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103 104<link rel="https://api.w.org/" href="https://bouldermountainwarriors.com/wp-json/" /><link rel="alternate" title="JSON" type="application/json" href="https://bouldermountainwarriors.com/wp-json/wp/v2/pages/1220" /><link rel="EditURI" type="application/rsd+xml" title="RSD" href="https://bouldermountainwarriors.com/xmlrpc.php?rsd" /> 105<meta name="generator" content="WordPress 7.1.3" /> 106<link rel="canonical" href="https://bouldermountainwarriors.com/program-registration-2/" /> 107<link rel='shortlink' href='https://bouldermountainwarriors.com/?p=1220' /> 108<style type="text/css" id="simple-css-output">/* Global css */body { color:#000000;}/* Override the Custom settings for links */a { color:#0091ad;}a:focus, a:hover { color: #f4b700;}/* Text Module with border */.text-box-border p { border: 2px solid #f4be16; border-radius:20px; padding:15px;}/* Gold background for sub-headers */.gold-background { background-color: #f4be16; padding: 20px 25px; border: 2px solid #f4be16; border-radius: 20px;}/* Testimonial widget */.fl-testimonials p { font-size:24px; text-align:center;}/* Gravity Forms */.gform_wrapper .description, .gform_wrapper .gfield_description, .gform_wrapper .gsection_description, .gform_wrapper .instruction { font-size: 1em; color:#000000;}.ginput_container.ginput_container_total input.ginput_total { font-size:20px; font-weight:700;}/* small buttons for events on home */.small-button a.fl-button { margin-top:14px; font-weight: 700; font-size: 14px!important; text-align: center; padding: 5px 10px!important;}/* Login Page */.login #nav { font-size: 18px!important; font-weight:700!important;}/* Menu item with background so it looks like a button */li.menu-item.menu-item-type-post_type.menu-item-object-page.menu-item-3669.nav-item { background-color: #f4be16; border: 2px solid #f4be16; border-radius: 10px;}li.menu-item.menu-item-type-post_type.menu-item-object-page.current-menu-item.page_item.page-item-3663.current_page_item.menu-item-3669.nav-item { color: #000!important;}@media (min-width: 992px) { .fl-page-nav-right .fl-page-nav-wrap .navbar-nav li.current-menu-item>a { color: #000!important; } .fl-page-nav-left .fl-page-header-row .col-lg-4, .fl-page-nav-right .fl-page-header-row .col-lg-4 { max-width: 200px; } /* .fl-page-nav-left .fl-page-header-row .col-lg-8, .fl-page-nav-right .fl-page-header-row .col-lg-8 { width: 1000px; max-width: 1000px; } */ .fl-page-nav-right .fl-page-header-row { width: 105%; }}/* End 992px width */@media (max-width: 767px) { /* Attempting menu open on mobile .fl-page-nav-toggle-icon.fl-page-nav-toggle-visible-medium-mobile .fl-page-nav ul.sub-menu li a { display:block!important; }*/} @media only screen and (max-width: 450px) { img.alignright.size-medium.wp-image-1363 { margin-right: 20px; } /* Mobile Menu - active color */ .fl-nav-mobile-offcanvas.fl-responsive-nav-enabled header[class*=" fl-page-nav-toggle-visible-"].fl-page-header .fl-nav-offcanvas-collapse .navbar-nav li>a:hover { color: #000000; } }/*.fl-page-content a { text-decoration: underline;}.fl-page-content .button_custom a { text-decoration: none;} */</style> 109<!-- Jetpack Open Graph Tags --> 110<meta property="og:type" content="article" /> 111<meta property="og:title" content="Program Registration" /> 112<meta property="og:url" content="https://bouldermountainwarriors.com/program-registration-2/" /> 113<meta property="og:description" content="Registration Page" /> 114<meta property="article:published_time" content="2016-03-18T02:37:16+00:00" /> 115<meta property="article:modified_time" content="2026-06-26T18:00:00+00:00" /> 116<meta property="og:site_name" content="Melody Fairchild" /> 117<meta property="og:image" content="https://s0.wp.com/i/blank.jpg" /> 118<meta property="og:image:width" content="200" /> 119<meta property="og:image:height" content="200" /> 120<meta property="og:image:alt" content="" /> 121<meta property="og:locale" content="en_US" /> 122<meta name="twitter:text:title" content="Program Registration" /> 123<meta name="twitter:card" content="summary" /> 124 125<!-- End Jetpack Open Graph Tags --> 126<style id="wp-custom-css"> 127/* Global Font */ 128.h1, .h2, .h3, h1, h2, h3 { 129 margin-top: 10px; 130 margin-bottom: 10px; 131} 132 133a { font-weight:700; 134} 135 136h1 a, h2 a, h3 a, h4 a { font-weight:400; 137} 138.button_custom { 139-webkit-border-radius: 4px; 140-moz-border-radius: 4px; 141color: #000000; 142font-size: 16px;
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173 174<link rel='stylesheet' id='fl-builder-wp-editor-css' href='https://bouldermountainwarriors.com/wp-content/plugins/bb-plugin/css/build/wp-editor.bundle.min.css?ver=2.11.1.2' media='all' /> 175 176</head> 177<body class="wp-singular page-template-default page page-id-1220 wp-theme-bb-theme wp-child-theme-bb-theme-child fl-builder fl-builder-2-11-1-2 fl-theme-1-7-20 fl-no-js dhf-template-beaver-builder-theme dhf-stylesheet-bb-theme-child fl-framework-bootstrap-4 fl-preset-default fl-full-width fl-nav-mobile-offcanvas fl-offcanvas-push-left fl-submenu-indicator fl-submenu-toggle" itemscope="itemscope" itemtype="https://schema.org/WebPage"> 178<a aria-label="Skip to content" class="fl-screen-reader-text" href="#fl-main-content">Skip to content</a><div class="fl-page"> 179 <header class="fl-page-header fl-page-header-fixed fl-page-nav-right fl-page-nav-toggle-icon fl-page-nav-toggle-visible-medium-mobile" role="banner"> 180 <div class="fl-page-header-wrap"> 181 <div class="fl-page-header-container container"> 182 <div class="fl-page-header-row row"> 183 <div class="col-md-12 col-lg-3 fl-page-logo-wrap"> 184 <div class="fl-page-header-logo"> 185 <a href="https://bouldermountainwarriors.com/"><img class="fl-logo-img" loading="false" data-no-lazy="1" itemscope