/*jslint nomen:false, debug:true, evil:true, vars:false, browser:true, forin:true, undef:false, white:false */
/**
* Includes a Form with javascript
* @param {Object} formId
* @param {Object} initialHeight
* @param {Object} iframeCode
*/
function FrameBuilder (formId, appendTo, initialHeight, iframeCode){
this.formId = formId;
this.initialHeight = initialHeight;
this.iframeCode = iframeCode;
this.frame = null;
this.timeInterval= 200;
this.appendTo = appendTo || false;
// initialize function for object
this.init = function(){
this.createFrame();
this.addFrameContent(this.iframeCode);
};
// Create the frame
this.createFrame = function(){
var htmlCode = "<"+"iframe src=\"\" allowtransparency=\"true\" frameborder=\"0\" name=\""+this.formId+"\" id=\""+this.formId+"\" style=\"width:100%; height:"+this.initialHeight+"px; border:none;\" scrolling=\"no\">";
if(this.appendTo === false){
document.write(htmlCode);
}else{
var tmp = document.createElement('div');
tmp.innerHTML = htmlCode;
var a = this.appendTo;
document.getElementById(a).appendChild(tmp.firstChild);
}
// also get the frame for future use.
this.frame = document.getElementById(this.formId);
// set the time on the on load event of the frame
this.addEvent(this.frame, 'load', this.bindMethod(this.setTimer, this));
};
// add event function for different browsers
this.addEvent = function( obj, type, fn ) {
if ( obj.attachEvent ) {
obj["e"+type+fn] = fn;
obj[type+fn] = function() { obj["e"+type+fn]( window.event ); };
obj.attachEvent( "on"+type, obj[type+fn] );
}
else{
obj.addEventListener( type, fn, false );
}
};
this.addFrameContent = function (string){
string = string.replace(new RegExp('src\\=\\"[^"]*captcha.php\"><\/scr'+'ipt>', 'gim'), 'src="http://api.recaptcha.net/js/recaptcha_ajax.js"><'+'div id="recaptcha_div"><'+'/div>'+
'<'+'style>#recaptcha_logo{ display:none;} #recaptcha_tagline{display:none;} #recaptcha_table{border:none !important;} .recaptchatable .recaptcha_image_cell, #recaptcha_table{ background-color:transparent !important; } <'+'/style>'+
'<'+'script defer="defer"> window.onload = function(){ Recaptcha.create("6Ld9UAgAAAAAAMon8zjt30tEZiGQZ4IIuWXLt1ky", "recaptcha_div", {theme: "clean",tabindex: 0,callback: function (){'+
'if (document.getElementById("uword")) { document.getElementById("uword").parentNode.removeChild(document.getElementById("uword")); } if (window["validate"] !== undefined) { if (document.getElementById("recaptcha_response_field")){ document.getElementById("recaptcha_response_field").onblur = function(){ validate(document.getElementById("recaptcha_response_field"), "Required"); } } } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_challenge_field")[0].setAttribute("name", "anum"); } if (document.getElementById("recaptcha_response_field")){ document.getElementsByName("recaptcha_response_field")[0].setAttribute("name", "qCap"); }}})'+
' }<'+'/script>');
string = string.replace(/(type="text\/javascript">)\s+(validate\(\"[^"]*"\);)/, '$1 jTime = setInterval(function(){if("validate" in window){$2clearTimeout(jTime);}}, 1000);');
var frameDocument = (this.frame.contentWindow) ? this.frame.contentWindow : (this.frame.contentDocument.document) ? this.frame.contentDocument.document : this.frame.contentDocument;
frameDocument.document.open();
frameDocument.document.write(string);
setTimeout( function(){
frameDocument.document.close();
try{
if('JotFormFrameLoaded' in window){
JotFormFrameLoaded();
}
}catch(e){}
},200);
};
this.setTimer = function(){
var self = this;
this.interval = setTimeout(function(){self.changeHeight();},this.timeInterval);
};
this.changeHeight = function (){
var actualHeight = this.getBodyHeight();
var currentHeight = this.getViewPortHeight();
if(actualHeight === undefined){
this.frame.style.height = "100%";
if(!this.frame.style.minHeight){
this.frame.style.minHeight = "300px";
}
}else if (Math.abs(actualHeight - currentHeight) > 18){
this.frame.style.height = (actualHeight)+"px";
}
this.setTimer();
};
this.bindMethod = function(method, scope) {
return function() {
method.apply(scope,arguments);
};
};
this.getBodyHeight = function (){
var height;
var scrollHeight;
var offsetHeight;
try{ // Prevent IE from throw errors
if (this.frame.contentWindow.document.height){
height = this.frame.contentWindow.document.height;
//Emre: to prevent "iframe height" problem (61059)
