchoice_2_55_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.1' type='checkbox'  value='Assistive technology\/AT'  id='choice_2_55_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_55_1' id='label_2_55_1' class='gform-field-label gform-field-label--type-inline'>Assistive technology\/AT<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_55_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.2' type='checkbox'  value='Before\/aftercare'  id='choice_2_55_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_55_2' id='label_2_55_2' class='gform-field-label gform-field-label--type-inline'>Before\/aftercare<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_55_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.3' type='checkbox'  value='Early Intervention'  id='choice_2_55_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_55_3' id='label_2_55_3' class='gform-field-label gform-field-label--type-inline'>Early Intervention<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_55_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.4' type='checkbox'  value='High school'  id='choice_2_55_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_55_4' id='label_2_55_4' class='gform-field-label gform-field-label--type-inline'>High school<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_55_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.5' type='checkbox'  value='Homeschooling'  id='choice_2_55_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_55_5' id='label_2_55_5' class='gform-field-label gform-field-label--type-inline'>Homeschooling<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_55_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.6' type='checkbox'  value='Hospital based schooling'  id='choice_2_55_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_55_6' id='label_2_55_6' class='gform-field-label gform-field-label--type-inline'>Hospital based schooling<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_55_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.7' type='checkbox'  value='IEP process'  id='choice_2_55_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_55_7' id='label_2_55_7' class='gform-field-label gform-field-label--type-inline'>IEP process<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_55_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.8' type='checkbox'  value='Mediation'  id='choice_2_55_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_55_8' id='label_2_55_8' class='gform-field-label gform-field-label--type-inline'>Mediation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_55_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.9' type='checkbox'  value='Middle school'  id='choice_2_55_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_55_9' id='label_2_55_9' class='gform-field-label gform-field-label--type-inline'>Middle school<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_55_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.11' type='checkbox'  value='Out-of-district placement'  id='choice_2_55_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_55_11' id='label_2_55_11' class='gform-field-label gform-field-label--type-inline'>Out-of-district placement<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_55_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.12' type='checkbox'  value='Post-secondary transition'  id='choice_2_55_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_55_12' id='label_2_55_12' class='gform-field-label gform-field-label--type-inline'>Post-secondary transition<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_55_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.13' type='checkbox'  value='Private school'  id='choice_2_55_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_55_13' id='label_2_55_13' class='gform-field-label gform-field-label--type-inline'>Private school<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_55_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.14' type='checkbox'  value='Public school'  id='choice_2_55_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_55_14' id='label_2_55_14' class='gform-field-label gform-field-label--type-inline'>Public school<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_55_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.15' type='checkbox'  value='Residential placement'  id='choice_2_55_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_55_15' id='label_2_55_15' class='gform-field-label gform-field-label--type-inline'>Residential placement<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_55_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.16' type='checkbox'  value='School medical plan'  id='choice_2_55_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_55_16' id='label_2_55_16' class='gform-field-label gform-field-label--type-inline'>School medical plan<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_55_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.17' type='checkbox'  value='Therapeutic placement'  id='choice_2_55_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_55_17' id='label_2_55_17' class='gform-field-label gform-field-label--type-inline'>Therapeutic placement<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_55_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.18' type='checkbox'  value='Turning Three Transition'  id='choice_2_55_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_55_18' id='label_2_55_18' class='gform-field-label gform-field-label--type-inline'>Turning Three Transition<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_55_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.19' type='checkbox'  value='Tutoring'  id='choice_2_55_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_55_19' id='label_2_55_19' class='gform-field-label gform-field-label--type-inline'>Tutoring<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_55_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.21' type='checkbox'  value='Virtual school'  id='choice_2_55_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_55_21' id='label_2_55_21' class='gform-field-label gform-field-label--type-inline'>Virtual school<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_55_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.22' type='checkbox'  value='None of the above'  id='choice_2_55_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_55_22' id='label_2_55_22' class='gform-field-label gform-field-label--type-inline'>None of the above<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_56\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Family related<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_56'><div class='gchoice gchoice_2_56_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.1' type='checkbox'  value='Domestic violence'  id='choice_2_56_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_56_1' id='label_2_56_1' class='gform-field-label gform-field-label--type-inline'>Domestic violence<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_56_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.2' type='checkbox'  value='Grandparent raising grandchild\/-ren'  id='choice_2_56_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_56_2' id='label_2_56_2' class='gform-field-label gform-field-label--type-inline'>Grandparent raising grandchild\/-ren<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_56_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.3' type='checkbox'  value='Gender transition'  id='choice_2_56_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_56_3' id='label_2_56_3' class='gform-field-label gform-field-label--type-inline'>Gender transition<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_56_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.4' type='checkbox'  value='Long distance moves'  id='choice_2_56_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_56_4' id='label_2_56_4' class='gform-field-label gform-field-label--type-inline'>Long distance moves<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_56_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.5' type='checkbox'  value='Loss of a parent\/sibling'  id='choice_2_56_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_56_5' id='label_2_56_5' class='gform-field-label gform-field-label--type-inline'>Loss of a parent\/sibling<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_56_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.6' type='checkbox'  value='Separation\/divorce'  id='choice_2_56_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_56_6' id='label_2_56_6' class='gform-field-label gform-field-label--type-inline'>Separation\/divorce<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_56_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.7' type='checkbox'  value='Sibling relationship challenges'  id='choice_2_56_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_56_7' id='label_2_56_7' class='gform-field-label gform-field-label--type-inline'>Sibling relationship challenges<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_56_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.8' type='checkbox'  value='Single parenting'  id='choice_2_56_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_56_8' id='label_2_56_8' class='gform-field-label gform-field-label--type-inline'>Single parenting<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_56_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.9' type='checkbox'  value='None of the above'  id='choice_2_56_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_56_9' id='label_2_56_9' class='gform-field-label gform-field-label--type-inline'>None of the above<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_116\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Allergies<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_116'>\n\t\t\t<div class='gchoice gchoice_2_116_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_116' type='radio' value='Yes'  id='choice_2_116_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_116_0' id='label_2_116_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_116_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_116' type='radio' value='No'  id='choice_2_116_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_116_1' id='label_2_116_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_117\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_117'>Specify Allergies<\/label><div class='ginput_container ginput_container_text'><input name='input_117' id='input_2_117' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_57\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_57'>Please share any personal beliefs\/habits\/other comments that you would like another caregiver to honor while they provide respite for your family.