itemtype="https://schema.org/ImageObject" src="https://bouldermountainwarriors.com/wp-content/uploads/2021/06/Mountain-2Warriors-2colors-120.png" data-retina="https://bouldermountainwarriors.com/wp-content/uploads/2021/06/Mountain-2Warriors-2colors-retina-240.png" title="" width="120" data-width="120" height="120" data-height="120" alt="Melody Fairchild" /><meta itemprop="name" content="Melody Fairchild" /></a> 186 </div> 187 </div> 188 <div class="col-md-12 col-lg-9 fl-page-fixed-nav-wrap"> 189 <div class="fl-page-nav-wrap"> 190 <nav class="fl-page-nav fl-nav navbar navbar-default navbar-expand-md" aria-label="Header Menu" role="navigation"> 191 <button type="button" class="navbar-toggle navbar-toggler" data-toggle="collapse" data-target=".fl-page-nav-collapse"> 192 <span><i class="fas fa-bars" aria-hidden="true"></i><span class="sr-only">Menu</span></span> 193 </button> 194 <div class="fl-page-nav-collapse collapse navbar-collapse"> 195 <ul id="menu-main-header" class="nav navbar-nav navbar-right menu fl-theme-menu"><li id="menu-item-1809" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-home menu-item-1809 nav-item"><a href="https://bouldermountainwarriors.com/" class="nav-link">Home</a></li> 196<li id="menu-item-3339" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-3339 nav-item"><a href="https://bouldermountainwarriors.com/programs-register/" class="nav-link">Programs</a></li> 197<li id="menu-item-1527" class="menu-item menu-item-type-custom menu-item-object-custom current-menu-item menu-item-1527 nav-item"><a href="https://bouldermountainwarriors.com/program-registration-2/" aria-current="page" class="nav-link">Registration</a></li> 198<li id="menu-item-1535" class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children menu-item-1535 nav-item"><a href="/boulder-mountain-warriors" class="nav-link">About BMWs</a><div class="fl-submenu-icon-wrap"><span class="fl-submenu-toggle-icon"></span></div> 199<ul class="sub-menu"> 200 <li id="menu-item-1448" class="menu-item menu-item-type-custom menu-item-object-custom menu-item-1448 nav-item"><a href="https://bouldermountainwarriors.com/photo-gallery/" class="nav-link">Photo Gallery</a></li> 201</ul> 202</li> 203<li id="menu-item-1401" class="menu-item menu-item-type-custom menu-item-object-custom menu-item-1401 nav-item"><a href="https://bouldermountainwarriors.com/coaches/" class="nav-link">Coaches</a></li> 204<li id="menu-item-3612" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-3612 nav-item"><a href="https://bouldermountainwarriors.com/why-run/" class="nav-link">Why Run</a><div class="fl-submenu-icon-wrap"><span class="fl-submenu-toggle-icon"></span></div> 205<ul class="sub-menu"> 206 <li id="menu-item-3655" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-3655 nav-item"><a href="https://bouldermountainwarriors.com/girls-running-book/" class="nav-link">Girls Running Book</a></li> 207</ul> 208</li> 209<li id="menu-item-3724" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-3724 nav-item"><a href="https://bouldermountainwarriors.com/attune/" class="nav-link">Attune</a></li> 210<li id="menu-item-624" class="menu-item menu-item-type-custom menu-item-object-custom menu-item-624 nav-item"><a href="https://bouldermountainwarriors.com/contact" title="Contact Melody Fair Child" class="nav-link">Contact</a></li> 211<li id="menu-item-3669" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-3669 nav-item"><a href="https://bouldermountainwarriors.com/donate/" class="nav-link">Give</a></li> 212</ul> </div> 213 </nav> 214 </div>
215 </div> 216 </div> 217 </div> 218 </div> 219</header><!-- .fl-page-header-fixed --> 220<header class="fl-page-header fl-page-header-primary fl-page-nav-right fl-page-nav-toggle-icon fl-page-nav-toggle-visible-medium-mobile" itemscope="itemscope" itemtype="https://schema.org/WPHeader" role="banner"> 221 <div class="fl-page-header-wrap"> 222 <div class="fl-page-header-container container"> 223 <div class="fl-page-header-row row"> 224 <div class="col-md-12 col-lg-4 fl-page-header-logo-col"> 225 <div class="fl-page-header-logo" itemscope="itemscope" itemtype="https://schema.org/Organization"> 226 <a href="https://bouldermountainwarriors.com/" itemprop="url"><img class="fl-logo-img" loading="false" data-no-lazy="1" itemscope itemtype="https://schema.org/ImageObject" src="https://bouldermountainwarriors.com/wp-content/uploads/2021/06/Mountain-2Warriors-2colors-120.png" data-retina="https://bouldermountainwarriors.com/wp-content/uploads/2021/06/Mountain-2Warriors-2colors-retina-240.png" title="" width="120" data-width="120" height="120" data-height="120" alt="Melody Fairchild" /><meta itemprop="name" content="Melody Fairchild" /></a> 227 </div> 228 </div> 229 <div class="col-md-12 col-lg-8 fl-page-nav-col"> 230 <div class="fl-page-nav-wrap"> 231 <nav class="fl-page-nav fl-nav navbar navbar-default navbar-expand-md" aria-label="Header Menu" itemscope="itemscope" itemtype="https://schema.org/SiteNavigationElement" role="navigation"> 232 <button type="button" class="navbar-toggle navbar-toggler" data-toggle="collapse" data-target=".fl-page-nav-collapse"> 233 <span><i class="fas fa-bars" aria-hidden="true"></i><span class="sr-only">Menu</span></span> 234 </button> 235 <div class="fl-page-nav-collapse collapse navbar-collapse"> 236 <ul id="menu-main-header-1" class="nav navbar-nav navbar-right menu fl-theme-menu"><li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-home menu-item-1809 nav-item"><a href="https://bouldermountainwarriors.com/" class="nav-link">Home</a></li> 237<li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-3339 nav-item"><a href="https://bouldermountainwarriors.com/programs-register/" class="nav-link">Programs</a></li> 238<li class="menu-item menu-item-type-custom menu-item-object-custom current-menu-item menu-item-1527 nav-item"><a href="https://bouldermountainwarriors.com/program-registration-2/" aria-current="page" class="nav-link">Registration</a></li> 