{"id":42708,"date":"2022-08-10T17:06:40","date_gmt":"2022-08-10T17:06:40","guid":{"rendered":"https:\/\/woundedwarriors.ca\/virtual-camp-registration-form\/"},"modified":"2026-02-09T20:56:40","modified_gmt":"2026-02-09T20:56:40","slug":"virtual-camp-registration-form","status":"publish","type":"page","link":"https:\/\/woundedwarriors.ca\/fr\/virtual-camp-registration-form\/","title":{"rendered":"Virtual Kids Camps Registration Form"},"content":{"rendered":"<p>[et_pb_section fb_built=\u00a0\u00bb1&Prime; module_class=\u00a0\u00bbtriangle\u00a0\u00bb _builder_version=\u00a0\u00bb4.16&Prime; background_color=\u00a0\u00bb#ffffff\u00a0\u00bb height=\u00a0\u00bb10px\u00a0\u00bb custom_padding=\u00a0\u00bb0px||0px|\u00a0\u00bb z_index_tablet=\u00a0\u00bb500&Prime; da_disable_devices=\u00a0\u00bboff|off|off\u00a0\u00bb collapsed=\u00a0\u00bbon\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb da_is_popup=\u00a0\u00bboff\u00a0\u00bb da_exit_intent=\u00a0\u00bboff\u00a0\u00bb da_has_close=\u00a0\u00bbon\u00a0\u00bb da_alt_close=\u00a0\u00bboff\u00a0\u00bb da_dark_close=\u00a0\u00bboff\u00a0\u00bb da_not_modal=\u00a0\u00bbon\u00a0\u00bb da_is_singular=\u00a0\u00bboff\u00a0\u00bb da_with_loader=\u00a0\u00bboff\u00a0\u00bb da_has_shadow=\u00a0\u00bbon\u00a0\u00bb][et_pb_row _builder_version=\u00a0\u00bb4.16&Prime; 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inner_width_tablet=\u00a0\u00bb50px\u00a0\u00bb inner_max_width_tablet=\u00a0\u00bb50px\u00a0\u00bb z_index_tablet=\u00a0\u00bb500&Prime; da_disable_devices=\u00a0\u00bboff|off|off\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb da_is_popup=\u00a0\u00bboff\u00a0\u00bb da_exit_intent=\u00a0\u00bboff\u00a0\u00bb da_has_close=\u00a0\u00bbon\u00a0\u00bb da_alt_close=\u00a0\u00bboff\u00a0\u00bb da_dark_close=\u00a0\u00bboff\u00a0\u00bb da_not_modal=\u00a0\u00bbon\u00a0\u00bb da_is_singular=\u00a0\u00bboff\u00a0\u00bb da_with_loader=\u00a0\u00bboff\u00a0\u00bb da_has_shadow=\u00a0\u00bbon\u00a0\u00bb][et_pb_row _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb hover_enabled=\u00a0\u00bb0&Prime; locked=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb width=\u00a0\u00bb90%\u00a0\u00bb sticky_enabled=\u00a0\u00bb0&Prime;][et_pb_column type=\u00a0\u00bb4_4&Prime; _builder_version=\u00a0\u00bb4.16&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb pac_dcm_carousel_specific_module_num=\u00a0\u00bb0&Prime; global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_text admin_label=\u00a0\u00bbTitle\u00a0\u00bb _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb header_text_color=\u00a0\u00bb#000000&Prime; header_3_font=\u00a0\u00bbKarma Regular||||||||\u00a0\u00bb header_3_text_color=\u00a0\u00bb#000000&Prime; header_3_font_size=\u00a0\u00bb64px\u00a0\u00bb custom_padding_tablet=\u00a0\u00bb||||false|false\u00a0\u00bb custom_padding_phone=\u00a0\u00bb||||false|false\u00a0\u00bb custom_padding_last_edited=\u00a0\u00bboff|desktop\u00a0\u00bb hover_enabled=\u00a0\u00bb0&Prime; header_3_font_size_tablet=\u00a0\u00bb58px\u00a0\u00bb header_3_font_size_phone=\u00a0\u00bb52px\u00a0\u00bb header_3_font_size_last_edited=\u00a0\u00bbon|phone\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb sticky_enabled=\u00a0\u00bb0&Prime;]<\/p>\n<h3>Warrior Kids Virtual Camp Registration Form<\/h3>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row disabled_on=\u00a0\u00bboff|off|off\u00a0\u00bb _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb custom_margin=\u00a0\u00bb||50px||false|false\u00a0\u00bb locked=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb width=\u00a0\u00bb90%\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4&Prime; _builder_version=\u00a0\u00bb4.16&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb pac_dcm_carousel_specific_module_num=\u00a0\u00bb0&Prime; global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_text disabled_on=\u00a0\u00bboff|off|off\u00a0\u00bb admin_label=\u00a0\u00bbText\u00a0\u00bb _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb text_font=\u00a0\u00bbLexend Deca Light||||||||\u00a0\u00bb text_text_color=\u00a0\u00bb#000000&Prime; text_font_size=\u00a0\u00bb22px\u00a0\u00bb link_text_color=\u00a0\u00bb#da642f\u00a0\u00bb header_2_font=\u00a0\u00bbOswald||||||||\u00a0\u00bb header_2_font_size=\u00a0\u00bb30px\u00a0\u00bb header_4_font=\u00a0\u00bbKarma Regular||||||||\u00a0\u00bb header_4_text_color=\u00a0\u00bb#508a59&Prime; background_enable_color=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<p>If you would like to take part in our event, please fill in your details in this Event Registration Form below.<\/p>\n<ul style=\"font-weight: 400;\">\n<li>Parent Intakes will take place four weeks prior to the program starting. Your online registration is confirmation of you have secured a spot in the program.<\/li>\n<li>Warrior Kids Boxes of supplies will ship out two weeks prior to program starting. Please be sure to let us know if you can no longer attend at least 2 weeks prior to the program starting.<\/li>\n<\/ul>\n<p>[\/et_pb_text][et_pb_text disabled_on=\u00a0\u00bbon|on|on\u00a0\u00bb _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb text_text_color=\u00a0\u00bb#000000&Prime; text_font_size=\u00a0\u00bb22px\u00a0\u00bb header_2_font=\u00a0\u00bbOswald||||||||\u00a0\u00bb header_2_font_size=\u00a0\u00bb30px\u00a0\u00bb background_color=\u00a0\u00bb#FFFFFF\u00a0\u00bb custom_padding=\u00a0\u00bb30px|30px|30px|30px|true|true\u00a0\u00bb disabled=\u00a0\u00bbon\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<p>Registration is now closed for the Virtual Kids Camp. Please check the Warrior Kids page for the most up-to-date registration information.<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row disabled_on=\u00a0\u00bboff|off|off\u00a0\u00bb _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb background_color=\u00a0\u00bb#f6da4a\u00a0\u00bb custom_padding=\u00a0\u00bb2%|2%|2%|2%|true|true\u00a0\u00bb border_radii=\u00a0\u00bbon|2rem|2rem|2rem|2rem\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb width=\u00a0\u00bb90%\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4&Prime; _builder_version=\u00a0\u00bb4.16&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb pac_dcm_carousel_specific_module_num=\u00a0\u00bb0&Prime; global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_text admin_label=\u00a0\u00bbForm\u00a0\u00bb _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb text_font=\u00a0\u00bbLexend Deca Light||||||||\u00a0\u00bb 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camp-form_wrapper' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_2' style='display:none'>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Warrior Kids Virtual Camp Signup<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_2' class='camp-form' action='\/fr\/wp-json\/wp\/v2\/pages\/42708' data-formid='2' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_2' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_2_12\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Warrior Kids Program Contact<\/h3><div class='gsection_description' id='gfield_description_2_12'>IF FOR ANY REASON YOU NEED TO CONTACT THE WARRIOR KIDS CAMP DIRECTORS: \n\nHelena Hawryluk PhD, RSW (she\/her) Email: helena@woundedwarriors.ca \n\nJerris Popik, MSW, RSW (she\/her) Email: Jerris@woundedwarriors.ca<\/div><\/div><div id=\"field_2_20\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_20'>Please Select a Virtual Camp<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_20' id='input_2_20' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Western Canada - Starts Fall 2026 (Nov \u2013 Dec)' >Western Canada - Starts Fall 2026 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             <input type='text' name='input_1.6' id='input_2_1_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_2_23\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_23'>Uniformed Service