{"id":1580,"date":"2019-11-12T10:02:00","date_gmt":"2019-11-12T10:02:00","guid":{"rendered":"http:\/\/qa.sphss108.co.za\/?page_id=1580"},"modified":"2019-11-27T13:58:55","modified_gmt":"2019-11-27T13:58:55","slug":"gujarati-school-application-form","status":"publish","type":"page","link":"https:\/\/www.sphss108.co.za\/index.php\/gujarati-school-application-form\/","title":{"rendered":"gujarati school application form"},"content":{"rendered":"<section class=\"kc-elm kc-css-741976 kc_row\"><div class=\"kc-row-container  kc-container\"><div class=\"kc-wrap-columns\"><div class=\"kc-elm kc-css-701477 kc_col-sm-1 kc_column kc_col-sm-1\"><div class=\"kc-col-container\"><\/div><\/div><div class=\"kc-elm kc-css-919147 kc_col-sm-10 kc_column kc_col-sm-10\"><div class=\"kc-col-container\"><style type=\"text\/css\">#nex-forms{display:none;}<\/style>\r\n\t\t\r\n\t\t<style type=\"text\/css\">\r\n\t\t\r\n\t\t\t#nex-forms.gujarati_school_application_form .nf-loader-lds-spinner div:after {background: #40C4FF; }\r\n\t\t\t#nex-forms.gujarati_school_application_form .nf-loader-lds-grid div {background: #40C4FF; }\r\n\t\t\t#nex-forms.gujarati_school_application_form .nf-loader-lds-ellipsis div { background: #40C4FF;}\r\n\t\t\t#nex-forms.gujarati_school_application_form .nf-loader-lds-default div {background: #40C4FF;}\r\n\t\t\t#nex-forms.gujarati_school_application_form .nf-loader-lds-roller div:after {background: #40C4FF;}\r\n\t\t\t#nex-forms.gujarati_school_application_form .nf-loader-lds-heart div,\r\n\t\t\t#nex-forms.gujarati_school_application_form .nf-loader-lds-heart div:after,\r\n\t\t\t#nex-forms.gujarati_school_application_form .nf-loader-lds-heart div:before {background: #40C4FF;}\r\n\r\n\t\t\t\r\n\t\t\t#nex-forms.gujarati_school_application_form .nf-loader-lds-facebook div {background: #40C4FF;}\r\n\t\t\t#nex-forms.gujarati_school_application_form .nf-loader-lds-circle > div {background: #40C4FF;}\r\n\t\t\t\r\n\t\t\t#nex-forms.gujarati_school_application_form .nf-loader-lds-dual-ring:after {border: 6px solid #40C4FF;border-color: #40C4FF transparent #40C4FF transparent;}\r\n\t\t\t#nex-forms.gujarati_school_application_form .nf-loader-lds-ring div {border: 8px solid #40C4FF;border-color: #40C4FF transparent transparent transparent;}\r\n\t\t\t#nex-forms.gujarati_school_application_form .nf-loader-lds-hourglass:after {border: 32px solid #40C4FF;border-color: #40C4FF transparent #40C4FF transparent;}\r\n\t\t\t#nex-forms.gujarati_school_application_form .nf-loader-lds-ripple div {border: 4px solid #40C4FF;}\r\n\t\t<\/style>\r\n\t\t\r\n\t\t\r\n\t\t<div id=\"nex-forms\" data-loader=\"ellipsis\"data-msg-hide-form=\"yes\" data-msg-position=\"top\" data-msg-placement=\"outside\"  class=\"nex-forms gujarati_school_application_form  \"><div class=\"pre_fill_fields\"><\/div><div class=\"set_form_theme theme-default\"><div class=\"nex_success_message oldv animated\" style=\"display:none;\"><div class=\"success_header\" ><div class=\"success_icon animated\" style=\"display:none;\"><span class=\"fa fa-check\"><\/span><\/div><\/div><div class=\"msg_box\"><div class=\"msg_text\" style=\"display:none;\"><p>Thank you for connecting with us. We will respond to you shortly.<\/p>\n<\/div><\/div><\/div><div data-timer-start=\"1\" data-timer-end=\"0\" class=\"inner-canvas-container ui-nex-forms-container  bootstrap\" id=\"ui-nex-forms-container\"  ><div class=\"current_step\" style=\"display:none;\">1<\/div><div class=\"last_visited_step\" style=\"display:none;\">1<\/div><div class=\"nf_step_breadcrumb\">\n\t\t\t\t\t\t\t\t\t<ol class=\"triangular cd-breadcrumb   triangle   md-color-light-blue\" data-text-pos=\"text-bottom\" data-breadcrumb-type=\"triangular\" data-theme=\"light-blue\" data-show-front-end=\"yes\" data-show-inside=\"no\"><li class=\"current\"><a data-show-step=\"1\">Child Info<\/a><\/li><li><a data-show-step=\"2\">Parents\/Father<\/a><\/li><li><a data-show-step=\"3\">Parents\/Mother<\/a><\/li><li><a data-show-step=\"4\">Guardian Details<\/a><\/li><li><a data-show-step=\"5\">Declaration &amp; Documents Upload<\/a><\/li><li><a data-show-step=\"6\">HEALTH QUESTIONNAIRE<\/a><\/li><li><a data-show-step=\"7\">FEES STRUCTURE:<\/a><\/li><\/ol>\n\t\t\t\t\t\t\t\t<\/div><div id=\"the_plugin_url\" style=\"display:none;\">https:\/\/www.sphss108.co.za\/wp-content\/plugins\/nex-forms<\/div><div id=\"nf_save_form_progress\" style=\"display:none;\">true<\/div><div id=\"confirmation_page\" class=\"confirmation_page\" style=\"display:none;\"><\/div><div id=\"on_form_submmision\" class=\"on_form_submmision\" style=\"display:none;\">message<\/div><div class=\"hidden\" id=\"nf_ajax_url\" style=\"display:none;\">https:\/\/www.sphss108.co.za\/wp-admin\/admin-ajax.php<\/div><div class=\"hidden\" id=\"paypal_return_url\" style=\"display:none;\">https:\/\/www.sphss108.co.za\/wp-json\/wp\/v2\/pages\/1580<\/div><div class=\"hidden\" id=\"ms_scroll_to_top\" style=\"display:none;\">yes<\/div><div class=\"v7_container form_type_normal   \" style=\"\"><div class=\"current_field_on_focus\" style=\"display:none\">1<\/div><form id=\"nf_form_51118\" class=\"submit-nex-form\" name=\"nex_form\" action=\"https:\/\/www.sphss108.co.za\/wp-admin\/admin-ajax.php\" method=\"post\" enctype=\"multipart\/form-data\"><div class=\"step_transition_in\" style=\"display:none;\">fadeIn<\/div><div class=\"step_transition_out\" style=\"display:none;\">fadeOut<\/div><input type=\"hidden\" name=\"nex_forms_Id\" value=\"60\"><input type=\"hidden\" name=\"page\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/1580\"><input type=\"hidden\" name=\"ip\" value=\"\"><input type=\"hidden\" name=\"nf_page_id\" value=\"1580\"><input type=\"hidden\" name=\"nf_page_title\" value=\"gujarati school application form\"><input type=\"text\" name=\"company_url\" value=\"\" placeholder=\"enter company url\" class=\"form-control req\">\n\t\t\t\t\t\t\t<div class=\"form_field hidden\" id=\"_30216\" style=\"\">\n\t\t\t\t\t\t\t\t<input class=\"ms_current_step\" value=\"1\" name=\"ms_current_step\" type=\"hidden\">\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"form_field all_fields heading html_fields\" id=\"_25246\" style=\"position: relative; left: 0px; top: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><h1 style=\"undefined\" data-original-math-equation=\"\" data-math-equation=\"\" class=\"the_input_element style_bold\">Application Form For Gujarati School<\/h1><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"custom-fields step nf_multi_step_1 is_grid\" id=\"_67813\" data-step-name=\"Child Info\" data-step-num=\"1\" style=\"position: relative; left: 0px; top: 0px; display: block;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"form_field all_fields heading html_fields\" id=\"_60355\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><h2 style=\"undefined\" data-original-math-equation=\"\" data-math-equation=\"\" class=\"the_input_element style_bold\">Details of Child<\/h2><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields  has_prefix_icon required text_only\" data-settings=\"s-text\" id=\"_94214\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">*Surname:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix\"><span class=\"fa fa-user\"><\/span><\/span><input type=\"text\" name=\"surname:\" class=\"form-control error_message the_input_element  aling_left ui-state-default required text_only\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"Only text are allowed\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"100\" data-length=\"100\" minlength=\"\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields  has_prefix_icon text_only\" data-settings=\"s-text\" id=\"_94120\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">First Name(s):<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix\"><span class=\"fa fa-user\"><\/span><\/span><input type=\"text\" name=\"first_names:\" class=\"form-control error_message the_input_element  aling_left ui-state-default text_only\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"Only text are allowed\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"100\" data-length=\"100\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572613649347\" data-scale=\"scale(2.8000000000000003)\" data-x=\"14.578125\" data-y=\"19\" style=\"top:19px;left:14.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"grid-system-4 is_grid\" id=\"_12571\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row grid_row\"><div class=\"grid_input_holder col-sm-6\"><div class=\"form_field all_fields  date special_fields  required\" data-settings=\"s-date\" id=\"_98993\" style=\"position: relative; left: 0px; top: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">*Date Of Birth:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\" id=\"datetimepicker\" data-format=\"MM\/DD\/YYYY\" data-language=\"en\"><span class=\"input-group-addon prefix ui-state-active\"><span class=\"fa fa-calendar-o\"><\/span><\/span><input type=\"text\" name=\"date_of_birth:\" class=\"error_message form-control the_input_element  aling_left  ui-state-default required\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" style=\"color: rgb(68, 68, 68);\"><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder col-sm-6\"><div class=\"form_field all_fields  text common_fields  numbers_only\" data-settings=\"s-text\" id=\"_93182\" style=\"position: relative; left: 0px; top: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Present Age:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"present_age:\" class=\"form-control error_message the_input_element  aling_left ui-state-default numbers_only\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"Only numbers are allowed\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"3\" data-length=\"3\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder col-sm-1\"><div class=\"panel-default\"><div class=\"panel-body\" style=\"\"><\/div><\/div><\/div><div class=\"grid_input_holder col-sm-1\"><div class=\"panel-default\"><div class=\"panel-body\" style=\"\"><\/div><\/div><\/div><\/div><div class=\"field_settings grid\" style=\"display:none\"><div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><div class=\"grid-system-3 is_grid\" id=\"_80380\"><div class=\"row  grid_row\"><div class=\"grid_input_holder col-sm-2\"><div class=\"form_field all_fields  select common_fields selection_fields  required\" data-settings=\"s-select\" id=\"_54987\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">*Gender<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><select name=\"gender\" class=\"the_input_element error_message text pre-format form-control  aling_left ui-state-default required\" data-content=\"Required\" data-default-selected-value=\"0\" style=\"color: rgb(68, 68, 68);\" data-required=\"true\"><option value=\"0\" selected=\"selected\">--- Select ---<\/option><option value=\"Male\">Male<\/option><option value=\"Female\">Female<\/option><\/select><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder col-sm-5\"><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_67964\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Birth Certificate Number:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"birth_certificate_number:\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"16\" data-length=\"16\" minlength=\"\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder col-sm-5\"><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_30269\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">ID \/ Passport Number:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"id__passport_number:\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"16\" data-length=\"16\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1571592642010\" data-scale=\"scale(2.8000000000000003)\" data-x=\"14.4375\" data-y=\"8\" style=\"top:8px;left:14.4375px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1571592812851\" data-scale=\"scale(2.8000000000000003)\" data-x=\"12.0625\" data-y=\"12\" style=\"top:12px;left:12.0625px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1571592820813\" data-scale=\"scale(2.8000000000000003)\" data-x=\"16.90625\" data-y=\"8\" style=\"top:8px;left:16.90625px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"field_settings grid\" style=\"display:none\"><div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"grid-system-2 is_grid\" id=\"_11167\"><div class=\"row grid_row\"><div class=\"grid_input_holder col-sm-6\"><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_61847\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Nationality:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"nationality:\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"16\" data-length=\"16\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder col-sm-6\"><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_95968\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Home Language:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"home_language:\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"16\" data-length=\"16\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1571593416641\" data-scale=\"scale(2.8000000000000003)\" data-x=\"11.8125\" data-y=\"12\" style=\"top:12px;left:11.8125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"field_settings grid\" style=\"display:none\"><div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><div class=\"form_field all_fields  textarea common_fields\" data-settings=\"s-textarea\" id=\"_16782\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Residential Address:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><textarea name=\"residential_address:\" placeholder=\"\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" class=\"error_message the_input_element textarea pre-format form-control  aling_left ui-state-default\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"200\" data-length=\"200\"><\/textarea><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_42173\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Zip\/Postal Code<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"zippostal_code\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"8\" data-length=\"8\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields phone_number phone_number preset_fields required\" data-settings=\"s-text\" id=\"_27472\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">*Home Telephone Number:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix  ui-state-active\"><span class=\"fa fa-phone\"><\/span><\/span><input type=\"text\" name=\"home_telephone_number:\" class=\"error_message required phone_number form-control the_input_element  aling_left ui-state-default\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" data-secondary-message=\"Invalid phone number\" style=\"color: rgb(68, 68, 68);\" maxlength=\"12\" data-length=\"12\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"grid-system-2 nex_prev_steps is_grid\" style=\"\" id=\"_30045\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row grid_row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"grid_input_holder col-xs-6\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"form_field all_fields submit-button