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_57' id='input_2_57' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_2_79\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_79'>Do you identify as a licensed medical professional?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_79' id='input_2_79' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/div><div id=\"field_2_82\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_82'>Please specify.<\/label><div class='ginput_container ginput_container_text'><input name='input_82' id='input_2_82' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_76\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_76'>Have you been a caregiver for another family before?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_76' id='input_2_76' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/div><div id=\"field_2_114\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_114'>Are you currently CPR\/First Aid Certified?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_114'>I understand that I would be required to be certified for having a match <\/div><div class='ginput_container ginput_container_select'><select name='input_114' id='input_2_114' class='large gfield_select'  aria-describedby=\"gfield_description_2_114\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/div><fieldset id=\"field_2_97\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Is there currently a caregiver who is part of C2C Respite  Network who you would prefer to be matched with?<\/legend><div class='gfield_description' id='gfield_description_2_97'>We will do our best to accommodate your request.<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_97'>\n\t\t\t<div class='gchoice gchoice_2_97_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_97' type='radio' value='Yes'  id='choice_2_97_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_2_97\"   \/>\n\t\t\t\t\t<label for='choice_2_97_0' id='label_2_97_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_97_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_97' type='radio' value='No'  id='choice_2_97_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_97_1' id='label_2_97_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_93\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_93'>Enter their first name<\/label><div class='ginput_container ginput_container_text'><input name='input_93' id='input_2_93' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_94\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_94'>Enter their last name<\/label><div class='ginput_container ginput_container_text'><input name='input_94' id='input_2_94' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_123' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_2_123' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_4' class='gform_page' data-js='page-field-id-123' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_64\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">References<\/h3><div class='gsection_description' id='gfield_description_2_64'>Please list below two individuals who have known you for at least 12 months on a personal or professional level and would be willing to speak to a C2C staff member over the phone or email.<\/div><\/div><div id=\"field_2_65\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_65'>Person 1:   First and last name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_65' id='input_2_65' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_66\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_66'>Phone number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_66' id='input_2_66' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_67\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_67'>Email address<\/label><div class='ginput_container ginput_container_text'><input name='input_67' id='input_2_67' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_69\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_69'>Relationship to Person 1?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_69' id='input_2_69' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Family member' >Family member<\/option><option value='Coworker' >Coworker<\/option><option value='Teacher\/student' >Teacher\/student<\/option><option value='Neighbor' >Neighbor<\/option><option value='Friend' >Friend<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_2_70\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_70'>Person 2:  First and last name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_70' id='input_2_70' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_71\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_71'>Phone number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_71' id='input_2_71' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_72\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_72'>Email address<\/label><div class='ginput_container ginput_container_text'><input name='input_72' id='input_2_72' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_73\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_73'>Relationship to Person 2?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_73' id='input_2_73' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Family member' >Family member<\/option><option value='Coworker' >Coworker<\/option><option value='Teacher\/student' >Teacher\/student<\/option><option value='Neighbor' >Neighbor<\/option><option value='Friend' >Friend<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><fieldset id=\"field_2_103\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I want to receive the FCSN newsletter<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_103'>\n\t\t\t<div class='gchoice gchoice_2_103_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_103' type='radio' value='Yes'  id='choice_2_103_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_103_0' id='label_2_103_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_103_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_103' type='radio' value='No'  id='choice_2_103_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_103_1' id='label_2_103_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_103_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_103' type='radio' value='I am already subscribed'  id='choice_2_103_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_103_2' id='label_2_103_2' class='gform-field-label gform-field-label--type-inline'>I am already subscribed<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_2_95\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Applicant Agreement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_95.1' id='input_2_95_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_2_95\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_2_95_1' >I understand and agree to the statements below.<\/label><input type='hidden' name='input_95.2' value='I understand and agree to the statements below.' class='gform_hidden' \/><input type='hidden' name='input_95.3' value='2' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_2_95' tabindex='0'>I certify that, to the best of my knowledge, the provided information is true and accurate. In order to participate in the Caregiver to Caregiver Respite Network, I understand that I will be required to consent to a Criminal Offender Record Information (CORI) and Sexual Offender Record Information (SORI) check. I understand that my application does not guarantee my membership in the program. <\/div><\/fieldset><fieldset id=\"field_2_131\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Terms of Use<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_131.1' id='input_2_131_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_2_131_1' >By checking here, I acknowledge that I have reviewed the C2C Terms of Use and agree to them.<\/label><input type='hidden' name='input_131.2' value='By checking here, I acknowledge that I have reviewed the C2C Terms of Use and agree to them.' class='gform_hidden' \/><input type='hidden' name='input_131.3' value='2' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_2_132\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >https:\/\/fcsn.org\/wp-content\/uploads\/2026\/07\/C2C-User-Agreement-1.pdf<\/div><div id=\"field_2_134\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Section Break<\/h3><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_2' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='submit' id='gform_submit_button_2' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_2' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_2' id='gform_theme_2' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_2' id='gform_style_settings_2' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_2' value='1' \/>\n            <input type='hidden' class='gform_hidden' 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