if (this.frame.contentWindow.document.body.scrollHeight){
height = scrollHeight = this.frame.contentWindow.document.body.scrollHeight;
}
if (this.frame.contentWindow.document.body.offsetHeight){
height = offsetHeight = this.frame.contentWindow.document.body.offsetHeight;
}
} else if (this.frame.contentWindow.document.body){
if (this.frame.contentWindow.document.body.scrollHeight){
height = scrollHeight = this.frame.contentWindow.document.body.scrollHeight;
}
if (this.frame.contentWindow.document.body.offsetHeight){
height = offsetHeight = this.frame.contentWindow.document.body.offsetHeight;
}
if (scrollHeight && offsetHeight){
height = Math.max(scrollHeight, offsetHeight);
}
}
}catch(e){ }
return height;
};
this.getViewPortHeight = function(){
var height = 0;
try{ // Prevent IE from throw errors
if (this.frame.contentWindow.window.innerHeight)
{
height = this.frame.contentWindow.window.innerHeight - 18;
}
else if ((this.frame.contentWindow.document.documentElement) &&
(this.frame.contentWindow.document.documentElement.clientHeight))
{
height = this.frame.contentWindow.document.documentElement.clientHeight;
}
else if ((this.frame.contentWindow.document.body) &&
(this.frame.contentWindow.document.body.clientHeight))
{
height = this.frame.contentWindow.document.body.clientHeight;
}
}catch(e){ }
return height;
};
this.init();
}
FrameBuilder.get = [];
var i1090100527 = new FrameBuilder("1090100527", false, "", "\n\n\n\n\nForm<\/title>\n<link href=\"http:\/\/max.jotfor.ms\/min\/g=formCss?3.0.2435\" rel=\"stylesheet\" type=\"text\/css\" \/>\n<style type=\"text\/css\">\n .form-label{\n width:150px !important;\n }\n .form-label-left{\n width:150px !important;\n }\n .form-line{\n padding:10px;\n }\n .form-label-right{\n width:150px !important;\n }\n body, html{\n margin:0;\n padding:0;\n background:false;\n }\n\n .form-all{\n margin:0px auto;\n padding-top:0px;\n width:900px;\n color:Black !important;\n font-family:Verdana;\n font-size:12px;\n }\n<\/style>\n\n<script src=\"http:\/\/max.jotfor.ms\/min\/g=jotform?3.0.2435\" type=\"text\/javascript\"><\/script>\n<script type=\"text\/javascript\">\n var jsTime = setInterval(function(){try{\n JotForm.jsForm = true;\n\n JotForm.init(function(){\n $('input_9').hint('ex: myname@example.com');\n $('input_11').hint('ex: myname@example.com');\n JotForm.totalCounter({\"input_43_102\":{\"price\":\"150.00\",\"quantityField\":\"input_43_quantity_102_0\"}});\n JotForm.setCalendar(\"48\");\n });\n\n clearInterval(jsTime);\n }catch(e){}}, 1000);\n<\/script>\n<\/head>\n<body>\n<form class=\"jotform-form\" action=\"http:\/\/submit.jotform.com\/submit.php\" method=\"post\" name=\"form_1090100527\" id=\"1090100527\" accept-charset=\"utf-8\">\n <input type=\"hidden\" name=\"formID\" value=\"1090100527\" \/>\n <div class=\"form-all\">\n <ul class=\"form-section\">\n <li id=\"cid_1\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_1\" class=\"form-header\">\n CMS Summer Camp Registration And Contact Form (one child per form, please)\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_3\">\n <label class=\"form-label-left\" id=\"label_3\" for=\"input_3\">\n Camper's Name<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_3\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_3\" name=\"q3_campersName3\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_4\">\n <label class=\"form-label-left\" id=\"label_4\" for=\"input_4\">\n Camper's Age<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_4\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_4\" name=\"q4_campersAge\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_5\">\n <label class=\"form-label-left\" id=\"label_5\" for=\"input_5\">\n Parent\/Guardian Name<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_5\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_5\" name=\"q5_parentguardianName\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_8\">\n <label class=\"form-label-left\" id=\"label_8\" for=\"input_8\">\n Emergency Number - Mother\/Guardian 1<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_8\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"tel\" name=\"q8_emergencyNumber8[area]\" id=\"input_8_area\" size=\"3\">\n -\n <label class=\"form-sub-label\" for=\"input_8_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"tel\" name=\"q8_emergencyNumber8[phone]\" id=\"input_8_phone\" size=\"8\">\n <label class=\"form-sub-label\" for=\"input_8_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_12\">\n <label class=\"form-label-left\" id=\"label_12\" for=\"input_12\"> 2nd Emergency # <\/label>\n <div id=\"cid_12\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q12_2ndEmergency12[area]\" id=\"input_12_area\" size=\"3\">\n -\n <label class=\"form-sub-label\" for=\"input_12_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q12_2ndEmergency12[phone]\" id=\"input_12_phone\" size=\"8\">\n <label class=\"form-sub-label\" for=\"input_12_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_9\">\n <label class=\"form-label-left\" id=\"label_9\" for=\"input_9\">\n Contact e-mail<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_9\" class=\"form-input\">\n <input type=\"email\" class=\"form-textbox validate[required, Email]\" id=\"input_9\" name=\"q9_contactEmail\" size=\"30\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_10\">\n <label class=\"form-label-left\" id=\"label_10\" for=\"input_10\"> Emergency Number - Father\/Guardian 2 <\/label>\n <div id=\"cid_10\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q10_emergencyNumber10[area]\" id=\"input_10_area\" size=\"3\">\n -\n <label class=\"form-sub-label\" for=\"input_10_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q10_emergencyNumber10[phone]\" id=\"input_10_phone\" size=\"8\">\n <label class=\"form-sub-label\" for=\"input_10_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_13\">\n <label class=\"form-label-left\" id=\"label_13\" for=\"input_13\"> 2nd Emergency # <\/label>\n <div id=\"cid_13\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q13_2ndEmergency[area]\" id=\"input_13_area\" size=\"3\">\n -\n <label class=\"form-sub-label\" for=\"input_13_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q13_2ndEmergency[phone]\" id=\"input_13_phone\" size=\"8\">\n <label class=\"form-sub-label\" for=\"input_13_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_11\">\n <label class=\"form-label-left\" id=\"label_11\" for=\"input_11\"> Contact e-mail <\/label>\n <div id=\"cid_11\" class=\"form-input\">\n <input type=\"email\" class=\"form-textbox validate[Email]\" id=\"input_11\" name=\"q11_contactEmail11\" size=\"30\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_14\">\n <label class=\"form-label-left\" id=\"label_14\" for=\"input_14\">\n If not available in an emergency, notify (name, number, e-mail)<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_14\" class=\"form-input\">\n <textarea id=\"input_14\" class=\"form-textarea validate[required]\" name=\"q14_ifNot14\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_15\">\n <label class=\"form-label-left\" id=\"label_15\" for=\"input_15\">\n Physician Name<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_15\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_15\" name=\"q15_physicianName\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_16\">\n <label class=\"form-label-left\" id=\"label_16\" for=\"input_16\">\n Physician Number<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_16\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"tel\" name=\"q16_physicianNumber[area]\" id=\"input_16_area\" size=\"3\">\n -\n <label class=\"form-sub-label\" for=\"input_16_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"tel\" name=\"q16_physicianNumber[phone]\" id=\"input_16_phone\" size=\"8\">\n <label class=\"form-sub-label\" for=\"input_16_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_17\">\n <label class=\"form-label-left\" id=\"label_17\" for=\"input_17\"> Insurance Company <\/label>\n <div id=\"cid_17\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_17\" name=\"q17_insuranceCompany\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_18\">\n <label class=\"form-label-left\" id=\"label_18\" for=\"input_18\"> Policy Number <\/label>\n <div id=\"cid_18\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_18\" name=\"q18_policyNumber\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_19\">\n <label class=\"form-label-left\" id=\"label_19\" for=\"input_19\"> Allergies: Medicine, Environmental, Food\/Diet (List all known) <\/label>\n <div id=\"cid_19\" class=\"form-input\">\n <textarea