{"id":16839,"date":"2020-09-04T21:05:36","date_gmt":"2020-09-04T21:05:36","guid":{"rendered":"https:\/\/www.allfive.org\/?page_id=16839"},"modified":"2023-05-25T12:57:24","modified_gmt":"2023-05-25T19:57:24","slug":"student-application-form","status":"publish","type":"page","link":"https:\/\/www.allfive.org\/es\/student-application-form\/","title":{"rendered":"Formulario de solicitud de estudiante"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\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 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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\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_7' style='display:none'><div id='gf_7' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <p class='gform_description'>Revised 10\/16\/2023 by KBrayton.<\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_7'  action='\/es\/wp-json\/wp\/v2\/pages\/16839#gf_7' data-formid='7' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_page_7_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_7_58\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><br \/><\/div><div id=\"field_7_1\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Child&#039;s Information<\/h3><\/div><fieldset id=\"field_7_2\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><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_7_2'>\n                            \n                            <span id='input_7_2_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.3' id='input_7_2_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_2_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_7_2_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_2.6' id='input_7_2_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_2_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_7_3\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \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_7_3' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_7_3_1_container' >\n                                        <input type='text' name='input_3.1' id='input_7_3_1' value=''    aria-required='true'    \/>\n                                        <label for='input_7_3_1' id='input_7_3_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_7_3_2_container' >\n                                        <input type='text' name='input_3.2' id='input_7_3_2' value=''     aria-required='false'   \/>\n                                        <label for='input_7_3_2' id='input_7_3_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_7_3_3_container' >\n                                    <input type='text' name='input_3.3' id='input_7_3_3' value=''    aria-required='true'    \/>\n                                    <label for='input_7_3_3' id='input_7_3_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_7_3_4_container' >\n                                        <select name='input_3.4' id='input_7_3_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_7_3_4' id='input_7_3_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_7_3_5_container' >\n                                    <input type='text' name='input_3.5' id='input_7_3_5' value=''    aria-required='true'    \/>\n                                    <label for='input_7_3_5' id='input_7_3_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_3.6' id='input_7_3_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_7_5\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Ethnicity<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_5'>\n\t\t\t<div class='gchoice gchoice_7_5_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='American Indian'  id='choice_7_5_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_5_0' id='label_7_5_0' class='gform-field-label gform-field-label--type-inline'>American Indian<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_5_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Alaska Native'  id='choice_7_5_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_5_1' id='label_7_5_1' class='gform-field-label gform-field-label--type-inline'>Alaska Native<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_5_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Black or African American'  id='choice_7_5_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_5_2' id='label_7_5_2' class='gform-field-label gform-field-label--type-inline'>Black or African American<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_5_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Causcasian (Non-Hispanic)'  id='choice_7_5_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_5_3' id='label_7_5_3' class='gform-field-label gform-field-label--type-inline'>Causcasian (Non-Hispanic)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_5_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Hispanic or Latino'  id='choice_7_5_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_5_4' id='label_7_5_4' class='gform-field-label gform-field-label--type-inline'>Hispanic or Latino<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_5_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Native Hawaiian'  id='choice_7_5_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_5_5' id='label_7_5_5' class='gform-field-label gform-field-label--type-inline'>Native Hawaiian<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_5_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Pacific Islander'  id='choice_7_5_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_5_6' id='label_7_5_6' class='gform-field-label gform-field-label--type-inline'>Pacific Islander<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_5_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Asian'  id='choice_7_5_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_5_7' id='label_7_5_7' class='gform-field-label gform-field-label--type-inline'>Asian<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_7_122\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_122'>\n\t\t\t<div class='gchoice