button_fields common_fields preset_fields special_fields selection_fields\" id=\"_83274\" style=\"position: relative; top: 0px; left: 0px; z-index: 100;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12\" id=\"field_container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12 input_container align_left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <button class=\"svg_ready the_input_element btn btn-default prev-step ui-state-default\">Back<\/button>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field_settings\" style=\"display:none\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"grid_input_holder col-xs-6\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"form_field all_fields submit-button button_fields common_fields preset_fields special_fields selection_fields\" id=\"_60281\" style=\"position: relative; top: 0px; left: 0px; z-index: 100;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12\" id=\"field_container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12 input_container align_right\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <button class=\"svg_ready the_input_element btn btn-default nex-step ui-state-default col-sm-12\">Next<\/button>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field_settings\" style=\"display:none\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"field_settings grid\" style=\"display: none;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div><div class=\"custom-fields step nf_multi_step_2 is_grid\" id=\"_26892\" data-step-name=\"Parents\/Father\" data-step-num=\"2\" style=\"position: relative; left: 0px; top: 0px; display: none;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"form_field all_fields heading html_fields\" id=\"_83925\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><h2 style=\"undefined\" data-original-math-equation=\"\" data-math-equation=\"\" class=\"the_input_element style_bold\">Details of Parents<\/h2><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields heading html_fields\" id=\"_51720\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><h3 style=\"undefined\" data-original-math-equation=\"\" data-math-equation=\"\" class=\"the_input_element style_bold\">Father:<\/h3><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"grid-system-2 is_grid\" id=\"_72005\"><div class=\"row grid_row\"><div class=\"grid_input_holder col-sm-2\"><div class=\"form_field all_fields  select common_fields selection_fields\" data-settings=\"s-select\" id=\"_70477\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Title:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><select name=\"title:\" class=\"the_input_element error_message text pre-format form-control  aling_left ui-state-default\" data-content=\"Required\" data-default-selected-value=\"0\" style=\"color: rgb(68, 68, 68);\"><option value=\"0\" selected=\"selected\">--- Select ---<\/option><option value=\"Mr.\">Mr.<\/option><option value=\"Mrs.\">Mrs.<\/option><option value=\"Dr.\">Dr.<\/option><\/select><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder col-sm-10\"><div class=\"form_field all_fields  text common_fields  required\" data-settings=\"s-text\" id=\"_70464\" style=\"position: relative; left: 0px; top: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">*Surname<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"surname\" class=\"form-control error_message the_input_element  aling_left ui-state-default required\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"100\" data-length=\"100\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"field_settings grid\" style=\"display:none\"><div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_41990\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">*First Name(s):<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"first_names:\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"100\" data-length=\"100\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572613800372\" data-scale=\"scale(2.8000000000000003)\" data-x=\"15.578125\" data-y=\"12\" style=\"top:12px;left:15.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  check-group common_fields selection_fields radio-group\" data-settings=\"s-checks\" id=\"_90732\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Marital Status:<\/span><\/label><\/div><div class=\"input_holder radio-group\"><div class=\"col-sm-12 the-radios input_container error_message\" id=\"the-radios\" data-checked-color=\"alert-success\" data-checked-class=\"fa-check\" data-unchecked-class=\"\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" data-secondary-message=\"Only text are allowed\"><div class=\"input-inner\"><label class=\"checkbox-inline radio-inline\" for=\"marital_status:_single_\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"marital_status:[]\" id=\"marital_status:_single_\" value=\"Single \" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"ui-state-default\" style=\"background: rgb(255, 255, 255);\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">Single <\/span><\/span><\/label><label class=\"checkbox-inline  radio-inline\" for=\"marital_status:_married\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"marital_status:[]\" id=\"marital_status:_married\" value=\"Married\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"fa ui-state-default\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">Married<\/span><\/span><\/label><label class=\"checkbox-inline radio-inline\" for=\"marital_status:_divorced\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"marital_status:[]\" id=\"marital_status:_divorced\" value=\"Divorced\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"ui-state-default\" style=\"background: rgb(255, 255, 255);\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">Divorced<\/span><\/span><\/label><label class=\"checkbox-inline  radio-inline\" for=\"marital_status:_widower\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"marital_status:[]\" id=\"marital_status:_widower\" value=\"Widower\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"fa ui-state-default\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">Widower<\/span><\/span><\/label><\/div><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields  hidden\" data-settings=\"s-text\" id=\"_13497\" style=\"\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">If divorced, who has legal custody of the child?<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"if_divorced_who_has_legal_custody_of_the_child\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"100\" data-length=\"100\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_55052\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">ID Number:<\/span><br><small class=\"sub-text style_italic\">Copy to be attached<\/small><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"id_number:\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"16\" data-length=\"16\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  textarea common_fields\" data-settings=\"s-textarea\" id=\"_81347\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Residential Address:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><textarea name=\"residential_address:\" placeholder=\"\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" class=\"error_message the_input_element textarea pre-format form-control  aling_left ui-state-default\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"200\" data-length=\"200\"><\/textarea><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  textarea common_fields\" data-settings=\"s-textarea\" id=\"_8001\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Postal Address:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><textarea name=\"postal_address:\" placeholder=\"\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" class=\"error_message the_input_element textarea pre-format form-control  aling_left ui-state-default\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"200\" data-length=\"200\"><\/textarea><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1571596688924\" data-scale=\"scale(2.8000000000000003)\" data-x=\"11.859375\" data-y=\"13\" style=\"top:13px;left:11.859375px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"grid-system-3 is_grid\" id=\"_47262\"><div class=\"row  grid_row\"><div class=\"grid_input_holder col-sm-4\"><div class=\"form_field all_fields  text common_fields  phone_number has_prefix_icon\" data-settings=\"s-text\" id=\"_61987\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Tel (H): <\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix ui-state-active\"><span class=\"fa fa-phone\"><\/span><\/span><input type=\"text\" name=\"tel_h:_\" class=\"form-control error_message the_input_element  aling_left phone_number ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"Invalid phone number format\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"12\" data-length=\"12\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1571596717241\" data-scale=\"scale(2.8000000000000003)\" data-x=\"16.375\" data-y=\"11\" style=\"top:11px;left:16.375px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder col-sm-4\"><div class=\"form_field all_fields  text common_fields  phone_number has_prefix_icon\" data-settings=\"s-text\" id=\"_4492\" style=\"position: relative; left: 0px; top: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Tel (W):<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix ui-state-active\"><span class=\"fa fa-phone\"><\/span><\/span><input type=\"text\" name=\"tel_w:\" class=\"form-control error_message the_input_element  aling_left phone_number ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"Invalid phone number format\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"12\" data-length=\"12\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder col-sm-4\"><div class=\"form_field all_fields  text common_fields  phone_number has_prefix_icon\" data-settings=\"s-text\" id=\"_41670\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Cell:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix ui-state-active\"><span class=\"fa fa-phone\"><\/span><\/span><input type=\"text\" name=\"cell:\" class=\"form-control error_message the_input_element  aling_left phone_number ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"Invalid phone number format\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"12\" data-length=\"12\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1571596721132\" data-scale=\"scale(2.8000000000000003)\" data-x=\"18.375\" data-y=\"10\" style=\"top:10px;left:18.375px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"field_settings grid\" style=\"display:none\"><div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields email email preset_fields required\" data-settings=\"s-text\" id=\"_15364\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">*Email<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix  ui-state-active\"><span class=\"fa fa-envelope\"><\/span><\/span><input type=\"text\" name=\"email\" class=\"error_message required email form-control the_input_element  aling_left ui-state-default\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" data-secondary-message=\"Invalid email address\" style=\"color: rgb(68, 68, 68);\" maxlength=\"120\" data-length=\"120\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_33666\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Occupation:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"occupation:\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"60\" data-length=\"60\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_2705\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Name of Employer:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"name_of_employer:\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"100\" data-length=\"100\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1571596954170\" data-scale=\"scale(2.8000000000000003)\" data-x=\"13.859375\" data-y=\"10\" style=\"top:10px;left:13.859375px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_43821\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Address of Employer:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"address_of_employer:\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"200\" data-length=\"200\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1571596954170\" data-scale=\"scale(2.8000000000000003)\" data-x=\"13.859375\" data-y=\"10\" style=\"top:10px;left:13.859375px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1571596964795\" data-scale=\"scale(2.8000000000000003)\" data-x=\"10.859375\" data-y=\"10\" style=\"top:10px;left:10.859375px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"grid-system-2 is_grid\" id=\"_11261\"><div class=\"row grid_row\"><div class=\"grid_input_holder col-sm-8\"><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_729\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Position Held:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"position_held:\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"60\" data-length=\"60\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder col-sm-4\"><div class=\"form_field all_fields  text common_fields  numbers_only\" data-settings=\"s-text\" id=\"_9259\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">No. of years with Employer: <\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"no_of_years_with_employer:_\" class=\"form-control error_message the_input_element  aling_left ui-state-default numbers_only\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"Only numbers are allowed\" title=\"\" style=\"color: rgb(68, 68, 68);\"><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1571597006444\" data-scale=\"scale(2.8000000000000003)\" data-x=\"18.625\" data-y=\"13\" style=\"top:13px;left:18.625px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"field_settings grid\" style=\"display:none\"><div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><div class=\"grid-system-2 nex_prev_steps is_grid\" style=\"\" id=\"_67156\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row grid_row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"grid_input_holder col-xs-6\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"form_field all_fields submit-button button_fields common_fields preset_fields special_fields selection_fields\" id=\"_45977\" style=\"position: relative; top: 0px; left: 0px; z-index: 100;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12\" id=\"field_container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12 input_container align_left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <button class=\"svg_ready the_input_element btn btn-default prev-step ui-state-default\">Back<\/button>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field_settings\" style=\"display:none\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"grid_input_holder col-xs-6\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"form_field all_fields submit-button button_fields common_fields preset_fields special_fields selection_fields\" id=\"_38392\" style=\"position: relative; top: 0px; left: 0px; z-index: 100;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12\" id=\"field_container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12 input_container align_right\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <button class=\"svg_ready the_input_element btn btn-default nex-step ui-state-default\">Next<\/button>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field_settings\" style=\"display:none\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"field_settings grid\" style=\"display: none;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div><div class=\"custom-fields step nf_multi_step_3 is_grid\" id=\"_28936\" data-step-name=\"Parents\/Mother\" data-step-num=\"3\" style=\"display: none;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"form_field all_fields heading html_fields\" id=\"_21116\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><h2 style=\"undefined\" data-original-math-equation=\"\" data-math-equation=\"\" class=\"the_input_element style_bold\">Details of Parents<\/h2><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields heading html_fields\" id=\"_59521\" style=\"position: relative; left: 0px; top: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><h3 style=\"undefined\" data-original-math-equation=\"\" data-math-equation=\"\" class=\"the_input_element style_bold\">Mother<\/h3><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"grid-system-2 is_grid\" id=\"_59467\"><div class=\"row grid_row\"><div class=\"grid_input_holder col-sm-2\"><div class=\"form_field all_fields  select common_fields selection_fields\" data-settings=\"s-select\" id=\"_2413\" style=\"position: relative; left: 0px; top: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Title:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><select name=\"title:\" class=\"the_input_element error_message text pre-format form-control  aling_left ui-state-default\" data-content=\"Required\" data-default-selected-value=\"0\" style=\"color: rgb(68, 68, 68);\"><option value=\"0\" selected=\"selected\">--- Select ---<\/option><option value=\"Mr.