{"id":1067,"date":"2023-03-30T17:35:30","date_gmt":"2023-03-30T17:35:30","guid":{"rendered":"https:\/\/www.littleducklingindy.com\/?page_id=1067"},"modified":"2023-03-30T17:41:04","modified_gmt":"2023-03-30T17:41:04","slug":"enrollment","status":"publish","type":"page","link":"https:\/\/www.littleducklingindy.com\/enrollment\/","title":{"rendered":"Enrollment"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1067\" class=\"elementor elementor-1067\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-e6df191 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"e6df191\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-9e207d4\" data-id=\"9e207d4\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-b001d99 elementor-widget elementor-widget-breadcrumbs\" data-id=\"b001d99\" data-element_type=\"widget\" data-widget_type=\"breadcrumbs.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<link rel=\"stylesheet\" href=\"https:\/\/www.littleducklingindy.com\/wp-content\/plugins\/elementor-pro\/assets\/css\/widget-theme-elements.min.css\"><p id=\"breadcrumbs\"><span><span><a href=\"https:\/\/www.littleducklingindy.com\/\">Home<\/a><\/span><\/span><\/p>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-04e3a85 elementor-widget elementor-widget-heading\" data-id=\"04e3a85\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.21.0 - 18-04-2024 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h1 class=\"elementor-heading-title elementor-size-default\">Enroll Today<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-7054298 elementor-hidden-mobile\" data-id=\"7054298\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-80a3c1e elementor-widget elementor-widget-image\" data-id=\"80a3c1e\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.21.0 - 18-04-2024 *\/\n.elementor-widget-image{text-align:center}.elementor-widget-image a{display:inline-block}.elementor-widget-image a img[src$=\".svg\"]{width:48px}.elementor-widget-image img{vertical-align:middle;display:inline-block}<\/style>\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"300\" height=\"269\" src=\"https:\/\/www.littleducklingindy.com\/wp-content\/uploads\/2022\/11\/Little-duckling-sparks-300x269.png\" class=\"attachment-medium size-medium wp-image-480\" alt=\"\" srcset=\"https:\/\/www.littleducklingindy.com\/wp-content\/uploads\/2022\/11\/Little-duckling-sparks-300x269.png 300w, https:\/\/www.littleducklingindy.com\/wp-content\/uploads\/2022\/11\/Little-duckling-sparks.png 441w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-80bc9ee elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"80bc9ee\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-cedfb19\" data-id=\"cedfb19\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-1c46294 elementor-widget elementor-widget-shortcode\" data-id=\"1c46294\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <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_5' ><div id='gf_5' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <p class='gform_description'>This is a student enrollment application. Please complete and submit this form to be considered for enrollment. It must be completed and submitted for all new students and updated yearly by current students.<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_5' id='gform_5'  action='\/wp-json\/wp\/v2\/pages\/1067#gf_5' data-formid='5' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_5' class='gform_fields top_label form_sublabel_below description_above'><fieldset id=\"field_5_5\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_5\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Child Information<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_5_5'>Enter the child's legal name.<\/div><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_5_5'>\n                            \n                            <span id='input_5_5_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.3' id='input_5_5_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_5_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            <span id='input_5_5_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.4' id='input_5_5_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_5_4' class='gform-field-label gform-field-label--type-sub '>Middle Initial<\/label>\n                                                <\/span>\n                            <span id='input_5_5_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.6' id='input_5_5_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_5_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_5_8\" class=\"gfield gfield--type-date gfield--input-type-datefield gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_8\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_5_8'>Enter the child's date of birth.<\/div><div id='input_5_8' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_5_8_1_container'>\n                                            <input type='number' maxlength='2' name='input_8[]' id='input_5_8_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_5_8_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_5_8_2_container'>\n                                            <input type='number' maxlength='2' name='input_8[]' id='input_5_8_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_5_8_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_5_8_3_container'>\n                                            <input type='number' maxlength='4' name='input_8[]' id='input_5_8_3' value=''   aria-required='true'   placeholder='YYYY' min='1920' max='2025' step='1'\/>\n                                            <label for='input_5_8_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                       <\/div>\n                                   <\/div><\/fieldset><fieldset id=\"field_5_14\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_14\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Home Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_5_14'>Enter the physical address where the child lives.<\/div>    \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_5_14' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_14_1_container' >\n                                        <input type='text' name='input_14.1' id='input_5_14_1' value=''    aria-required='true'    \/>\n                                        <label for='input_5_14_1' id='input_5_14_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_5_14_2_container' >\n                                        <input type='text' name='input_14.2' id='input_5_14_2' value=''     aria-required='false'   \/>\n                                        <label for='input_5_14_2' id='input_5_14_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_5_14_3_container' >\n                                    <input type='text' name='input_14.3' id='input_5_14_3' value=''    aria-required='true'    \/>\n                                    <label for='input_5_14_3' id='input_5_14_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_5_14_4_container' >\n                                        <select name='input_14.4' id='input_5_14_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_5_14_4' id='input_5_14_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_5_14_5_container' >\n                                    <input type='text' name='input_14.5' id='input_5_14_5' value=''    aria-required='true'    \/>\n                                    <label for='input_5_14_5' id='input_5_14_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_14.6' id='input_5_14_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_5_16\" class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_16\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Mother or Legal Guardian&#039;s Information<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_5_16'>Enter the mother or legal guardian's name.<\/div><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_5_16'>\n                            \n                            <span id='input_5_16_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_16.3' id='input_5_16_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_16_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            <span id='input_5_16_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_16.4' id='input_5_16_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_16_4' class='gform-field-label gform-field-label--type-sub '>Middle Initial<\/label>\n                                                <\/span>\n                            <span id='input_5_16_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_16.6' id='input_5_16_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_16_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_5_17\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_17\" ><label class='gfield_label gform-field-label' for='input_5_17'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_17'>Enter the mother or legal guardian's date of birth.