239<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children menu-item-1535 nav-item"><a href="/boulder-mountain-warriors" class="nav-link">About BMWs</a><div class="fl-submenu-icon-wrap"><span class="fl-submenu-toggle-icon"></span></div> 240<ul class="sub-menu"> 241 <li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-1448 nav-item"><a href="https://bouldermountainwarriors.com/photo-gallery/" class="nav-link">Photo Gallery</a></li> 242</ul> 243</li> 244<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-1401 nav-item"><a href="https://bouldermountainwarriors.com/coaches/" class="nav-link">Coaches</a></li> 245<li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-3612 nav-item"><a href="https://bouldermountainwarriors.com/why-run/" class="nav-link">Why Run</a><div class="fl-submenu-icon-wrap"><span class="fl-submenu-toggle-icon"></span></div> 246<ul class="sub-menu"> 247 <li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-3655 nav-item"><a href="https://bouldermountainwarriors.com/girls-running-book/" class="nav-link">Girls Running Book</a></li> 248</ul> 249</li> 250<li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-3724 nav-item"><a href="https://bouldermountainwarriors.com/attune/" class="nav-link">Attune</a></li> 251<li class="menu-item menu-item-type-custom menu-item-object-custom menu-item-624 nav-item"><a href="https://bouldermountainwarriors.com/contact" title="Contact Melody Fair Child" class="nav-link">Contact</a></li> 252<li class="menu-item menu-item-type-post_type menu-item-object-page menu-item-3669 nav-item"><a href="https://bouldermountainwarriors.com/donate/" class="nav-link">Give</a></li> 253</ul> </div> 254 </nav> 255 </div>
256 </div> 257 </div> 258 </div> 259 </div> 260</header><!-- .fl-page-header --> 261 <div id="fl-main-content" class="fl-page-content" itemprop="mainContentOfPage" role="main"> 262 263 264<div class="fl-content-full container"> 265 <div class="row"> 266 <div class="fl-content col-md-12"> 267 <article class="fl-post post-1220 page type-page status-publish hentry" id="fl-post-1220" itemscope="itemscope" itemtype="https://schema.org/CreativeWork"> 268 269 <div class="fl-post-content clearfix" itemprop="text"> 270 <div class="fl-builder-content fl-builder-content-1220 fl-builder-content-primary fl-builder-global-templates-locked" data-post-id="1220"><div class="fl-row fl-row-fixed-width fl-row-bg-none fl-node-gre1l8qouav7 fl-row-default-height fl-row-align-center" data-node="gre1l8qouav7"> 271 <div class="fl-row-content-wrap"> 272 <div class="fl-row-content fl-row-fixed-width fl-node-content"> 273 274<div class="fl-col-group fl-node-tbm5yxrp7z2d" data-node="tbm5yxrp7z2d"> 275 <div class="fl-col fl-node-f19i58amovhd fl-col-bg-color" data-node="f19i58amovhd"> 276 <div class="fl-col-content fl-node-content"><div class="fl-module fl-module-rich-text fl-node-5e7924d6f3a71" data-node="5e7924d6f3a71" aria-label="Text Editor"> 277 <div class="fl-module-content fl-node-content"> 278 <div class="fl-rich-text"> 279 <h3>Registration Page</h3> 280</div> 281 </div> 282</div> 283</div> 284</div> 285 </div> 286 </div> 287 </div> 288</div> 289<div class="fl-row fl-row-fixed-width fl-row-bg-none fl-node-5e226196b6a1c fl-row-default-height fl-row-align-center" data-node="5e226196b6a1c"> 290 <div class="fl-row-content-wrap"> 291 <div class="fl-row-content fl-row-fixed-width fl-node-content"> 292 293<div class="fl-col-group fl-node-5e226196b774b" data-node="5e226196b774b"> 294 <div class="fl-col fl-node-5e226196b7857 fl-col-bg-color" data-node="5e226196b7857"> 295 <div class="fl-col-content fl-node-content"><div class="fl-module fl-module-rich-text fl-node-5e226196b9361" data-node="5e226196b9361" aria-label="Text Editor"> 296 <div class="fl-module-content fl-node-content"> 297 <div class="fl-rich-text"> 298 <p> 299 <div class='gf_browser_chrome gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_22' style='display:none'> 300 <div class='gform_heading'> 301 <p class='gform_required_legend'>"<span class="gfield_required gfield_required_asterisk">*</span>" indicates required fields</p> 302 </div><form method='post' enctype='multipart/form-data' id='gform_22' action='/program-registration-2/' data-formid='22' novalidate><div id="payments-sdk__contingency-lightbox"></div> 303 <div class='gform-body gform_body'><div id='gform_fields_22' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id="field_22_79" class="gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" ><hr> 304<h3><span style="color: #E5B61B;">Program Registration and Payment</span></h3></div><div id="field_22_87" class="gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" >After filling in the registration, you will be prompted for credit card payment at the bottom.<br> 305</div><fieldset id="field_22_66" class="gfield gfield--type-product gfield--type-choice gfield--input-type-radio gfield_price gfield_price_22_66 gfield_product_22_66 gfield_contains_required field_sublabel_below gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible gfield--choice-align-vertical" ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Fall Cross Country</span><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_22_66'> 306 <div class='gchoice gchoice_22_66_0'> 307 <input class='gfield-choice-input' name='input_66' type='radio' value='350.00|350' id='choice_22_66_0' onchange='gformToggleRadioOther( this )' /> 308 <label for='choice_22_66_0' id='label_22_66_0' class='gform-field-label gform-field-label--type-inline'>U8 Program - 2 Days/Week - $350.00</label> 309 </div> 310 <div class='gchoice gchoice_22_66_1'> 311 <input class='gfield-choice-input' name='input_66' type='radio' value='175.00|175' id='choice_22_66_1' onchange='gformToggleRadioOther( this )' /> 312 <label for='choice_22_66_1' id='label_22_66_1' class='gform-field-label gform-field-label--type-inline'>U8 Program - 1 Days/Week - $175.00</label> 313 </div> 314 <div class='gchoice