\">Mr.<\/option><option value=\"Mrs.\">Mrs.<\/option><option value=\"Dr.\">Dr.<\/option><\/select><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder col-sm-10\"><div class=\"form_field all_fields  text common_fields  required\" data-settings=\"s-text\" id=\"_64730\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">*Surname:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"surname:\" class=\"form-control error_message the_input_element  aling_left required ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"100\" data-length=\"100\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"field_settings grid\" style=\"display:none\"><div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields  required\" data-settings=\"s-text\" id=\"_66000\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">*First Name(s):<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"first_names:\" class=\"form-control error_message the_input_element  aling_left required ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"100\" data-length=\"100\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572613977357\" data-scale=\"scale(2.8000000000000003)\" data-x=\"16.578125\" data-y=\"14\" style=\"top:14px;left:16.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  check-group common_fields selection_fields radio-group\" data-settings=\"s-checks\" id=\"_71723\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Marital Status:<\/span><\/label><\/div><div class=\"input_holder radio-group\"><div class=\"col-sm-12 the-radios input_container error_message\" id=\"the-radios\" data-checked-color=\"alert-success\" data-checked-class=\"fa-check\" data-unchecked-class=\"\" data-placement=\"bottom\" data-content=\"Required\" title=\"\"><div class=\"input-inner\"><label class=\"checkbox-inline  radio-inline\" for=\"marital_status:_single\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"marital_status:[]\" id=\"marital_status:_single\" value=\"Single\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"fa ui-state-default\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">Single<\/span><\/span><\/label><label class=\"checkbox-inline  radio-inline\" for=\"marital_status:_married\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"marital_status:[]\" id=\"marital_status:_married\" value=\"Married\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"fa ui-state-default\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">Married<\/span><\/span><\/label><label class=\"checkbox-inline  radio-inline\" for=\"marital_status:_divorced\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"marital_status:[]\" id=\"marital_status:_divorced\" value=\"Divorced\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"fa ui-state-default\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">Divorced<\/span><\/span><\/label><label class=\"checkbox-inline  radio-inline\" for=\"marital_status:_widower\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"marital_status:[]\" id=\"marital_status:_widower\" value=\"Widower\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"fa ui-state-default\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">Widower<\/span><\/span><\/label><\/div><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_24769\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">If divorced, who has legal custody of the child?<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"if_divorced_who_has_legal_custody_of_the_child\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"100\" data-length=\"100\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_29406\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">ID Number:<\/span><br><small class=\"sub-text style_italic\">Copy to be attached<\/small><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"id_number:\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"16\" data-length=\"16\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572522985885\" data-scale=\"scale(2.8000000000000003)\" data-x=\"17.578125\" data-y=\"9\" style=\"top:9px;left:17.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  textarea common_fields\" data-settings=\"s-textarea\" id=\"_72141\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Residential Address:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><textarea name=\"residential_address:\" placeholder=\"\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" class=\"error_message the_input_element textarea pre-format form-control  aling_left ui-state-default\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"200\" data-length=\"200\"><\/textarea><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  textarea common_fields\" data-settings=\"s-textarea\" id=\"_20032\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Postal Address:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><textarea name=\"postal_address:\" placeholder=\"\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" class=\"error_message the_input_element textarea pre-format form-control  aling_left ui-state-default\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"200\" data-length=\"200\"><\/textarea><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572523071465\" data-scale=\"scale(2.8000000000000003)\" data-x=\"16.578125\" data-y=\"12\" style=\"top:12px;left:16.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"grid-system-3 is_grid\" id=\"_43399\"><div class=\"row  grid_row\"><div class=\"grid_input_holder col-sm-4\"><div class=\"form_field all_fields  text common_fields  phone_number has_prefix_icon\" data-settings=\"s-text\" id=\"_16175\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Tel (H): <\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix ui-state-active\"><span class=\"fa fa-phone\"><\/span><\/span><input type=\"text\" name=\"tel_h:_\" class=\"form-control error_message the_input_element  aling_left phone_number ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"Invalid phone number format\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"12\" data-length=\"12\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder col-sm-4\"><div class=\"form_field all_fields  text common_fields  phone_number has_prefix_icon\" data-settings=\"s-text\" id=\"_10849\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Tel(W):<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix ui-state-active\"><span class=\"fa fa-phone\"><\/span><\/span><input type=\"text\" name=\"telw:\" class=\"form-control error_message the_input_element  aling_left phone_number ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"Invalid phone number format\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"12\" data-length=\"12\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder col-sm-4\"><div class=\"form_field all_fields  text common_fields  phone_number has_prefix_icon\" data-settings=\"s-text\" id=\"_43224\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Cell:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix ui-state-active\"><span class=\"fa fa-phone\"><\/span><\/span><input type=\"text\" name=\"cell:\" class=\"form-control error_message the_input_element  aling_left phone_number ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"Invalid phone number format\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"12\" data-length=\"12\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572523127449\" data-scale=\"scale(2.8000000000000003)\" data-x=\"14.9375\" data-y=\"14\" style=\"top:14px;left:14.9375px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572523131668\" data-scale=\"scale(2.8000000000000003)\" data-x=\"11.78125\" data-y=\"16\" style=\"top:16px;left:11.78125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"field_settings grid\" style=\"display:none\"><div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields email email preset_fields required\" data-settings=\"s-text\" id=\"_98370\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">*Email:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix  ui-state-active\"><span class=\"fa fa-envelope\"><\/span><\/span><input type=\"text\" name=\"email:\" class=\"error_message required email form-control the_input_element  aling_left ui-state-default\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" data-secondary-message=\"Invalid email address\" style=\"color: rgb(68, 68, 68);\" maxlength=\"120\" data-length=\"120\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_38920\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Occupation:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"occupation:\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"60\" data-length=\"60\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_57444\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Name of Employer:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"name_of_employer:\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"100\" data-length=\"100\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_80228\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Address of Employer:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"address_of_employer:\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"200\" data-length=\"200\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572523292518\" data-scale=\"scale(2.8000000000000003)\" data-x=\"13.578125\" data-y=\"13\" style=\"top:13px;left:13.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572523303427\" data-scale=\"scale(2.8000000000000003)\" data-x=\"17.578125\" data-y=\"10\" style=\"top:10px;left:17.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"grid-system-2 is_grid\" id=\"_4122\"><div class=\"row grid_row\"><div class=\"grid_input_holder col-sm-8\"><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_13837\" style=\"position: relative; left: 0px; top: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Position Held:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"position_held:\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"60\" data-length=\"60\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder col-sm-4\"><div class=\"form_field all_fields  text common_fields  numbers_only\" data-settings=\"s-text\" id=\"_1660\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">No. of years with Employer: <\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"no_of_years_with_employer:_\" class=\"form-control error_message the_input_element  aling_left ui-state-default numbers_only\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"Only numbers are allowed\" title=\"\" style=\"color: rgb(68, 68, 68);\"><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572523334700\" data-scale=\"scale(2.8000000000000003)\" data-x=\"14.84375\" data-y=\"9\" style=\"top:9px;left:14.84375px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"field_settings grid\" style=\"display:none\"><div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_83538\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Who will bring your child to School? <\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"who_will_bring_your_child_to_school_\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"100\" data-length=\"100\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields phone_number phone_number preset_fields required\" data-settings=\"s-text\" id=\"_751\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Contact number of person bringing your child to school:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix  ui-state-active\"><span class=\"fa fa-phone\"><\/span><\/span><input type=\"text\" name=\"contact_number_of_person_bringing_your_child_to_school:\" class=\"error_message required phone_number form-control the_input_element  aling_left ui-state-default\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" data-secondary-message=\"Invalid phone number\" style=\"color: rgb(68, 68, 68);\" maxlength=\"12\" data-length=\"12\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_89685\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Who will fetch your child from School?<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"who_will_fetch_your_child_from_school\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"100\" data-length=\"100\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572524255831\" data-scale=\"scale(2.8000000000000003)\" data-x=\"15.578125\" data-y=\"15\" style=\"top:15px;left:15.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields phone_number phone_number preset_fields required\" data-settings=\"s-text\" id=\"_76176\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Contact number of person fetching your child from school:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix  ui-state-active\"><span class=\"fa fa-phone\"><\/span><\/span><input type=\"text\" name=\"contact_number_of_person_fetching_your_child_from_school:\" class=\"error_message required phone_number form-control the_input_element  aling_left ui-state-default\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" data-secondary-message=\"Invalid phone number\" style=\"color: rgb(68, 68, 68);\" maxlength=\"12\" data-length=\"12\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572524285546\" data-scale=\"scale(2.8000000000000003)\" data-x=\"21.578125\" data-y=\"14\" style=\"top:14px;left:21.