<\/div><div class='ginput_container ginput_container_date'>\n                            <input name='input_17' id='input_5_17' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_5_17_date_format gfield_description_5_17\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_5_17_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_5_17' class='gform_hidden' value='https:\/\/www.littleducklingindy.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_5_18\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_18\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Home Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_5_18'>Enter the mother or legal guardian's home address.<\/div>    \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_5_18' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_18_1_container' >\n                                        <input type='text' name='input_18.1' id='input_5_18_1' value=''    aria-required='true'    \/>\n                                        <label for='input_5_18_1' id='input_5_18_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_5_18_2_container' >\n                                        <input type='text' name='input_18.2' id='input_5_18_2' value=''     aria-required='false'   \/>\n                                        <label for='input_5_18_2' id='input_5_18_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_5_18_3_container' >\n                                    <input type='text' name='input_18.3' id='input_5_18_3' value=''    aria-required='true'    \/>\n                                    <label for='input_5_18_3' id='input_5_18_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_5_18_4_container' >\n                                        <select name='input_18.4' id='input_5_18_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_5_18_4' id='input_5_18_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_5_18_5_container' >\n                                    <input type='text' name='input_18.5' id='input_5_18_5' value=''    aria-required='true'    \/>\n                                    <label for='input_5_18_5' id='input_5_18_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_18.6' id='input_5_18_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_5_23\" class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_23\" ><label class='gfield_label gform-field-label' for='input_5_23'>Cell Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_23'>Enter the mother or legal guardian's cell phone number.<\/div><div class='ginput_container ginput_container_phone'><input name='input_23' id='input_5_23' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_5_23\"  \/><\/div><\/div><fieldset id=\"field_5_24\" class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_24\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_5_24'>Enter the mother or legal guardian's email address.<\/div><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_5_24_container'>\n                                <span id='input_5_24_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_24' id='input_5_24' value=''    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_5_24\" \/>\n                                    <label for='input_5_24' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_5_24_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_24_2' id='input_5_24_2' value=''    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_5_24\" \/>\n                                    <label for='input_5_24_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_5_19\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_19\" ><label class='gfield_label gform-field-label' for='input_5_19'>Employer&#039;s Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_19'>Enter the mother or legal guardian's employer's name or place of employment.<\/div><div class='ginput_container ginput_container_text'><input name='input_19' id='input_5_19' type='text' value='' class='large'  aria-describedby=\"gfield_description_5_19\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_5_20\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_20\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Employer&#039;s Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_5_20'>Enter the mother or legal guardian's employer's physical address.<\/div>    \n                    <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_5_20' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_20_1_container' >\n                                        <input type='text' name='input_20.1' id='input_5_20_1' value=''    aria-required='true'    \/>\n                                        <label for='input_5_20_1' id='input_5_20_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_5_20_2_container' >\n                                        <input type='text' name='input_20.2' id='input_5_20_2' value=''     aria-required='false'   \/>\n                                        <label for='input_5_20_2' id='input_5_20_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_5_20_3_container' >\n                                    <input type='text' name='input_20.3' id='input_5_20_3' value=''    aria-required='true'    \/>\n                                    <label for='input_5_20_3' id='input_5_20_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_5_20_4_container' >\n                                        <input type='text' name='input_20.4' id='input_5_20_4' value=''      aria-required='true'    \/>\n                                        <label for='input_5_20_4' id='input_5_20_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_5_20_5_container' >\n                                    <input type='text' name='input_20.5' id='input_5_20_5' value=''    aria-required='true'    \/>\n                                    <label for='input_5_20_5' id='input_5_20_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_5_20_6_container' >\n                                        <select name='input_20.6' id='input_5_20_6'   aria-required='true'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_5_20_6' id='input_5_20_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_5_25\" class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_25\" ><label class='gfield_label gform-field-label' for='input_5_25'>Employer&#039;s Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_25'>Enter the mother or legal guardian's employer's phone number.<\/div><div class='ginput_container ginput_container_phone'><input name='input_25' id='input_5_25' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_5_25\"  \/><\/div><\/div><fieldset id=\"field_5_21\" class=\"gfield gfield--type-name gfield--width-eleven-twelfths field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_21\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Father or Additional Legal Guardian&#039;s Information<\/legend><div class='gfield_description' id='gfield_description_5_21'>Enter the father or additional legal guardian's name.<\/div><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_5_21'>\n                            \n                            <span id='input_5_21_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_21.3' id='input_5_21_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_21_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            <span id='input_5_21_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_21.4' id='input_5_21_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_21_4' class='gform-field-label gform-field-label--type-sub '>Middle Initial<\/label>\n                                                <\/span>\n                            <span id='input_5_21_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_21.6' id='input_5_21_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_21_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_5_30\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_30\" ><label class='gfield_label gform-field-label' for='input_5_30'>Date of Birth<\/label><div class='gfield_description' id='gfield_description_5_30'>Enter the father or additional legal guardian's date of birth.<\/div><div class='ginput_container ginput_container_date'>\n                            <input name='input_30' id='input_5_30' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_5_30_date_format gfield_description_5_30\" aria-invalid=\"false\" \/>\n                            <span id='input_5_30_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_5_30' class='gform_hidden' value='https:\/\/www.littleducklingindy.