{"id":3647,"date":"2021-07-27T19:24:51","date_gmt":"2021-07-27T19:24:51","guid":{"rendered":"https:\/\/littlemedsch.wpengine.com\/regionofwaterloo\/?page_id=3647"},"modified":"2025-01-28T19:55:13","modified_gmt":"2025-01-28T19:55:13","slug":"birthday-party-request-form","status":"publish","type":"page","link":"https:\/\/littlemedicalschool.com\/regionofwaterloo\/birthday-party-request-form\/","title":{"rendered":"Birthday Party Request Form"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_19' ><form method='post' enctype='multipart\/form-data'  id='gform_19'  action='\/regionofwaterloo\/wp-json\/wp\/v2\/pages\/3647' data-formid='19' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_19' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_19_34\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Contact Information<\/h2><\/li><li id=\"field_19_5\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Parent&#039;s Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_19_5'>\n                            \n                            <span id='input_19_5_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.3' id='input_19_5_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_19_5_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_19_5_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.6' id='input_19_5_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_19_5_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_19_7\" class=\"gfield gfield--type-phone gfield--phone-format-standard gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_7'><span class='gform-field-label__text'>Phone Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_7' id='input_19_7' type='tel' value='' class='medium'  placeholder='(999) 999-9999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/li><li id=\"field_19_16\" class=\"gfield gfield--type-email gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_19_16_container'>\n                                <span id='input_19_16_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_16' id='input_19_16' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_19_16' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_19_16_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_16_2' id='input_19_16_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_19_16_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/li><li id=\"field_19_6\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Address of Birthday Party<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_19_6' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_19_6_1_container' >\n                                        <input type='text' name='input_6.1' id='input_19_6_1' value=''    aria-required='true'    \/>\n                                        <label for='input_19_6_1' id='input_19_6_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_19_6_2_container' >\n                                        <input type='text' name='input_6.2' id='input_19_6_2' value=''     aria-required='false'   \/>\n                                        <label for='input_19_6_2' id='input_19_6_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_19_6_3_container' >\n                                    <input type='text' name='input_6.3' id='input_19_6_3' value=''    aria-required='true'    \/>\n                                    <label for='input_19_6_3' id='input_19_6_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_19_6_4_container' >\n                                        <select name='input_6.4' id='input_19_6_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alberta' >Alberta<\/option><option value='British Columbia' >British Columbia<\/option><option value='Manitoba' >Manitoba<\/option><option value='New Brunswick' >New Brunswick<\/option><option value='Newfoundland and Labrador' >Newfoundland and Labrador<\/option><option value='Northwest Territories' >Northwest Territories<\/option><option value='Nova Scotia' >Nova Scotia<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' >Ontario<\/option><option value='Prince Edward Island' >Prince Edward Island<\/option><option value='Quebec' >Quebec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><\/select>\n                                        <label for='input_19_6_4' id='input_19_6_4_label' class='gform-field-label gform-field-label--type-sub '>Province<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_19_6_5_container' >\n                                    <input type='text' name='input_6.5' id='input_19_6_5' value=''    aria-required='true'    \/>\n                                    <label for='input_19_6_5' id='input_19_6_5_label' class='gform-field-label gform-field-label--type-sub '>Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_6.6' id='input_19_6_6' value='CA' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_19_35\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Party Details<\/h2><\/li><li id=\"field_19_36\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_36'><span class='gform-field-label__text'>Preferred Date:<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_19_36'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_36'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_19_36' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_19_36' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_19_36' aria-label='Preferred Date:: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/li><li id=\"field_19_37\" class=\"gfield gfield--type-time field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Preferred Time:<\/span><\/label><div class=\"ginput_container ginput_complex gform-grid-row\"><div class=\"clear-multi\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_19_37'>\n                            <input type='number' name='input_37[]' id='input_19_37_1' value=''  min='0' max='12' step='1'  placeholder='HH' aria-required='false'   \/> <i>:<\/i>\n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_19_37_1'>Hours<\/label>\n                        <\/div>\n                        \n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_37[]' id='input_19_37_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='false'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_19_37_2'>Minutes<\/label>\n                        <\/div>\n                        <div class='gfield_time_ampm ginput_container ginput_container_time above gform-grid-col' >\n                                \n                                <select name='input_37[]' id='input_19_37_3'  >\n                                    <option value='am' >AM<\/option>\n                                    <option value='pm' >PM<\/option>\n                                <\/select>\n                                <label class='gform-field-label gform-field-label--type-sub am_pm_label screen-reader-text' for='input_19_37_3'>AM\/PM<\/label>\n                           <\/div>\n                    <\/div><\/div><\/li><li id=\"field_19_38\" class=\"gfield gfield--type-name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Child&#039;s Name<\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_19_38'>\n                            \n                            <span id='input_19_38_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_38.3' id='input_19_38_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_19_38_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_19_38_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_38.6' id='input_19_38_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_19_38_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_19_10\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_10'><span class='gform-field-label__text'>Child&#039;s Actual