gchoice_22_66_2'> 315 <input class='gfield-choice-input' name='input_66' type='radio' value='615.00|615' id='choice_22_66_2' onchange='gformToggleRadioOther( this )' /> 316 <label for='choice_22_66_2' id='label_22_66_2' class='gform-field-label gform-field-label--type-inline'>Veteran Mountain Warriors - 2 Days/Week - $615.00</label> 317 </div> 318 <div class='gchoice gchoice_22_66_3'> 319 <input class='gfield-choice-input' name='input_66' type='radio' value='305.00|305' id='choice_22_66_3' onchange='gformToggleRadioOther( this )' /> 320 <label for='choice_22_66_3' id='label_22_66_3' class='gform-field-label gform-field-label--type-inline'>Veteran Mountain Warriors - 1 Days/Week - $305.00</label> 321 </div> 322 <div class='gchoice gchoice_22_66_4'> 323 <input class='gfield-choice-input' name='input_66' type='radio' value='525.00|525' id='choice_22_66_4' onchange='gformToggleRadioOther( this )' /> 324 <label for='choice_22_66_4' id='label_22_66_4' class='gform-field-label gform-field-label--type-inline'>Middle School Warriors - 2 Days/Week - $525.00</label> 325 </div> 326 <div class='gchoice gchoice_22_66_5'> 327 <input class='gfield-choice-input' name='input_66' type='radio' value='260.00|260' id='choice_22_66_5' onchange='gformToggleRadioOther( this )' /> 328 <label for='choice_22_66_5' id='label_22_66_5' class='gform-field-label gform-field-label--type-inline'>Middle School Warriors - 1 Days/Week - $260.00</label> 329 </div></div></div></fieldset><fieldset id="field_22_88" class="gfield gfield--type-radio gfield--type-choice gfield--in
329put-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical" ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Select Day if 1 Day per Week</span><span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend><div class='gfield_description' id='gfield_description_22_88'>You may only select 1 day to commit for the season</div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_88'> 330 <div class='gchoice gchoice_22_88_0'> 331 <input class='gfield-choice-input' name='input_88' type='radio' value='Monday' id='choice_22_88_0' onchange='gformToggleRadioOther( this )' aria-describedby="gfield_description_22_88" /> 332 <label for='choice_22_88_0' id='label_22_88_0' class='gform-field-label gform-field-label--type-inline'>Monday</label> 333 </div> 334 <div class='gchoice gchoice_22_88_1'> 335 <input class='gfield-choice-input' name='input_88' type='radio' value='Wednesday' id='choice_22_88_1' onchange='gformToggleRadioOther( this )' /> 336 <label for='choice_22_88_1' id='label_22_88_1' class='gform-field-label gform-field-label--type-inline'>Wednesday</label> 337 </div></div></div></fieldset><div id="field_22_48" class="gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" ><hr> 338<h3><span style="color: #E5B61B;">Athlete</span></h3></div><fieldset id="field_22_47" class="gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Athlete's Name</span><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_22_47'> 339 340 <span id='input_22_47_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' > 341 <input type='text' name='input_47.3' id='input_22_47_3' value='' aria-required='true' /> 342 <label for='input_22_47_3' class='gform-field-label gform-field-label--type-sub '>First</label> 343 </span> 344 345 <span id='input_22_47_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' > 346 <input type='text' name='input_47.6' id='input_22_47_6' value='' aria-required='true' /> 347 <label for='input_22_47_6' class='gform-field-label gform-field-label--type-sub '>Last</label> 348 </span> 349 350 </div></fieldset><fieldset id="field_22_3" class="gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Athlete's Address</span><span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend> 351 <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_22_3' >
352 <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_22_3_1_container' > 353 <input type='text' name='input_3.1' id='input_22_3_1' value='' aria-required='true' /> 354 <label for='input_22_3_1' id='input_22_3_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address</label> 355 </span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_22_3_2_container' > 356 <input type='text' name='input_3.2' id='input_22_3_2' value='' aria-required='false' /> 357 <label for='input_22_3_2' id='input_22_3_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2</label> 358 </span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_22_3_3_container' > 359 <input type='text' name='input_3.3' id='input_22_3_3' value='' aria-required='true' /> 360 <label for='input_22_3_3' id='input_22_3_3_label' class='gform-field-label gform-field-label--type-sub '>City</label> 361 </span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_22_3_4_container' > 362 <select name='input_3.4' id='input_22_3_4' aria-required='true' ><option value='' ></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' selected='selected'>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> 363 <label for='input_22_3_4' id='input_22_3_4_label' class='gform-field-label gform-field-label--type-sub '>State</label> 364 </span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_22_3_5_container' > 365 <input type='text' name='input_3.5' id='input_22_3_5' value='' aria-required='true' /> 366 <label for='input_22_3_5' id='input_22_3_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code</label> 367 </span><input type='hidden' class='gform_hidden' name='input_3.6' id='input_22_3_6' value='US' /> 368 <div class='gf_clear gf_clear_complex'></div> 369 </div></fieldset><div id="field_22_63" class="gfield gfield--type-date gfield--in