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_5_26\" class=\"gfield gfield--type-address gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_26\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Home Address<\/legend><div class='gfield_description' id='gfield_description_5_26'>Enter the father or additional legal guardian's home address.<\/div>    \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_5_26' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_26_1_container' >\n                                        <input type='text' name='input_26.1' id='input_5_26_1' value=''    aria-required='false'    \/>\n                                        <label for='input_5_26_1' id='input_5_26_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_5_26_2_container' >\n                                        <input type='text' name='input_26.2' id='input_5_26_2' value=''     aria-required='false'   \/>\n                                        <label for='input_5_26_2' id='input_5_26_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_5_26_3_container' >\n                                    <input type='text' name='input_26.3' id='input_5_26_3' value=''    aria-required='false'    \/>\n                                    <label for='input_5_26_3' id='input_5_26_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_5_26_4_container' >\n                                        <select name='input_26.4' id='input_5_26_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_5_26_4' id='input_5_26_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_5_26_5_container' >\n                                    <input type='text' name='input_26.5' id='input_5_26_5' value=''    aria-required='false'    \/>\n                                    <label for='input_5_26_5' id='input_5_26_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_26.6' id='input_5_26_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_5_27\" class=\"gfield gfield--type-phone gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_27\" ><label class='gfield_label gform-field-label' for='input_5_27'>Cell Phone<\/label><div class='gfield_description' id='gfield_description_5_27'>Enter father or additional legal guardian's cell phone number<\/div><div class='ginput_container ginput_container_phone'><input name='input_27' id='input_5_27' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_5_27\"  \/><\/div><\/div><fieldset id=\"field_5_28\" class=\"gfield gfield--type-email gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_28\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Email<\/legend><div class='gfield_description' id='gfield_description_5_28'>Enter the father or additional legal guardian's email address.<\/div><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_5_28_container'>\n                                <span id='input_5_28_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_28' id='input_5_28' value=''     aria-invalid=\"false\" aria-describedby=\"gfield_description_5_28\" \/>\n                                    <label for='input_5_28' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_5_28_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_28_2' id='input_5_28_2' value=''     aria-invalid=\"false\" aria-describedby=\"gfield_description_5_28\" \/>\n                                    <label for='input_5_28_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_5_29\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_29\" ><label class='gfield_label gform-field-label' for='input_5_29'>Employer&#039;s Name<\/label><div class='gfield_description' id='gfield_description_5_29'>Enter the father or additional legal guardian's employer's name or place of employment.<\/div><div class='ginput_container ginput_container_text'><input name='input_29' id='input_5_29' type='text' value='' class='large'  aria-describedby=\"gfield_description_5_29\"    aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_5_31\" class=\"gfield gfield--type-address gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_31\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Employer&#039;s Address<\/legend><div class='gfield_description' id='gfield_description_5_31'>Enter the father or additional legal guardian's employer's physical address.<\/div>    \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_5_31' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_31_1_container' >\n                                        <input type='text' name='input_31.1' id='input_5_31_1' value=''    aria-required='false'    \/>\n                                        <label for='input_5_31_1' id='input_5_31_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_5_31_2_container' >\n                                        <input type='text' name='input_31.2' id='input_5_31_2' value=''     aria-required='false'   \/>\n                                        <label for='input_5_31_2' id='input_5_31_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_5_31_3_container' >\n                                    <input type='text' name='input_31.3' id='input_5_31_3' value=''    aria-required='false'    \/>\n                                    <label for='input_5_31_3' id='input_5_31_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_5_31_4_container' >\n                                        <select name='input_31.4' id='input_5_31_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_5_31_4' id='input_5_31_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_5_31_5_container' >\n                                    <input type='text' name='input_31.5' id='input_5_31_5' value=''    aria-required='false'    \/>\n                                    <label for='input_5_31_5' id='input_5_31_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_31.6' id='input_5_31_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_5_32\" class=\"gfield gfield--type-phone gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_32\" ><label class='gfield_label gform-field-label' for='input_5_32'>Employer&#039;s Phone Number<\/label><div class='gfield_description' id='gfield_description_5_32'>Enter the father or additional legal guardian's employer's phone number.<\/div><div class='ginput_container ginput_container_phone'><input name='input_32' id='input_5_32' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_5_32\"  \/><\/div><\/div><div id=\"field_5_33\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_33\" ><label class='gfield_label gform-field-label' for='input_5_33'>Custody: Child lives with:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_33'>Select who the child lives with.<\/div><div class='ginput_container ginput_container_select'><select name='input_33' id='input_5_33' class='large gfield_select'  aria-describedby=\"gfield_description_5_33\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='Mother - Name entered above' >Mother - Name entered above<\/option><option value='Father - Name entered above' >Father - Name entered above<\/option><option value='Legal Guardian - Name entered above' >Legal Guardian - Name entered above<\/option><\/select><\/div><\/div><div id=\"field_5_34\" class=\"gfield gfield--type-select gfield--width-eleven-twelfths gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_34\" ><label class='gfield_label gform-field-label' for='input_5_34'>Does a court order exist restricting contact with anyone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_34'>Select whether a court has forbidden someone from having contact with the child. If you've answered \"Yes\", you must provide Little Duckling a copy of the court order detailing the restricted contact. \n<\/div><div class='ginput_container ginput_container_select'><select name='input_34' id='input_5_34' class='large gfield_select'  aria-describedby=\"gfield_description_5_34\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/div><fieldset id=\"field_5_37\" class=\"gfield gfield--type-name field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_37\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Emergency Contact<\/legend><div class='gfield_description' id='gfield_description_5_37'>Enter the name of someone who may be contacted in the event of an emergency when the parent or legal guardian cannot be reached.