gchoice_7_122_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_122' type='radio' value='Female'  id='choice_7_122_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_122_0' id='label_7_122_0' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_122_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_122' type='radio' value='Male'  id='choice_7_122_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_122_1' id='label_7_122_1' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_7_134\" class=\"gfield gfield--type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_134'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_134' id='input_7_134' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div data-fieldId=\"134\" class=\"spacer gfield\" style=\"grid-column: span 9;\" data-groupId=\"47643991\"><\/div><div id=\"field_7_7\" 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_7_7'>Primary Language<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_7_7' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_8\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><br \/><\/div><div id=\"field_7_9\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Family Information<\/h3><\/div><fieldset id=\"field_7_10\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >First Parent&#039;s Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><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_7_10'>\n                            \n                            <span id='input_7_10_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_10.3' id='input_7_10_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_10_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_7_10_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_10.6' id='input_7_10_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_7_10_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_7_11\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >First Parent&#039;s Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \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_7_11' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_7_11_1_container' >\n                                        <input type='text' name='input_11.1' id='input_7_11_1' value=''    aria-required='true'    \/>\n                                        <label for='input_7_11_1' id='input_7_11_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_7_11_2_container' >\n                                        <input type='text' name='input_11.2' id='input_7_11_2' value=''     aria-required='false'   \/>\n                                        <label for='input_7_11_2' id='input_7_11_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_7_11_3_container' >\n                                    <input type='text' name='input_11.3' id='input_7_11_3' value=''    aria-required='true'    \/>\n                                    <label for='input_7_11_3' id='input_7_11_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_7_11_4_container' >\n                                        <select name='input_11.4' id='input_7_11_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_7_11_4' id='input_7_11_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_7_11_5_container' >\n                                    <input type='text' name='input_11.5' id='input_7_11_5' value=''    aria-required='true'    \/>\n                                    <label for='input_7_11_5' id='input_7_11_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_11.6' id='input_7_11_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_7_87\" class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_87'>First Parent&#039;s Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_87' id='input_7_87' type='tel' value='' class='medium'  placeholder='(xxx) xxx-xxxx' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_72\" class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_72'>First Parent&#039;s Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_72' id='input_7_72' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_7_90\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_90'>First Parent&#039;s Occupation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_90' id='input_7_90' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_91\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_91'>First Parent&#039;s Preferred Language<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_91' id='input_7_91' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_92\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Information about the Second Parent<\/h3><\/div><fieldset id=\"field_7_14\" class=\"gfield gfield--type-name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Second Parent&#039;s Name<\/legend><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_7_14'>\n                            \n                            <span id='input_7_14_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_14.3' id='input_7_14_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_14_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_7_14_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_14.6' id='input_7_14_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_7_14_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_7_15\" class=\"gfield gfield--type-address field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Second Parent&#039;s Address<\/legend>    \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_7_15' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_7_15_1_container' >\n                                        <input type='text' name='input_15.1' id='input_7_15_1' value=''    aria-required='false'    \/>\n                                        <label for='input_7_15_1' id='input_7_15_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_7_15_2_container' >\n                                        <input type='text' name='input_15.2' id='input_7_15_2' value=''     aria-required='false'   \/>\n                                        <label for='input_7_15_2' id='input_7_15_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_7_15_3_container' >\n                                    <input type='text' name='input_15.3' id='input_7_15_3' value=''    aria-required='false'    \/>\n                                    <label for='input_7_15_3' id='input_7_15_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_7_15_4_container' >\n                                        <select name='input_15.4' id='input_7_15_4'     aria-required='false'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_7_15_4' id='input_7_15_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_7_15_5_container' >\n                                    <input type='text' name='input_15.5' id='input_7_15_5' value=''    aria-required='false'    \/>\n                                    <label for='input_7_15_5' id='input_7_15_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_15.6' id='input_7_15_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_7_17\" class=\"gfield gfield--type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_17'>Second Parent&#039;s Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_17' id='input_7_17' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_16\" class=\"gfield gfield--type-email field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_16'>Second Parent&#039;s Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_16' id='input_7_16' type='email' value='' class='medium'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_7_93\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_93'>Second Parent&#039;s Occupation<\/label><div class='ginput_container ginput_container_text'><input name='input_93' id='input_7_93' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_94\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_94'>Second Parent&#039;s Preferred Language<\/label><div class='ginput_container ginput_container_text'><input name='input_94' id='input_7_94' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_7_20\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><br \/><\/div><div id=\"field_7_21\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Child&#039;s Background<\/h3><\/div><fieldset id=\"field_7_22\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Child lives with<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_22'>\n\t\t\t<div class='gchoice gchoice_7_22_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='First Parent'  id='choice_7_22_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_22_0' id='label_7_22_0' class='gform-field-label gform-field-label--type-inline'>First Parent<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_22_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Second Parent'  id='choice_7_22_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_22_1' id='label_7_22_1' class='gform-field-label gform-field-label--type-inline'>Second Parent<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_22_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Both Parents'  id='choice_7_22_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_22_2' id='label_7_22_2' class='gform-field-label gform-field-label--type-inline'>Both Parents<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_22_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Guardian'  id='choice_7_22_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_22_3' id='label_7_22_3' class='gform-field-label gform-field-label--type-inline'>Guardian<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_22_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='gf_other_choice'  id='choice_7_22_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_22_4' id='label_7_22_4' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_7_22_other' class='gchoice_other_control' name='input_22_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_7_24\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are there any siblings living in the household?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_24'>\n\t\t\t<div class='gchoice gchoice_7_24_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Yes'  id='choice_7_24_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_24_0' id='label_7_24_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_24_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='No'  id='choice_7_24_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_24_1' id='label_7_24_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_7_97\" class=\"gfield gfield--type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_97'>How many siblings?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_97' id='input_7_97' type='number' step='any' min='1' max='12' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_7_97\" \/><div class='gfield_description instruction ' id='gfield_instruction_7_97'>Please enter a number from <strong>1<\/strong> to <strong>12<\/strong>.<\/div><\/div><\/div><div id=\"field_7_99\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_99'>Sibling 1 Name and Age<\/label><div class='ginput_container ginput_container_text'><input name='input_99' id='input_7_99' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_99\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_99'>First Name, Last Name, Age<\/div><\/div><div id=\"field_7_100\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_100'>Sibling 2 Name and Age<\/label><div class='ginput_container ginput_container_text'><input name='input_100' id='input_7_100' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_100\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_100'>Firstname Lastname, Age<\/div><\/div><div id=\"field_7_101\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_101'>Sibling 3 Name and Age<\/label><div class='ginput_container ginput_container_text'><input name='input_101' id='input_7_101' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_101\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_101'>First Name, Last Name, Age<\/div><\/div><div