369put-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gf_left_third gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" ><label class='gfield_label gform-field-label' for='input_22_63'><span class='gform-field-label__text'>Birth date</span><span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_date'> 370 <input 371 placeholder='mm/dd/yyyy' 372 id='input_22_63' 373 class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon' 374 type='text' 375 name='input_63' 376 value='' 377 378 aria-invalid="false" 379 aria-required="true" 380 381 382 data-mask="99/99/9999" 383 /> 384 <kbd id='keyboardHint_input_22_63' hidden class='down'></kbd> 385 <button type='button' id='datepicker_toggle_input_22_63' 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_22_63' aria-label='Birth date: Choose date on calendar' > 386 <span class="gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt" aria-hidden="true"></span> 387 </button> 388 </div></div><div id="field_22_70" class="gfield gfield--type-select gfield--input-type-select gf_middle_third gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" ><label class='gfield_label gform-field-label' for='input_22_70'><span class='gform-field-label__text'>Gender</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_70' id='input_22_70' class='small gfield_select' aria-required="true" aria-invalid="false" ><option value='Female' >Female</option><option value='Male' >Male</option></select></div></div><div id="field_22_78" class="gfield gfield--type-number gfield--input-type-number gf_right_third gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" ><label class='gfield_label gform-field-label' for='input_22_78'><span class='gform-field-label__text'>Age at Program Date</span><span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_number'><input name='input_78' id='input_22_78' type='number' step='any' min='2' max='20' value='' class='small' aria-required="true" aria-invalid="false" aria-describedby="gfield_instruction_22_78" /><div class='gfield_description instruction ' id='gfield_instruction_22_78'>Please enter a number from <strong>2</strong> to <strong>20</strong>.</div></div></div><div id="field_22_32" class="gfield gfield--type-text gfield--input-type-text gf_left_half gfield--width-half field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" ><label class='gfield_label gform-field-label' for='input_22_32'><span class='gform-field-label__text'>Grade in Fall</span></label><div class='ginput_container ginput_container_text' data-text-counter-max='2' data-text-counter-template='{current} of {max} max characters'><input name='input_32' id='input_22_32' type='text' value='' class='small' maxlength='2' aria-invalid="false" /></div></div><div id="field_22_33" class="gfield gfield--type-text gfield--input-type-text gf_right_half gfield--width-half field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" ><label class='gfield_label gform-field-label' for='input_22_33'><span class='gform-field-label__text'>School in Fall</span></label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_22_33' type='text' value='' class='medium' aria-invalid="false" /></div></div><div id="field_22_51" class="gfield gfield--type-email gfield--in
388put-type-email gf_left_half gfield--width-half field_sublabel_below gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_hidden" ><label class='gfield_label gform-field-label' for='input_22_51'><span class='gform-field-label__text'>Athlete's Email</span></label><div class='ginput_container ginput_container_email'> 389 <input name='input_51' id='input_22_51' type='email' value='' class='medium' aria-invalid="false" /> 390 </div></div><div id="field_22_10" class="gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gf_left_half gfield--width-half field_sublabel_below gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_hidden" ><label class='gfield_label gform-field-label' for='input_22_10'><span class='gform-field-label__text'>Athlete's Cell Phone</span></label><div class='ginput_container ginput_container_phone'><input name='input_10' id='input_22_10' type='tel' value='' class='medium' placeholder='(999) 999-9999' aria-invalid="false" data-mask="(999) 999-9999" /></div></div><div id="field_22_65" class="gfield gfield--type-text gfield--input-type-text gf_right_half gfield--width-half field_sublabel_below gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_hidden" ><label class='gfield_label gform-field-label' for='input_22_65'><span class='gform-field-label__text'>USATF Number</span></label><div class='ginput_container ginput_container_text' data-text-counter-max='13' data-text-counter-template='{current} of {max} max characters'><input name='input_65' id='input_22_65' type='text' value='' class='medium' maxlength='13' aria-invalid="false" /></div></div><div id="field_22_73" class="gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible" ><label class='gfield_label gform-field-label' for='input_22_73'><span class='gform-field-label__text'>Player Position</span></label><div class='gfield_description' id='gfield_description_22_73'>Please indicate Gender and Birth year as "F2006" for example.</div><div class='ginput_container ginput_container_text' data-text-counter-max='5' data-text-counter-template='{current} of {max} max characters'><input name='input_73' id='input_22_73' type='text' value='' class='medium' maxlength='5' aria-describedby="gfield_description_22_73" aria-invalid="false" /></div></div><div id="field_22_74" class="gfield gfield--type-textarea gfield--input-type-textarea gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible" ><label class='gfield_label gform-field-label' for='input_22_74'><span class='gform-field-label__text'>Allergies/Medical Conditions</span><span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='gfield_description' id='gfield_description_22_74'>Please list any allergies or medical conditions. Enter "None" if there are not any to list.</div><div class='ginput_container ginput_container_textarea'><textarea name='input_74' id='input_22_74' class='textarea medium' aria-describedby="gfield_description_22_74" aria-required="true" aria-invalid="false" rows='10' cols='50'></textarea></div></div><div id="field_22_75" class="gfield gfield--type-text gfield--input-type-text gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" ><label class='gfield_label gform-field-label' for='input_22_75'><span class='gform-field-label__text'>Doctor</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_75' id='input_22_75' type='text' value='' class='medium' aria-required="true" aria-invalid="false" /></div></div><div id="field_22_76" class="gfield gfield--type-text gfield--in