<\/div><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_5_37'>\n                            \n                            <span id='input_5_37_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_37.3' id='input_5_37_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_37_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_37_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_37.6' id='input_5_37_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_37_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_5_38\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_38\" ><label class='gfield_label gform-field-label' for='input_5_38'>Relationship<\/label><div class='gfield_description' id='gfield_description_5_38'>Enter the emergency contact person's relationship to the child.<\/div><div class='ginput_container ginput_container_text'><input name='input_38' id='input_5_38' type='text' value='' class='large'  aria-describedby=\"gfield_description_5_38\"    aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_5_39\" class=\"gfield gfield--type-phone field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_39\" ><label class='gfield_label gform-field-label' for='input_5_39'>Cell Phone<\/label><div class='gfield_description' id='gfield_description_5_39'>Enter the emergency contact person's cell phone number to be called in the event of an emergency when the parent or legal guardian cannot be reached.<\/div><div class='ginput_container ginput_container_phone'><input name='input_39' id='input_5_39' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_5_39\"  \/><\/div><\/div><fieldset id=\"field_5_40\" class=\"gfield gfield--type-name field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_40\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Pick Up Authorization 1<\/legend><div class='gfield_description' id='gfield_description_5_40'>To ensure the safety of your child, please enter the name of an adult to whom your child may be released. Photo ID will be required to verify identity upon pick up.<\/div><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_5_40'>\n                            \n                            <span id='input_5_40_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_40.3' id='input_5_40_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_40_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_40_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_40.6' id='input_5_40_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_40_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_5_42\" class=\"gfield gfield--type-name gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_42\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Pick Up Authorization 2<\/legend><div class='gfield_description' id='gfield_description_5_42'>To ensure the safety of your child, please enter the name of an adult to whom your child may be released. Photo ID will be required to verify identity upon pick up.<\/div><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_5_42'>\n                            \n                            <span id='input_5_42_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_42.3' id='input_5_42_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_42_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_42_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_42.6' id='input_5_42_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_42_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_5_41\" class=\"gfield gfield--type-name field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_41\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Pick Up Authorization 3<\/legend><div class='gfield_description' id='gfield_description_5_41'>To ensure the safety of your child, please enter the name of an adult to whom your child may be released. Photo ID will be required to verify identity upon pick up.<\/div><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_5_41'>\n                            \n                            <span id='input_5_41_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_41.3' id='input_5_41_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_41_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_41_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_41.6' id='input_5_41_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_5_41_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_5_46\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_5_46\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Pick Up Authorization Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_46.1' id='input_5_46_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_5_46\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_5_46_1' >I authorize the above listed individuals to pick up my child.<\/label><input type='hidden' name='input_46.2' value='I authorize the above listed individuals to pick up my child.' class='gform_hidden' \/><input type='hidden' name='input_46.3' value='5' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_5_46'>I understand by completing this authorization, that if I need to update the above listed individuals, I must do so in writing and submit the request to Little Duckling before the updated individual is allowed to pick up.<\/div><\/fieldset><fieldset id=\"field_5_49\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_49\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Emergency Medical Contact Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_5_49'>In the event of a serious accident or injury, we will immediately call 911 and administer First Aid or CPR. We will then call the parent\/guardian immediately. If we are unable to reach a parent or guardian, we will contact the designated Emergency Contact Person.<\/div><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_5_49'>\n                            \n                            <span id='input_5_49_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_49.3' id='input_5_49_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_49_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                <\/span>\n                            \n                            <span id='input_5_49_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_49.6' id='input_5_49_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_5_49_6' class='gform-field-label gform-field-label--type-sub '>Last Name<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_5_59\" class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_59\" ><label class='gfield_label gform-field-label' for='input_5_59'>Emergency Medical Contact Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_59'>Enter the emergency contact person's cell phone number.<\/div><div class='ginput_container ginput_container_phone'><input name='input_59' id='input_5_59' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_5_59\"  \/><\/div><\/div><fieldset id=\"field_5_58\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_58\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Emergency Medical Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_5_58'>I hereby authorize Little Duckling to administer First Aid, CPR, or emergency medical care to my child in the case of an emergency, severe injury, or acute illness. I understand 911 will be called immediately. I understand I will be contacted immediately.<\/div><div class='ginput_container ginput_container_consent'><input name='input_58.1' id='input_5_58_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_5_58\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_5_58_1' >I authorize Little Duckling to administer emergency medical care.