vendor: 4,280 bytes, lines 1-11
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11),e.jsxs("p",{className:"text-slate-600 dark:text-slate-400",children:["Mercy House Adult Teen Challenge",e.jsx("br",{}),"1110 Mary St, PO Box 266",e.jsx("br",{}),"Georgetown, MS 39078",e.jsx("br",{}),"Intake Coordinator: (601) 720-3718"]})]}),e.jsxs("div",{children:[e.jsx("p",{className:"text-center text-slate-600 dark:text-slate-400 mb-4 text-sm font-medium",children:"Optional: Pay your $1,000 intake fee now to secure your spot â or wait until you hear from our team."}),e.jsx(Ke,{applicantName:t.full_legal_name,applicantEmail:t.email})]})]})}):e.jsx("div",{className:"min-h-screen bg-slate-50 dark:bg-slate-900 py-12",children:e.jsxs("div",{className:"max-w-4xl mx-auto px-4 sm:px-6 lg:px-8",children:[e.jsx("section",{className:"mb-10 rounded-2xl bg-navy dark:bg-slate-950 text-white overflow-hidden shadow-lg",children:e.jsxs("div",{className:"px-6 py-10 md:px-12 md:py-14 text-center",children:[e.jsx(Ne,{className:"w-10 h-10 text-gold mx-auto mb-4","aria-hidden":"true"}),e.jsx("h1",{className:"text-3xl md:text-5xl font-bold mb-4",children:"Get Help Now â Weâre Here for You"}),e.jsx("p",{className:"text-lg md:text-xl text-slate-200 max-w-2xl mx-auto mb-6 leading-relaxed",children:"You donât have to do this alone. 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11)]}),e.jsx("p",{className:"text-sm text-slate-600 dark:text-slate-400",children:"By signing below, I authorize the tests listed to be completed and information sent to Mercy House Adult Teen Challenge. I certify that all information provided is true and accurate to the best of my knowledge."}),e.jsx(f,{id:"signature",label:"Signature (Type your full name)",required:!0,error:r.signature,children:e.jsx(h,{id:"signature",value:t.signature,onChange:a=>s("signature",a.target.value),placeholder:"Type your full legal name","aria-required":"true","aria-invalid":!!r.signature,className:"text-base mt-1"})}),e.jsxs("div",{children:[e.jsx(d,{className:"text-base font-medium",children:"Date"}),e.jsx(h,{value:t.submission_date,readOnly:!0,className:"bg-slate-100 dark:bg-slate-700 text-base mt-1","aria-readonly":"true"})]}),e.jsxs("div",{className:"bg-navy dark:bg-slate-950 text-white p-4 rounded-lg text-center text-sm",children:[e.jsx("p",{className:"font-semibold",children:"Submit Application To:"}),e.jsx("p",{className:"mt-1",children:"Mercy House Adult Teen Challenge"}),e.jsx("p",{children:"1110 Mary St, PO Box 266, Georgetown, MS 39078"}),e.jsx("p",{children:"Intake Coordinator: (601) 720-3718"})]})]})]})]}),e.jsxs("div",{className:"flex justify-between mt-6",children:[l>1?e.jsxs(q,{type:"button",variant:"outline",onClick:()=>{p(a=>a-1),window.scrollTo({top:0,behavior:"smooth"})},className:"font-semibold",children:[e.jsx(qe,{className:"w-4 h-4 mr-2","aria-hidden":"true"}),"Previous"]}):e.jsx("div",{}),l<I?e.jsxs(q,{type:"button",onClick:xe,className:"ml-auto bg-navy dark:bg-gold hover:bg-navy/90 dark:hover:bg-gold/90 text-white dark:text-navy font-semibold",children:["Next",e.jsx(Se,{className:"w-4 h-4 ml-2","aria-hidden":"true"})]}):e.jsx(q,{type:"submit",disabled:i,className:"ml-auto bg-navy dark:bg-gold hover:bg-navy/90 dark:hover:bg-gold/90 text-white dark:text-navy px-10 py-6 text-lg font-bold shadow-xl",children:i?e.jsxs(e.Fragment,{children:[e.jsx(J,{className:"mr-2 h-5 w-5 animate-spin","aria-hidden":"true"}),"Submittingâ¦"]}):"Submit Application"})]})]})]})})}export{xa as default};
Line numbers count LF bytes from the start of the resource, as the search results do. Vendor segments are library code the classifier recognised; they are stored but not indexed. Bytes are shown as Latin1 characters, one per byte.