390put-type-text gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible" ><label class='gfield_label gform-field-label' for='input_22_76'><span class='gform-field-label__text'>Insurance Provider</span><span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='gfield_description' id='gfield_description_22_76'>Medical Insurance</div><div class='ginput_container ginput_container_text'><input name='input_76' id='input_22_76' type='text' value='' class='medium' aria-describedby="gfield_description_22_76" aria-required="true" aria-invalid="false" /></div></div><div id="field_22_77" class="gfield gfield--type-text gfield--input-type-text gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible" ><label class='gfield_label gform-field-label' for='input_22_77'><span class='gform-field-label__text'>Insurance Member ID</span><span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='gfield_description' id='gfield_description_22_77'>Medical Insurance ID Number</div><div class='ginput_container ginput_container_text'><input name='input_77' id='input_22_77' type='text' value='' class='medium' aria-describedby="gfield_description_22_77" aria-required="true" aria-invalid="false" /></div></div><div id="field_22_36" class="gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" ><hr> 391<h3><span style="color: #E5B61B;">Parent/Guardian Information</span></h3></div><fieldset id="field_22_1" class="gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Parent/Guardian Name</span><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_22_1'> 392 393 <span id='input_22_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' > 394 <input type='text' name='input_1.3' id='input_22_1_3' value='' aria-required='true' /> 395 <label for='input_22_1_3' class='gform-field-label gform-field-label--type-sub '>First</label> 396 </span> 397 398 <span id='input_22_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' > 399 <input type='text' name='input_1.6' id='input_22_1_6' value='' aria-required='true' /> 400 <label for='input_22_1_6' class='gform-field-label gform-field-label--type-sub '>Last</label> 401 </span> 402 403 </div></fieldset><div id="field_22_38" class="gfield gfield--type-email gfield--input-type-email gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" ><label class='gfield_label gform-field-label' for='input_22_38'><span class='gform-field-label__text'>Parent/Guardian Email</span><span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'> 404 <input name='input_38' id='input_22_38' type='email' value='' class='medium' aria-required="true" aria-invalid="false" /> 405 </div></div><div id="field_22_67" class="gfield gfield--type-phone gfield--in
405put-type-phone gfield--phone-format-standard gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" ><label class='gfield_label gform-field-label' for='input_22_67'><span class='gform-field-label__text'>Parent/Guardian Phone</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_67' id='input_22_67' type='tel' value='' class='medium' placeholder='(999) 999-9999' aria-required="true" aria-invalid="false" data-mask="(999) 999-9999" /></div></div><div id="field_22_37" class="gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" ><hr> 406<h3><span style="color: #E5B61B;">Additional emergency contacts, when I cannot be reached:</h3> 407In addition to those already listed above, an additional contact is required by the State of Colorado Department of Childcare. The following has my permission to sign my child out from the program and may be contacted in an emergency in case I cannot be reached. 408</div><fieldset id="field_22_56" class="gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Emergency Contact</span><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_22_56'> 409 410 <span id='input_22_56_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' > 411 <input type='text' name='input_56.3' id='input_22_56_3' value='' aria-required='true' /> 412 <label for='input_22_56_3' class='gform-field-label gform-field-label--type-sub '>First</label> 413 </span> 414 415 <span id='input_22_56_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' > 416 <input type='text' name='input_56.6' id='input_22_56_6' value='' aria-required='true' /> 417 <label for='input_22_56_6' class='gform-field-label gform-field-label--type-sub '>Last</label> 418 </span> 419 420 </div></fieldset><div id="field_22_42" class="gfield gfield--type-text gfield--input-type-text gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" ><label class='gfield_label gform-field-label' for='input_22_42'><span class='gform-field-label__text'>Relationship</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_42' id='input_22_42' type='text' value='' class='medium' aria-required="true" aria-invalid="false" /></div></div><fieldset id="field_22_22" class="gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Address - Emergency Contact</span><span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></legend> 421 <div class='ginput_complex ginput_container has_street has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_22_22' >