<\/label><input type='hidden' name='input_58.2' value='I authorize Little Duckling to administer emergency medical care.' class='gform_hidden' \/><input type='hidden' name='input_58.3' value='5' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_5_53\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_53\" ><label class='gfield_label gform-field-label' for='input_5_53'>Physician&#039;s Name<\/label><div class='gfield_description' id='gfield_description_5_53'>Enter the name of your child's primary care physician. <\/div><div class='ginput_container ginput_container_text'><input name='input_53' id='input_5_53' type='text' value='' class='large'  aria-describedby=\"gfield_description_5_53\"    aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_5_54\" class=\"gfield gfield--type-address gfield--width-half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_54\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Physician&#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_5_54' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_54_1_container' >\n                                        <input type='text' name='input_54.1' id='input_5_54_1' value=''    aria-required='false'    \/>\n                                        <label for='input_5_54_1' id='input_5_54_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_5_54_2_container' >\n                                        <input type='text' name='input_54.2' id='input_5_54_2' value=''     aria-required='false'   \/>\n                                        <label for='input_5_54_2' id='input_5_54_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_5_54_3_container' >\n                                    <input type='text' name='input_54.3' id='input_5_54_3' value=''    aria-required='false'    \/>\n                                    <label for='input_5_54_3' id='input_5_54_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_5_54_4_container' >\n                                        <select name='input_54.4' id='input_5_54_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_5_54_4' id='input_5_54_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_5_54_5_container' >\n                                    <input type='text' name='input_54.5' id='input_5_54_5' value=''    aria-required='false'    \/>\n                                    <label for='input_5_54_5' id='input_5_54_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_54.6' id='input_5_54_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_5_51\" class=\"gfield gfield--type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_51\" ><label class='gfield_label gform-field-label' for='input_5_51'>Physician&#039;s Phone Number<\/label><div class='ginput_container ginput_container_phone'><input name='input_51' id='input_5_51' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_57\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_57\" ><label class='gfield_label gform-field-label' for='input_5_57'>Dentist&#039;s Name<\/label><div class='gfield_description' id='gfield_description_5_57'>Enter the name of your child's dentist.<\/div><div class='ginput_container ginput_container_text'><input name='input_57' id='input_5_57' type='text' value='' class='large'  aria-describedby=\"gfield_description_5_57\"    aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_5_55\" class=\"gfield gfield--type-address gfield--width-half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_55\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Dentist&#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_5_55' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_5_55_1_container' >\n                                        <input type='text' name='input_55.1' id='input_5_55_1' value=''    aria-required='false'    \/>\n                                        <label for='input_5_55_1' id='input_5_55_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_5_55_2_container' >\n                                        <input type='text' name='input_55.2' id='input_5_55_2' value=''     aria-required='false'   \/>\n                                        <label for='input_5_55_2' id='input_5_55_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_5_55_3_container' >\n                                    <input type='text' name='input_55.3' id='input_5_55_3' value=''    aria-required='false'    \/>\n                                    <label for='input_5_55_3' id='input_5_55_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_5_55_4_container' >\n                                        <select name='input_55.4' id='input_5_55_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_5_55_4' id='input_5_55_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_5_55_5_container' >\n                                    <input type='text' name='input_55.5' id='input_5_55_5' value=''    aria-required='false'    \/>\n                                    <label for='input_5_55_5' id='input_5_55_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_55.6' id='input_5_55_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_5_56\" class=\"gfield gfield--type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_56\" ><label class='gfield_label gform-field-label' for='input_5_56'>Dentist&#039;s Phone Number<\/label><div class='ginput_container ginput_container_phone'><input name='input_56' id='input_5_56' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_5_60\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_60\" ><label class='gfield_label gform-field-label' for='input_5_60'>Hospital Preference<\/label><div class='gfield_description' id='gfield_description_5_60'>Enter the name of the hospital you want your child transported to in the event of a medical emergency. If emergency personnel transports your child to a different hospital based on medical need, you will be notified immediately.<\/div><div class='ginput_container ginput_container_text'><input name='input_60' id='input_5_60' type='text' value='' class='large'  aria-describedby=\"gfield_description_5_60\"    aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_5_61\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_61\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Medical Information<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_5_61'>Does your child have any of the following medical conditions? A medical condition does not exclude your child from care. Disclosing important medical information allows Little Duckling to provide the best level of care your child requires. If you indicate your child has a medical need, you must provide a doctor's statement with signature to Little Duckling detailing any special accommodations, medications, or instructions that are required to care for your child. <\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_5_61'><div class='gchoice gchoice_5_61_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.1' type='checkbox'  value='None'  id='choice_5_61_1'   aria-describedby=\"gfield_description_5_61\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_61_1' id='label_5_61_1' class='gform-field-label gform-field-label--type-inline'>None<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_61_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.2' type='checkbox'  value='ADHD'  id='choice_5_61_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_61_2' id='label_5_61_2' class='gform-field-label gform-field-label--type-inline'>ADHD<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_61_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.3' type='checkbox'  value='Asthma'  id='choice_5_61_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_61_3' id='label_5_61_3' class='gform-field-label gform-field-label--type-inline'>Asthma<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_61_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.4' type='checkbox'  value='Depression'  id='choice_5_61_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_61_4' id='label_5_61_4' class='gform-field-label gform-field-label--type-inline'>Depression<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_61_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.5' type='checkbox'  value='Developmental Delay or First Steps'  id='choice_5_61_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_61_5' id='label_5_61_5' class='gform-field-label gform-field-label--type-inline'>Developmental Delay or First Steps<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_61_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.6' type='checkbox'  value='Diabetes'  id='choice_5_61_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_61_6' id='label_5_61_6' class='gform-field-label gform-field-label--type-inline'>Diabetes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_61_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.7' type='checkbox'  value='Epilepsy or prone to seizures'  id='choice_5_61_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_61_7' id='label_5_61_7' class='gform-field-label gform-field-label--type-inline'>Epilepsy or prone to seizures<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_61_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.8' type='checkbox'  value='Food Allergy or Intolerance'  id='choice_5_61_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_61_8' id='label_5_61_8' class='gform-field-label gform-field-label--type-inline'>Food Allergy or Intolerance<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_61_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.9' type='checkbox'  value='Hearing or visual impairment'  id='choice_5_61_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_61_9' id='label_5_61_9' class='gform-field-label gform-field-label--type-inline'>Hearing or visual impairment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_61_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.11' type='checkbox'  value='Other'  id='choice_5_61_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_61_11' id='label_5_61_11' 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_5_64\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_64\" ><label class='gfield_label gform-field-label' for='input_5_64'>Medications<\/label><div class='gfield_description' id='gfield_description_5_64'>List any medications your student is required to take. A doctor's statement with signature must be submitted to Little Duckling.