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"grid-system-2 nex_prev_steps is_grid\" style=\"\" id=\"_25186\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row grid_row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"grid_input_holder col-xs-6\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"form_field all_fields submit-button button_fields common_fields preset_fields special_fields selection_fields\" id=\"_49571\" style=\"position: relative; top: 0px; left: 0px; z-index: 100;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12\" id=\"field_container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12 input_container align_left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <button class=\"svg_ready the_input_element btn btn-default prev-step ui-state-default\">Back<\/button>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field_settings\" style=\"display:none\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"grid_input_holder col-xs-6\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"form_field all_fields submit-button button_fields common_fields preset_fields special_fields selection_fields\" id=\"_7083\" style=\"position: relative; top: 0px; left: 0px; z-index: 100;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12\" id=\"field_container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12 input_container align_right\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <button class=\"svg_ready the_input_element btn btn-default nex-step ui-state-default\">Next<\/button>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field_settings\" style=\"display:none\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"field_settings grid\" style=\"display: none;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div><div class=\"custom-fields step nf_multi_step_4 is_grid\" id=\"_38545\" data-step-name=\"Guardian Details\" data-step-num=\"4\" style=\"display: none;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"form_field all_fields heading html_fields\" id=\"_89126\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><h1 class=\"the_input_element style_bold\" data-math-equation=\"\" data-original-math-equation=\"\" data-decimal-places=\"0\">Guardian Details<\/h1><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"grid-system-2 is_grid\" id=\"_61713\"><div class=\"row grid_row\"><div class=\"grid_input_holder col-sm-2\"><div class=\"form_field all_fields  select common_fields selection_fields\" data-settings=\"s-select\" id=\"_63340\" style=\"position: relative; left: 0px; top: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Title:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><select name=\"title:\" class=\"the_input_element error_message text pre-format form-control  aling_left ui-state-default\" data-content=\"Required\" data-default-selected-value=\"0\" style=\"color: rgb(68, 68, 68);\"><option value=\"0\" selected=\"selected\">--- Select ---<\/option><option value=\"Mr.\">Mr.<\/option><option value=\"Mrs.\">Mrs.<\/option><option value=\"Dr.\">Dr.<\/option><\/select><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder col-sm-10\"><div class=\"form_field all_fields  text common_fields  required text_only\" data-settings=\"s-text\" id=\"_51029\" style=\"position: relative; left: 0px; top: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">*Surname:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"surname:\" class=\"form-control error_message the_input_element  aling_left ui-state-default required text_only\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"Only text are allowed\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"100\" data-length=\"100\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"field_settings grid\" style=\"display:none\"><div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields  text_only\" data-settings=\"s-text\" id=\"_32229\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">First Name(s):<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"first_names:\" class=\"form-control error_message the_input_element  aling_left ui-state-default text_only\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"Only text are allowed\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"100\" data-length=\"100\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572614021193\" data-scale=\"scale(2.8000000000000003)\" data-x=\"11.578125\" data-y=\"9\" style=\"top:9px;left:11.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  textarea common_fields\" data-settings=\"s-textarea\" id=\"_13382\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Residential Address:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><textarea name=\"residential_address:\" placeholder=\"\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" class=\"error_message the_input_element textarea pre-format form-control  aling_left ui-state-default\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"200\" data-length=\"200\"><\/textarea><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"grid-system-3 is_grid\" id=\"_58612\"><div class=\"row  grid_row\"><div class=\"grid_input_holder col-sm-4\"><div class=\"form_field all_fields  text common_fields  phone_number has_prefix_icon\" data-settings=\"s-text\" id=\"_21902\" style=\"position: relative; left: 0px; top: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Tel (H):<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix ui-state-active\"><span class=\"fa fa-phone\"><\/span><\/span><input type=\"text\" name=\"tel_h:\" class=\"form-control error_message the_input_element  aling_left phone_number ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"Invalid phone number format\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"12\" data-length=\"12\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder col-sm-4\"><div class=\"form_field all_fields  text common_fields  phone_number has_prefix_icon\" data-settings=\"s-text\" id=\"_66646\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Tel (W):<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix ui-state-active\"><span class=\"fa fa-phone\"><\/span><\/span><input type=\"text\" name=\"tel_w:\" class=\"form-control error_message the_input_element  aling_left phone_number ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"Invalid phone number format\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"12\" data-length=\"12\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder col-sm-4\"><div class=\"form_field all_fields  text common_fields  phone_number has_prefix_icon\" data-settings=\"s-text\" id=\"_50608\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Cell:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix ui-state-active\"><span class=\"fa fa-phone\"><\/span><\/span><input type=\"text\" name=\"cell:\" class=\"form-control error_message the_input_element  aling_left phone_number ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"Invalid phone number format\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"12\" data-length=\"12\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572524582343\" data-scale=\"scale(2.8000000000000003)\" data-x=\"17.9375\" data-y=\"11\" style=\"top:11px;left:17.9375px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572524588482\" data-scale=\"scale(2.8000000000000003)\" data-x=\"20.78125\" data-y=\"12\" style=\"top:12px;left:20.78125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"field_settings grid\" style=\"display:none\"><div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields email email preset_fields required\" data-settings=\"s-text\" id=\"_48565\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">*Email<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix  ui-state-active\"><span class=\"fa fa-envelope\"><\/span><\/span><input type=\"text\" name=\"email\" class=\"error_message required email form-control the_input_element  aling_left ui-state-default\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" data-secondary-message=\"Invalid email address\" style=\"color: rgb(68, 68, 68);\" maxlength=\"120\" data-length=\"120\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields  text_only\" data-settings=\"s-text\" id=\"_45812\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Occupation:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"occupation:\" class=\"form-control error_message the_input_element  aling_left ui-state-default text_only\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"Only text are allowed\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"60\" data-length=\"60\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields heading html_fields\" id=\"_49320\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><h4 style=\"color: rgb(242, 6, 6);\" data-original-math-equation=\"\" data-math-equation=\"\" class=\"the_input_element\">Please note that there will be admin fee of R 100 (Non-refundable) when handing in your form. <\/h4><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"grid-system-2 nex_prev_steps is_grid\" style=\"\" id=\"_87574\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row grid_row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"grid_input_holder col-xs-6\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"form_field all_fields submit-button button_fields common_fields preset_fields special_fields selection_fields\" id=\"_58481\" style=\"position: relative; top: 0px; left: 0px; z-index: 100;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12\" id=\"field_container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12 input_container align_left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <button class=\"svg_ready the_input_element btn btn-default prev-step ui-state-default\">Back<\/button>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field_settings\" style=\"display:none\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"grid_input_holder col-xs-6\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"form_field all_fields submit-button button_fields common_fields preset_fields special_fields selection_fields\" id=\"_63683\" style=\"position: relative; top: 0px; left: 0px; z-index: 100;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12\" id=\"field_container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12 input_container align_right\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <button class=\"svg_ready the_input_element btn btn-default nex-step ui-state-default\">Next<\/button>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field_settings\" style=\"display:none\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"field_settings grid\" style=\"display: none;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div><div class=\"custom-fields step nf_multi_step_5 is_grid\" id=\"_99374\" data-step-name=\"Declaration &amp; Documents Upload\" data-step-num=\"5\" style=\"position: relative; left: 0px; top: 0px; display: none;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"form_field all_fields heading html_fields\" id=\"_95658\" style=\"position: relative; left: 0px; top: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><h2 style=\"undefined\" data-original-math-equation=\"\" data-math-equation=\"\" class=\"the_input_element\">DECLARATION BY PARENTS\/GUARDIANS<\/h2><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields html html_fields\" id=\"_99128\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><div class=\"the_input_element ui-state-default\" data-math-equation=\"\" data-original-math-equation=\"\" data-decimal-places=\"0\"><p class=\"MsoNormal\" style=\"margin-bottom: 0.0001pt; line-height: 115%; text-align: center;\"><b style=\"mso-bidi-font-weight: normal;\"><span style=\"font-size: 12.0pt; mso-bidi-font-size: 14.0pt; line-height: 115%;\">DECLARATION BY PARENTS\/GUARDIANS<\/span><\/b><\/p>\n<ol>\n \t<li>I\/We declare that all particulars furnished by me\/us on and attached to this form are true and correct.<\/li>\n \t<li>I\/We hereby certify that I\/we have legal custody and\/or guardianship in respect of the above-mentioned child.<\/li>\n<\/ol>\n<ol start=\"3\">\n \t<li>I\/We hereby agree to:<\/li>\n<\/ol>\n<ul style=\"margin-left: 25px;\">\n \t<li>Accept and support the ethos of the school;<\/li>\n \t<li>Abide by the Code of Conduct set out by the School<\/li>\n \t<li>Acknowledge the authority of the Board of Management, Principal and the teachers.<\/li>\n \t<li>Accept responsibility for my child\u2019s transport to and from School<\/li>\n \t<li>Pay the stipulated school fees as agreed above (Monthly\/Termly\/Annually). The School fees will be reviewed from time to time. Learners whose Parent\/Guardian fails to pay the fees as required, or who fail to make an acceptable arrangement for the payment of fees in arrears, or who fail to adhere strictly to the terms of arrangements made for the payment of fees in arrears, will be given notice in writing that this contract will be cancelled and after one month\u2019s notice in writing, the Learner concerned will unfortunately not be allowed to return to the School.<\/li>\n \t<li>A R 50 monthly admin fee will be charged on late payments along with interest at the rate of 12%p.a. on outstanding fee.<\/li>\n \t<li>Notify the Teachers\/Principal\/Administration Official, in writing, at least one (1) term in advance, in the event of my child leaving the school<\/li>\n \t<li>Ensure that my child attends school regularly.