422 <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_22_22_1_container' > 423 <input type='text' name='input_22.1' id='input_22_22_1' value='' aria-required='true' /> 424 <label for='input_22_22_1' id='input_22_22_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address</label> 425 </span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_22_22_3_container' > 426 <input type='text' name='input_22.3' id='input_22_22_3' value='' aria-required='true' /> 427 <label for='input_22_22_3' id='input_22_22_3_label' class='gform-field-label gform-field-label--type-sub '>City</label> 428 </span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_22_22_4_container' > 429 <select name='input_22.4' id='input_22_22_4' aria-required='true' ><option value='' ></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' selected='selected'>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> 430 <label for='input_22_22_4' id='input_22_22_4_label' class='gform-field-label gform-field-label--type-sub '>State</label> 431 </span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_22_22_5_container' > 432 <input type='text' name='input_22.5' id='input_22_22_5' value='' aria-required='true' /> 433 <label for='input_22_22_5' id='input_22_22_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code</label> 434 </span><input type='hidden' class='gform_hidden' name='input_22.6' id='input_22_22_6' value='US' /> 435 <div class='gf_clear gf_clear_complex'></div> 436 </div></fieldset><div id="field_22_69" class="gfield gfield--type-email gfield--in
436put-type-email gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" ><label class='gfield_label gform-field-label' for='input_22_69'><span class='gform-field-label__text'>Emergency Contact eMail</span><span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'> 437 <input name='input_69' id='input_22_69' type='email' value='' class='medium' aria-required="true" aria-invalid="false" /> 438 </div></div><div id="field_22_68" class="gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" ><label class='gfield_label gform-field-label' for='input_22_68'><span class='gform-field-label__text'>Emergency Contact Phone</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_68' id='input_22_68' type='tel' value='' class='medium' placeholder='(999) 999-9999' aria-required="true" aria-invalid="false" data-mask="(999) 999-9999" /></div></div><fieldset id="field_22_82" class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_hidden gfield--choice-align-vertical" ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Is your child vegetarian, vegan, carnivore or omnivore?</span></legend><div class='gfield_description' id='gfield_description_22_82'>Check any that apply.</div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_22_82'><div class='gchoice gchoice_22_82_1'> 439 <input class='gfield-choice-input' name='input_82.1' type='checkbox' value='Vegetarian' id='choice_22_82_1' aria-describedby="gfield_description_22_82"/> 440 <label for='choice_22_82_1' id='label_22_82_1' class='gform-field-label gform-field-label--type-inline'>Vegetarian</label> 441 </div><div class='gchoice gchoice_22_82_2'> 442 <input class='gfield-choice-input' name='input_82.2' type='checkbox' value='Vegan' id='choice_22_82_2' /> 443 <label for='choice_22_82_2' id='label_22_82_2' class='gform-field-label gform-field-label--type-inline'>Vegan</label> 444 </div><div class='gchoice gchoice_22_82_3'> 445 <input class='gfield-choice-input' name='input_82.3' type='checkbox' value='Carnivore' id='choice_22_82_3' /> 446 <label for='choice_22_82_3' id='label_22_82_3' class='gform-field-label gform-field-label--type-inline'>Carnivore</label> 447 </div><div class='gchoice gchoice_22_82_4'> 448 <input class='gfield-choice-input' name='input_82.4' type='checkbox' value='Omnivore' id='choice_22_82_4' /> 449 <label for='choice_22_82_4' id='label_22_82_4' class='gform-field-label gform-field-label--type-inline'>Omnivore</label> 450 </div></div></div></fieldset><div id="field_22_83" class="gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" ><h3 class="gsection_title">Liability Waiver</h3></div><div id="field_22_81" class="gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" >Please review the <strong><a href="/wp-content/uploads/2018/12/Fairchild-FitnessInc-Liability-Waiver.pdf" target="_blank" rel="noopener">Liability Waiver</a></strong></div><fieldset id="field_22_80" class="gfield gfield--type-checkbox gfield--type-choice gfield--in
450put-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible gfield--choice-align-vertical" ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Liability Waiver</span><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_22_80'><div class='gchoice gchoice_22_80_1'> 451 <input class='gfield-choice-input' name='input_80.1' type='checkbox' value='I have read and agreed to the liability waiver' id='choice_22_80_1' /> 452 <label for='choice_22_80_1' id='label_22_80_1' class='gform-field-label gform-field-label--type-inline'>I have read and agreed to the liability waiver</label> 453 </div></div></div></fieldset><fieldset id="field_22_92" class="gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical" ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Newsletter Opt In</span></legend><div class='gfield_description' id='gfield_description_22_92'>Opt In for our monthly newsletter</div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_22_92'><div class='gchoice gchoice_22_92_1'> 454 <input class='gfield-choice-input' name='input_92.1' type='checkbox' value='Yes, send me the monthly newsletter' checked='checked' id='choice_22_92_1' aria-describedby="gfield_description_22_92"/> 455 <label for='choice_22_92_1' id='label_22_92_1' class='gform-field-label gform-field-label--type-inline'>Yes, send me the monthly newsletter</label> 456 </div></div></div></fieldset><div id="field_22_85" class="gfield gfield--type-total gfield--input-type-total gfield--width-full Form-Total gfield_price gfield_price_22_ gfield_total gfield_total_22_ field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible" aria-atomic="true" aria-live="polite" ><label