<\/div><div class='ginput_container ginput_container_text'><input name='input_64' id='input_5_64' type='text' value='' class='large'  aria-describedby=\"gfield_description_5_64\"    aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_5_66\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_66\" ><label class='gfield_label gform-field-label' for='input_5_66'>Anything we need to know or concerns you may have?<\/label><div class='gfield_description' id='gfield_description_5_66'>Please provide any other information you feel will help Little Duckling provide care for your child or any concerns you may have related to your child's medical or developmental needs.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_66' id='input_5_66' class='textarea large'  aria-describedby=\"gfield_description_5_66\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_5_67\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_67\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Photographic &amp; Video Release<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_5_67'>Little Duckling Early Learning Christian Academy has continuous interior and exterior video surveillance of its parking area, entryways, interior hallways, and each classroom. This surveillance is used for the protection and safety of its facility, staff members, visitors, students, and families on site. Video recorded through our surveillance system will not be shared with any unauthorized individual unless required through court order.\n<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_5_67'><div class='gchoice gchoice_5_67_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.1' type='checkbox'  value='I authorize Little Duckling to take pictures or video of my child participating in activities at Little Duckling and use said photos or videos for instructional, publicity, or marketing purposes as well as use in the Procare App for observations, assessments, and developmental purposes.'  id='choice_5_67_1'   aria-describedby=\"gfield_description_5_67\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_5_67_1' id='label_5_67_1' class='gform-field-label gform-field-label--type-inline'>I authorize Little Duckling to take pictures or video of my child participating in activities at Little Duckling and use said photos or videos for instructional, publicity, or marketing purposes as well as use in the Procare App for observations, assessments, and developmental purposes.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_67_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.2' type='checkbox'  value='I authorize Little Duckling to take pictures or video of my child participating in activities at Little Duckling and use said photos or videos in the Procare App for observations, assessments, and developmental purposes only.'  id='choice_5_67_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_67_2' id='label_5_67_2' class='gform-field-label gform-field-label--type-inline'>I authorize Little Duckling to take pictures or video of my child participating in activities at Little Duckling and use said photos or videos in the Procare App for observations, assessments, and developmental purposes only.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_5_67_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.3' type='checkbox'  value='I do not authorize Little Duckling to take pictures or videos of my child for any purpose.'  id='choice_5_67_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_5_67_3' id='label_5_67_3' class='gform-field-label gform-field-label--type-inline'>I do not authorize Little Duckling to take pictures or videos of my child for any purpose.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_5_68\" class=\"gfield gfield--type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_68\" ><label class='gfield_label gform-field-label' for='input_5_68'>Urgent Text Notification<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_68'>In the event of severe weather closings, special events, center closing reminders, or emergencies, Little Duckling wants to notify parents as soon as possible. Please provide a cell phone number for text notifications.<\/div><div class='ginput_container ginput_container_phone'><input name='input_68' id='input_5_68' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_5_68\"  \/><\/div><\/div><fieldset id=\"field_5_69\" class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_69\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Urgent Email Notification<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_5_69'>In the event of severe weather closings, special events, center closing reminders, or emergencies, Little Duckling wants to notify parents as soon as possible. Please provide an email address to receive messages.<\/div><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_5_69_container'>\n                                <span id='input_5_69_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_69' id='input_5_69' value=''    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_5_69\" \/>\n                                    <label for='input_5_69' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_5_69_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_69_2' id='input_5_69_2' value=''    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_5_69\" \/>\n                                    <label for='input_5_69_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><fieldset id=\"field_5_70\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_70\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Urgent Contact Acknowledgement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_5_70'>Little Duckling will contact you via phone, text, or email for urgent updates or notifications. You must keep valid contact information on file at all times.<br \/>\n<\/div><div class='ginput_container ginput_container_consent'><input name='input_70.1' id='input_5_70_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_5_70\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_5_70_1' >I understand Little Duckling will contact me by phone, text, and email for urgent notifications and it is my responsibility to keep valid contact information on file at all time<\/label><input type='hidden' name='input_70.2' value='I understand Little Duckling will contact me by phone, text, and email for urgent notifications and it is my responsibility to keep valid contact information on file at all time' class='gform_hidden' \/><input type='hidden' name='input_70.3' value='5' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_5_71\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_71\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Additional Documents Acknowlegement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_5_71'>There are additional documents required to complete your child's enrollment process with Little Duckling Early Learning Christian Academy. Little Duckling will provide you with those items after receiving your online enrollment application. <\/div><div class='ginput_container ginput_container_consent'><input name='input_71.1' id='input_5_71_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_5_71\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_5_71_1' >I understand there are additional documents that must be submitted to complete my child's enrollment application with Little Duckling Early Learning Christian Academy. I agree to submit all required items.<\/label><input type='hidden' name='input_71.2' value='I understand there are additional documents that must be submitted to complete my child&#039;s enrollment application with Little Duckling Early Learning Christian Academy. I agree to submit all required items.' class='gform_hidden' \/><input type='hidden' name='input_71.3' value='5' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_5_72\" class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_72\" ><label class='gfield_label gform-field-label' for='gform_browse_button_5_72'>Upload Required Documents (Birth Certificate)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_72'>Please provide a copy of your child's birth certificate.