<\/li>\n<\/ul><\/div><div style=\"clear:both;\"><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields html html_fields\" id=\"_6803\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><div class=\"the_input_element ui-state-default\" data-math-equation=\"\" data-original-math-equation=\"\" data-decimal-places=\"0\"><p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; line-height: 115%; tab-stops: 187.5pt;\">I, _________________________________________________ (full name of person responsible for payment), Identity Number ________________________________, hereby agree and take responsibility of settling the annual school fees of the agreed amount in full settlement for the academic year, final payment to be made on or before 7th November of current academic year and made due to the Shree Pretoria Hindu Seva Samaj. <span style=\"mso-tab-count: 7;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <\/span><span style=\"mso-spacerun: yes;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/span><span style=\"font-size: 8.0pt; line-height: 115%;\"><span style=\"mso-spacerun: yes;\">&nbsp;<\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; line-height: 115%; tab-stops: 187.5pt;\"><span style=\"font-size: 5.0pt; mso-bidi-font-size: 11.0pt; line-height: 115%;\">&nbsp;<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; line-height: 115%; tab-stops: 187.5pt;\"><b style=\"mso-bidi-font-weight: normal;\">ALL THE ABOVE INFORMATION GIVEN IN THE ENROLMENT FORM IS TRUE AND CORRECT. <\/b><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; line-height: 115%; tab-stops: 187.5pt;\"><span style=\"font-size: 5.0pt; mso-bidi-font-size: 11.0pt; line-height: 115%;\">&nbsp;<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; line-height: 115%; tab-stops: 187.5pt;\">Signed at _______________________________ this ____ day of __________________ 20____<\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; line-height: 115%; tab-stops: 187.5pt;\"><span style=\"font-size: 5.0pt; mso-bidi-font-size: 11.0pt; line-height: 115%;\">&nbsp;<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; line-height: 115%; tab-stops: 187.5pt;\">Signature of Father:<span style=\"mso-tab-count: 3;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <\/span>________________________________<\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; line-height: 115%; tab-stops: 187.5pt;\">Signature of Mother:<span style=\"mso-tab-count: 3;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <\/span>________________________________<\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; line-height: 115%; tab-stops: 187.5pt;\">Signature of Guardian (if applicable):<span style=\"mso-tab-count: 3;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <\/span>________________________________<\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; line-height: 115%; tab-stops: 187.5pt;\">Signature of name of person responsible for account: <span style=\"mso-tab-count: 1;\">&nbsp;&nbsp; <\/span>________________________________<\/p>\n<p class=\"MsoNormal\" style=\"line-height: 115%; tab-stops: 187.5pt; margin: 0in 0in .0001pt 1.0in;\"><span style=\"font-size: 8.0pt; line-height: 115%;\"><span style=\"mso-tab-count: 7;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <\/span><span style=\"mso-spacerun: yes;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <\/span><\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; line-height: 115%; tab-stops: 187.5pt;\"><b style=\"mso-bidi-font-weight: normal;\">The applicant is required to initial each general information page relating to rules and regulations of the Balmandir School.<\/b><\/p><\/div><div style=\"clear:both;\"><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields divider html_fields\" id=\"_81181\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><hr class=\"the_input_element ui-state-default\"><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields html html_fields\" id=\"_15137\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><div class=\"the_input_element ui-state-default\" data-math-equation=\"\" data-original-math-equation=\"\" data-decimal-places=\"0\"><p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; line-height: 115%; tab-stops: 187.5pt;\">Please note the following:<\/p>\n<p class=\"MsoListParagraphCxSpFirst\" style=\"mso-add-space: auto; text-indent: -.25in; line-height: 115%; mso-list: l0 level1 lfo1; tab-stops: 187.5pt; margin: 0in 0in .0001pt 39.0pt;\"><!-- [if !supportLists]--><span style=\"mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;\"><span style=\"mso-list: Ignore;\">1.<span style=\"font: 7.0pt 'Times New Roman';\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <\/span><\/span><\/span><!--[endif]-->A copy of unabridged birth certificate must accompany the application.<\/p>\n<p class=\"MsoListParagraphCxSpMiddle\" style=\"mso-add-space: auto; text-indent: -.25in; line-height: 115%; mso-list: l0 level1 lfo1; tab-stops: 187.5pt; margin: 0in 0in .0001pt 39.0pt;\"><!-- [if !supportLists]--><span style=\"mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;\"><span style=\"mso-list: Ignore;\">2.<span style=\"font: 7.0pt 'Times New Roman';\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <\/span><\/span><\/span><!--[endif]-->If the child is not a South African National, a copy of a passport or another document is required.<\/p>\n<p class=\"MsoListParagraphCxSpMiddle\" style=\"mso-add-space: auto; text-indent: -.25in; line-height: 115%; mso-list: l0 level1 lfo1; tab-stops: 187.5pt; margin: 0in 0in .0001pt 39.0pt;\"><!-- [if !supportLists]--><span style=\"mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;\"><span style=\"mso-list: Ignore;\">3.<span style=\"font: 7.0pt 'Times New Roman';\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <\/span><\/span><\/span><!--[endif]-->Name of the child must match birth certificate or another official document provided<\/p>\n<p class=\"MsoListParagraphCxSpMiddle\" style=\"mso-add-space: auto; text-indent: -.25in; line-height: 115%; mso-list: l0 level1 lfo1; tab-stops: 187.5pt; margin: 0in 0in .0001pt 39.0pt;\"><!-- [if !supportLists]--><span style=\"mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;\"><span style=\"mso-list: Ignore;\">4.<span style=\"font: 7.0pt 'Times New Roman';\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <\/span><\/span><\/span><!--[endif]-->One enrolment form required per child<\/p>\n<p class=\"MsoListParagraphCxSpMiddle\" style=\"mso-add-space: auto; text-indent: -.25in; line-height: 115%; mso-list: l0 level1 lfo1; tab-stops: 187.5pt; margin: 0in 0in .0001pt 39.0pt;\"><!-- [if !supportLists]--><span style=\"mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;\"><span style=\"mso-list: Ignore;\">5.<span style=\"font: 7.0pt 'Times New Roman';\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <\/span><\/span><\/span><!--[endif]-->Form to be completed in print (CAPITAL LETTERS)<\/p>\n<p class=\"MsoListParagraphCxSpMiddle\" style=\"mso-add-space: auto; text-indent: -.25in; line-height: 115%; mso-list: l0 level1 lfo1; tab-stops: 187.5pt; margin: 0in 0in .0001pt 39.0pt;\"><!-- [if !supportLists]--><span style=\"mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;\"><span style=\"mso-list: Ignore;\">6.<span style=\"font: 7.0pt 'Times New Roman';\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <\/span><\/span><\/span><!--[endif]-->Indemnity form must be completed and handed in with the application form.<\/p>\n<p class=\"MsoListParagraphCxSpLast\" style=\"mso-add-space: auto; text-indent: -.25in; line-height: 115%; mso-list: l0 level1 lfo1; tab-stops: 187.5pt; margin: 0in 0in .0001pt 39.0pt;\"><!-- [if !supportLists]--><span style=\"font-size: 10.0pt; mso-bidi-font-size: 11.0pt; line-height: 115%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;\"><span style=\"mso-list: Ignore;\">7.<span style=\"font: 7.0pt 'Times New Roman';\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <\/span><\/span><\/span><!--[endif]-->A copy of the child\u2019s clinic card should be also handed in with the application form<span style=\"font-size: 10.0pt; mso-bidi-font-size: 11.0pt; line-height: 115%;\">.<\/span><\/p><\/div><div style=\"clear:both;\"><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields heading html_fields\" id=\"_56395\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><h2 style=\"undefined\" data-original-math-equation=\"\" data-math-equation=\"\" class=\"the_input_element\">Documents to be Uploaded<\/h2><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"grid-system-2 is_grid\" id=\"_43673\"><div class=\"row grid_row\"><div class=\"grid_input_holder col-sm-6\"><div class=\"form_field all_fields  upload-single upload_fields\" data-settings=\"s-upload-file\" id=\"_58963\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Learners Birth Certificate<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"fileinput fileinput-new\" data-provides=\"fileinput\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"input-group\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"the_input_element form-control  aling_left uneditable-input span3 error_message ui-state-default\" data-content=\"Required\" data-secondary-message=\"Invalid file extension\" data-placement=\"bottom\" data-trigger=\"fileinput\" name=\"learners_birth_certificate\"><i class=\"glyphicon glyphicon-file fileinput-exists\"><\/i> <span class=\"fileinput-filename\"><\/span><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"input-group-addon btn-default btn-file postfix ui-state-active\"><span class=\"fa fa-cloud-upload\"><\/span><input type=\"file\" name=\"learners_birth_certificate\" class=\"the_input_element ui-state-default\" style=\"color: rgb(68, 68, 68);\"><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" class=\"input-group-addon btn btn-default fileinput-exists ui-state-active\" data-dismiss=\"fileinput\"><span class=\"fa fa-close\"><\/span><\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"get_file_ext\" style=\"display:none;\">doc\ndocx\nmpg\nmpeg\nmp3\nmp4\nodt\nodp\nods\npdf\nppt\npptx\ntxt\nxls\nxlsx\njpg\njpeg<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder col-sm-6\"><div class=\"form_field all_fields  upload-single upload_fields\" data-settings=\"s-upload-file\" id=\"_78812\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Learners Clinic Card<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"fileinput fileinput-new\" data-provides=\"fileinput\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"input-group\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"the_input_element form-control  aling_left uneditable-input span3 error_message ui-state-default\" data-content=\"Required\" data-secondary-message=\"Invalid file extension\" data-placement=\"bottom\" data-trigger=\"fileinput\" name=\"learners_clinic_card\"><i class=\"glyphicon glyphicon-file fileinput-exists\"><\/i> <span class=\"fileinput-filename\"><\/span><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"input-group-addon btn-default btn-file postfix ui-state-active\"><span class=\"fa fa-cloud-upload\"><\/span><input type=\"file\" name=\"learners_clinic_card\" class=\"the_input_element ui-state-default\" style=\"color: rgb(68, 68, 68);\"><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" class=\"input-group-addon btn btn-default fileinput-exists ui-state-active\" data-dismiss=\"fileinput\"><span class=\"fa fa-close\"><\/span><\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"get_file_ext\" style=\"display:none;\">doc\ndocx\nmpg\nmpeg\nmp3\nmp4\nodt\nodp\nods\npdf\nppt\npptx\ntxt\nxls\nxlsx\n<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572605187568\" data-scale=\"scale(2.8000000000000003)\" data-x=\"15.84375\" data-y=\"11\" style=\"top:11px;left:15.84375px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"field_settings grid\" style=\"display:none\"><div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><div class=\"grid-system-2 is_grid\" id=\"_67736\" style=\"position: relative; left: 0px; top: 0px;\"><div class=\"row grid_row\"><div class=\"grid_input_holder col-sm-6\"><div class=\"form_field all_fields  upload-single upload_fields\" data-settings=\"s-upload-file\" id=\"_84959\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Father\u2019s ID Document<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"fileinput fileinput-new\" data-provides=\"fileinput\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"input-group\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"the_input_element form-control  aling_left uneditable-input span3 error_message ui-state-default\" data-content=\"Required\" data-secondary-message=\"Invalid file extension\" data-placement=\"bottom\" data-trigger=\"fileinput\" name=\"father\u2019s_id_document\"><i class=\"glyphicon glyphicon-file fileinput-exists\"><\/i> <span class=\"fileinput-filename\"><\/span><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"input-group-addon btn-default btn-file postfix ui-state-active\"><span class=\"fa fa-cloud-upload\"><\/span><input type=\"file\" name=\"father\u2019s_id_document\" class=\"the_input_element ui-state-default\" style=\"color: rgb(68, 68, 68);\"><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" class=\"input-group-addon btn btn-default fileinput-exists ui-state-active\" data-dismiss=\"fileinput\"><span class=\"fa fa-close\"><\/span><\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"get_file_ext\" style=\"display:none;\">doc\ndocx\nmpg\nmpeg\nmp3\nmp4\nodt\nodp\nods\npdf\nppt\npptx\ntxt\nxls\nxlsx\njpg\njpeg\n<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder col-sm-6\"><div class=\"form_field all_fields  upload-single upload_fields\" data-settings=\"s-upload-file\" id=\"_43584\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Mother\u2019s ID Document<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"fileinput fileinput-new\" data-provides=\"fileinput\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"input-group\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"the_input_element form-control  aling_left uneditable-input span3 error_message ui-state-default\" data-content=\"Required\" data-secondary-message=\"Invalid file extension\" data-placement=\"bottom\" data-trigger=\"fileinput\" name=\"mother\u2019s_id_document\"><i class=\"glyphicon glyphicon-file fileinput-exists\"><\/i> <span class=\"fileinput-filename\"><\/span><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"input-group-addon btn-default btn-file postfix ui-state-active\"><span class=\"fa fa-cloud-upload\"><\/span><input type=\"file\" name=\"mother\u2019s_id_document\" class=\"the_input_element ui-state-default\" style=\"color: rgb(68, 68, 68);\"><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" class=\"input-group-addon btn btn-default fileinput-exists ui-state-active\" data-dismiss=\"fileinput\"><span class=\"fa fa-close\"><\/span><\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"get_file_ext\" style=\"display:none;\">doc\ndocx\nmpg\nmpeg\nmp3\nmp4\nodt\nodp\nods\npdf\nppt\npptx\ntxt\nxls\nxlsx\n<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572605187568\" data-scale=\"scale(2.8000000000000003)\" data-x=\"15.84375\" data-y=\"11\" style=\"top:11px;left:15.84375px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"field_settings grid\" style=\"display:none\"><div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><div class=\"grid-system-2 is_grid\" id=\"_81579\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row grid_row\"><div class=\"grid_input_holder col-sm-6\"><div class=\"form_field all_fields  upload-single upload_fields\" data-settings=\"s-upload-file\" id=\"_14098\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Guardian\u2019s ID Document<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"fileinput fileinput-new\" data-provides=\"fileinput\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"input-group\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"the_input_element form-control  aling_left uneditable-input span3 error_message ui-state-default\" data-content=\"Required\" data-secondary-message=\"Invalid file extension\" data-placement=\"bottom\" data-trigger=\"fileinput\" name=\"guardian\u2019s_id_document\"><i class=\"glyphicon glyphicon-file fileinput-exists\"><\/i> <span class=\"fileinput-filename\"><\/span><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"input-group-addon btn-default btn-file postfix ui-state-active\"><span class=\"fa fa-cloud-upload\"><\/span><input type=\"file\" name=\"guardian\u2019s_id_document\" class=\"the_input_element ui-state-default\" style=\"color: rgb(68, 