/*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 i1940223373 = new FrameBuilder("1940223373", 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:20px;\n width:365px;\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.setConditions([{\"action\":{\"field\":\"22\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"20\",\"operator\":\"equals\",\"value\":\"Yes\"}],\"type\":\"field\"},{\"action\":{\"field\":\"22\",\"visibility\":\"Show\"},\"link\":\"Any\",\"terms\":[{\"field\":\"20\",\"operator\":\"equals\",\"value\":\"Yes\"}],\"type\":\"field\"}]);\n JotForm.init(function(){\n $('input_7').hint('ex: myname@example.com');\n JotForm.totalCounter({\"input_111_1001\":{\"price\":\"40.00\",\"quantityField\":\"input_111_quantity_1001_0\"}});\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_1940223373\" id=\"1940223373\" accept-charset=\"utf-8\">\n <input type=\"hidden\" name=\"formID\" value=\"1940223373\" \/>\n <div class=\"form-all\">\n <ul class=\"form-section\">\n <li class=\"form-line\" id=\"id_46\">\n <div id=\"cid_46\" class=\"form-input-wide\">\n <div style=\"text-align:center;\">\n <img alt=\"\" class=\"form-image\" border=\"0\" src=\"https:\/\/products.connectionpower.com\/products\/common\/devedit_uploads\/images\/1980\/Awana%20logo%20w-kids.gif\" height=\"138\" width=\"218\" \/>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_48\">\n <div id=\"cid_48\" class=\"form-input-wide\">\n <div id=\"text_48\" class=\"form-html\">\n <p style=\"text-align: center;\"><span style=\"font-size: medium; color: #000000; font-family: verdana,geneva;\"><strong><span style=\"line-height: 16px;\"><span style=\"font-size: large;\">AWANA<\/span>\n is fun with a purpose – to reach and train kids for Jesus Christ.  <\/span>\n <\/strong><\/span>\n <\/p>\n <p style=\"text-align: center;\"><span style=\"color: #000000; font-family: verdana,geneva;\"><span style=\"font-size: 12px;\"><span style=\"line-height: 16px;\">For kids<\/span><\/span><span style=\"font-size: 12px;\"> ages 3 through 5th grade<\/span><\/span>\n <\/p>\n <p style=\"text-align: center;\"><span style=\"color: #000000; font-family: verdana,geneva;\"><span style=\"font-size: 12px;\">Bible lessons, Bible memorization, worship, games, awards <\/span><span style=\"font-size: 12px; line-height: 16px;\">and other activities transform the AWANA program into a lively weekly experience where fun and learning go hand in hand.<\/span><\/span>\n <\/p>\n <p style=\"text-align: center;\"><span style=\"font-size: small;\"><strong><span style=\"font-family: verdana,geneva; line-height: 16px;\">AWANA Pre-Registration Fee: $40<\/span>\n <\/strong><\/span>\n <\/p>\n <p style=\"text-align: center;\"><span style=\"font-size: small; color: #000000; font-family: verdana,geneva;\"><span style=\"font-size: 12px; line-height: 16px;\"><span style=\"line-height: normal; font-size: small;\">Register securely with\n <em>\n PayPal\n <\/em><\/span><\/span><\/span>\n <\/p>\n <p style=\"text-align: center;\"><span style=\"font-family: verdana,geneva;\"><span style=\"font-size: small; color: #000000;\"><span style=\"font-size: 12px; line-height: 16px;\">Books and uniforms will be available for purchase at the AWANA Club.  Please contact Amy Reed:  <\/span><\/span><span style=\"font-size: small;\"><span style=\"font-size: 12px; line-height: 16px;\"><a href=\"mailto:amy@coastbible.org\">amy@coastbible.org<\/a><\/span><\/span><span style=\"font-size: small; color: #000000;\"><span style=\"font-size: 12px; line-height: 16px;\">for more information.<\/span><\/span><\/span>\n <\/p>\n <p style=\"text-align: center;\"><span style=\"font-size: small; color: #000000; font-family: verdana,geneva;\"><span style=\"font-size: 12px; line-height: 16px;\"><span style=\"line-height: normal; font-size: small;\">___________________\n <br \/><\/span><\/span><\/span>\n <\/p>\n <p style=\"text-align: center;\"><span style=\"font-size: large;\"><strong>\n AWANA Families... Don't Miss the AWANA Kick-off BBQ!\n <br \/>\n <\/strong><\/span>\n <\/p>\n <p style=\"text-align: center;\">\n <strong><span style=\"font-size: medium;\">September 7 - 6:00 to 8:00 pm<\/span>\n <\/strong>\n <\/p>\n <p style=\"text-align: center;\"><span style=\"font-size: small;\"><strong>\n Enjoy a BBQ meal and fellowship with other AWANA families.  Meet your AWANA Leaders and learn more about the program.\n <\/strong><\/span>\n <\/p>\n <p style=\"text-align: center;\"><span style=\"font-size: small; color: #000000; font-family: verdana,geneva;\"><span style=\"font-size: 12px; line-height: 16px;\"><span style=\"line-height: normal; font-size: small;\">___________________\n <br \/><\/span><\/span><\/span>\n <\/p>\n <p style=\"text-align: center;\"><span style=\"font-family: verdana,geneva;\"><em><span style=\"font-size: small; color: #000000;\"><span style=\"font-size: 12px; line-height: 16px;\">Register for AWANA by clicking \"Next\" below:<\/span><\/span>\n <\/em><\/span>\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li id=\"cid_109\" class=\"form-input-wide\">\n <div class=\"form-pagebreak\">\n <div class=\"form-pagebreak-back-container form-label-left\">\n <button type=\"button\" class=\"form-pagebreak-back\" id=\"form-pagebreak-back_109\">\n Back\n <\/button>\n <\/div>\n <div class=\"form-pagebreak-next-container\">\n <button type=\"button\" class=\"form-pagebreak-next\" id=\"form-pagebreak-next_109\">\n Next\n <\/button>\n <\/div>\n <\/div>\n <\/li>\n <\/ul>\n <ul class=\"form-section\" style=\"display:none;\">\n <li id=\"cid_2\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h1 id=\"header_2\" class=\"form-header\">\n AWANA Registration\n <\/h1>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_4\">\n <label class=\"form-label-top\" id=\"label_4\" for=\"input_4\">\n Parent\/Guardian Name<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_4\" class=\"form-input-wide\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"10\" name=\"q4_parentguardianName4[first]\" id=\"first_4\" \/>\n <label class=\"form-sub-label\" for=\"first_4\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"15\" name=\"q4_parentguardianName4[last]\" id=\"last_4\" \/>\n <label class=\"form-sub-label\" for=\"last_4\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_5\">\n <label class=\"form-label-top\" id=\"label_5\" for=\"input_5\">\n Address<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_5\" class=\"form-input-wide\">\n <table summary=\"\" class=\"form-address-table\" border=\"0\" cellpadding=\"0\" cellspacing=\"0\">\n <tr>\n <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-line\" type=\"text\" name=\"q5_address[addr_line1]\" id=\"input_5_addr_line1\" \/>\n <label class=\"form-sub-label\" for=\"input_5_addr_line1\" id=\"sublabel_addr_line1\"> Street Address <\/label><\/span>\n <\/td>\n <\/tr>\n <tr>\n <td colspan=\"2\"><span class=\"form-sub-label-container\"><input class=\"form-textbox form-address-line\" type=\"text\" name=\"q5_address[addr_line2]\" id=\"input_5_addr_line2\" size=\"46\" \/>\n <label class=\"form-sub-label\" for=\"input_5_addr_line2\" id=\"sublabel_addr_line2\"> Street Address Line 2 <\/label><\/span>\n <\/td>\n <\/tr>\n <tr>\n <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-city\" type=\"text\" name=\"q5_address[city]\" id=\"input_5_city\" size=\"21\" \/>\n <label class=\"form-sub-label\" for=\"input_5_city\" id=\"sublabel_city\"> City <\/label><\/span>\n <\/td>\n <td><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-state\" type=\"text\" name=\"q5_address[state]\" id=\"input_5_state\" size=\"22\" \/>\n <label class=\"form-sub-label\" for=\"input_5_state\" id=\"sublabel_state\"> State \/ Province <\/label><\/span>\n <\/td>\n <\/tr>\n <tr>\n <td width=\"50%\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required] form-address-postal\" type=\"text\" name=\"q5_address[postal]\" id=\"input_5_postal\" size=\"10\" \/>\n <label class=\"form-sub-label\" for=\"input_5_postal\" id=\"sublabel_postal\"> Postal \/ Zip Code <\/label><\/span>\n <\/td>\n <td><span class=\"form-sub-label-container\"><select class=\"form-dropdown validate[required] form-address-country\" name=\"q5_address[country]\" id=\"input_5_country\">\n <option selected> Please Select <\/option>\n <option selected=\"selected\" value=\"United States\"> United States <\/option>\n <option value=\"Abkhazia\"> Abkhazia <\/option>\n <option value=\"Afghanistan\"> Afghanistan <\/option>\n <option value=\"Albania\"> Albania <\/option>\n <option value=\"Algeria\"> Algeria <\/option>\n <option value=\"American Samoa\"> American Samoa <\/option>\n <option value=\"Andorra\"> Andorra <\/option>\n <option value=\"Angola\"> Angola <\/option>\n <option value=\"Anguilla\"> Anguilla <\/option>\n <option value=\"Antigua and Barbuda\"> Antigua and Barbuda <\/option>\n <option value=\"Argentina\"> Argentina <\/option>\n <option value=\"Armenia\"> Armenia <\/option>\n <option value=\"Aruba\"> Aruba <\/option>\n <option value=\"Australia\"> Australia <\/option>\n <option value=\"Austria\"> Austria <\/option>\n <option value=\"Azerbaijan\"> Azerbaijan <\/option>\n <option value=\"The Bahamas\"> The Bahamas <\/option>\n <option value=\"Bahrain\"> Bahrain <\/option>\n <option value=\"Bangladesh\"> Bangladesh <\/option>\n <option value=\"Barbados\"> Barbados <\/option>\n <option value=\"Belarus\"> Belarus <\/option>\n <option value=\"Belgium\"> Belgium <\/option>\n <option value=\"Belize\"> Belize <\/option>\n <option value=\"Benin\"> Benin <\/option>\n <option value=\"Bermuda\"> Bermuda <\/option>\n <option value=\"Bhutan\"> Bhutan <\/option>\n <option value=\"Bolivia\"> Bolivia <\/option>\n <option value=\"Bosnia and Herzegovina\"> Bosnia and Herzegovina <\/option>\n <option value=\"Botswana\"> Botswana <\/option>\n <option value=\"Brazil\"> Brazil <\/option>\n <option value=\"Brunei\"> Brunei <\/option>\n <option value=\"Bulgaria\"> Bulgaria <\/option>\n <option value=\"Burkina Faso\"> Burkina Faso <\/option>\n <option value=\"Burundi\"> Burundi <\/option>\n <option value=\"Cambodia\"> Cambodia <\/option>\n <option value=\"Cameroon\"> Cameroon <\/option>\n <option value=\"Canada\"> Canada <\/option>\n <option value=\"Cape Verde\"> Cape Verde <\/option>\n <option value=\"Cayman Islands\"> Cayman Islands <\/option>\n <option value=\"Central African Republic\"> Central African Republic <\/option>\n <option value=\"Chad\"> Chad <\/option>\n <option value=\"Chile\"> Chile <\/option>\n <option value=\"People's Republic of China\"> People's Republic of China <\/option>\n <option value=\"Republic of China\"> Republic of China <\/option>\n <option value=\"Christmas Island\"> Christmas Island <\/option>\n <option value=\"Cocos (Keeling) Islands\"> Cocos (Keeling) Islands <\/option>\n <option value=\"Colombia\"> Colombia <\/option>\n <option value=\"Comoros\"> Comoros <\/option>\n <option value=\"Congo\"> Congo <\/option>\n <option value=\"Cook Islands\"> Cook Islands <\/option>\n <option value=\"Costa Rica\"> Costa Rica <\/option>\n <option value=\"Cote d'Ivoire\"> Cote d'Ivoire <\/option>\n <option value=\"Croatia\"> Croatia <\/option>\n <option value=\"Cuba\"> Cuba <\/option>\n <option value=\"Cyprus\"> Cyprus <\/option>\n <option value=\"Czech Republic\"> Czech Republic <\/option>\n <option value=\"Denmark\"> Denmark <\/option>\n <option value=\"Djibouti\"> Djibouti <\/option>\n <option value=\"Dominica\"> Dominica <\/option>\n <option value=\"Dominican Republic\"> Dominican Republic <\/option>\n <option value=\"Ecuador\"> Ecuador <\/option>\n <option value=\"Egypt\"> Egypt <\/option>\n <option value=\"El Salvador\"> El Salvador <\/option>\n <option value=\"Equatorial Guinea\"> Equatorial Guinea <\/option>\n <option value=\"Eritrea\"> Eritrea <\/option>\n <option value=\"Estonia\"> Estonia <\/option>\n <option value=\"Ethiopia\"> Ethiopia <\/option>\n <option value=\"Falkland Islands\"> Falkland Islands <\/option>\n <option value=\"Faroe Islands\"> Faroe Islands <\/option>\n <option value=\"Fiji\"> Fiji <\/option>\n <option value=\"Finland\"> Finland <\/option>\n <option value=\"France\"> France <\/option>\n <option value=\"French Polynesia\"> French Polynesia <\/option>\n <option value=\"Gabon\"> Gabon <\/option>\n <option value=\"The Gambia\"> The Gambia <\/option>\n <option value=\"Georgia\"> Georgia <\/option>\n <option value=\"Germany\"> Germany <\/option>\n <option value=\"Ghana\"> Ghana <\/option>\n <option value=\"Gibraltar\"> Gibraltar <\/option>\n <option value=\"Greece\"> Greece <\/option>\n <option value=\"Greenland\"> Greenland <\/option>\n <option value=\"Grenada\"> Grenada <\/option>\n <option value=\"Guadeloupe\"> Guadeloupe <\/option>\n <option value=\"Guam\"> Guam <\/option>\n <option value=\"Guatemala\"> Guatemala <\/option>\n <option value=\"Guernsey\"> Guernsey <\/option>\n <option value=\"Guinea\"> Guinea <\/option>\n <option value=\"Guinea-Bissau\"> Guinea-Bissau <\/option>\n <option value=\"Guyana\"> Guyana <\/option>\n <option value=\"Haiti\"> Haiti <\/option>\n <option value=\"Honduras\"> Honduras <\/option>\n <option value=\"Hong Kong\"> Hong Kong <\/option>\n <option value=\"Hungary\"> Hungary <\/option>\n <option value=\"Iceland\"> Iceland <\/option>\n <option value=\"India\"> India <\/option>\n <option value=\"Indonesia\"> Indonesia <\/option>\n <option value=\"Iran\"> Iran <\/option>\n <option value=\"Iraq\"> Iraq <\/option>\n <option value=\"Ireland\"> Ireland <\/option>\n <option value=\"Israel\"> Israel <\/option>\n <option value=\"Italy\"> Italy <\/option>\n <option value=\"Jamaica\"> Jamaica <\/option>\n <option value=\"Japan\"> Japan <\/option>\n <option value=\"Jersey\"> Jersey <\/option>\n <option value=\"Jordan\"> Jordan <\/option>\n <option value=\"Kazakhstan\"> Kazakhstan <\/option>\n <option value=\"Kenya\"> Kenya <\/option>\n <option value=\"Kiribati\"> Kiribati <\/option>\n <option value=\"North Korea\"> North Korea <\/option>\n <option value=\"South Korea\"> South Korea <\/option>\n <option value=\"Kosovo\"> Kosovo <\/option>\n <option value=\"Kuwait\"> Kuwait <\/option>\n <option value=\"Kyrgyzstan\"> Kyrgyzstan <\/option>\n <option value=\"Laos\"> Laos <\/option>\n <option value=\"Latvia\"> Latvia <\/option>\n <option value=\"Lebanon\"> Lebanon <\/option>\n <option value=\"Lesotho\"> Lesotho <\/option>\n <option value=\"Liberia\"> Liberia <\/option>\n <option value=\"Libya\"> Libya <\/option>\n <option value=\"Liechtenstein\"> Liechtenstein <\/option>\n <option value=\"Lithuania\"> Lithuania <\/option>\n <option value=\"Luxembourg\"> Luxembourg <\/option>\n <option value=\"Macau\"> Macau <\/option>\n <option value=\"Macedonia\"> Macedonia <\/option>\n <option value=\"Madagascar\"> Madagascar <\/option>\n <option value=\"Malawi\"> Malawi <\/option>\n <option value=\"Malaysia\"> Malaysia <\/option>\n <option value=\"Maldives\"> Maldives <\/option>\n <option value=\"Mali\"> Mali <\/option>\n <option value=\"Malta\"> Malta <\/option>\n <option value=\"Marshall Islands\"> Marshall Islands <\/option>\n <option value=\"Martinique\"> Martinique <\/option>\n <option value=\"Mauritania\"> Mauritania <\/option>\n <option value=\"Mauritius\"> Mauritius <\/option>\n <option value=\"Mayotte\"> Mayotte <\/option>\n <option value=\"Mexico\"> Mexico <\/option>\n <option value=\"Micronesia\"> Micronesia <\/option>\n <option value=\"Moldova\"> Moldova <\/option>\n <option value=\"Monaco\"> Monaco <\/option>\n <option value=\"Mongolia\"> Mongolia <\/option>\n <option value=\"Montenegro\"> Montenegro <\/option>\n <option value=\"Montserrat\"> Montserrat <\/option>\n <option value=\"Morocco\"> Morocco <\/option>\n <option value=\"Mozambique\"> Mozambique <\/option>\n <option value=\"Myanmar\"> Myanmar <\/option>\n <option value=\"Nagorno-Karabakh\"> Nagorno-Karabakh <\/option>\n <option value=\"Namibia\"> Namibia <\/option>\n <option value=\"Nauru\"> Nauru <\/option>\n <option value=\"Nepal\"> Nepal <\/option>\n <option value=\"Netherlands\"> Netherlands <\/option>\n <option value=\"Netherlands Antilles\"> Netherlands Antilles <\/option>\n <option value=\"New Caledonia\"> New Caledonia <\/option>\n <option value=\"New Zealand\"> New Zealand <\/option>\n <option value=\"Nicaragua\"> Nicaragua <\/option>\n <option value=\"Niger\"> Niger <\/option>\n <option value=\"Nigeria\"> Nigeria <\/option>\n <option value=\"Niue\"> Niue <\/option>\n <option value=\"Norfolk Island\"> Norfolk Island <\/option>\n <option value=\"Turkish Republic of Northern Cyprus\"> Turkish Republic of Northern Cyprus <\/option>\n <option value=\"Northern Mariana\"> Northern Mariana <\/option>\n <option value=\"Norway\"> Norway <\/option>\n <option value=\"Oman\"> Oman <\/option>\n <option value=\"Pakistan\"> Pakistan <\/option>\n <option value=\"Palau\"> Palau <\/option>\n <option value=\"Palestine\"> Palestine <\/option>\n <option value=\"Panama\"> Panama <\/option>\n <option value=\"Papua New Guinea\"> Papua New Guinea <\/option>\n <option value=\"Paraguay\"> Paraguay <\/option>\n <option value=\"Peru\"> Peru <\/option>\n <option value=\"Philippines\"> Philippines <\/option>\n <option value=\"Pitcairn Islands\"> Pitcairn Islands <\/option>\n <option value=\"Poland\"> Poland <\/option>\n <option value=\"Portugal\"> Portugal <\/option>\n <option value=\"Puerto Rico\"> Puerto Rico <\/option>\n <option value=\"Qatar\"> Qatar <\/option>\n <option value=\"Romania\"> Romania <\/option>\n <option value=\"Russia\"> Russia <\/option>\n <option value=\"Rwanda\"> Rwanda <\/option>\n <option value=\"Saint Barthelemy\"> Saint Barthelemy <\/option>\n <option value=\"Saint Helena\"> Saint Helena <\/option>\n <option value=\"Saint Kitts and Nevis\"> Saint Kitts and Nevis <\/option>\n <option value=\"Saint Lucia\"> Saint Lucia <\/option>\n <option value=\"Saint Martin\"> Saint Martin <\/option>\n <option value=\"Saint Pierre and Miquelon\"> Saint Pierre and Miquelon <\/option>\n <option value=\"Saint Vincent and the Grenadines\"> Saint Vincent and the Grenadines <\/option>\n <option value=\"Samoa\"> Samoa <\/option>\n <option value=\"San Marino\"> San Marino <\/option>\n <option value=\"Sao Tome and Principe\"> Sao Tome and Principe <\/option>\n <option value=\"Saudi Arabia\"> Saudi Arabia <\/option>\n <option value=\"Senegal\"> Senegal <\/option>\n <option value=\"Serbia\"> Serbia <\/option>\n <option value=\"Seychelles\"> Seychelles <\/option>\n <option value=\"Sierra Leone\"> Sierra Leone <\/option>\n <option value=\"Singapore\"> Singapore <\/option>\n <option value=\"Slovakia\"> Slovakia <\/option>\n <option value=\"Slovenia\"> Slovenia <\/option>\n <option value=\"Solomon Islands\"> Solomon Islands <\/option>\n <option value=\"Somalia\"> Somalia <\/option>\n <option value=\"Somaliland\"> Somaliland <\/option>\n <option value=\"South Africa\"> South Africa <\/option>\n <option value=\"South Ossetia\"> South Ossetia <\/option>\n <option value=\"Spain\"> Spain <\/option>\n <option value=\"Sri Lanka\"> Sri Lanka <\/option>\n <option value=\"Sudan\"> Sudan <\/option>\n <option value=\"Suriname\"> Suriname <\/option>\n <option value=\"Svalbard\"> Svalbard <\/option>\n <option value=\"Swaziland\"> Swaziland <\/option>\n <option value=\"Sweden\"> Sweden <\/option>\n <option value=\"Switzerland\"> Switzerland <\/option>\n <option value=\"Syria\"> Syria <\/option>\n <option value=\"Taiwan\"> Taiwan <\/option>\n <option value=\"Tajikistan\"> Tajikistan <\/option>\n <option value=\"Tanzania\"> Tanzania <\/option>\n <option value=\"Thailand\"> Thailand <\/option>\n <option value=\"Timor-Leste\"> Timor-Leste <\/option>\n <option value=\"Togo\"> Togo <\/option>\n <option value=\"Tokelau\"> Tokelau <\/option>\n <option value=\"Tonga\"> Tonga <\/option>\n <option value=\"Transnistria Pridnestrovie\"> Transnistria Pridnestrovie <\/option>\n <option value=\"Trinidad and Tobago\"> Trinidad and Tobago <\/option>\n <option value=\"Tristan da Cunha\"> Tristan da Cunha <\/option>\n <option value=\"Tunisia\"> Tunisia <\/option>\n <option value=\"Turkey\"> Turkey <\/option>\n <option value=\"Turkmenistan\"> Turkmenistan <\/option>\n <option value=\"Turks and Caicos Islands\"> Turks and Caicos Islands <\/option>\n <option value=\"Tuvalu\"> Tuvalu <\/option>\n <option value=\"Uganda\"> Uganda <\/option>\n <option value=\"Ukraine\"> Ukraine <\/option>\n <option value=\"United Arab Emirates\"> United Arab Emirates <\/option>\n <option value=\"United Kingdom\"> United Kingdom <\/option>\n <option value=\"Uruguay\"> Uruguay <\/option>\n <option value=\"Uzbekistan\"> Uzbekistan <\/option>\n <option value=\"Vanuatu\"> Vanuatu <\/option>\n <option value=\"Vatican City\"> Vatican City <\/option>\n <option value=\"Venezuela\"> Venezuela <\/option>\n <option value=\"Vietnam\"> Vietnam <\/option>\n <option value=\"British Virgin Islands\"> British Virgin Islands <\/option>\n <option value=\"US Virgin Islands\"> US Virgin Islands <\/option>\n <option value=\"Wallis and Futuna\"> Wallis and Futuna <\/option>\n <option value=\"Western Sahara\"> Western Sahara <\/option>\n <option value=\"Yemen\"> Yemen <\/option>\n <option value=\"Zambia\"> Zambia <\/option>\n <option value=\"Zimbabwe\"> Zimbabwe <\/option>\n <option value=\"other\"> Other <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"input_5_country\" id=\"sublabel_country\"> Country <\/label><\/span>\n <\/td>\n <\/tr>\n <\/table>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_57\">\n <div id=\"cid_57\" class=\"form-input-wide\">\n <div id=\"text_57\" class=\"form-html\">\n <p><span style=\"font-size: small;\"><strong>\n Telephone Numbers:\n <\/strong><\/span>\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_51\">\n <label class=\"form-label-top\" id=\"label_51\" for=\"input_51\">\n Home Phone<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_51\" class=\"form-input-wide\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"tel\" name=\"q51_homePhone51[area]\" id=\"input_51_area\" size=\"3\">\n -\n <label class=\"form-sub-label\" for=\"input_51_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"tel\" name=\"q51_homePhone51[phone]\" id=\"input_51_phone\" size=\"8\">\n <label class=\"form-sub-label\" for=\"input_51_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_54\">\n <label class=\"form-label-top\" id=\"label_54\" for=\"input_54\"> Work Phone <\/label>\n <div id=\"cid_54\" class=\"form-input-wide\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q54_workPhone54[area]\" id=\"input_54_area\" size=\"3\">\n -\n <label class=\"form-sub-label\" for=\"input_54_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q54_workPhone54[phone]\" id=\"input_54_phone\" size=\"8\">\n <label class=\"form-sub-label\" for=\"input_54_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_53\">\n <label class=\"form-label-top\" id=\"label_53\" for=\"input_53\"> Cell Phone <\/label>\n <div id=\"cid_53\" class=\"form-input-wide\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q53_cellPhone[area]\" id=\"input_53_area\" size=\"3\">\n -\n <label class=\"form-sub-label\" for=\"input_53_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q53_cellPhone[phone]\" id=\"input_53_phone\" size=\"8\">\n <label class=\"form-sub-label\" for=\"input_53_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_7\">\n <label class=\"form-label-top\" id=\"label_7\" for=\"input_7\">\n E-mail<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_7\" class=\"form-input-wide\">\n <input type=\"email\" class=\"form-textbox validate[required, Email]\" id=\"input_7\" name=\"q7_email\" size=\"30\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_64\">\n <div id=\"cid_64\" class=\"form-input-wide\">\n <div id=\"text_64\" class=\"form-html\">\n <p><span style=\"font-size: small;\"><strong>\n Persons Authorized to Pick Up Children (other than parents):\n <\/strong><\/span>\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_61\">\n <label class=\"form-label-top\" id=\"label_61\" for=\"input_61\"> Name #1 <\/label>\n <div id=\"cid_61\" class=\"form-input-wide\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"10\" name=\"q61_name1[first]\" id=\"first_61\" \/>\n <label class=\"form-sub-label\" for=\"first_61\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"15\" name=\"q61_name1[last]\" id=\"last_61\" \/>\n <label class=\"form-sub-label\" for=\"last_61\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_66\">\n <label class=\"form-label-top\" id=\"label_66\" for=\"input_66\"> Phone Number <\/label>\n <div id=\"cid_66\" class=\"form-input-wide\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q66_phoneNumber[area]\" id=\"input_66_area\" size=\"3\">\n -\n <label class=\"form-sub-label\" for=\"input_66_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q66_phoneNumber[phone]\" id=\"input_66_phone\" size=\"8\">\n <label class=\"form-sub-label\" for=\"input_66_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_65\">\n <label class=\"form-label-top\" id=\"label_65\" for=\"input_65\"> Name #2 <\/label>\n <div id=\"cid_65\" class=\"form-input-wide\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"10\" name=\"q65_name2[first]\" id=\"first_65\" \/>\n <label class=\"form-sub-label\" for=\"first_65\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"15\" name=\"q65_name2[last]\" id=\"last_65\" \/>\n <label class=\"form-sub-label\" for=\"last_65\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_62\">\n <label class=\"form-label-top\" id=\"label_62\" for=\"input_62\"> Phone Number <\/label>\n <div id=\"cid_62\" class=\"form-input-wide\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q62_phoneNumber62[area]\" id=\"input_62_area\" size=\"3\">\n -\n <label class=\"form-sub-label\" for=\"input_62_area\" id=\"sublabel_area\"> Area Code <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"tel\" name=\"q62_phoneNumber62[phone]\" id=\"input_62_phone\" size=\"8\">\n <label class=\"form-sub-label\" for=\"input_62_phone\" id=\"sublabel_phone\"> Phone Number <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_56\">\n <div id=\"cid_56\" class=\"form-input-wide\">\n <div id=\"text_56\" class=\"form-html\">\n <p><span style=\"font-size: small;\"><strong>\n Emergency Contact Information (other than parents):\n <\/strong><\/span>\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_11\">\n <label class=\"form-label-top\" id=\"label_11\" for=\"input_11\">\n Emergency Contact - Name<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_11\" class=\"form-input-wide\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"10\" name=\"q11_emergencyContact11[first]\" id=\"first_11\" \/>\n <label class=\"form-sub-label\" for=\"first_11\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"text\" size=\"15\" name=\"q11_emergencyContact11[last]\" id=\"last_11\" \/>\n <label class=\"form-sub-label\" for=\"last_11\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_10\">\n <label class=\"form-label-top\" id=\"label_10\" for=\"input_10\">\n Emergency Contact - Phone Number<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_10\" class=\"form-input-wide\"><span class=\"form-sub-label-container\"><input class=\"form-textbox validate[required]\" type=\"tel\" name=\"q10_emergencyContact10[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 validate[required]\" type=\"tel\" name=\"q10_emergencyContact10[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 id=\"cid_110\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h2 id=\"header_110\" class=\"form-header\">\n Children's Information\n <\/h2>\n <div id=\"subHeader_110\" class=\"form-subHeader\">\n (For children enrolling in AWANA)\n <\/div>\n <\/div>\n <\/li>\n <li id=\"cid_31\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h3 id=\"header_31\" class=\"form-header\">\n Child #1\n <\/h3>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_26\">\n <label class=\"form-label-top\" id=\"label_26\" for=\"input_26\"> Name <\/label>\n <div id=\"cid_26\" class=\"form-input-wide\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"10\" name=\"q26_name26[first]\" id=\"first_26\" \/>\n <label class=\"form-sub-label\" for=\"first_26\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"10\" name=\"q26_name26[middle]\" id=\"middle_26\" \/>\n <label class=\"form-sub-label\" for=\"middle_26\" id=\"sublabel_middle\"> Middle Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"15\" name=\"q26_name26[last]\" id=\"last_26\" \/>\n <label class=\"form-sub-label\" for=\"last_26\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_69\">\n <label class=\"form-label-top\" id=\"label_69\" for=\"input_69\"> Nickname <\/label>\n <div id=\"cid_69\" class=\"form-input-wide\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_69\" name=\"q69_nickname69\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_28\">\n <label class=\"form-label-top\" id=\"label_28\" for=\"input_28\"> Gender <\/label>\n <div id=\"cid_28\" class=\"form-input-wide\">\n <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_28\" name=\"q28_gender28\">\n <option> <\/option>\n <option value=\"Male\"> Male <\/option>\n <option value=\"Female\"> Female <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_42\">\n <label class=\"form-label-top\" id=\"label_42\" for=\"input_42\"> Date of Birth <\/label>\n <div id=\"cid_42\" class=\"form-input-wide\"><span class=\"form-sub-label-container\"><select class=\"form-dropdown\" name=\"q42_42[month]\" id=\"input_42_month\">\n <option> <\/option>\n <option value=\"January\"> January <\/option>\n <option value=\"February\"> February <\/option>\n <option value=\"March\"> March <\/option>\n <option value=\"April\"> April <\/option>\n <option value=\"May\"> May <\/option>\n <option value=\"June\"> June <\/option>\n <option value=\"July\"> July <\/option>\n <option value=\"August\"> August <\/option>\n <option value=\"September\"> September <\/option>\n <option value=\"October\"> October <\/option>\n <option value=\"November\"> November <\/option>\n <option value=\"December\"> December <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"input_42_month\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown\" name=\"q42_42[day]\" id=\"input_42_day\">\n <option> <\/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 <option value=\"11\"> 11 <\/option>\n <option value=\"12\"> 12 <\/option>\n <option value=\"13\"> 13 <\/option>\n <option value=\"14\"> 14 <\/option>\n <option value=\"15\"> 15 <\/option>\n <option value=\"16\"> 16 <\/option>\n <option value=\"17\"> 17 <\/option>\n <option value=\"18\"> 18 <\/option>\n <option value=\"19\"> 19 <\/option>\n <option value=\"20\"> 20 <\/option>\n <option value=\"21\"> 21 <\/option>\n <option value=\"22\"> 22 <\/option>\n <option value=\"23\"> 23 <\/option>\n <option value=\"24\"> 24 <\/option>\n <option value=\"25\"> 25 <\/option>\n <option value=\"26\"> 26 <\/option>\n <option value=\"27\"> 27 <\/option>\n <option value=\"28\"> 28 <\/option>\n <option value=\"29\"> 29 <\/option>\n <option value=\"30\"> 30 <\/option>\n <option value=\"31\"> 31 <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"input_42_day\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown\" name=\"q42_42[year]\" id=\"input_42_year\">\n <option> <\/option>\n <option value=\"2016\"> 2016 <\/option>\n <option value=\"2015\"> 2015 <\/option>\n <option value=\"2014\"> 2014 <\/option>\n <option value=\"2013\"> 2013 <\/option>\n <option value=\"2012\"> 2012 <\/option>\n <option value=\"2011\"> 2011 <\/option>\n <option value=\"2010\"> 2010 <\/option>\n <option value=\"2009\"> 2009 <\/option>\n <option value=\"2008\"> 2008 <\/option>\n <option value=\"2007\"> 2007 <\/option>\n <option value=\"2006\"> 2006 <\/option>\n <option value=\"2005\"> 2005 <\/option>\n <option value=\"2004\"> 2004 <\/option>\n <option value=\"2003\"> 2003 <\/option>\n <option value=\"2002\"> 2002 <\/option>\n <option value=\"2001\"> 2001 <\/option>\n <option value=\"2000\"> 2000 <\/option>\n <option value=\"1999\"> 1999 <\/option>\n <option value=\"1998\"> 1998 <\/option>\n <option value=\"1997\"> 1997 <\/option>\n <option value=\"1996\"> 1996 <\/option>\n <option value=\"1995\"> 1995 <\/option>\n <option value=\"1994\"> 1994 <\/option>\n <option value=\"1993\"> 1993 <\/option>\n <option value=\"1992\"> 1992 <\/option>\n <option value=\"1991\"> 1991 <\/option>\n <option value=\"1990\"> 1990 <\/option>\n <option value=\"1989\"> 1989 <\/option>\n <option value=\"1988\"> 1988 <\/option>\n <option value=\"1987\"> 1987 <\/option>\n <option value=\"1986\"> 1986 <\/option>\n <option value=\"1985\"> 1985 <\/option>\n <option value=\"1984\"> 1984 <\/option>\n <option value=\"1983\"> 1983 <\/option>\n <option value=\"1982\"> 1982 <\/option>\n <option value=\"1981\"> 1981 <\/option>\n <option value=\"1980\"> 1980 <\/option>\n <option value=\"1979\"> 1979 <\/option>\n <option value=\"1978\"> 1978 <\/option>\n <option value=\"1977\"> 1977 <\/option>\n <option value=\"1976\"> 1976 <\/option>\n <option value=\"1975\"> 1975 <\/option>\n <option value=\"1974\"> 1974 <\/option>\n <option value=\"1973\"> 1973 <\/option>\n <option value=\"1972\"> 1972 <\/option>\n <option value=\"1971\"> 1971 <\/option>\n <option value=\"1970\"> 1970 <\/option>\n <option value=\"1969\"> 1969 <\/option>\n <option value=\"1968\"> 1968 <\/option>\n <option value=\"1967\"> 1967 <\/option>\n <option value=\"1966\"> 1966 <\/option>\n <option value=\"1965\"> 1965 <\/option>\n <option value=\"1964\"> 1964 <\/option>\n <option value=\"1963\"> 1963 <\/option>\n <option value=\"1962\"> 1962 <\/option>\n <option value=\"1961\"> 1961 <\/option>\n <option value=\"1960\"> 1960 <\/option>\n <option value=\"1959\"> 1959 <\/option>\n <option value=\"1958\"> 1958 <\/option>\n <option value=\"1957\"> 1957 <\/option>\n <option value=\"1956\"> 1956 <\/option>\n <option value=\"1955\"> 1955 <\/option>\n <option value=\"1954\"> 1954 <\/option>\n <option value=\"1953\"> 1953 <\/option>\n <option value=\"1952\"> 1952 <\/option>\n <option value=\"1951\"> 1951 <\/option>\n <option value=\"1950\"> 1950 <\/option>\n <option value=\"1949\"> 1949 <\/option>\n <option value=\"1948\"> 1948 <\/option>\n <option value=\"1947\"> 1947 <\/option>\n <option value=\"1946\"> 1946 <\/option>\n <option value=\"1945\"> 1945 <\/option>\n <option value=\"1944\"> 1944 <\/option>\n <option value=\"1943\"> 1943 <\/option>\n <option value=\"1942\"> 1942 <\/option>\n <option value=\"1941\"> 1941 <\/option>\n <option value=\"1940\"> 1940 <\/option>\n <option value=\"1939\"> 1939 <\/option>\n <option value=\"1938\"> 1938 <\/option>\n <option value=\"1937\"> 1937 <\/option>\n <option value=\"1936\"> 1936 <\/option>\n <option value=\"1935\"> 1935 <\/option>\n <option value=\"1934\"> 1934 <\/option>\n <option value=\"1933\"> 1933 <\/option>\n <option value=\"1932\"> 1932 <\/option>\n <option value=\"1931\"> 1931 <\/option>\n <option value=\"1930\"> 1930 <\/option>\n <option value=\"1929\"> 1929 <\/option>\n <option value=\"1928\"> 1928 <\/option>\n <option value=\"1927\"> 1927 <\/option>\n <option value=\"1926\"> 1926 <\/option>\n <option value=\"1925\"> 1925 <\/option>\n <option value=\"1924\"> 1924 <\/option>\n <option value=\"1923\"> 1923 <\/option>\n <option value=\"1922\"> 1922 <\/option>\n <option value=\"1921\"> 1921 <\/option>\n <option value=\"1920\"> 1920 <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"input_42_year\" id=\"sublabel_year\"> Year <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_71\">\n <label class=\"form-label-top\" id=\"label_71\" for=\"input_71\"> Grade <\/label>\n <div