class='gfield_label gform-field-label' for='input_22_85'><span class='gform-field-label__text'>Check Out Total:</span></label><div class='ginput_container ginput_container_total'> 457 <input type='text' readonly name='input_85' id='input_22_85' value='$0.00' class='gform-text-input-reset ginput_total ginput_total_22' /> 458 </div></div><fieldset id="field_22_84" class="gfield gfield--type-paypal gfield--input-type-paypal gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gform_ppcp_custom_card_fields" data-field-class="gform_ppcp_custom_card_fields" ><legend class='gfield_label gfield_label_before_complex gform-field-label' for='input_22_84_1' ><label class='gfield_label gform-field-label'>Payment Method</label></legend><div class='ginput_container ginput_container_select gform_ppcp_payment_method' ><select name='input_84.6' id='input_84_6' class='medium gfield_select' aria-label='Payment Method' ><option value='PayPal Checkout' >PayPal Checkout</option><option value='Credit Card' selected='selected'>Credit Card</option></select></div><div class='ginput_complex ginput_container ginput_container_custom_card_fields gform-grid-row' id='input_22_84' ><span class='ginput_full gform-grid-col' id='input_22_84_1_container' > 459 <div class='gform_card_icon_container gform_card_icon_style1'><div class='gform_card_icon gform_card_icon_discover' >Discover</div><div class='gform_card_icon gform_card_icon_mastercard' >MasterCard</div><div class='gform_card_icon gform_card_icon_visa' >Visa</div><span class='screen-reader-text' id='field_22_84_supported_creditcards'>Supported Credit Cards: Discover, MasterCard, Visa</span></div>
460 <span id='input_22_84_1' class='ginput_card_field ginput_card_number gform-theme-field-control'></span> 461 <label for='input_22_84_1' id='input_22_84_1_label' class='gform-field-label gform-field-label--type-sub'>Card Number</label> 462 </span><span class='ginput_full ginput_cardextras gform-grid-col gform-grid-row' id='input_22_84_2_container'> 463 <span class='ginput_cardinfo_left gform-grid-col' id='input_22_84_2_cardinfo_left'> 464 <span id='input_22_84_2' class='ginput_card_field ginput_card_expiration gform-theme-field-control'></span> 465 <label for='input_22_84_2' class='gform-field-label gform-field-label--type-sub'>Expiration Date</label> 466 </span><span class='ginput_cardinfo_right gform-grid-col' id='input_22_84_2_cardinfo_right'> 467 <span id='input_22_84_3' class='ginput_card_field ginput_card_security_code gform-theme-field-control'></span> 468 <span class='ginput_card_security_code_icon'> </span> 469 <label for='input_22_84_3' class='gform-field-label gform-field-label--type-sub'>Security Code</label> 470 </span> 471 </span><span class='ginput_full gform-grid-col' id='input_22_84_5_container'> 472 <input type='text' name='input_84.5' id='input_22_84_5' value='' /> 473 <label for='input_22_84_5' id='input_22_84_5_label' class='gform-field-label gform-field-label--type-sub'>Cardholder Name</label> 474 </span> </div></fieldset></div></div> 475 <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_22' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' class='gform_button button gform_image_button' ><img src='/wp-content/uploads/2015/03/Melody-Warrior-Button.png' alt='Submit'></button><div id="gform_ppcp_smart_payment_buttons_22" class="medium gform_ppcp_smart_payment_buttons"></div> 476 <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_22' value='postback' /> 477 <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_22' id='gform_theme_22' value='gravity-theme' /> 478 <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_22' id='gform_style_settings_22' value='[]' /> 479 <input type='hidden' class='gform_hidden' name='is_submit_22' value='1' /> 480 <input type='hidden' class='gform_hidden' name='gform_submit' value='22' /> 481 482 <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='gp0/wbVcqvymTi9YgQSVNVTNYzkQ12XjzSHytKPaSRta635w9eEaBr7zxLK3jhbIzHf+ZozVXEqTlMlQhn8VFzMxiV4md5Ql4JqlftgvOhHVoN4=' /> 483 <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' /> 484 <input type='hidden' class='gform_hidden' name='state_22' value='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' /> 485 <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_22' id='gform_target_page_number_22' value='0' /> 486 <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_22' id='gform_source_page_number_22' value='1' /> 487 <input type='hidden' name='gform_field_values' value='' /> 488 489 </div> 490 <p style="display: none !important;" class="akismet-fields-container" data-prefix="ak_"><label>Δ<textarea name="ak_hp_textarea" cols="45" rows="8" maxlength="100"></textarea></label><input type="hidden" id="ak_js_1" name="ak_js" value="53"/>
490<script> 491document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 492</script>
492 493</p></form> 494 </div></p> 495</div> 496 </div> 497</div> 498</div> 499</div> 500 </div> 501 </div> 502 </div> 503</div> 504</div> </div><!-- .fl-post-content --> 505 506</article> 507 508<!-- .fl-post --> 509 </div> 510 </div> 511</div> 512 513 514 </div><!-- .fl-page-content --> 515 <footer class="fl-page-footer-wrap" itemscope="itemscope" itemtype="https://schema.org/WPFooter" role="contentinfo"> 516 <div class="fl-page-footer"> 517 <div class="fl-page-footer-container container"> 518 <div class="fl-page-footer-row row"> 519 <div class="col-md-6 col-lg-6 text-left clearfix"><div class="fl-page-footer-text fl-page-footer-text-1">© 2021 Melody Fairchild. All rights reserved. </div></div> <div class="col-md-6 col-lg-6 text-right clearfix"><div class="fl-page-footer-text fl-page-footer-text-2">P.O. Box 592, Lyons, Co. 80450 | Phone: (303) 818-8063</div></div> </div> 520 </div> 521</div><!-- .fl-page-footer --> 522 </footer> 523 </div><!-- .fl-page -->
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536
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