68, 68);\"><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" class=\"input-group-addon btn btn-default fileinput-exists ui-state-active\" data-dismiss=\"fileinput\"><span class=\"fa fa-close\"><\/span><\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"get_file_ext\" style=\"display:none;\">doc\ndocx\nmpg\nmpeg\nmp3\nmp4\nodt\nodp\nods\npdf\nppt\npptx\ntxt\nxls\nxlsx\njpg\njpeg<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder col-sm-6\"><div class=\"form_field all_fields  upload-single upload_fields\" data-settings=\"s-upload-file\" id=\"_8916\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Any Other Document<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"fileinput fileinput-new\" data-provides=\"fileinput\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"input-group\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"the_input_element form-control  aling_left uneditable-input span3 error_message ui-state-default\" data-content=\"Required\" data-secondary-message=\"Invalid file extension\" data-placement=\"bottom\" data-trigger=\"fileinput\" name=\"any_other_document\"><i class=\"glyphicon glyphicon-file fileinput-exists\"><\/i> <span class=\"fileinput-filename\"><\/span><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"input-group-addon btn-default btn-file postfix ui-state-active\"><span class=\"fa fa-cloud-upload\"><\/span><input type=\"file\" name=\"any_other_document\" class=\"the_input_element ui-state-default\" style=\"color: rgb(68, 68, 68);\"><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" class=\"input-group-addon btn btn-default fileinput-exists ui-state-active\" data-dismiss=\"fileinput\"><span class=\"fa fa-close\"><\/span><\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"get_file_ext\" style=\"display:none;\">doc\ndocx\nmpg\nmpeg\nmp3\nmp4\nodt\nodp\nods\npdf\nppt\npptx\ntxt\nxls\nxlsx\njpg\njpeg\n<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572605187568\" data-scale=\"scale(2.8000000000000003)\" data-x=\"15.84375\" data-y=\"11\" style=\"top:11px;left:15.84375px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"field_settings grid\" style=\"display:none\"><div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><div class=\"grid-system-2 nex_prev_steps is_grid\" style=\"\" id=\"_36966\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row grid_row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"grid_input_holder col-xs-6\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"form_field all_fields submit-button button_fields common_fields preset_fields special_fields selection_fields\" id=\"_20042\" style=\"position: relative; top: 0px; left: 0px; z-index: 100;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12\" id=\"field_container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12 input_container align_left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <button class=\"svg_ready the_input_element btn btn-default prev-step ui-state-default\">Back<\/button>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field_settings\" style=\"display:none\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"grid_input_holder col-xs-6\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"form_field all_fields submit-button button_fields common_fields preset_fields special_fields selection_fields\" id=\"_10574\" style=\"position: relative; top: 0px; left: 0px; z-index: 100;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12\" id=\"field_container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12 input_container align_right\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <button class=\"svg_ready the_input_element btn btn-default nex-step ui-state-default\">Next<\/button>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field_settings\" style=\"display:none\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"field_settings grid\" style=\"display: none;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div><div class=\"custom-fields step nf_multi_step_6 is_grid\" id=\"_20075\" data-step-name=\"HEALTH QUESTIONNAIRE\" data-step-num=\"6\" style=\"position: relative; left: 0px; top: 0px; display: none;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"form_field all_fields heading html_fields\" id=\"_53377\" style=\"position: relative; left: 0px; top: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><h2 style=\"undefined\" data-original-math-equation=\"\" data-math-equation=\"\" class=\"the_input_element style_bold\">HEALTH QUESTIONNAIRE<\/h2><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields  text_only\" data-settings=\"s-text\" id=\"_3769\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Full Name and Surname of child:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"full_name_and_surname_of_child:\" class=\"form-control error_message the_input_element  aling_left ui-state-default text_only\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"Only text are allowed\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"140\" data-length=\"140\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"grid-system-2 is_grid\" id=\"_97180\"><div class=\"row grid_row\"><div class=\"grid_input_holder col-sm-2\"><div class=\"form_field all_fields  select common_fields selection_fields\" data-settings=\"s-select\" id=\"_18560\" style=\"position: relative; left: 0px; top: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Gender:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><select name=\"gender:\" class=\"the_input_element error_message text pre-format form-control  aling_left ui-state-default\" data-content=\"Required\" data-default-selected-value=\"0\" style=\"color: rgb(68, 68, 68);\"><option value=\"0\" selected=\"selected\">--- Select ---<\/option><option value=\"Male\">Male<\/option><option value=\"Female\">Female<\/option><\/select><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder col-sm-10\"><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_29880\" style=\"position: relative; left: 0px; top: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">General Health Condition of the child:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"general_health_condition_of_the_child:\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"160\" data-length=\"160\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"field_settings grid\" style=\"display:none\"><div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><div class=\"form_field all_fields  check-group common_fields selection_fields radio-group\" data-settings=\"s-checks\" id=\"_30378\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">What infectious diseases has your child had?<\/span><br><small class=\"sub-text style_italic\">Please tick where applicable<\/small><\/label><\/div><div class=\"input_holder radio-group\"><div class=\"col-sm-12 the-radios input_container error_message\" id=\"the-radios\" data-checked-color=\"alert-success\" data-checked-class=\"fa-check\" data-unchecked-class=\"\" data-placement=\"bottom\" data-content=\"Required\" title=\"\"><div class=\"input-inner\"><label class=\"checkbox-inline  radio-inline\" for=\"what_infectious_diseases_has_your_child_had_chicken_pox\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"what_infectious_diseases_has_your_child_had[]\" id=\"what_infectious_diseases_has_your_child_had_chicken_pox\" value=\"Chicken Pox\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"fa ui-state-default\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">Chicken Pox<\/span><\/span><\/label><label class=\"checkbox-inline  radio-inline\" for=\"what_infectious_diseases_has_your_child_had_mumps\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"what_infectious_diseases_has_your_child_had[]\" id=\"what_infectious_diseases_has_your_child_had_mumps\" value=\"Mumps\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"fa ui-state-default\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">Mumps<\/span><\/span><\/label><label class=\"checkbox-inline  radio-inline\" for=\"what_infectious_diseases_has_your_child_had_whooping_cough\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"what_infectious_diseases_has_your_child_had[]\" id=\"what_infectious_diseases_has_your_child_had_whooping_cough\" value=\"Whooping Cough\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"fa ui-state-default\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">Whooping Cough<\/span><\/span><\/label><label class=\"checkbox-inline  radio-inline\" for=\"what_infectious_diseases_has_your_child_had_measles\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"what_infectious_diseases_has_your_child_had[]\" id=\"what_infectious_diseases_has_your_child_had_measles\" value=\"Measles\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"fa ui-state-default\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">Measles<\/span><\/span><\/label><label class=\"checkbox-inline  radio-inline\" for=\"what_infectious_diseases_has_your_child_had_german\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"what_infectious_diseases_has_your_child_had[]\" id=\"what_infectious_diseases_has_your_child_had_german\" value=\"German\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"fa ui-state-default\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">German<\/span><\/span><\/label><label class=\"checkbox-inline  radio-inline\" for=\"what_infectious_diseases_has_your_child_had_measles\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"what_infectious_diseases_has_your_child_had[]\" id=\"what_infectious_diseases_has_your_child_had_measles\" value=\"Measles\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"fa ui-state-default\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">Measles<\/span><\/span><\/label><label class=\"checkbox-inline  radio-inline\" for=\"what_infectious_diseases_has_your_child_had_encephalitis\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"what_infectious_diseases_has_your_child_had[]\" id=\"what_infectious_diseases_has_your_child_had_encephalitis\" value=\"Encephalitis\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"fa ui-state-default\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">Encephalitis<\/span><\/span><\/label><label class=\"checkbox-inline  radio-inline\" for=\"what_infectious_diseases_has_your_child_had_meningitis\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"what_infectious_diseases_has_your_child_had[]\" id=\"what_infectious_diseases_has_your_child_had_meningitis\" value=\"Meningitis\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"fa ui-state-default\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">Meningitis<\/span><\/span><\/label><label class=\"checkbox-inline  radio-inline\" for=\"what_infectious_diseases_has_your_child_had_other\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"what_infectious_diseases_has_your_child_had[]\" id=\"what_infectious_diseases_has_your_child_had_other\" value=\"Other\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"fa ui-state-default\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">Other<\/span><\/span><\/label><\/div><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  check-group common_fields selection_fields radio-group\" data-settings=\"s-checks\" id=\"_95725\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Is your child\u2019s immunization up to date? <\/span><br><small class=\"sub-text style_italic\">Please tick immunization already obtained<\/small><\/label><\/div><div class=\"input_holder radio-group\"><div class=\"col-sm-12 the-radios input_container error_message\" id=\"the-radios\" data-checked-color=\"alert-success\" data-checked-class=\"fa-check\" data-unchecked-class=\"\" data-placement=\"bottom\" data-content=\"Required\" title=\"\"><div class=\"input-inner\"><label class=\"checkbox-inline  radio-inline\" for=\"is_your_child\u2019s_immunization_up_to_date__tuberculosis_bcg\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"is_your_child\u2019s_immunization_up_to_date_[]\" id=\"is_your_child\u2019s_immunization_up_to_date__tuberculosis_bcg\" value=\"Tuberculosis (BCG)\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"fa ui-state-default\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">Tuberculosis (BCG)<\/span><\/span><\/label><label class=\"checkbox-inline  radio-inline\" for=\"is_your_child\u2019s_immunization_up_to_date__polio\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"is_your_child\u2019s_immunization_up_to_date_[]\" id=\"is_your_child\u2019s_immunization_up_to_date__polio\" value=\"Polio\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"fa ui-state-default\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">Polio<\/span><\/span><\/label><label class=\"checkbox-inline  radio-inline\" for=\"is_your_child\u2019s_immunization_up_to_date__diphtheria_tetanus____whooping_cough\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"is_your_child\u2019s_immunization_up_to_date_[]\" id=\"is_your_child\u2019s_immunization_up_to_date__diphtheria_tetanus____whooping_cough\" value=\"Diphtheria, Tetanus  &amp;  Whooping cough\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"fa ui-state-default\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">Diphtheria, Tetanus  &amp;  Whooping cough<\/span><\/span><\/label><label class=\"checkbox-inline  radio-inline\" for=\"is_your_child\u2019s_immunization_up_to_date__measles\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"is_your_child\u2019s_immunization_up_to_date_[]\" id=\"is_your_child\u2019s_immunization_up_to_date__measles\" value=\"Measles\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"fa ui-state-default\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">Measles<\/span><\/span><\/label><\/div><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572605947146\" data-scale=\"scale(2.8000000000000003)\" data-x=\"17.578125\" data-y=\"14\" style=\"top:14px;left:17.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_75393\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Has your child had any serious operations or accidents?<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"has_your_child_had_any_serious_operations_or_accidents\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"200\" data-length=\"200\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_50314\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Has your child a history of epilepsy or any other convulsions?<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"has_your_child_a_history_of_epilepsy_or_any_other_convulsions\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"100\" data-length=\"100\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572606101396\" data-scale=\"scale(2.8000000000000003)\" data-x=\"14.578125\" data-y=\"13\" style=\"top:13px;left:14.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_66765\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Has your child a history of ear infections, grommets etc?<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"has_your_child_a_history_of_ear_infections_grommets_etc\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"100\" data-length=\"100\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572606101396\" data-scale=\"scale(2.8000000000000003)\" data-x=\"14.578125\" data-y=\"13\" style=\"top:13px;left:14.