Birthday:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_19_10'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_10'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_19_10' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_19_10' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_19_10' aria-label='Child's Actual Birthday:: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/li><li id=\"field_19_11\" class=\"gfield gfield--type-text gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_11'><span class='gform-field-label__text'>Age that child is turning:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_19_11' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_19_19\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_19'><span class='gform-field-label__text'>Child&#039;s Lab Coat Size:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_19' id='input_19_19' class='medium gfield_select'  aria-describedby=\"gfield_description_19_19\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='Small (ages 3-5)' >Small (ages 3-5)<\/option><option value='Medium (ages 6-8)' >Medium (ages 6-8)<\/option><option value='Large (ages 9-12)' >Large (ages 9-12)<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_19_19'>FIT GUIDE: \n\nShoulder to Shoulder:  \nSmall (11'); Medium (12'); Large (14'); \n\nShoulder to Bottom Hem:\nSmall (22'); Medium (22.5'); Large (26.5');\n\nSleeve Length:\nSmall (15'); Medium (17'); Large (18.5');\n\nBottom Hem: \nSmall (16.5'); Medium (18.5'); Large (20.5'). \n<\/div><\/li><li id=\"field_19_39\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_39'><span class='gform-field-label__text'>Number of children attending (including celebrant):<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_39' id='input_19_39' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_19_40\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Party Package<\/h2><\/li><li id=\"field_19_41\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Party Theme:<\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_41'>\n\t\t\t<li class='gchoice gchoice_19_41_0'>\n\t\t\t\t<input name='input_41' type='radio' value='Medical Doctor in Training Birthday Package'  id='choice_19_41_0'    \/>\n\t\t\t\t<label for='choice_19_41_0' id='label_19_41_0' class='gform-field-label gform-field-label--type-inline'>Medical Doctor in Training Birthday Package<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_41_1'>\n\t\t\t\t<input name='input_41' type='radio' value='Veterinarian in Training Birthday Package'  id='choice_19_41_1'    \/>\n\t\t\t\t<label for='choice_19_41_1' id='label_19_41_1' class='gform-field-label gform-field-label--type-inline'>Veterinarian in Training Birthday Package<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_43\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Upgrades and add-ons:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_43'>\n\t\t\t<li class='gchoice gchoice_19_43_0'>\n\t\t\t\t<input name='input_43' type='radio' value='Stethoscope ($12 each)'  id='choice_19_43_0'    \/>\n\t\t\t\t<label for='choice_19_43_0' id='label_19_43_0' class='gform-field-label gform-field-label--type-inline'>Stethoscope ($12 each)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_43_1'>\n\t\t\t\t<input name='input_43' type='radio' value='Little Medical School T-shirts ($10 each)'  id='choice_19_43_1'    \/>\n\t\t\t\t<label for='choice_19_43_1' id='label_19_43_1' class='gform-field-label gform-field-label--type-inline'>Little Medical School T-shirts ($10 each)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_43_2'>\n\t\t\t\t<input name='input_43' type='radio' value='Plush puppy ($10 each)'  id='choice_19_43_2'    \/>\n\t\t\t\t<label for='choice_19_43_2' id='label_19_43_2' class='gform-field-label gform-field-label--type-inline'>Plush puppy ($10 each)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_43_3'>\n\t\t\t\t<input name='input_43' type='radio' value='Plush kitten ($10 each)'  id='choice_19_43_3'    \/>\n\t\t\t\t<label for='choice_19_43_3' id='label_19_43_3' class='gform-field-label gform-field-label--type-inline'>Plush kitten ($10 each)<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_19_43'>Birthday celebrant receieves a special Little Medical School Kit (premium fabric lab coat and hat and stethoscope). Guests will receive a lightweight lab coat and special Little Medical School gift bag. <\/div><\/li><li id=\"field_19_44\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_44'><span class='gform-field-label__text'>Additional Requests and Comments<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_44' id='input_19_44' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_19_46\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Preferred Method of Payment:<\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_19_46'><li class='gchoice gchoice_19_46_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.1' type='checkbox'  value='E-transfer'  id='choice_19_46_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_46_1' id='label_19_46_1' class='gform-field-label gform-field-label--type-inline'>E-transfer<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_19_46_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.2' type='checkbox'  value='Credit Card (+3% handling charge)'  id='choice_19_46_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_19_46_2' id='label_19_46_2' class='gform-field-label gform-field-label--type-inline'>Credit Card (+3% handling charge)<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_45\" class=\"gfield gfield--type-captcha field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_45'><span class='gform-field-label__text'>CAPTCHA<\/span><\/label><div id='input_19_45' class='ginput_container ginput_recaptcha' data-sitekey='6LfK24oUAAAAAEMQu3PwEYW8-2o4u8of0E14EcE5'  data-theme='light' data-tabindex='0'  data-badge=''><\/div><\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_19' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_19' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_19' id='gform_theme_19' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_19' id='gform_style_settings_19' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_19' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='19' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='CAD' value='uMdx1vI1xzCX2qVDo5TUfNjJ4vhn3S380R+X14EHSvrtRaXpW1XeYPgOLjY2p8lR6QcxDk5Lyyo0JCuFAfiUctMtxUOqBzKkAQ\/MDwO8sx6iEzg=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_19' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_19' id='gform_target_page_number_19' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_19' id='gform_source_page_number_19' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":50,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_monsterinsights_skip_tracking":false,"footnotes":""},"class_list":["post-3647","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/littlemedicalschool.com\/regionofwaterloo\/wp-json\/wp\/v2\/pages\/3647","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/littlemedicalschool.com\/regionofwaterloo\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/littlemedicalschool.com\/regionofwaterloo\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/littlemedicalschool.com\/regionofwaterloo\/wp-json\/wp\/v2\/users\/50"}],"replies":[{"embeddable":true,"href":"https:\/\/littlemedicalschool.com\/regionofwaterloo\/wp-json\/wp\/v2\/comments?post=3647"}],"version-history":[{"count":0,"href":"https:\/\/littlemedicalschool.com\/regionofwaterloo\/wp-json\/wp\/v2\/pages\/3647\/revisions"}],"wp:attachment":[{"href":"https:\/\/littlemedicalschool.com\/regionofwaterloo\/wp-json\/wp\/v2\/media?parent=3647"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}