id=\"field_7_103\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_103'>Sibling 4 Name and Age<\/label><div class='ginput_container ginput_container_text'><input name='input_103' id='input_7_103' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_103\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_103'>First Name, Last Name, Age<\/div><\/div><div id=\"field_7_102\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_102'>Sibling 5 Name and Age<\/label><div class='ginput_container ginput_container_text'><input name='input_102' id='input_7_102' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_102\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_102'>First Name, Last Name, Age<\/div><\/div><div id=\"field_7_104\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_104'>Sibling 6 Name and Age<\/label><div class='ginput_container ginput_container_text'><input name='input_104' id='input_7_104' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_104\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_104'>First Name, Last Name, Age<\/div><\/div><div id=\"field_7_105\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_105'>Sibling 7 Name and Age<\/label><div class='ginput_container ginput_container_text'><input name='input_105' id='input_7_105' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_105\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_105'>First Name, Last Name, Age<\/div><\/div><div id=\"field_7_106\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_106'>Sibling 8 Name and Age<\/label><div class='ginput_container ginput_container_text'><input name='input_106' id='input_7_106' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_106\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_106'>First Name, Last Name, Age<\/div><\/div><div id=\"field_7_107\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_107'>Sibling 9 Name and Age<\/label><div class='ginput_container ginput_container_text'><input name='input_107' id='input_7_107' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_107\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_107'>First Name, Last Name, Age<\/div><\/div><div id=\"field_7_108\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_108'>Sibling 10 Name and Age<\/label><div class='ginput_container ginput_container_text'><input name='input_108' id='input_7_108' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_108\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_108'>First Name, Last Name, Age<\/div><\/div><div id=\"field_7_109\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_109'>Sibling 11 Name and Age<\/label><div class='ginput_container ginput_container_text'><input name='input_109' id='input_7_109' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_109\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_109'>First Name, Last Name, Age<\/div><\/div><div id=\"field_7_110\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_110'>Sibling 12 Name and Age<\/label><div class='ginput_container ginput_container_text'><input name='input_110' id='input_7_110' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_110\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_110'>First Name, Last Name, Age<\/div><\/div><fieldset id=\"field_7_27\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Are there any other adults\/family members in the household?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_27'>\n\t\t\t<div class='gchoice gchoice_7_27_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Yes'  id='choice_7_27_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_27_0' id='label_7_27_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='No'  id='choice_7_27_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_27_1' id='label_7_27_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_7_111\" class=\"gfield gfield--type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_111'>How many other adults\/familiy members live in the household?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_111' id='input_7_111' type='number' step='any' min='1' max='20' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_7_111\" \/><div class='gfield_description instruction ' id='gfield_instruction_7_111'>Please enter a number from <strong>1<\/strong> to <strong>20<\/strong>.<\/div><\/div><\/div><div id=\"field_7_112\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_112'>Adult\/Family Member 1 Name, Age, and Relationship<\/label><div class='ginput_container ginput_container_text'><input name='input_112' id='input_7_112' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_112\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_112'>First Name Last Name, Age, Relationship\n<\/div><\/div><div id=\"field_7_113\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_113'>Adult\/Family Member 2 Name, Age, and Relationship<\/label><div class='ginput_container ginput_container_text'><input name='input_113' id='input_7_113' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_113\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_113'>First Name Last Name, Age, Relationship\n<\/div><\/div><div id=\"field_7_114\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_114'>Adult\/Family Member 3 Name, Age, and Relationship<\/label><div class='ginput_container ginput_container_text'><input name='input_114' id='input_7_114' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_114\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_114'>First Name Last Name, Age, Relationship\n<\/div><\/div><div id=\"field_7_115\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_115'>Adult\/Family Member 4 Name, Age, and Relationship<\/label><div class='ginput_container ginput_container_text'><input name='input_115' id='input_7_115' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_115\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_115'>First Name Last Name, Age, Relationship\n<\/div><\/div><div id=\"field_7_116\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_116'>Adult\/Family