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606118595\" data-scale=\"scale(2.8000000000000003)\" data-x=\"16.578125\" data-y=\"15\" style=\"top:15px;left:16.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_26793\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Has your child any allergies? If yes please provide details:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"has_your_child_any_allergies_if_yes_please_provide_details:\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"200\" data-length=\"200\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572606101396\" data-scale=\"scale(2.8000000000000003)\" data-x=\"14.578125\" data-y=\"13\" style=\"top:13px;left:14.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606118595\" data-scale=\"scale(2.8000000000000003)\" data-x=\"16.578125\" data-y=\"15\" style=\"top:15px;left:16.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606137263\" data-scale=\"scale(2.8000000000000003)\" data-x=\"17.578125\" data-y=\"14\" style=\"top:14px;left:17.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_29464\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Please provide any details of habits or difficulties that your child may have (e.g. nail biting, thumb sucking, bedwetting, night terrors, etc.)<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"please_provide_any_details_of_habits_or_difficulties_that_your_child_may_have_eg_nail_biting_thumb_sucking_bedwetting_night_terrors_etc\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"200\" data-length=\"200\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572606101396\" data-scale=\"scale(2.8000000000000003)\" data-x=\"14.578125\" data-y=\"13\" style=\"top:13px;left:14.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606118595\" data-scale=\"scale(2.8000000000000003)\" data-x=\"16.578125\" data-y=\"15\" style=\"top:15px;left:16.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606137263\" data-scale=\"scale(2.8000000000000003)\" data-x=\"17.578125\" data-y=\"14\" style=\"top:14px;left:17.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_42715\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Are there any other health problems that the teacher should be made aware of?<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"are_there_any_other_health_problems_that_the_teacher_should_be_made_aware_of\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"200\" data-length=\"200\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572606101396\" data-scale=\"scale(2.8000000000000003)\" data-x=\"14.578125\" data-y=\"13\" style=\"top:13px;left:14.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606118595\" data-scale=\"scale(2.8000000000000003)\" data-x=\"16.578125\" data-y=\"15\" style=\"top:15px;left:16.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606137263\" data-scale=\"scale(2.8000000000000003)\" data-x=\"17.578125\" data-y=\"14\" style=\"top:14px;left:17.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606166189\" data-scale=\"scale(2.8000000000000003)\" data-x=\"19.578125\" data-y=\"13\" style=\"top:13px;left:19.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_96044\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">How would you describe your child\u2019s behavior?<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"how_would_you_describe_your_child\u2019s_behavior\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"200\" data-length=\"200\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572606101396\" data-scale=\"scale(2.8000000000000003)\" data-x=\"14.578125\" data-y=\"13\" style=\"top:13px;left:14.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606118595\" data-scale=\"scale(2.8000000000000003)\" data-x=\"16.578125\" data-y=\"15\" style=\"top:15px;left:16.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606137263\" data-scale=\"scale(2.8000000000000003)\" data-x=\"17.578125\" data-y=\"14\" style=\"top:14px;left:17.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606166189\" data-scale=\"scale(2.8000000000000003)\" data-x=\"19.578125\" data-y=\"13\" style=\"top:13px;left:19.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606199755\" data-scale=\"scale(2.8000000000000003)\" data-x=\"15.578125\" data-y=\"10\" style=\"top:10px;left:15.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606208125\" data-scale=\"scale(2.8000000000000003)\" data-x=\"14.578125\" data-y=\"10\" style=\"top:10px;left:14.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_41696\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">What times does your child normally fall off to sleep at night? <\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"what_times_does_your_child_normally_fall_off_to_sleep_at_night_\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"60\" data-length=\"60\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572606101396\" data-scale=\"scale(2.8000000000000003)\" data-x=\"14.578125\" data-y=\"13\" style=\"top:13px;left:14.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606118595\" data-scale=\"scale(2.8000000000000003)\" data-x=\"16.578125\" data-y=\"15\" style=\"top:15px;left:16.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606137263\" data-scale=\"scale(2.8000000000000003)\" data-x=\"17.578125\" data-y=\"14\" style=\"top:14px;left:17.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606166189\" data-scale=\"scale(2.8000000000000003)\" data-x=\"19.578125\" data-y=\"13\" style=\"top:13px;left:19.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606199755\" data-scale=\"scale(2.8000000000000003)\" data-x=\"15.578125\" data-y=\"10\" style=\"top:10px;left:15.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606208125\" data-scale=\"scale(2.8000000000000003)\" data-x=\"14.578125\" data-y=\"10\" style=\"top:10px;left:14.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606233546\" data-scale=\"scale(2.8000000000000003)\" data-x=\"15.578125\" data-y=\"10\" style=\"top:10px;left:15.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields divider html_fields\" id=\"_78808\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><hr class=\"the_input_element ui-state-default\"><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields  has_prefix_icon required text_only\" data-settings=\"s-text\" id=\"_87261\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Name of family doctor:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix\"><span class=\"fa fa-user\"><\/span><\/span><input type=\"text\" name=\"name_of_family_doctor:\" class=\"form-control error_message the_input_element  aling_left ui-state-default required text_only\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"Only text are allowed\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"100\" data-length=\"100\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572606101396\" data-scale=\"scale(2.8000000000000003)\" data-x=\"14.578125\" data-y=\"13\" style=\"top:13px;left:14.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606118595\" data-scale=\"scale(2.8000000000000003)\" data-x=\"16.578125\" data-y=\"15\" style=\"top:15px;left:16.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606137263\" data-scale=\"scale(2.8000000000000003)\" data-x=\"17.578125\" data-y=\"14\" style=\"top:14px;left:17.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_5767\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Address of doctor:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"address_of_doctor:\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"200\" data-length=\"200\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572606101396\" data-scale=\"scale(2.8000000000000003)\" data-x=\"14.578125\" data-y=\"13\" style=\"top:13px;left:14.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606118595\" data-scale=\"scale(2.8000000000000003)\" data-x=\"16.578125\" data-y=\"15\" style=\"top:15px;left:16.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606137263\" data-scale=\"scale(2.8000000000000003)\" data-x=\"17.578125\" data-y=\"14\" style=\"top:14px;left:17.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606166189\" data-scale=\"scale(2.8000000000000003)\" data-x=\"19.578125\" data-y=\"13\" style=\"top:13px;left:19.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606199755\" data-scale=\"scale(2.8000000000000003)\" data-x=\"15.578125\" data-y=\"10\" style=\"top:10px;left:15.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606208125\" data-scale=\"scale(2.8000000000000003)\" data-x=\"14.578125\" data-y=\"10\" style=\"top:10px;left:14.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"grid-system-2 is_grid\" id=\"_60383\"><div class=\"row grid_row\"><div class=\"grid_input_holder col-sm-6\"><div class=\"form_field all_fields phone_number phone_number preset_fields\" data-settings=\"s-text\" id=\"_96836\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Contact number of doctor: (W) <\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix  ui-state-active\"><span class=\"fa fa-phone\"><\/span><\/span><input type=\"text\" name=\"contact_number_of_doctor:_w_\" class=\"error_message phone_number form-control the_input_element  aling_left ui-state-default\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" data-secondary-message=\"Invalid phone number\" style=\"color: rgb(68, 68, 68);\" maxlength=\"12\" data-length=\"12\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><div class=\"grid_input_holder col-sm-6\"><div class=\"form_field all_fields phone_number phone_number preset_fields\" data-settings=\"s-text\" id=\"_85196\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Contact number of doctor: (C)<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix  ui-state-active\"><span class=\"fa fa-phone\"><\/span><\/span><input type=\"text\" name=\"contact_number_of_doctor:_c\" class=\"error_message phone_number form-control the_input_element  aling_left ui-state-default\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" data-secondary-message=\"Invalid phone number\" style=\"color: rgb(68, 68, 68);\" maxlength=\"12\" data-length=\"12\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572611393803\" data-scale=\"scale(2.8000000000000003)\" data-x=\"20.84375\" data-y=\"8\" style=\"top:8px;left:20.84375px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"field_settings grid\" style=\"display:none\"><div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_92936\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">In case of emergency at school, can a local doctor treat your child? <\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"in_case_of_emergency_at_school_can_a_local_doctor_treat_your_child_\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"60\" data-length=\"60\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_54692\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Name of Medical Aid: <\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"name_of_medical_aid:_\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"100\" data-length=\"100\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields\" data-settings=\"s-text\" id=\"_91557\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Medical aid membership number:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"medical_aid_membership_number:\" class=\"form-control error_message the_input_element  aling_left ui-state-default\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"20\" data-length=\"20\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572611509531\" data-scale=\"scale(2.8000000000000003)\" data-x=\"15.578125\" data-y=\"13\" style=\"top:13px;left:15.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572611526425\" data-scale=\"scale(2.8000000000000003)\" data-x=\"16.578125\" data-y=\"14\" style=\"top:14px;left:16.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields heading html_fields\" id=\"_31873\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><h3 style=\"undefined\" data-original-math-equation=\"\" data-math-equation=\"\" class=\"the_input_element\">For cases of emergency provide an alternate contact detail: <\/h3><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields  has_prefix_icon required text_only\" data-settings=\"s-text\" id=\"_80631\" style=\"position: relative; top: 0px; left: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">*Name of Person:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix\"><span class=\"fa fa-user\"><\/span><\/span><input type=\"text\" name=\"name_of_person:\" class=\"form-control error_message the_input_element  aling_left ui-state-default required text_only\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"Only text are allowed\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"140\" data-length=\"140\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><div class=\"waves-ripple \" data-hold=\"1572606101396\" data-scale=\"scale(2.8000000000000003)\" data-x=\"14.578125\" data-y=\"13\" style=\"top:13px;left:14.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606118595\" data-scale=\"scale(2.8000000000000003)\" data-x=\"16.578125\" data-y=\"15\" style=\"top:15px;left:16.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572606137263\" data-scale=\"scale(2.8000000000000003)\" data-x=\"17.578125\" data-y=\"14\" style=\"top:14px;left:17.