id=\"cid_71\" class=\"form-input-wide\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_71\" name=\"q71_grade\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_73\">\n <label class=\"form-label-top\" id=\"label_73\" for=\"input_73\"> Name of School <\/label>\n <div id=\"cid_73\" class=\"form-input-wide\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_73\" name=\"q73_nameOf\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_98\">\n <label class=\"form-label-top\" id=\"label_98\" for=\"input_98\"> Any allergies, medications or special needs? <\/label>\n <div id=\"cid_98\" class=\"form-input-wide\">\n <textarea id=\"input_98\" class=\"form-textarea\" name=\"q98_anyAllergies\" cols=\"37\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_74\">\n <label class=\"form-label-top\" id=\"label_74\" for=\"input_74\"> Please check, if applicable: <\/label>\n <div id=\"cid_74\" class=\"form-input-wide\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_74_0\" name=\"q74_pleaseCheck74[]\" value=\"My child will need a book\" \/>\n <label for=\"input_74_0\"> My child will need a book <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_74_1\" name=\"q74_pleaseCheck74[]\" value=\"My child will need a uniform\" \/>\n <label for=\"input_74_1\"> My child will need a uniform <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li id=\"cid_67\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h3 id=\"header_67\" class=\"form-header\">\n Child #2\n <\/h3>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_32\">\n <label class=\"form-label-top\" id=\"label_32\" for=\"input_32\"> Name <\/label>\n <div id=\"cid_32\" class=\"form-input-wide\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"10\" name=\"q32_name26[first]\" id=\"first_32\" \/>\n <label class=\"form-sub-label\" for=\"first_32\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"10\" name=\"q32_name26[middle]\" id=\"middle_32\" \/>\n <label class=\"form-sub-label\" for=\"middle_32\" id=\"sublabel_middle\"> Middle Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"15\" name=\"q32_name26[last]\" id=\"last_32\" \/>\n <label class=\"form-sub-label\" for=\"last_32\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_76\">\n <label class=\"form-label-top\" id=\"label_76\" for=\"input_76\"> Nickname <\/label>\n <div id=\"cid_76\" class=\"form-input-wide\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_76\" name=\"q76_nickname76\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_33\">\n <label class=\"form-label-top\" id=\"label_33\" for=\"input_33\"> Gender <\/label>\n <div id=\"cid_33\" class=\"form-input-wide\">\n <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_33\" name=\"q33_gender33\">\n <option> <\/option>\n <option value=\"Male\"> Male <\/option>\n <option value=\"Female\"> Female <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_77\">\n <label class=\"form-label-top\" id=\"label_77\" for=\"input_77\"> Date of Birth <\/label>\n <div id=\"cid_77\" class=\"form-input-wide\"><span class=\"form-sub-label-container\"><select class=\"form-dropdown\" name=\"q77_dateOf[month]\" id=\"input_77_month\">\n <option> <\/option>\n <option value=\"January\"> January <\/option>\n <option value=\"February\"> February <\/option>\n <option value=\"March\"> March <\/option>\n <option value=\"April\"> April <\/option>\n <option value=\"May\"> May <\/option>\n <option value=\"June\"> June <\/option>\n <option value=\"July\"> July <\/option>\n <option value=\"August\"> August <\/option>\n <option value=\"September\"> September <\/option>\n <option value=\"October\"> October <\/option>\n <option value=\"November\"> November <\/option>\n <option value=\"December\"> December <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"input_77_month\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown\" name=\"q77_dateOf[day]\" id=\"input_77_day\">\n <option> <\/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 <option value=\"11\"> 11 <\/option>\n <option value=\"12\"> 12 <\/option>\n <option value=\"13\"> 13 <\/option>\n <option value=\"14\"> 14 <\/option>\n <option value=\"15\"> 15 <\/option>\n <option value=\"16\"> 16 <\/option>\n <option value=\"17\"> 17 <\/option>\n <option value=\"18\"> 18 <\/option>\n <option value=\"19\"> 19 <\/option>\n <option value=\"20\"> 20 <\/option>\n <option value=\"21\"> 21 <\/option>\n <option value=\"22\"> 22 <\/option>\n <option value=\"23\"> 23 <\/option>\n <option value=\"24\"> 24 <\/option>\n <option value=\"25\"> 25 <\/option>\n <option value=\"26\"> 26 <\/option>\n <option value=\"27\"> 27 <\/option>\n <option value=\"28\"> 28 <\/option>\n <option value=\"29\"> 29 <\/option>\n <option value=\"30\"> 30 <\/option>\n <option value=\"31\"> 31 <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"input_77_day\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown\" name=\"q77_dateOf[year]\" id=\"input_77_year\">\n <option> <\/option>\n <option value=\"2016\"> 2016 <\/option>\n <option value=\"2015\"> 2015 <\/option>\n <option value=\"2014\"> 2014 <\/option>\n <option value=\"2013\"> 2013 <\/option>\n <option value=\"2012\"> 2012 <\/option>\n <option value=\"2011\"> 2011 <\/option>\n <option value=\"2010\"> 2010 <\/option>\n <option value=\"2009\"> 2009 <\/option>\n <option value=\"2008\"> 2008 <\/option>\n <option value=\"2007\"> 2007 <\/option>\n <option value=\"2006\"> 2006 <\/option>\n <option value=\"2005\"> 2005 <\/option>\n <option value=\"2004\"> 2004 <\/option>\n <option value=\"2003\"> 2003 <\/option>\n <option value=\"2002\"> 2002 <\/option>\n <option value=\"2001\"> 2001 <\/option>\n <option value=\"2000\"> 2000 <\/option>\n <option value=\"1999\"> 1999 <\/option>\n <option value=\"1998\"> 1998 <\/option>\n <option value=\"1997\"> 1997 <\/option>\n <option value=\"1996\"> 1996 <\/option>\n <option value=\"1995\"> 1995 <\/option>\n <option value=\"1994\"> 1994 <\/option>\n <option value=\"1993\"> 1993 <\/option>\n <option value=\"1992\"> 1992 <\/option>\n <option value=\"1991\"> 1991 <\/option>\n <option value=\"1990\"> 1990 <\/option>\n <option value=\"1989\"> 1989 <\/option>\n <option value=\"1988\"> 1988 <\/option>\n <option value=\"1987\"> 1987 <\/option>\n <option value=\"1986\"> 1986 <\/option>\n <option value=\"1985\"> 1985 <\/option>\n <option value=\"1984\"> 1984 <\/option>\n <option value=\"1983\"> 1983 <\/option>\n <option value=\"1982\"> 1982 <\/option>\n <option value=\"1981\"> 1981 <\/option>\n <option value=\"1980\"> 1980 <\/option>\n <option value=\"1979\"> 1979 <\/option>\n <option value=\"1978\"> 1978 <\/option>\n <option value=\"1977\"> 1977 <\/option>\n <option value=\"1976\"> 1976 <\/option>\n <option value=\"1975\"> 1975 <\/option>\n <option value=\"1974\"> 1974 <\/option>\n <option value=\"1973\"> 1973 <\/option>\n <option value=\"1972\"> 1972 <\/option>\n <option value=\"1971\"> 1971 <\/option>\n <option value=\"1970\"> 1970 <\/option>\n <option value=\"1969\"> 1969 <\/option>\n <option value=\"1968\"> 1968 <\/option>\n <option value=\"1967\"> 1967 <\/option>\n <option value=\"1966\"> 1966 <\/option>\n <option value=\"1965\"> 1965 <\/option>\n <option value=\"1964\"> 1964 <\/option>\n <option value=\"1963\"> 1963 <\/option>\n <option value=\"1962\"> 1962 <\/option>\n <option value=\"1961\"> 1961 <\/option>\n <option value=\"1960\"> 1960 <\/option>\n <option value=\"1959\"> 1959 <\/option>\n <option value=\"1958\"> 1958 <\/option>\n <option value=\"1957\"> 1957 <\/option>\n <option value=\"1956\"> 1956 <\/option>\n <option value=\"1955\"> 1955 <\/option>\n <option value=\"1954\"> 1954 <\/option>\n <option value=\"1953\"> 1953 <\/option>\n <option value=\"1952\"> 1952 <\/option>\n <option value=\"1951\"> 1951 <\/option>\n <option value=\"1950\"> 1950 <\/option>\n <option value=\"1949\"> 1949 <\/option>\n <option value=\"1948\"> 1948 <\/option>\n <option value=\"1947\"> 1947 <\/option>\n <option value=\"1946\"> 1946 <\/option>\n <option value=\"1945\"> 1945 <\/option>\n <option value=\"1944\"> 1944 <\/option>\n <option value=\"1943\"> 1943 <\/option>\n <option value=\"1942\"> 1942 <\/option>\n <option value=\"1941\"> 1941 <\/option>\n <option value=\"1940\"> 1940 <\/option>\n <option value=\"1939\"> 1939 <\/option>\n <option value=\"1938\"> 1938 <\/option>\n <option value=\"1937\"> 1937 <\/option>\n <option value=\"1936\"> 1936 <\/option>\n <option value=\"1935\"> 1935 <\/option>\n <option value=\"1934\"> 1934 <\/option>\n <option value=\"1933\"> 1933 <\/option>\n <option value=\"1932\"> 1932 <\/option>\n <option value=\"1931\"> 1931 <\/option>\n <option value=\"1930\"> 1930 <\/option>\n <option value=\"1929\"> 1929 <\/option>\n <option value=\"1928\"> 1928 <\/option>\n <option value=\"1927\"> 1927 <\/option>\n <option value=\"1926\"> 1926 <\/option>\n <option value=\"1925\"> 1925 <\/option>\n <option value=\"1924\"> 1924 <\/option>\n <option value=\"1923\"> 1923 <\/option>\n <option value=\"1922\"> 1922 <\/option>\n <option