id=\"input_19\" class=\"form-textarea\" name=\"q19_allergiesMedicine\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_20\">\n <label class=\"form-label-left\" id=\"label_20\" for=\"input_20\"> Allergic Reactions <\/label>\n <div id=\"cid_20\" class=\"form-input\">\n <textarea id=\"input_20\" class=\"form-textarea\" name=\"q20_allergicReactions\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_21\">\n <label class=\"form-label-left\" id=\"label_21\" for=\"input_21\"> Allergy Management <\/label>\n <div id=\"cid_21\" class=\"form-input\">\n <textarea id=\"input_21\" class=\"form-textarea\" name=\"q21_allergyManagement\" cols=\"40\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li id=\"cid_23\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_23\" class=\"form-header\">\n Registration and Course Name ($150 per child\/per camp). All camps are from 9AM to 1 PM. Registration deadline is 2 weeks prior to start of camp.\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_24\">\n <label class=\"form-label-left\" id=\"label_24\" for=\"input_24\">\n Camp Dates<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_24\" class=\"form-input\">\n <select class=\"form-dropdown validate[required]\" style=\"width:150px\" id=\"input_24\" name=\"q24_campDates24\">\n <option> <\/option>\n <option value=\"MAY 31 - JUNE 3\"> MAY 31 - JUNE 3 <\/option>\n <option value=\"JUNE 6 - 10\"> JUNE 6 - 10 <\/option>\n <option value=\"JUNE 13 - 17\"> JUNE 13 - 17 <\/option>\n <option value=\"JUNE 20 - 24\"> JUNE 20 - 24 <\/option>\n <option value=\"JUNE 27 - JULY 1\"> JUNE 27 - JULY 1 <\/option>\n <option value=\"JULY 11 - 15\"> JULY 11 - 15 <\/option>\n <option value=\"JULY 18 - 22\"> JULY 18 - 22 <\/option>\n <option value=\"JULY 25 - 29\"> JULY 25 - 29 <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_31\">\n <label class=\"form-label-left\" id=\"label_31\" for=\"input_31\">\n Course Name<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_31\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_31\" name=\"q31_courseName\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_26\">\n <label class=\"form-label-left\" id=\"label_26\" for=\"input_26\"> Camp Dates <\/label>\n <div id=\"cid_26\" class=\"form-input\">\n <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_26\" name=\"q26_campDates\">\n <option> <\/option>\n <option value=\"Week 1 - June 1-4\"> Week 1 - June 1-4 <\/option>\n <option value=\"Week 2 - June 7-11\"> Week 2 - June 7-11 <\/option>\n <option value=\"Week 3 - June 14-18\"> Week 3 - June 14-18 <\/option>\n <option value=\"Week 4 - June 21-25\"> Week 4 - June 21-25 <\/option>\n <option value=\"Week 5 - June 28 - July 2\"> Week 5 - June 28 - July 2 <\/option>\n <option value=\"Week 6 - July 12 - 16\"> Week 6 - July 12 - 16 <\/option>\n <option value=\"Week 7 - July 19 - 23\"> Week 7 - July 19 - 23 <\/option>\n <option value=\"Week 8 - July 26 - 30\"> Week 8 - July 26 - 30 <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_33\">\n <label class=\"form-label-left\" id=\"label_33\" for=\"input_33\"> Course Name <\/label>\n <div id=\"cid_33\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_33\" name=\"q33_courseName\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_30\">\n <label class=\"form-label-left\" id=\"label_30\" for=\"input_30\"> Camp Dates <\/label>\n <div id=\"cid_30\" class=\"form-input\">\n <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_30\" name=\"q30_campDates\">\n <option> <\/option>\n <option value=\"Week 1 - June 1-4\"> Week 1 - June 1-4 <\/option>\n <option value=\"Week 2 - June 7-11\"> Week 2 - June 7-11 <\/option>\n <option value=\"Week 3 - June 14-18\"> Week 3 - June 14-18 <\/option>\n <option value=\"Week 4 - June 21-25\"> Week 4 - June 21-25 <\/option>\n <option value=\"Week 5 - June 28 - July 2\"> Week 5 - June 28 - July 2 <\/option>\n <option value=\"Week 6 - July 12 - 16\"> Week 6 - July 12 - 16 <\/option>\n <option value=\"Week 7 - July 19 - 23\"> Week 7 - July 19 - 23 <\/option>\n <option value=\"Week 8 - July 26 - 30\"> Week 8 - July 26 - 30 <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_25\">\n <label class=\"form-label-left\" id=\"label_25\" for=\"input_25\"> Course Name <\/label>\n <div id=\"cid_25\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_25\" name=\"q25_courseName\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_29\">\n <label class=\"form-label-left\" id=\"label_29\" for=\"input_29\"> Camp Dates <\/label>\n <div id=\"cid_29\" class=\"form-input\">\n <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_29\" name=\"q29_campDates\">\n <option> <\/option>\n <option value=\"Week 1 - June 1-4\"> Week 1 - June 1-4 <\/option>\n <option value=\"Week 2 - June 7-11\"> Week 2 - June 7-11 <\/option>\n <option value=\"Week 3 - June 14-18\"> Week 3 - June 14-18 <\/option>\n <option value=\"Week 4 - June 21-25\"> Week 4 - June 21-25 <\/option>\n <option value=\"Week 5 - June 28 - July 2\"> Week 5 - June 28 - July 2 <\/option>\n <option value=\"Week 6 - July 12 - 16\"> Week 6 - July 12 - 16 <\/option>\n <option value=\"Week 7 - July 19 - 23\"> Week 7 - July 19 - 23 <\/option>\n <option value=\"Week 8 - July 26 - 30\"> Week 8 - July 26 - 30 <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_32\">\n <label class=\"form-label-left\" id=\"label_32\" for=\"input_32\"> Course Name <\/label>\n <div id=\"cid_32\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_32\" name=\"q32_courseName\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_28\">\n <label class=\"form-label-left\" id=\"label_28\" for=\"input_28\"> Camp Dates <\/label>\n <div id=\"cid_28\" class=\"form-input\">\n <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_28\" name=\"q28_campDates\">\n <option> <\/option>\n <option value=\"Week 1 - June 1-4\"> Week 1 - June 1-4 <\/option>\n <option value=\"Week 2 - June 7-11\"> Week 2 - June 7-11 <\/option>\n <option value=\"Week 3 - June 14-18\"> Week 3 - June 14-18 <\/option>\n <option value=\"Week 4 - June 21-25\"> Week 4 - June 21-25 <\/option>\n <option value=\"Week 5 - June 28 - July 2\"> Week 5 - June 28 - July 2 <\/option>\n <option value=\"Week 6 - July 12 - 16\"> Week 6 - July 12 - 16 <\/option>\n <option value=\"Week 7 - July 19 - 23\"> Week 7 - July 19 - 23 <\/option>\n <option value=\"Week 8 - July 26 - 30\"> Week 8 - July 26 - 30 <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_27\">\n <label class=\"form-label-left\" id=\"label_27\" for=\"input_27\"> Course Name <\/label>\n <div id=\"cid_27\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_27\" name=\"q27_courseName\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_36\">\n <label class=\"form-label-left\" id=\"label_36\" for=\"input_36\"> Camp Dates <\/label>\n <div id=\"cid_36\" class=\"form-input\">\n <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_36\" name=\"q36_campDates\">\n <option> <\/option>\n <option value=\"Week 1 - June 1-4\"> Week 1 - June 1-4 <\/option>\n <option value=\"Week 2 - June 7-11\"> Week 2 - June 7-11 <\/option>\n <option value=\"Week 3 - June 14-18\"> Week 3 - June 14-18 <\/option>\n <option value=\"Week 4 - June 21-25\"> Week 4 - June 21-25 <\/option>\n <option value=\"Week 5 - June 28 - July 2\"> Week 5 - June 28 - July 2 <\/option>\n <option value=\"Week 6 - July 12 - 16\"> Week 6 - July 12 - 16 <\/option>\n <option value=\"Week 7 - July 19 - 23\"> Week 7 - July 19 - 23 <\/option>\n <option value=\"Week 8 - July 26 - 30\"> Week 8 - July 26 - 30 <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_37\">\n <label class=\"form-label-left\" id=\"label_37\" for=\"input_37\"> Course Name <\/label>\n <div id=\"cid_37\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_37\" name=\"q37_courseName\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_35\">\n <label class=\"form-label-left\" id=\"label_35\" for=\"input_35\"> Camp Dates <\/label>\n <div id=\"cid_35\" class=\"form-input\">\n <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_35\" name=\"q35_campDates\">\n <option> <\/option>\n <option value=\"Week 1 - June 1-4\"> Week 1 - June 1-4 <\/option>\n <option value=\"Week 2 - June 7-11\"> Week 2 - June 7-11 <\/option>\n <option value=\"Week 3 - June 14-18\"> Week 3 - June 14-18 <\/option>\n <option value=\"Week 4 - June 21-25\"> Week 4 - June 21-25 <\/option>\n <option value=\"Week 5 - June 28 - July 2\"> Week 5 - June 28 - July 2 <\/option>\n <option value=\"Week 6 - July 12 - 16\"> Week 6 - July 12 - 16 <\/option>\n <option value=\"Week 7 - July 19 - 23\"> Week 7 - July 19 - 23 <\/option>\n <option value=\"Week 8 - July 26 - 30\"> Week 8 - July 26 - 30 <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_38\">\n <label class=\"form-label-left\" id=\"label_38\" for=\"input_38\"> Course