<\/div><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_5_72' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_5_72&quot;,&quot;container&quot;:&quot;gform_multifile_upload_5_72&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_5_72&quot;,&quot;filelist&quot;:&quot;gform_preview_5_72&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/www.littleducklingindy.com\\\/?gf_page=9c45a5d9c0df2bb&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/www.littleducklingindy.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/www.littleducklingindy.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;52428800b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:5,&quot;field_id&quot;:72},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_5_72&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_5_72' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_5_72' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_5_72 gfield_description_5_72\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_72'>Max. file size: 50 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_5_72'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_5_72' class='ginput_preview_list'><\/div><\/div><div id=\"field_5_73\" class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_73\" ><label class='gfield_label gform-field-label' for='gform_browse_button_5_73'>Upload Required Documents (Immunization Record)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_73'>Please provide a copy of your child's CURRENT immunization record.<\/div><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_5_73' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_5_73&quot;,&quot;container&quot;:&quot;gform_multifile_upload_5_73&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_5_73&quot;,&quot;filelist&quot;:&quot;gform_preview_5_73&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/www.littleducklingindy.com\\\/?gf_page=9c45a5d9c0df2bb&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/www.littleducklingindy.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/www.littleducklingindy.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;52428800b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:5,&quot;field_id&quot;:73},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_5_73&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_5_73' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_5_73' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_5_73 gfield_description_5_73\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_73'>Max. file size: 50 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_5_73'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_5_73' class='ginput_preview_list'><\/div><\/div><div id=\"field_5_74\" class=\"gfield gfield--type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_5_74\" ><label class='gfield_label gform-field-label' for='gform_browse_button_5_74'>Upload Required Documents (Physical)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_5_74'>Please provide a copy of your child's most recent physical dated within 1 year and signed by a physician.<\/div><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_5_74' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_5_74&quot;,&quot;container&quot;:&quot;gform_multifile_upload_5_74&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_5_74&quot;,&quot;filelist&quot;:&quot;gform_preview_5_74&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/www.littleducklingindy.com\\\/?gf_page=9c45a5d9c0df2bb&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/www.littleducklingindy.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/www.littleducklingindy.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;52428800b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:5,&quot;field_id&quot;:74},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_5_74&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_5_74' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_5_74' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_5_74 gfield_description_5_74\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_5_74'>Max. file size: 50 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_5_74'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_5_74' class='ginput_preview_list'><\/div><\/div><\/div><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_5' class='gform_button button' value='Submit'  onclick='if(window[\"gf_submitting_5\"]){return false;}  if( !jQuery(\"#gform_5\")[0].checkValidity || jQuery(\"#gform_5\")[0].checkValidity()){window[\"gf_submitting_5\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_5\"]){return false;} if( !jQuery(\"#gform_5\")[0].checkValidity || jQuery(\"#gform_5\")[0].checkValidity()){window[\"gf_submitting_5\"]=true;}  jQuery(\"#gform_5\").trigger(\"submit\",[true]); }' \/> <button type='button'  id='gform_save_5_footer_link' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  onclick='if(window[\"gf_submitting_5\"]){return false;}  if( !jQuery(\"#gform_5\")[0].checkValidity || jQuery(\"#gform_5\")[0].checkValidity()){window[\"gf_submitting_5\"]=true;} jQuery(\"#gform_save_5\").val(1); jQuery(\"#gform_5\").trigger(\"submit\",[true]);' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_5\"]){return false;} if( !jQuery(\"#gform_5\")[0].checkValidity || jQuery(\"#gform_5\")[0].checkValidity()){window[\"gf_submitting_5\"]=true;} jQuery(\"#gform_save_5\").val(1); jQuery(\"#gform_5\").trigger(\"submit\",[true]); }'><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> Save and Continue Later<\/button><input type='hidden' name='gform_ajax' value='form_id=5&amp;title=&amp;description=1&amp;tabindex=0&amp;theme=gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_5' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='5' \/>\n            <input type='hidden' class='gform_hidden' name='gform_save' id='gform_save_5' value='' \/>\n                             <input type='hidden' class='gform_hidden' name='gform_resume_token' id='gform_resume_token_5' value='' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_5' value='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' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_5' id='gform_target_page_number_5' value='0' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_5' id='gform_source_page_number_5' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            <input type='hidden' name='gform_uploaded_files' id='gform_uploaded_files_5' value='' \/>\n        <\/div>\n                        <p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"ak_\"><label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"117\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><\/form>\n                        <\/div>\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_5' id='gform_ajax_frame_5' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n\t\t                <script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 5, 'https:\/\/www.littleducklingindy.com\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_5').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_5');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_5').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_5').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_5').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_5').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_5').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_5').val();gformInitSpinner( 5, 'https:\/\/www.littleducklingindy.com\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [5, current_page]);window['gf_submitting_5'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_5').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_5').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [5]);window['gf_submitting_5'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_5').text());}, 50);}else{jQuery('#gform_5').