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><div class=\"waves-ripple \" data-hold=\"1572614331515\" data-scale=\"scale(2.8000000000000003)\" data-x=\"14.578125\" data-y=\"13\" style=\"top:13px;left:14.578125px;-webkit-transform:scale(2.8000000000000003);-moz-transform:scale(2.8000000000000003);-ms-transform:scale(2.8000000000000003);-o-transform:scale(2.8000000000000003);transform:scale(2.8000000000000003);opacity:1;-webkit-transition-duration:750ms;-moz-transition-duration:750ms;-o-transition-duration:750ms;transition-duration:750ms;-webkit-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-moz-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);-o-transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);transition-timing-function:cubic-bezier(0.250, 0.460, 0.450, 0.940);\"><\/div><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields phone_number phone_number preset_fields required\" data-settings=\"s-text\" id=\"_92961\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">*Contact Details: <\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\"><span class=\"input-group-addon prefix  ui-state-active\"><span class=\"fa fa-phone\"><\/span><\/span><input type=\"text\" name=\"contact_details:_\" class=\"error_message required phone_number form-control the_input_element  aling_left ui-state-default\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" data-secondary-message=\"Invalid phone number\" style=\"color: rgb(68, 68, 68);\" maxlength=\"12\" data-length=\"12\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  text common_fields  text_only\" data-settings=\"s-text\" id=\"_69096\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Relationship to child:<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><input type=\"text\" name=\"relationship_to_child:\" class=\"form-control error_message the_input_element  aling_left ui-state-default text_only\" data-maxlength-color=\"label label-success\" data-maxlength-position=\"bottom\" data-maxlength-show=\"false\" data-default-value=\"\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" data-secondary-message=\"Only text are allowed\" title=\"\" style=\"color: rgb(68, 68, 68);\" maxlength=\"40\" data-length=\"40\"><span class=\"character-counter\" style=\"float: right; font-size: 12px; height: 1px;\"><\/span><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields divider html_fields\" id=\"_29183\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><hr class=\"the_input_element ui-state-default\"><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields html html_fields\" id=\"_63333\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><div class=\"the_input_element ui-state-default\" data-math-equation=\"\" data-original-math-equation=\"\" data-decimal-places=\"0\"><p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; line-height: 150%; tab-stops: 187.5pt;\"><span style=\"mso-bidi-font-size: 14.0pt; line-height: 150%;\">I declare that the information furnished in the above Heath Questionnaire is true and correct: <\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; line-height: 150%; tab-stops: 187.5pt;\"><span style=\"mso-bidi-font-size: 14.0pt; line-height: 150%;\">&nbsp;<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; line-height: 150%; tab-stops: 187.5pt;\"><span style=\"mso-bidi-font-size: 14.0pt; line-height: 150%;\">&nbsp;<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; line-height: 150%; tab-stops: 187.5pt;\"><span style=\"mso-bidi-font-size: 14.0pt; line-height: 150%;\">&nbsp;<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; line-height: 150%; tab-stops: 187.5pt;\"><span style=\"mso-bidi-font-size: 14.0pt; line-height: 150%;\">Signed at __________________________________ this ____ day of ___________________ 20____ <\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; line-height: 150%; tab-stops: 187.5pt;\"><span style=\"mso-bidi-font-size: 14.0pt; line-height: 150%;\">&nbsp;<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; line-height: 150%; tab-stops: 187.5pt;\"><span style=\"mso-bidi-font-size: 14.0pt; line-height: 150%;\">Signature of Father:<span style=\"mso-tab-count: 3;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <\/span>____________________________________<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; line-height: 150%; tab-stops: 187.5pt;\"><span style=\"mso-bidi-font-size: 14.0pt; line-height: 150%;\">Signature of Mother:<span style=\"mso-tab-count: 3;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <\/span>____________________________________<\/span><\/p>\n<p class=\"MsoNormal\" style=\"margin-bottom: .0001pt; line-height: 150%; tab-stops: 187.5pt;\"><span style=\"mso-bidi-font-size: 14.0pt; line-height: 150%;\">Signature of Guardian (if applicable):<span style=\"mso-tab-count: 3;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <\/span>____________________________________<\/span><\/p><\/div><div style=\"clear:both;\"><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  check-group common_fields selection_fields radio-group\" data-settings=\"s-checks\" id=\"_41756\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\"><\/span><\/label><\/div><div class=\"input_holder radio-group\"><div class=\"col-sm-12 the-radios input_container error_message\" id=\"the-radios\" data-checked-color=\"alert-success\" data-checked-class=\"fa-check\" data-unchecked-class=\"\" data-placement=\"bottom\" data-content=\"Required\" title=\"\"><div class=\"input-inner\"><label class=\"checkbox-inline  radio-inline\" for=\"undefined_iwe_declare_that_all_particulars_furnished_by_meus_on_and_attached_to_this_form_are_true_and_correct\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"undefined[]\" id=\"undefined_iwe_declare_that_all_particulars_furnished_by_meus_on_and_attached_to_this_form_are_true_and_correct\" value=\"I\/We declare that all particulars furnished by me\/us on and attached to this form are true and correct.\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"fa ui-state-default\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">I\/We declare that all particulars furnished by me\/us on and attached to this form are true and correct.<\/span><\/span><\/label><\/div><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  date special_fields\" data-settings=\"s-date\" id=\"_18248\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Date<\/span><\/label><\/div><div class=\"col-sm-12  input_container\"><div class=\"input-group\" id=\"datetimepicker\" data-format=\"MM\/DD\/YYYY\" data-language=\"en\"><span class=\"input-group-addon prefix ui-state-active\"><span class=\"fa fa-calendar-o\"><\/span><\/span><input type=\"text\" name=\"date\" class=\"error_message form-control the_input_element  aling_left  ui-state-default\" data-onfocus-color=\"#66AFE9\" data-drop-focus-swadow=\"1\" data-placement=\"bottom\" data-content=\"Required\" title=\"\" style=\"color: rgb(68, 68, 68);\"><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"grid-system-2 nex_prev_steps is_grid\" style=\"\" id=\"_41092\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row grid_row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"grid_input_holder col-xs-6\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"form_field all_fields submit-button button_fields common_fields preset_fields special_fields selection_fields\" id=\"_4850\" style=\"position: relative; top: 0px; left: 0px; z-index: 100;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12\" id=\"field_container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12 input_container align_left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <button class=\"svg_ready the_input_element btn btn-default prev-step ui-state-default\">Back<\/button>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field_settings\" style=\"display:none\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"grid_input_holder col-xs-6\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"form_field all_fields submit-button button_fields common_fields preset_fields special_fields selection_fields\" id=\"_67574\" style=\"position: relative; top: 0px; left: 0px; z-index: 100;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12\" id=\"field_container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12 input_container align_right\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <button class=\"svg_ready the_input_element btn btn-default nex-step ui-state-default\">Next<\/button>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field_settings\" style=\"display:none\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"field_settings grid\" style=\"display: none;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div><div class=\"custom-fields step nf_multi_step_7 is_grid\" id=\"_63085\" data-step-name=\"FEES STRUCTURE:\" data-step-num=\"7\" style=\"display: none;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"form_field all_fields heading html_fields\" id=\"_25149\" style=\"position: relative; left: 0px; top: 0px;\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><h2 style=\"undefined\" data-original-math-equation=\"\" data-math-equation=\"\" class=\"the_input_element style_bold\">FEES STRUCTURE:<\/h2><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields html html_fields\" id=\"_89854\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><div class=\"the_input_element ui-state-default style_bold style_italic style_underline align_center\" data-math-equation=\"\" data-original-math-equation=\"\" data-decimal-places=\"0\" style=\"font-size: 20px;\">(Free of Cost) \n\nDonations are Welcome\n<\/div><div style=\"clear:both;\"><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields  check-group common_fields selection_fields radio-group\" data-settings=\"s-checks\" id=\"_2183\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12  label_container align_let\"><label class=\"nf_title \"><span class=\"the_label style_bold\" style=\"color: rgb(0, 0, 0);\">Payment Method:<\/span><\/label><\/div><div class=\"input_holder radio-group\"><div class=\"col-sm-12 the-radios input_container error_message\" id=\"the-radios\" data-checked-color=\"alert-success\" data-checked-class=\"fa-check\" data-unchecked-class=\"\" data-placement=\"bottom\" data-content=\"Required\" title=\"\"><div class=\"input-inner\"><label class=\"checkbox-inline  radio-inline\" for=\"payment_method:_cash\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"payment_method:[]\" id=\"payment_method:_cash\" value=\"Cash\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"fa ui-state-default\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">Cash<\/span><\/span><\/label><label class=\"checkbox-inline  radio-inline\" for=\"payment_method:_debit\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"payment_method:[]\" id=\"payment_method:_debit\" value=\"Debit\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"fa ui-state-default\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">Debit<\/span><\/span><\/label><label class=\"checkbox-inline  radio-inline\" for=\"payment_method:_internet_bankingeft\" style=\"color: rgb(0, 0, 0);\"><span class=\"has-pretty-child\"><div class=\"clearfix prettycheckbox labelright  blue has-pretty-child\"><input class=\"check the_input_element ui-state-default\" type=\"checkbox\" name=\"payment_method:[]\" id=\"payment_method:_internet_bankingeft\" value=\"Internet Banking\/EFT\" style=\"display: none; color: rgb(68, 68, 68);\"><a class=\"fa ui-state-default\"><\/a><\/div><span class=\"input-label check-label\" style=\"color: rgb(0, 0, 0);\">Internet Banking\/EFT<\/span><\/span><\/label><\/div><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"form_field all_fields html html_fields\" id=\"_84367\"><div class=\"row\"><div class=\"col-sm-12\" id=\"field_container\"><div class=\"row\"><div class=\"col-sm-12 input_container\"><input type=\"hidden\" class=\"set_math_result\" value=\"0\" name=\"math_result\"><div class=\"the_input_element ui-state-default\" data-math-equation=\"\" data-original-math-equation=\"\" data-decimal-places=\"0\">Banking Details:\n\n<em>Name:<\/em>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <em>Shree Pretoria Hindu Seva Samaj<\/em>\n\n<em>Bank:<\/em>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <em>First National Bank<\/em>\n\n<em>Account Number:<\/em>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <em>6223 8050 330<\/em>\n\n<em>Branch:<\/em>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <em>252245<\/em>\n\n<em>Reference:<\/em>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <strong><em>Guj\/Child\u2019s name &amp; surname<\/em><\/strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <em>(very important)<\/em>\n\nProof of payment for electronic transfer must be given to the administrator managing school fees at the SPHSS<\/div><div style=\"clear:both;\"><\/div><\/div><\/div><\/div><div class=\"field_settings\" style=\"display:none\"><div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div><div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div><\/div><\/div><\/div><div class=\"grid-system-2 nex_prev_steps is_grid\" style=\"\" id=\"_93406\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row grid_row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"grid_input_holder col-xs-6\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"form_field all_fields submit-button button_fields common_fields preset_fields special_fields selection_fields\" id=\"_76316\" style=\"position: relative; top: 0px; left: 0px; z-index: 100;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12\" id=\"field_container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12 input_container align_left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <button class=\"svg_ready the_input_element btn btn-default prev-step ui-state-default\">Back<\/button>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field_settings\" style=\"display:none\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"grid_input_holder col-xs-6\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"form_field all_fields submit-button button_fields common_fields preset_fields special_fields selection_fields\" id=\"_72597\" style=\"position: relative; top: 0px; left: 0px; z-index: 100;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12\" id=\"field_container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"row\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"col-sm-12 input_container align_right\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <button class=\"svg_ready the_input_element btn btn-default nex-submit ui-state-default\">Submit<\/button>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"field_settings\" style=\"display:none\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs duplicate_field\" title=\"Duplicate Field\"><i class=\"fa fa-files-o\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"btn btn-default waves-effect waves-light btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <div class=\"field_settings grid\" style=\"display: none;\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"btn btn-default btn-xs edit\" title=\"Edit Field Attributes\"><i class=\"fa fa-edit\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div title=\"Duplicate Field\" class=\"btn btn-default btn-xs duplicate_field\"><i class=\"fa fa-files-o\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"btn btn-default btn-xs delete\" title=\"Delete field\"><i class=\"fa fa-close\"><\/i><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t  <\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t  \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div><div style=\"clear:both;\"><\/div><\/form><\/div><\/div><\/div><\/div><style type=\"text\/css\" class=\"nex-forms-custom-css\"><\/style><\/div><\/div><div class=\"kc-elm kc-css-888151 kc_col-sm-1 kc_column kc_col-sm-1\"><div class=\"kc-col-container\"><\/div><\/div><\/div><\/div><\/section>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"acf":[],"_links":{"self":[{"href":"https:\/\/www.sphss108.co.za\/index.php\/wp-json\/wp\/v2\/pages\/1580"}],"collection":[{"href":"https:\/\/www.sphss108.co.za\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.sphss108.co.za\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.sphss108.co.za\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.sphss108.co.za\/index.php\/wp-json\/wp\/v2\/comments?post=1580"}],"version-history":[{"count":5,"href":"https:\/\/www.sphss108.co.za\/index.php\/wp-json\/wp\/v2\/pages\/1580\/revisions"}],"predecessor-version":[{"id":1624,"href":"https:\/\/www.sphss108.co.za\/index.php\/wp-json\/wp\/v2\/pages\/1580\/revisions\/1624"}],"wp:attachment":[{"href":"https:\/\/www.sphss108.co.za\/index.php\/wp-json\/wp\/v2\/media?parent=1580"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}