Name <\/label>\n <div id=\"cid_38\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_38\" name=\"q38_courseName\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_39\">\n <label class=\"form-label-left\" id=\"label_39\" for=\"input_39\"> Camp Dates <\/label>\n <div id=\"cid_39\" class=\"form-input\">\n <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_39\" name=\"q39_campDates\">\n <option> <\/option>\n <option value=\"Week 1 - June 1-4\"> Week 1 - June 1-4 <\/option>\n <option value=\"Week 2 - June 7-11\"> Week 2 - June 7-11 <\/option>\n <option value=\"Week 3 - June 14-18\"> Week 3 - June 14-18 <\/option>\n <option value=\"Week 4 - June 21-25\"> Week 4 - June 21-25 <\/option>\n <option value=\"Week 5 - June 28 - July 2\"> Week 5 - June 28 - July 2 <\/option>\n <option value=\"Week 6 - July 12 - 16\"> Week 6 - July 12 - 16 <\/option>\n <option value=\"Week 7 - July 19 - 23\"> Week 7 - July 19 - 23 <\/option>\n <option value=\"Week 8 - July 26 - 30\"> Week 8 - July 26 - 30 <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_40\">\n <label class=\"form-label-left\" id=\"label_40\" for=\"input_40\"> Course Name <\/label>\n <div id=\"cid_40\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_40\" name=\"q40_courseName\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_43\">\n <label class=\"form-label-left\" id=\"label_43\" for=\"input_43\">\n Camp Totals<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_43\" class=\"form-input\"><span class=\"form-product-item\"><input class=\"form-radio validate[required]\" type=\"radio\" id=\"input_43_102\" name=\"q43_campTotals[][id]\" value=\"102\" \/>\n <label for=\"input_43_102\">\n $150 per Child per Camp<span class=\"form-product-details\"><b>\n $<span id=\"\">150.00<\/span>\n USD\n <\/b><\/span>\n <\/label>\n <br \/>\n <br \/><span class=\"form-sub-label-container\"><select class=\"form-dropdown validate[required]\" name=\"q43_campTotals[special_102][item_0]\" id=\"input_43_quantity_102_0\">\n <option value=\"0\"> 0 <\/option>\n <option value=\"1\"> 1 <\/option>\n <option value=\"2\"> 2 <\/option>\n <option value=\"3\"> 3 <\/option>\n <option value=\"4\"> 4 <\/option>\n <option value=\"5\"> 5 <\/option>\n <option value=\"6\"> 6 <\/option>\n <option value=\"7\"> 7 <\/option>\n <option value=\"8\"> 8 <\/option>\n <option value=\"9\"> 9 <\/option>\n <option value=\"10\"> 10 <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"input_43_quantity_102_0\"> Quantity <\/label><\/span><\/span>\n <br \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_41\">\n <label class=\"form-label-left\" id=\"label_41\" for=\"input_41\"> Form of Payment <\/label>\n <div id=\"cid_41\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_41_0\" name=\"q41_formOf[]\" value=\"PayPal (will automatically take you to PayPal upon completion of form)\" \/>\n <label for=\"input_41_0\"> PayPal (will automatically take you to PayPal upon completion of form) <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_50\">\n <label class=\"form-label-left\" id=\"label_50\" for=\"input_50\"> .... <\/label>\n <div id=\"cid_50\" class=\"form-input\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_50_0\" name=\"q50_50[]\" value=\"Check (Make checks payable to CMS and mail them in or drop them off.)\" \/>\n <label for=\"input_50_0\"> Check (Make checks payable to CMS and mail them in or drop them off.) <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_50_1\" name=\"q50_50[]\" value=\"Cash (Please do not mail, rather drop off at CMS)\" \/>\n <label for=\"input_50_1\"> Cash (Please do not mail, rather drop off at CMS) <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li id=\"cid_42\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_42\" class=\"form-header\">\n Permission, Consent, and Release\n <\/h2>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_44\">\n <div id=\"cid_44\" class=\"form-input-wide\">\n <div id=\"text_44\" class=\"form-html\">\n In sending my child to camp, I understand that I am giving my child permission to participate in all activities that are described under the camp description. I understand that any items my child brings to camp are the responsibility of my child, and the school is in no way responsible for lost or damaged items.