Member 5 Name, Age, and Relationship<\/label><div class='ginput_container ginput_container_text'><input name='input_116' id='input_7_116' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_116\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_116'>First Name Last Name, Age, Relationship\n<\/div><\/div><div id=\"field_7_117\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_117'>Adult\/Family Member 6 Name, Age, and Relationship<\/label><div class='ginput_container ginput_container_text'><input name='input_117' id='input_7_117' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_117\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_117'>First Name Last Name, Age, Relationship\n<\/div><\/div><div id=\"field_7_118\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_118'>Adult\/Family Member 7 Name, Age, and Relationship<\/label><div class='ginput_container ginput_container_text'><input name='input_118' id='input_7_118' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_118\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_118'>First Name Last Name, Age, Relationship\n<\/div><\/div><div id=\"field_7_119\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_119'>Adult\/Family Member 8 Name, Age, and Relationship<\/label><div class='ginput_container ginput_container_text'><input name='input_119' id='input_7_119' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_119\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_119'>First Name Last Name, Age, Relationship\n<\/div><\/div><div id=\"field_7_120\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_120'>Adult\/Family Member 9 Name, Age, and Relationship<\/label><div class='ginput_container ginput_container_text'><input name='input_120' id='input_7_120' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_120\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_120'>First Name Last Name, Age, Relationship\n<\/div><\/div><div id=\"field_7_121\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_121'>Adult\/Family Member 10 Name, Age, and Relationship<\/label><div class='ginput_container ginput_container_text'><input name='input_121' id='input_7_121' type='text' value='' class='large'  aria-describedby=\"gfield_description_7_121\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_7_121'>First Name Last Name, Age, Relationship\n<\/div><\/div><div id=\"field_7_66\" class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_66'>Does the child have any previous group experience? If yes, please provide details:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_66' id='input_7_66' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_7_29\" class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_29'>Are there any special health conditions, fears or dislikes you feel we should be aware of?  Please include allergies\/food restrictions. If there are none, then please answer \u201cnone\u201d.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_29' id='input_7_29' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_7_31\" class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_31'>Please share why you are interested in All Five<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_31' id='input_7_31' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_7_32\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><br \/><br \/><\/div><div id=\"field_7_33\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">About You and All Five<\/h3><\/div><fieldset id=\"field_7_34\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >How did you hear about All Five?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_7_34'><div class='gchoice gchoice_7_34_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.1' type='checkbox'  value='Passed by the school'  id='choice_7_34_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_34_1' id='label_7_34_1' class='gform-field-label gform-field-label--type-inline'>Passed by the school<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_7_34_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.2' type='checkbox'  value='Website'  id='choice_7_34_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_34_2' id='label_7_34_2' class='gform-field-label gform-field-label--type-inline'>Website<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_7_34_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.3' type='checkbox'  value='Preschool Fair'  id='choice_7_34_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_34_3' id='label_7_34_3' class='gform-field-label gform-field-label--type-inline'>Preschool Fair<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_7_34_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.4' type='checkbox'  value='Social Media'  id='choice_7_34_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_34_4' id='label_7_34_4' class='gform-field-label gform-field-label--type-inline'>Social Media<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_7_34_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_34.5' type='checkbox'  value='Other'  id='choice_7_34_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_34_5' id='label_7_34_5' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_7_35\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_35'>Did someone refer you to All Five? If yes, please tell us their name. We&#039;d like to send them a big thank you!