value=\"1921\"> 1921 <\/option>\n <option value=\"1920\"> 1920 <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"input_77_year\" id=\"sublabel_year\"> Year <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_79\">\n <label class=\"form-label-top\" id=\"label_79\" for=\"input_79\"> Grade <\/label>\n <div id=\"cid_79\" class=\"form-input-wide\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_79\" name=\"q79_grade79\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_78\">\n <label class=\"form-label-top\" id=\"label_78\" for=\"input_78\"> Name of School <\/label>\n <div id=\"cid_78\" class=\"form-input-wide\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_78\" name=\"q78_nameOf78\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_99\">\n <label class=\"form-label-top\" id=\"label_99\" for=\"input_99\"> Any allergies, medications or special needs? <\/label>\n <div id=\"cid_99\" class=\"form-input-wide\">\n <textarea id=\"input_99\" class=\"form-textarea\" name=\"q99_anyAllergies\" cols=\"37\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_80\">\n <label class=\"form-label-top\" id=\"label_80\" for=\"input_80\"> Please check, if applicable: <\/label>\n <div id=\"cid_80\" class=\"form-input-wide\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_80_0\" name=\"q80_pleaseCheck80[]\" value=\"My child will need a book\" \/>\n <label for=\"input_80_0\"> My child will need a book <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_80_1\" name=\"q80_pleaseCheck80[]\" value=\"My child will need a uniform\" \/>\n <label for=\"input_80_1\"> My child will need a uniform <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li id=\"cid_35\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h3 id=\"header_35\" class=\"form-header\">\n Child #3\n <\/h3>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_36\">\n <label class=\"form-label-top\" id=\"label_36\" for=\"input_36\"> Name <\/label>\n <div id=\"cid_36\" class=\"form-input-wide\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"10\" name=\"q36_name26[first]\" id=\"first_36\" \/>\n <label class=\"form-sub-label\" for=\"first_36\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"10\" name=\"q36_name26[middle]\" id=\"middle_36\" \/>\n <label class=\"form-sub-label\" for=\"middle_36\" id=\"sublabel_middle\"> Middle Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"15\" name=\"q36_name26[last]\" id=\"last_36\" \/>\n <label class=\"form-sub-label\" for=\"last_36\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_82\">\n <label class=\"form-label-top\" id=\"label_82\" for=\"input_82\"> Nickname <\/label>\n <div id=\"cid_82\" class=\"form-input-wide\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_82\" name=\"q82_nickname\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_41\">\n <label class=\"form-label-top\" id=\"label_41\" for=\"input_41\"> Gender <\/label>\n <div id=\"cid_41\" class=\"form-input-wide\">\n <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_41\" name=\"q41_gender41\">\n <option> <\/option>\n <option value=\"Male\"> Male <\/option>\n <option value=\"Female\"> Female <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_83\">\n <label class=\"form-label-top\" id=\"label_83\" for=\"input_83\"> Birth Date <\/label>\n <div id=\"cid_83\" class=\"form-input-wide\"><span class=\"form-sub-label-container\"><select class=\"form-dropdown\" name=\"q83_birthDate83[month]\" id=\"input_83_month\">\n <option> <\/option>\n <option value=\"January\"> January <\/option>\n <option value=\"February\"> February <\/option>\n <option value=\"March\"> March <\/option>\n <option value=\"April\"> April <\/option>\n <option value=\"May\"> May <\/option>\n <option value=\"June\"> June <\/option>\n <option value=\"July\"> July <\/option>\n <option value=\"August\"> August <\/option>\n <option value=\"September\"> September <\/option>\n <option value=\"October\"> October <\/option>\n <option value=\"November\"> November <\/option>\n <option value=\"December\"> December <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"input_83_month\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown\" name=\"q83_birthDate83[day]\" id=\"input_83_day\">\n <option> <\/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 <option value=\"11\"> 11 <\/option>\n <option value=\"12\"> 12 <\/option>\n <option value=\"13\"> 13 <\/option>\n <option value=\"14\"> 14 <\/option>\n <option value=\"15\"> 15 <\/option>\n <option value=\"16\"> 16 <\/option>\n <option value=\"17\"> 17 <\/option>\n <option value=\"18\"> 18 <\/option>\n <option value=\"19\"> 19 <\/option>\n <option value=\"20\"> 20 <\/option>\n <option value=\"21\"> 21 <\/option>\n <option value=\"22\"> 22 <\/option>\n <option value=\"23\"> 23 <\/option>\n <option value=\"24\"> 24 <\/option>\n <option value=\"25\"> 25 <\/option>\n <option value=\"26\"> 26 <\/option>\n <option value=\"27\"> 27 <\/option>\n <option value=\"28\"> 28 <\/option>\n <option value=\"29\"> 29 <\/option>\n <option value=\"30\"> 30 <\/option>\n <option value=\"31\"> 31 <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"input_83_day\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown\" name=\"q83_birthDate83[year]\" id=\"input_83_year\">\n <option> <\/option>\n <option value=\"2016\"> 2016 <\/option>\n <option value=\"2015\"> 2015 <\/option>\n <option value=\"2014\"> 2014 <\/option>\n <option value=\"2013\"> 2013 <\/option>\n <option value=\"2012\"> 2012 <\/option>\n <option value=\"2011\"> 2011 <\/option>\n <option value=\"2010\"> 2010 <\/option>\n <option value=\"2009\"> 2009 <\/option>\n <option value=\"2008\"> 2008 <\/option>\n <option value=\"2007\"> 2007 <\/option>\n <option value=\"2006\"> 2006 <\/option>\n <option value=\"2005\"> 2005 <\/option>\n <option value=\"2004\"> 2004 <\/option>\n <option value=\"2003\"> 2003 <\/option>\n <option value=\"2002\"> 2002 <\/option>\n <option value=\"2001\"> 2001 <\/option>\n <option value=\"2000\"> 2000 <\/option>\n <option value=\"1999\"> 1999 <\/option>\n <option value=\"1998\"> 1998 <\/option>\n <option value=\"1997\"> 1997 <\/option>\n <option value=\"1996\"> 1996 <\/option>\n <option value=\"1995\"> 1995 <\/option>\n <option value=\"1994\"> 1994 <\/option>\n <option value=\"1993\"> 1993 <\/option>\n <option value=\"1992\"> 1992 <\/option>\n <option value=\"1991\"> 1991 <\/option>\n <option value=\"1990\"> 1990 <\/option>\n <option value=\"1989\"> 1989 <\/option>\n <option value=\"1988\"> 1988 <\/option>\n <option value=\"1987\"> 1987 <\/option>\n <option value=\"1986\"> 1986 <\/option>\n <option value=\"1985\"> 1985 <\/option>\n <option value=\"1984\"> 1984 <\/option>\n <option value=\"1983\"> 1983 <\/option>\n <option value=\"1982\"> 1982 <\/option>\n <option value=\"1981\"> 1981 <\/option>\n <option value=\"1980\"> 1980 <\/option>\n <option value=\"1979\"> 1979 <\/option>\n <option value=\"1978\"> 1978 <\/option>\n <option value=\"1977\"> 1977 <\/option>\n <option value=\"1976\"> 1976 <\/option>\n <option value=\"1975\"> 1975 <\/option>\n <option value=\"1974\"> 1974 <\/option>\n <option value=\"1973\"> 1973 <\/option>\n <option value=\"1972\"> 1972 <\/option>\n <option value=\"1971\"> 1971 <\/option>\n <option value=\"1970\"> 1970 <\/option>\n <option value=\"1969\"> 1969 <\/option>\n <option value=\"1968\"> 1968 <\/option>\n <option value=\"1967\"> 1967 <\/option>\n <option value=\"1966\"> 1966 <\/option>\n <option value=\"1965\"> 1965 <\/option>\n <option value=\"1964\"> 1964 <\/option>\n <option value=\"1963\"> 1963 <\/option>\n <option value=\"1962\"> 1962 <\/option>\n <option value=\"1961\"> 1961 <\/option>\n <option value=\"1960\"> 1960 <\/option>\n <option value=\"1959\"> 1959 <\/option>\n <option value=\"1958\"> 1958 <\/option>\n <option value=\"1957\"> 1957 <\/option>\n <option value=\"1956\"> 1956 <\/option>\n <option value=\"1955\"> 1955 <\/option>\n <option value=\"1954\"> 1954 <\/option>\n <option value=\"1953\"> 1953 <\/option>\n <option value=\"1952\"> 1952 <\/option>\n <option value=\"1951\"> 1951 <\/option>\n <option value=\"1950\"> 1950 <\/option>\n <option value=\"1949\"> 1949 <\/option>\n <option value=\"1948\"> 1948 <\/option>\n <option value=\"1947\"> 1947 <\/option>\n <option value=\"1946\"> 1946 <\/option>\n <option value=\"1945\"> 1945 <\/option>\n <option value=\"1944\"> 1944 <\/option>\n <option value=\"1943\"> 1943 <\/option>\n <option value=\"1942\"> 1942 <\/option>\n <option value=\"1941\"> 1941 <\/option>\n <option value=\"1940\"> 1940 <\/option>\n <option value=\"1939\"> 1939 <\/option>\n <option value=\"1938\"> 1938 <\/option>\n <option value=\"1937\"> 1937 <\/option>\n <option value=\"1936\"> 1936 <\/option>\n <option value=\"1935\"> 1935 <\/option>\n <option value=\"1934\"> 1934 <\/option>\n <option value=\"1933\"> 1933 <\/option>\n <option value=\"1932\"> 1932 <\/option>\n <option value=\"1931\"> 1931 <\/option>\n <option