\n <br>\n I hereby give my permission to the medical personnel selected by the camp director to order X-rays and routine tests and treatment for my child in the event I cannot be reached in an emergency. I hereby give permission to the physician selected by the camp director to hospitalize,\n <br>\n secure proper treatment for, and to order injections and\/or anesthesia and\/or surgery for my child.\n <br>\n For parents of campers that are participating in \"off-site\" camps:\n <br>\n As a parent of a child participating in the \"off-site\" program, I understand that my child will be participating in activities that are, for the majority of the time, outside of camp and at a higher risk level than normal camp activities. I understand that during a typical week, my child will be participating\n <br>\n in activities on or near the beach, nature trails, fishing docks, and other out-door locations. In signing this form, I give my permission for my child to participate in all the activities that the Montessori Summer Camp offers.\n <br>\n I hereby release, waive, indemnify, hold harmless and discharge Christian Montessori School and its affiliates and all of their member, officers, trustees, employees, agents, representatives, insurers, successors and assigns (Released Parties) from any and all responsibility owed to my child, me, other parents and guardians of the child, our legal representatives,\n <br>\n heirs, assigns for any and all claims, expenses, damages, actions and causes of action.\n <br>\n I further acknowledge that I have carefully read the above release, understand its contents, and I recognize that by signing this legally binding\n <br>\n agreement on behalf of myself and my child and other parents and guardians of the child, we are freely giving up substantial rights and assuming\n <br>\n risk of injury, death and\/or property damage. \n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_45\">\n <label class=\"form-label-left\" id=\"label_45\" for=\"input_45\">\n Camper's Name<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_45\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_45\" name=\"q45_campersName45\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_47\">\n <label class=\"form-label-left\" id=\"label_47\" for=\"input_47\">\n Parent\/Guardian Digital Signature (type full name)<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_47\" class=\"form-input\">\n <input type=\"text\" class=\"form-textbox validate[required]\" id=\"input_47\" name=\"q47_parentguardianDigital\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_48\">\n <label class=\"form-label-left\" id=\"label_48\" for=\"input_48\">\n Date<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_48\" class=\"form-input\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" id=\"month_48\" name=\"q48_date[month]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"02\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"month_48\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" id=\"day_48\" name=\"q48_date[day]\" type=\"text\" size=\"2\" maxlength=\"2\" value=\"09\" \/><span class=\"date-separate\"> -<\/span>\n <label class=\"form-sub-label\" for=\"day_48\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" id=\"year_48\" name=\"q48_date[year]\" type=\"text\" size=\"4\" maxlength=\"4\" value=\"2012\" \/>\n <label class=\"form-sub-label\" for=\"year_48\" id=\"sublabel_year\"> Year <\/label><\/span><span class=\"form-sub-label-container\"><img alt=\"Pick a Date\" id=\"input_48_pick\" src=\"http:\/\/www.jotform.com\/images\/calendar.png\" align=\"absmiddle\" \/>\n <label class=\"form-sub-label\" for=\"input_48_pick\"> <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_49\">\n <div id=\"cid_49\" class=\"form-input-wide\">\n <div style=\"margin-left:156px\" class=\"form-buttons-wrapper\">\n <button id=\"input_49\" type=\"submit\" class=\"form-submit-button\">\n Submit Form\n <\/button>\n <\/div>\n <\/div>\n <\/li>\n <li style=\"display:none\">\n Should be Empty:\n <input type=\"text\" name=\"website\" value=\"\" \/>\n <\/li>\n <\/ul>\n <\/div>\n <input type=\"hidden\" id=\"simple_spc\" name=\"simple_spc\" value=\"1090100527\" \/>\n <script type=\"text\/javascript\">\n document.getElementById(\"si\" + \"mple\" + \"_spc\").value = \"1090100527-1090100527\";\n <\/script>\n<\/form><\/body>\n<\/html>\n");