<\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_7_35' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_7_36\" class=\"gfield gfield--type-time gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Expected Time of Drop Off<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_7_36'>\n                            <input type='number' name='input_36[]' id='input_7_36_1' value=''  min='0' max='12' step='1'  placeholder='HH' aria-required='true'   aria-describedby=\"gfield_description_7_36\"\/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_7_36_1'>Hours<\/label>\n                        <\/div>\n                        <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_36[]' id='input_7_36_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='true'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_7_36_2'>Minutes<\/label>\n                        <\/div>\n                        <div class='gfield_time_ampm ginput_container ginput_container_time below gform-grid-col' >\n                                \n                                <select name='input_36[]' id='input_7_36_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_7_36_3'>AM\/PM<\/label>                                \n                           <\/div>\n                    <\/div><div class='gfield_description' id='gfield_description_7_36'>School is open from 7:30am - 5:30pm<\/div><\/fieldset><fieldset id=\"field_7_37\" class=\"gfield gfield--type-time gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Expected Time of Pick Up<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_7_37'>\n                            <input type='number' name='input_37[]' id='input_7_37_1' value=''  min='0' max='12' step='1'  placeholder='HH' aria-required='true'   aria-describedby=\"gfield_description_7_37\"\/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_7_37_1'>Hours<\/label>\n                        <\/div>\n                        <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_37[]' id='input_7_37_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='true'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_7_37_2'>Minutes<\/label>\n                        <\/div>\n                        <div class='gfield_time_ampm ginput_container ginput_container_time below gform-grid-col' >\n                                \n                                <select name='input_37[]' id='input_7_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_7_37_3'>AM\/PM<\/label>                                \n                           <\/div>\n                    <\/div><div class='gfield_description' id='gfield_description_7_37'>School is open from 7:30am - 5:30pm<\/div><\/fieldset><div id=\"field_7_67\" 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_7_67'>CAPTCHA<\/label><div id='input_7_67' class='ginput_container ginput_recaptcha' data-sitekey='6LdISOAZAAAAAJqC5soB40jiUT4u5gN4RQ9LqjVW'  data-theme='light' data-tabindex='0'  data-badge=''><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_7_39' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_7_2' class='gform_page' data-js='page-field-id-39' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_7_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_7_129\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">2023-24 ALL FIVE PROGRAM FEE FORM<\/h3><div class='gsection_description' id='gfield_description_7_129'>This form must be returned, completed and signed with your application.<\/div><\/div><fieldset id=\"field_7_40\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Please select which Fee Program you will be applying for<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_40'>\n\t\t\t<div class='gchoice gchoice_7_40_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Total Monthly Program Fee'  id='choice_7_40_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_40_0' id='label_7_40_0' class='gform-field-label gform-field-label--type-inline'>Total Monthly Program Fee<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_40_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='SMCOE Subsidy Program Fee'  id='choice_7_40_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_40_1' id='label_7_40_1' class='gform-field-label gform-field-label--type-inline'>SMCOE Subsidy Program Fee<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_7_59\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p><span style=\"font-family: Verdana, Geneva, sans-serif;font-size: 20px\"><strong>Total Monthly Program Fee<\/strong><\/span><\/p>\n    <p style=\"line-height: 1.5\"><span style=\"font-family: Verdana, Geneva, sans-serif\"><span>Families applying under this category will be required to pay a <strong>deposit of $500<\/strong> within 1 week of being notified of&nbsp;<\/span><\/span><span style=\"font-family: Verdana, Geneva, sans-serif\"><span>your child&rsquo;s placement. This will be credited to your account towards your child&rsquo;s last month with All Five. Should&nbsp;<\/span><\/span><span style=\"font-family: Verdana, Geneva, sans-serif\"><span>you decide not to continue with your child&rsquo;s admission once this deposit has been paid, a <strong>$100 administration&nbsp;<\/strong><\/span><\/span><span style=\"font-family: Verdana, Geneva, sans-serif\"><strong>fee<\/strong> will be deducted from your deposit before it is returned to you.<\/span><\/p>\n\n\n<\/div><fieldset id=\"field_7_130\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Fee Program Applying for<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_7_130'>\n\t\t\t<div class='gchoice gchoice_7_130_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_130' type='radio' value='Infant\/Toddler Program'  id='choice_7_130_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_130_0' id='label_7_130_0' class='gform-field-label gform-field-label--type-inline'>Infant\/Toddler Program<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_7_130_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_130' type='radio' value='Preschool Program'  id='choice_7_130_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_7_130_1' id='label_7_130_1' class='gform-field-label gform-field-label--type-inline'>Preschool Program<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_7_43\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield_price gfield_price_7_43 gfield_product_7_43 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' for='input_7_43_1'>Total Infant\/Toddler Monthly Program Fee<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_43.1' value='Total Infant\/Toddler Monthly Program