value=\"1930\"> 1930 <\/option>\n <option value=\"1929\"> 1929 <\/option>\n <option value=\"1928\"> 1928 <\/option>\n <option value=\"1927\"> 1927 <\/option>\n <option value=\"1926\"> 1926 <\/option>\n <option value=\"1925\"> 1925 <\/option>\n <option value=\"1924\"> 1924 <\/option>\n <option value=\"1923\"> 1923 <\/option>\n <option value=\"1922\"> 1922 <\/option>\n <option value=\"1921\"> 1921 <\/option>\n <option value=\"1920\"> 1920 <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"input_83_year\" id=\"sublabel_year\"> Year <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_84\">\n <label class=\"form-label-top\" id=\"label_84\" for=\"input_84\"> Grade <\/label>\n <div id=\"cid_84\" class=\"form-input-wide\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_84\" name=\"q84_grade84\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_85\">\n <label class=\"form-label-top\" id=\"label_85\" for=\"input_85\"> Name of School <\/label>\n <div id=\"cid_85\" class=\"form-input-wide\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_85\" name=\"q85_nameOf85\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_100\">\n <label class=\"form-label-top\" id=\"label_100\" for=\"input_100\"> Any allergies, medications or special needs? <\/label>\n <div id=\"cid_100\" class=\"form-input-wide\">\n <textarea id=\"input_100\" class=\"form-textarea\" name=\"q100_anyAllergies\" cols=\"37\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_86\">\n <label class=\"form-label-top\" id=\"label_86\" for=\"input_86\"> Please check, if applicable: <\/label>\n <div id=\"cid_86\" class=\"form-input-wide\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_86_0\" name=\"q86_pleaseCheck86[]\" value=\"My child will need a book\" \/>\n <label for=\"input_86_0\"> My child will need a book <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_86_1\" name=\"q86_pleaseCheck86[]\" value=\"My child will need a uniform\" \/>\n <label for=\"input_86_1\"> My child will need a uniform <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li id=\"cid_39\" class=\"form-input-wide\">\n <div class=\"form-header-group\">\n <h3 id=\"header_39\" class=\"form-header\">\n Child #4\n <\/h3>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_40\">\n <label class=\"form-label-top\" id=\"label_40\" for=\"input_40\"> Name <\/label>\n <div id=\"cid_40\" class=\"form-input-wide\"><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"10\" name=\"q40_name40[first]\" id=\"first_40\" \/>\n <label class=\"form-sub-label\" for=\"first_40\" id=\"sublabel_first\"> First Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"10\" name=\"q40_name40[middle]\" id=\"middle_40\" \/>\n <label class=\"form-sub-label\" for=\"middle_40\" id=\"sublabel_middle\"> Middle Name <\/label><\/span><span class=\"form-sub-label-container\"><input class=\"form-textbox\" type=\"text\" size=\"15\" name=\"q40_name40[last]\" id=\"last_40\" \/>\n <label class=\"form-sub-label\" for=\"last_40\" id=\"sublabel_last\"> Last Name <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_87\">\n <label class=\"form-label-top\" id=\"label_87\" for=\"input_87\"> Nickname <\/label>\n <div id=\"cid_87\" class=\"form-input-wide\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_87\" name=\"q87_nickname87\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_38\">\n <label class=\"form-label-top\" id=\"label_38\" for=\"input_38\"> Gender <\/label>\n <div id=\"cid_38\" class=\"form-input-wide\">\n <select class=\"form-dropdown\" style=\"width:150px\" id=\"input_38\" name=\"q38_gender38\">\n <option> <\/option>\n <option value=\"Male\"> Male <\/option>\n <option value=\"Female\"> Female <\/option>\n <\/select>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_37\">\n <label class=\"form-label-top\" id=\"label_37\" for=\"input_37\"> Birth Date <\/label>\n <div id=\"cid_37\" class=\"form-input-wide\"><span class=\"form-sub-label-container\"><select class=\"form-dropdown\" name=\"q37_birthDate[month]\" id=\"input_37_month\">\n <option> <\/option>\n <option value=\"January\"> January <\/option>\n <option value=\"February\"> February <\/option>\n <option value=\"March\"> March <\/option>\n <option value=\"April\"> April <\/option>\n <option value=\"May\"> May <\/option>\n <option value=\"June\"> June <\/option>\n <option value=\"July\"> July <\/option>\n <option value=\"August\"> August <\/option>\n <option value=\"September\"> September <\/option>\n <option value=\"October\"> October <\/option>\n <option value=\"November\"> November <\/option>\n <option value=\"December\"> December <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"input_37_month\" id=\"sublabel_month\"> Month <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown\" name=\"q37_birthDate[day]\" id=\"input_37_day\">\n <option> <\/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 <option value=\"11\"> 11 <\/option>\n <option value=\"12\"> 12 <\/option>\n <option value=\"13\"> 13 <\/option>\n <option value=\"14\"> 14 <\/option>\n <option value=\"15\"> 15 <\/option>\n <option value=\"16\"> 16 <\/option>\n <option value=\"17\"> 17 <\/option>\n <option value=\"18\"> 18 <\/option>\n <option value=\"19\"> 19 <\/option>\n <option value=\"20\"> 20 <\/option>\n <option value=\"21\"> 21 <\/option>\n <option value=\"22\"> 22 <\/option>\n <option value=\"23\"> 23 <\/option>\n <option value=\"24\"> 24 <\/option>\n <option value=\"25\"> 25 <\/option>\n <option value=\"26\"> 26 <\/option>\n <option value=\"27\"> 27 <\/option>\n <option value=\"28\"> 28 <\/option>\n <option value=\"29\"> 29 <\/option>\n <option value=\"30\"> 30 <\/option>\n <option value=\"31\"> 31 <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"input_37_day\" id=\"sublabel_day\"> Day <\/label><\/span><span class=\"form-sub-label-container\"><select class=\"form-dropdown\" name=\"q37_birthDate[year]\" id=\"input_37_year\">\n <option> <\/option>\n <option value=\"2016\"> 2016 <\/option>\n <option value=\"2015\"> 2015 <\/option>\n <option value=\"2014\"> 2014 <\/option>\n <option value=\"2013\"> 2013 <\/option>\n <option value=\"2012\"> 2012 <\/option>\n <option value=\"2011\"> 2011 <\/option>\n <option value=\"2010\"> 2010 <\/option>\n <option value=\"2009\"> 2009 <\/option>\n <option value=\"2008\"> 2008 <\/option>\n <option value=\"2007\"> 2007 <\/option>\n <option value=\"2006\"> 2006 <\/option>\n <option value=\"2005\"> 2005 <\/option>\n <option value=\"2004\"> 2004 <\/option>\n <option value=\"2003\"> 2003 <\/option>\n <option value=\"2002\"> 2002 <\/option>\n <option value=\"2001\"> 2001 <\/option>\n <option value=\"2000\"> 2000 <\/option>\n <option value=\"1999\"> 1999 <\/option>\n <option value=\"1998\"> 1998 <\/option>\n <option value=\"1997\"> 1997 <\/option>\n <option value=\"1996\"> 1996 <\/option>\n <option value=\"1995\"> 1995 <\/option>\n <option value=\"1994\"> 1994 <\/option>\n <option value=\"1993\"> 1993 <\/option>\n <option value=\"1992\"> 1992 <\/option>\n <option value=\"1991\"> 1991 <\/option>\n <option value=\"1990\"> 1990 <\/option>\n <option value=\"1989\"> 1989 <\/option>\n <option value=\"1988\"> 1988 <\/option>\n <option value=\"1987\"> 1987 <\/option>\n <option value=\"1986\"> 1986 <\/option>\n <option value=\"1985\"> 1985 <\/option>\n <option value=\"1984\"> 1984 <\/option>\n <option value=\"1983\"> 1983 <\/option>\n <option value=\"1982\"> 1982 <\/option>\n <option value=\"1981\"> 1981 <\/option>\n <option value=\"1980\"> 1980 <\/option>\n <option value=\"1979\"> 1979 <\/option>\n <option value=\"1978\"> 1978 <\/option>\n <option value=\"1977\"> 1977 <\/option>\n <option value=\"1976\"> 1976 <\/option>\n <option value=\"1975\"> 1975 <\/option>\n <option value=\"1974\"> 1974 <\/option>\n <option value=\"1973\"> 1973 <\/option>\n <option value=\"1972\"> 1972 <\/option>\n <option value=\"1971\"> 1971 <\/option>\n <option value=\"1970\"> 1970 <\/option>\n <option value=\"1969\"> 1969 <\/option>\n <option value=\"1968\"> 1968 <\/option>\n <option value=\"1967\"> 1967 <\/option>\n <option value=\"1966\"> 1966 <\/option>\n <option value=\"1965\"> 1965 <\/option>\n <option value=\"1964\"> 1964 <\/option>\n <option value=\"1963\"> 1963 <\/option>\n <option value=\"1962\"> 1962 <\/option>\n <option value=\"1961\"> 1961 <\/option>\n <option value=\"1960\"> 1960 <\/option>\n <option value=\"1959\"> 1959 <\/option>\n <option value=\"1958\"> 1958 <\/option>\n <option value=\"1957\"> 1957 <\/option>\n <option value=\"1956\"> 1956 <\/option>\n <option value=\"1955\"> 1955 <\/option>\n <option value=\"1954\"> 1954 <\/option>\n <option value=\"1953\"> 1953 <\/option>\n <option value=\"1952\"> 1952 <\/option>\n <option value=\"1951\"> 1951 <\/option>\n <option value=\"1950\"> 1950 <\/option>\n <option value=\"1949\"> 1949 <\/option>\n <option value=\"1948\"> 1948 <\/option>\n <option value=\"1947\"> 1947 <\/option>\n <option value=\"1946\"> 1946 <\/option>\n <option value=\"1945\"> 1945 <\/option>\n <option value=\"1944\"> 1944 <\/option>\n <option value=\"1943\"> 1943 <\/option>\n <option value=\"1942\"> 1942 <\/option>\n <option value=\"1941\"> 1941 <\/option>\n <option value=\"1940\"> 1940 <\/option>\n <option value=\"1939\"> 1939 <\/option>\n <option value=\"1938\"> 1938 <\/option>\n <option value=\"1937\"> 1937 <\/option>\n <option value=\"1936\"> 1936 <\/option>\n <option value=\"1935\"> 1935 <\/option>\n <option value=\"1934\"> 1934 <\/option>\n <option value=\"1933\"> 1933 <\/option>\n <option value=\"1932\"> 1932 <\/option>\n <option value=\"1931\"> 1931 <\/option>\n <option value=\"1930\"> 1930 <\/option>\n <option value=\"1929\"> 1929 <\/option>\n <option value=\"1928\"> 1928 <\/option>\n <option value=\"1927\"> 1927 <\/option>\n <option value=\"1926\"> 1926 <\/option>\n <option value=\"1925\"> 1925 <\/option>\n <option value=\"1924\"> 1924 <\/option>\n <option value=\"1923\"> 1923 <\/option>\n <option value=\"1922\"> 1922 <\/option>\n <option value=\"1921\"> 1921 <\/option>\n <option value=\"1920\"> 1920 <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"input_37_year\" id=\"sublabel_year\"> Year <\/label><\/span>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_88\">\n <label class=\"form-label-top\" id=\"label_88\" for=\"input_88\"> Grade <\/label>\n <div id=\"cid_88\" class=\"form-input-wide\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_88\" name=\"q88_grade88\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line form-line-column\" id=\"id_90\">\n <label class=\"form-label-top\" id=\"label_90\" for=\"input_90\"> Name of School <\/label>\n <div id=\"cid_90\" class=\"form-input-wide\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_90\" name=\"q90_nameOf90\" size=\"20\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_101\">\n <label class=\"form-label-top\" id=\"label_101\" for=\"input_101\"> Any allergies, medications or special needs? <\/label>\n <div id=\"cid_101\" class=\"form-input-wide\">\n <textarea id=\"input_101\" class=\"form-textarea\" name=\"q101_anyAllergies\" cols=\"37\" rows=\"6\"><\/textarea>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_91\">\n <label class=\"form-label-top\" id=\"label_91\" for=\"input_91\"> Please check, if applicable: <\/label>\n <div id=\"cid_91\" class=\"form-input-wide\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_91_0\" name=\"q91_pleaseCheck[]\" value=\"My child will need a book\" \/>\n <label for=\"input_91_0\"> My child will need a book <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_91_1\" name=\"q91_pleaseCheck[]\" value=\"My child will need a uniform\" \/>\n <label for=\"input_91_1\"> My child will need a uniform <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_103\">\n <div id=\"cid_103\" class=\"form-input-wide\">\n <div id=\"text_103\" class=\"form-html\">\n <p style=\"text-align: center;\">\n _______________________\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_96\">\n <label class=\"form-label-top\" id=\"label_96\" for=\"input_96\"> Name of Doctor \/ Phone Number <\/label>\n <div id=\"cid_96\" class=\"form-input-wide\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_96\" name=\"q96_nameOf96\" size=\"35\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_97\">\n <label class=\"form-label-top\" id=\"label_97\" for=\"input_97\"> Name of Dentist \/ Phone Number <\/label>\n <div id=\"cid_97\" class=\"form-input-wide\">\n <input type=\"text\" class=\"form-textbox\" id=\"input_97\" name=\"q97_nameOf97\" size=\"35\" \/>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_102\">\n <label class=\"form-label-top\" id=\"label_102\" for=\"input_102\"> Yes, I am interested in helping with AWANA*: <\/label>\n <div id=\"cid_102\" class=\"form-input-wide\">\n <div class=\"form-single-column\"><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_102_0\" name=\"q102_yesI102[]\" value=\"Weekly\" \/>\n <label for=\"input_102_0\"> Weekly <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_102_1\" name=\"q102_yesI102[]\" value=\"Every other week\" \/>\n <label for=\"input_102_1\"> Every other week <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_102_2\" name=\"q102_yesI102[]\" value=\"Monthly\" \/>\n <label for=\"input_102_2\"> Monthly <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-checkbox-item\" style=\"clear:left;\"><input type=\"checkbox\" class=\"form-checkbox\" id=\"input_102_3\" name=\"q102_yesI102[]\" value=\"For special events\" \/>\n <label for=\"input_102_3\"> For special events <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_104\">\n <div id=\"cid_104\" class=\"form-input-wide\">\n <div id=\"text_104\" class=\"form-html\">\n <p><span style=\"font-size: x-small;\"><em>\n *Please note:  All AWANA Club leaders and listeners must submit to a background check before working with the children.\n <\/em><\/span>\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_105\">\n <div id=\"cid_105\" class=\"form-input-wide\">\n <div id=\"text_105\" class=\"form-html\">\n <p style=\"text-align: justify;\">\n <strong><span style=\"font-size: small;\">Terms and Conditions<\/span>\n <\/strong>\n <\/p>\n <p style=\"text-align: justify;\">\n 1)  I understand that my child\/children may participate in physical activities such as those held during Game Time.  As with any physical activity, there is a risk of injury.  I fully accept this risk and hold harmless from any legal liability, Coast Bible Church and any persons involved in the AWANA Club ministry.  \n <\/p>\n <p style=\"text-align: justify;\">\n 2) In the event of an emergency that requires medical treatment for the above named child\/children, I understand every effort will be made to contact me or my emergency contact. However, if I\/we cannot be reached, I give my permission to the AWANA volunteers to secure the services of a licensed physician to provide the care necessary for my child's well-being.  I assume responsibility for all costs connected to any accident or treatment of my child.\n <\/p>\n <p style=\"text-align: justify;\">\n 3)  I grant permission for a photo of my child to appear in an unpublished club directory to be used by AWANA Leaders only.  I also give permission for photo(s) of my child to appear among other general club photos as long s there is no identifying information shown.\n <\/p>\n <p style=\"text-align: justify;\">\n 4)  I grant permission for my child to travel to\/from AWANA Club events with an adult leader.  Any such event will be clearly communicated with me beforehand.\n <\/p>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_108\">\n <label class=\"form-label-top\" id=\"label_108\" for=\"input_108\">\n Have you read, and do you agree to the Terms and Conditions stated above?<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_108\" class=\"form-input-wide\">\n <div class=\"form-single-column\"><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_108_0\" name=\"q108_haveYou108\" value=\"Yes\" \/>\n <label for=\"input_108_0\"> Yes <\/label><\/span><span class=\"clearfix\"><\/span><span class=\"form-radio-item\" style=\"clear:left;\"><input type=\"radio\" class=\"form-radio validate[required]\" id=\"input_108_1\" name=\"q108_haveYou108\" value=\"No\" \/>\n <label for=\"input_108_1\"> No <\/label><\/span><span class=\"clearfix\"><\/span>\n <\/div>\n <\/div>\n <\/li>\n <li class=\"form-line\" id=\"id_111\">\n <label class=\"form-label-top\" id=\"label_111\" for=\"input_111\">\n Payment Information:<span class=\"form-required\">*<\/span>\n <\/label>\n <div id=\"cid_111\" class=\"form-input-wide\"><span class=\"form-product-item\"><input class=\"form-checkbox validate[required]\" type=\"checkbox\" id=\"input_111_1001\" name=\"q111_paymentInformation[][id]\" value=\"1001\" checked=\"checked\" \/>\n <label for=\"input_111_1001\">\n Yes, please register my child(ren)<span class=\"form-product-details\"><b>\n $<span id=\"\">40.00<\/span>\n USD\n <\/b><\/span>\n <\/label>\n <br \/>\n <br \/><span class=\"form-sub-label-container\"><select class=\"form-dropdown validate[required]\" name=\"q111_paymentInformation[special_1001][item_0]\" id=\"input_111_quantity_1001_0\">\n <option value=\"1\"> 1 <\/option>\n <option value=\"2\"> 2 <\/option>\n <option value=\"3\"> 3 <\/option>\n <option value=\"4\"> 4 <\/option>\n <option value=\"5\"> 5 <\/option>\n <option value=\"6\"> 6 <\/option>\n <\/select>\n <label class=\"form-sub-label\" for=\"input_111_quantity_1001_0\"> Quantity <\/label><\/span><\/span>\n <br \/>\n <br \/>\n <b>\n Total: <span>$<span id=\"payment_total\">0.00<\/span>\n USD<\/span>\n <\/b>\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=\"1940223373\" \/>\n <script type=\"text\/javascript\">\n document.getElementById(\"si\" + \"mple\" + \"_spc\").value = \"1940223373-1940223373\";\n <\/script>\n<\/form><\/body>\n<\/html>\n");