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"5\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);                if (event.defaultPrevented) {                return;         }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_5\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_5\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_5\" );        let postRenderFired = false;                function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            jQuery( document ).trigger( 'gform_post_render', [5, current_page] );            gform.utils.trigger( { event: 'gform\/postRender', native: false, data: { formId: 5, currentPage: current_page } } );            if ( visibilityTestDiv ) {                visibilityTestDiv.parentNode.removeChild( visibilityTestDiv );            }        }        function debounce( func, wait, immediate ) {            var timeout;            return function() {                var context = this, args = arguments;                var later = function() {                    timeout = null;                    if ( !immediate ) func.apply( context, args );                };                var callNow = immediate && !timeout;                clearTimeout( timeout );                timeout = setTimeout( later, wait );                if ( callNow ) func.apply( context, args );            };        }        const debouncedTriggerPostRender = debounce( function() {            triggerPostRender();        }, 200 );        if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) {            const observer = new MutationObserver( ( mutations ) => {                mutations.forEach( ( mutation ) => {                    if ( mutation.type === 'attributes' && visibilityTestDiv.offsetParent !== null ) {                        debouncedTriggerPostRender();                        observer.disconnect();                    }                });            });            observer.observe( document.body, {                attributes: true,                childList: false,                subtree: true,                attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} ); \n\/* ]]> *\/\n<\/script>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Enroll Today<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Enrollment - Daycare in Indianapolis, IN<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.littleducklingindy.com\/enrollment\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Enrollment - Daycare in Indianapolis, IN\" \/>\n<meta property=\"og:description\" content=\"Enroll Today\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.littleducklingindy.com\/enrollment\/\" \/>\n<meta property=\"og:site_name\" content=\"Daycare in Indianapolis, IN\" \/>\n<meta property=\"article:modified_time\" content=\"2023-03-30T17:41:04+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.littleducklingindy.com\/wp-content\/uploads\/2022\/11\/Little-duckling-sparks-300x269.png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"12 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.littleducklingindy.com\/enrollment\/\",\"url\":\"https:\/\/www.littleducklingindy.com\/enrollment\/\",\"name\":\"Enrollment - Daycare in Indianapolis, IN\",\"isPartOf\":{\"@id\":\"https:\/\/www.littleducklingindy.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/www.littleducklingindy.com\/enrollment\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/www.littleducklingindy.com\/enrollment\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/www.littleducklingindy.com\/wp-content\/uploads\/2022\/11\/Little-duckling-sparks-300x269.png\",\"datePublished\":\"2023-03-30T17:35:30+00:00\",\"dateModified\":\"2023-03-30T17:41:04+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/www.littleducklingindy.com\/enrollment\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.littleducklingindy.com\/enrollment\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.littleducklingindy.com\/enrollment\/#primaryimage\",\"url\":\"https:\/\/www.littleducklingindy.com\/wp-content\/uploads\/2022\/11\/Little-duckling-sparks.png\",\"contentUrl\":\"https:\/\/www.littleducklingindy.com\/wp-content\/uploads\/2022\/11\/Little-duckling-sparks.png\",\"width\":441,\"height\":396},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/www.littleducklingindy.com\/enrollment\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/www.littleducklingindy.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Enrollment\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.littleducklingindy.com\/#website\",\"url\":\"https:\/\/www.littleducklingindy.com\/\",\"name\":\"Daycare in Indianapolis, IN\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\/\/www.littleducklingindy.com\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/www.littleducklingindy.com\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/www.littleducklingindy.com\/#organization\",\"name\":\"Daycare in Indianapolis, IN\",\"url\":\"https:\/\/www.littleducklingindy.com\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.littleducklingindy.com\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/www.littleducklingindy.com\/wp-content\/uploads\/2022\/10\/little-duckling-logo.png\",\"contentUrl\":\"https:\/\/www.littleducklingindy.com\/wp-content\/uploads\/2022\/10\/little-duckling-logo.png\",\"width\":254,\"height\":156,\"caption\":\"Daycare in Indianapolis, IN\"},\"image\":{\"@id\":\"https:\/\/www.littleducklingindy.com\/#\/schema\/logo\/image\/\"}}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Enrollment - Daycare in Indianapolis, IN","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.littleducklingindy.com\/enrollment\/","og_locale":"en_US","og_type":"article","og_title":"Enrollment - Daycare in Indianapolis, IN","og_description":"Enroll Today","og_url":"https:\/\/www.littleducklingindy.com\/enrollment\/","og_site_name":"Daycare in Indianapolis, IN","article_modified_time":"2023-03-30T17:41:04+00:00","og_image":[{"url":"https:\/\/www.littleducklingindy.com\/wp-content\/uploads\/2022\/11\/Little-duckling-sparks-300x269.png"}],"twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"12 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/www.littleducklingindy.com\/enrollment\/","url":"https:\/\/www.littleducklingindy.com\/enrollment\/","name":"Enrollment - Daycare in Indianapolis, IN","isPartOf":{"@id":"https:\/\/www.littleducklingindy.com\/#website"},"primaryImageOfPage":{"@id":"https:\/\/www.littleducklingindy.com\/enrollment\/#primaryimage"},"image":{"@id":"https:\/\/www.littleducklingindy.com\/enrollment\/#primaryimage"},"thumbnailUrl":"https:\/\/www.littleducklingindy.com\/wp-content\/uploads\/2022\/11\/Little-duckling-sparks-300x269.png","datePublished":"2023-03-30T17:35:30+00:00","dateModified":"2023-03-30T17:41:04+00:00","breadcrumb":{"@id":"https:\/\/www.littleducklingindy.com\/enrollment\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.littleducklingindy.com\/enrollment\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.littleducklingindy.com\/enrollment\/#primaryimage","url":"https:\/\/www.littleducklingindy.com\/wp-content\/uploads\/2022\/11\/Little-duckling-sparks.png","contentUrl":"https:\/\/www.littleducklingindy.com\/wp-content\/uploads\/2022\/11\/Little-duckling-sparks.png","width":441,"height":396},{"@type":"BreadcrumbList","@id":"https:\/\/www.littleducklingindy.com\/enrollment\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.littleducklingindy.com\/"},{"@type":"ListItem","position":2,"name":"Enrollment"}]},{"@type":"WebSite","@id":"https:\/\/www.littleducklingindy.com\/#website","url":"https:\/\/www.littleducklingindy.com\/","name":"Daycare in Indianapolis, IN","description":"","publisher":{"@id":"https:\/\/www.littleducklingindy.com\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.littleducklingindy.com\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/www.littleducklingindy.com\/#organization","name":"Daycare in Indianapolis, IN","url":"https:\/\/www.littleducklingindy.com\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.littleducklingindy.com\/#\/schema\/logo\/image\/","url":"https:\/\/www.littleducklingindy.com\/wp-content\/uploads\/2022\/10\/little-duckling-logo.png","contentUrl":"https:\/\/www.littleducklingindy.com\/wp-content\/uploads\/2022\/10\/little-duckling-logo.png","width":254,"height":156,"caption":"Daycare in Indianapolis, IN"},"image":{"@id":"https:\/\/www.littleducklingindy.com\/#\/schema\/logo\/image\/"}}]}},"_links":{"self":[{"href":"https:\/\/www.littleducklingindy.com\/wp-json\/wp\/v2\/pages\/1067"}],"collection":[{"href":"https:\/\/www.littleducklingindy.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.littleducklingindy.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.littleducklingindy.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.littleducklingindy.com\/wp-json\/wp\/v2\/comments?post=1067"}],"version-history":[{"count":8,"href":"https:\/\/www.littleducklingindy.com\/wp-json\/wp\/v2\/pages\/1067\/revisions"}],"predecessor-version":[{"id":1092,"href":"https:\/\/www.littleducklingindy.com\/wp-json\/wp\/v2\/pages\/1067\/revisions\/1092"}],"wp:attachment":[{"href":"https:\/\/www.littleducklingindy.com\/wp-json\/wp\/v2\/media?parent=1067"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}