Fee' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_7_43' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_7_43' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_43.2' id='ginput_base_price_7_43' value='$2,750.00' aria-label='Total Infant\/Toddler Monthly Program Fee Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_43.3' value='1' class='ginput_quantity_7_43 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_7_131\" class=\"gfield gfield--type-product gfield--input-type-singleproduct gfield--width-full gfield_price gfield_price_7_131 gfield_product_7_131 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' for='input_7_131_1'>Total Preschool Monthly Program Fee<\/label><div class='ginput_container ginput_container_singleproduct'>\n\t\t\t\t\t<input type='hidden' name='input_131.1' value='Total Preschool Monthly Program Fee' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_7_131' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<label for='ginput_base_price_7_131' class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Price:<\/label>\n\t\t\t\t\t\t<input type='text' readonly class='ginput_product_price gform-text-input-reset' name='input_131.2' id='ginput_base_price_7_131' value='$2,450.00' aria-label='Total Preschool Monthly Program Fee Price'  \/>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_131.3' value='1' class='ginput_quantity_7_131 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><div id=\"field_7_60\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><style>\n .heading {\n  font-family: Verdana, Geneva, sans-serif;\n  font-size: 20px;\n  font-weight: bold;\n }\n .text {\n  font-family: Verdana, Geneva, sans-serif;\n  font-size: 16px;\n  line-height: 1.5;\n }\n<\/style>\n<p class=\"heading\">San Mateo County of Education (SMCOE) Subsidy Program Fee<\/p>\n<p class=\"text\">To qualify under the SMCOE Subsidy Program, a family must provide documentation and verification (when asked) of at least one each of the following categories:<\/p>\n\n    <table style=\"width: 100%;border-collapse: collapse;border: none;padding: 5px\">\n        <tbody>\n            <tr>\n                <td style=\"width: 50%;border: none;padding: 5px\"><strong>Eligibility:<\/strong><\/td>\n                <td style=\"width: 50%;border: none;padding: 5px\"><strong>Need:<\/strong><\/td>\n            <\/tr>\n            <tr>\n                <td style=\"width: 50%;border: none;padding: 5px\">1. Protective Services<\/td>\n                <td style=\"width: 50%;border: none;padding: 5px\">1. Protective Services<\/td>\n            <\/tr>\n            <tr>\n                <td style=\"width: 50%;border: none;padding: 5px\">2. Current Aid Recipient<\/td>\n                <td style=\"width: 50%;border: none;padding: 5px\">2. Employed\/Seeking Employment<\/td>\n            <\/tr>\n            <tr>\n                <td style=\"width: 50%;border: none;padding: 5px\">3. Income eligible (See table below)<\/td>\n                <td style=\"width: 50%;border: none;padding: 5px\">3. Education\/Training<\/td>\n            <\/tr>\n            <tr>\n                <td style=\"width: 50%;border: none;padding: 5px\">4. Homeless<\/td>\n                <td style=\"width: 50%;border: none;padding: 5px\">4. Seeking Permanent Housing<\/td>\n            <\/tr>\n            <tr>\n                <td style=\"width: 50%;border: none;padding: 5px\"><br><\/td>\n                <td style=\"width: 50%;border: none;padding: 5px\">5. Parent\/Guardian Incapacitation<\/td>\n            <\/tr>\n        <\/tbody>\n    <\/table>\n<p class=\"text\">When a family applies under the SMCOE Subsidy Program, an eligibility ranking is assigned by the California Department of Education, Title V Child Development Division. Priority is identified by family size and gross income, and families are enrolled based on that ranking.<\/p>\n<p class=\"text\">All Five does not set the requirements or fees under the SMCOE Subsidy Program but will work with families to assess their eligibility to participate.<\/p><\/div><div id=\"field_7_126\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Monthly Income (before tax):<\/h3><div class='gsection_description' id='gfield_description_7_126'>Enter the following income values on a <strong>MONTHLY basis<\/strong><\/div><\/div><div id=\"field_7_47\" class=\"gfield gfield--type-number 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_7_47'>Wages or Salary<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_47' id='input_7_47' type='text' step='any' min='0' max='999999' value='$0.00' class='medium'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_7_47\" \/><div class='gfield_description instruction ' id='gfield_instruction_7_47'>Please enter a number from <strong>0<\/strong> to <strong>999999<\/strong>.<\/div><\/div><\/div><div id=\"field_7_123\" class=\"gfield gfield--type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_123'>Public Cash Assistance (CalWORKS\/TANF)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_123' id='input_7_123' type='text' step='any' min='0' max='999999' value='$0.00' class='medium'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_7_123\" \/><div class='gfield_description instruction ' id='gfield_instruction_7_123'>Please enter a number from <strong>0<\/strong> to <strong>999999<\/strong>.<\/div><\/div><\/div><div id=\"field_7_48\" class=\"gfield gfield--type-number 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_7_48'>Bonuses, tips, commissions, royalties<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_48' id='input_7_48' type='text' step='any' min='0' max='999999' value='$0.00' class='medium'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_7_48\" \/><div class='gfield_description instruction ' id='gfield_instruction_7_48'>Please enter a number from <strong>0<\/strong> to <strong>999999<\/strong>.<\/div><\/div><\/div><div id=\"field_7_124\" class=\"gfield gfield--type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_124'>Self Employment Income<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_124' id='input_7_124' type='text' step='any' min='0' max='999999' value='$0.00' class='medium'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_7_124\" \/><div class='gfield_description instruction ' id='gfield_instruction_7_124'>Please enter a number from <strong>0<\/strong> to <strong>999999<\/strong>.<\/div><\/div><\/div><div id=\"field_7_50\" class=\"gfield gfield--type-number 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_7_50'>All Other Income (i.e. gifts, alimony, child support payments)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_50' id='input_7_50' type='text' step='any' min='0' max='999999' value='$0.00' class='medium'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_7_50\" \/><div class='gfield_description instruction ' id='gfield_instruction_7_50'>Please enter a number from <strong>0<\/strong> to <strong>999999<\/strong>.<\/div><\/div><\/div><div id=\"field_7_52\" class=\"gfield gfield--type-number gfield_calculation field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_7_52'>Total Monthly Income<\/label><div class='ginput_container ginput_container_number'><input name='input_52' id='input_7_52' type='text' step='any'   value='' class='medium gform-text-input-reset'  readonly=\"readonly\"    aria-invalid=\"false\" aria-describedby=\"gfield_description_7_52\" \/><\/div><div class='gfield_description' id='gfield_description_7_52'>This field will automatically calculate based on the above total monthly income values.<\/div><\/div><div id=\"field_7_54\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><br \/><\/div><div id=\"field_7_55\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><style>\n  .td-head {\n    border: 1px solid black;\n    width: 13%;\n    text-align: right;\n    vertical-align: middle;\n    padding: 5px;\n  }\n  .td-fee {\n    border: 1px solid black;\n    width: 11%;\n    text-align: center;\n    vertical-align: middle;\n    padding: 5px;\n  }\n  .max-fee {\n    width: 73%;\n    text-align: center;\n    vertical-align: middle;\n  }\n<\/style>\n        <table style=\"width: 100%;font-family: Verdana, Geneva, sans-serif;font-size: 16px;border-collapse: collapse;margin: 0px auto; border: 1px solid black;\">\n\t    <caption style=\"font-weight: bold; font-size: 20px; padding: 5px;\">Monthly Income Fee Structure<\/caption>\n            <tbody>\n                <tr>\n                    <td class=\"td-head\">Family Size<\/td>\n                    <td class=\"td-fee\">1 or 2<\/td>\n                    <td class=\"td-fee\">3<\/td>\n                    <td class=\"td-fee\">4<\/td>\n                    <td class=\"td-fee\">5<\/td>\n                    <td class=\"td-fee\">6<\/td>\n                    <td class=\"td-fee\">7<\/td>\n                    <td class=\"td-fee\">8 or more<\/td>\n                <\/tr>\n                <tr>\n                    <td class=\"td-head\">Infant\/Toddler Program<\/td>\n                    <td class=\"td-fee\">&lt; $6,128<\/td>\n                    <td class=\"td-fee\">&lt; $6,931<\/td>\n                    <td class=\"td-fee\">&lt; $8,025<\/td>\n                    <td class=\"td-fee\">&lt; $9,309<\/td>\n                    <td class=\"td-fee\">&lt; $10,593<\/td>\n                    <td class=\"td-fee\">&lt; $10,834<\/td>\n                    <td class=\"td-fee\">&lt; $11,074<\/td>\n                <\/tr>\n                <tr>\n                    <td class=\"td-head\"><strong><em>Maximum<\/em><\/strong> Monthly Fee<\/td>\n                    <td colspan=\"7\" class=\"max-fee\"><strong>$72<\/strong><\/td>\n                <\/tr>\n            <\/tbody>\n        <\/table>\n<\/div><div id=\"field_7_137\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><style>\n  .td-head {\n    border: 1px solid black;\n    width: 13%;\n    text-align: right;\n    vertical-align: middle;\n    padding: 5px;\n  }\n  .td-fee {\n    border: 1px solid black;\n    width: 11%;\n    text-align: center;\n    vertical-align: middle;\n    padding: 5px;\n  }\n  .max-fee {\n    width: 73%;\n    text-align: center;\n    vertical-align: middle;\n  }\n<\/style>\n        <table style=\"width: 100%;font-family: Verdana, Geneva, sans-serif;font-size: 16px;border-collapse: collapse;margin: 0px auto; border: 1px solid black;\">\n\t    <caption style=\"font-weight: bold; font-size: 20px; padding: 5px;\">Monthly Income Fee Structure<\/caption>\n            <tbody>\n                <tr>\n                    <td class=\"td-head\">Family Size<\/td>\n                    <td class=\"td-fee\">1 or 2<\/td>\n                    <td class=\"td-fee\">3<\/td>\n                    <td class=\"td-fee\">4<\/td>\n                    <td class=\"td-fee\">5<\/td>\n                    <td class=\"td-fee\">6<\/td>\n                    <td class=\"td-fee\">7<\/td>\n                    <td class=\"td-fee\">8 or more<\/td>\n                <\/tr>\n                <tr>\n                    <td class=\"td-head\">Preschool Program<\/td>\n                    <td class=\"td-fee\">&lt; $7,209<\/td>\n                    <td class=\"td-fee\">&lt; $8,154<\/td>\n                    <td class=\"td-fee\">&lt; $9,441<\/td>\n                    <td class=\"td-fee\">&lt; $10,952<\/td>\n                    <td class=\"td-fee\">&lt; $12,462<\/td>\n                    <td class=\"td-fee\">&lt; $12,745<\/td>\n                    <td class=\"td-fee\">&lt; $13,029<\/td>\n                <\/tr>\n                <tr>\n                    <td class=\"td-head\"><strong><em>Maximum<\/em><\/strong> Monthly Fee<\/td>\n                    <td colspan=\"7\" class=\"max-fee\"><strong>$72<\/strong><\/td>\n                <\/tr>\n            <\/tbody>\n        <\/table>\n<\/div><div id=\"field_7_136\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >    <br \/>\n    <ul>\n        <li style=\"line-height: 2\">This chart indicates the <strong>maximum<\/strong> monthly income and fees.<\/li>\n        <li style=\"line-height: 2\">Your <strong>actual<\/strong> monthly fee will be determined once your enrollment has been 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