Affiliation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_23' id='input_2_23' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Military' >Military<\/option><option value='Veteran' 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for='input_2_21_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_21.6' id='input_2_21_6' value=''   aria-required='false'    autocomplete=\"family-name\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_2_24\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address of Family<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_2_24' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_2_24_1_container' >\n                                        <label for='input_2_24_1' id='input_2_24_1_label' class='gform-field-label gform-field-label--type-sub '>Adresse postale<\/label>\n                                        <input type='text' name='input_24.1' id='input_2_24_1' value=''    aria-required='true'   autocomplete=\"address-line1\" \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_2_24_2_container' >\n                                        <label for='input_2_24_2' id='input_2_24_2_label' class='gform-field-label gform-field-label--type-sub '>Adresse ligne 2<\/label>\n                                        <input type='text' name='input_24.2' id='input_2_24_2' value=''    autocomplete=\"address-line2\" aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_2_24_3_container' >\n                                    <label for='input_2_24_3' id='input_2_24_3_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                    <input type='text' name='input_24.3' id='input_2_24_3' value=''    aria-required='true'   autocomplete=\"address-level2\" \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_2_24_4_container' >\n                                        <label for='input_2_24_4' id='input_2_24_4_label' class='gform-field-label gform-field-label--type-sub '>\u00c9tat\/Province\/R\u00e9gion<\/label>\n                                        <input type='text' name='input_24.4' id='input_2_24_4' value=''      aria-required='true'   autocomplete=\"address-level1\" \/>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_2_24_5_container' >\n                                    <label for='input_2_24_5' id='input_2_24_5_label' class='gform-field-label gform-field-label--type-sub '>Code postal<\/label>\n                                    <input type='text' name='input_24.5' id='input_2_24_5' value=''    aria-required='true'   autocomplete=\"postal-code\" \/>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_2_24_6_container' >\n                                        <label for='input_2_24_6' id='input_2_24_6_label' class='gform-field-label gform-field-label--type-sub '>Pays<\/label>\n                                        <select name='input_24.6' id='input_2_24_6'   aria-required='true'   autocomplete=\"country-name\" ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Afrique du Sud' >Afrique du Sud<\/option><option value='Albanie' >Albanie<\/option><option value='Alg\u00e9rie' >Alg\u00e9rie<\/option><option value='Allemagne' >Allemagne<\/option><option value='Andorre' >Andorre<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctique' >Antarctique<\/option><option value='Antigua-et-Barbuda' >Antigua-et-Barbuda<\/option><option value='Arabie Saoudite' >Arabie Saoudite<\/option><option value='Argentine' >Argentine<\/option><option value='Arm\u00e9nie' >Arm\u00e9nie<\/option><option value='Aruba' >Aruba<\/option><option value='Australie' >Australie<\/option><option value='Autriche' >Autriche<\/option><option value='Azerba\u00efdjan' >Azerba\u00efdjan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahre\u00efn' >Bahre\u00efn<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Belarus' >Belarus<\/option><option value='Belgique' >Belgique<\/option><option value='Belize' >Belize<\/option><option value='Bermudes' >Bermudes<\/option><option value='Bhoutan' >Bhoutan<\/option><option value='Bolivie' >Bolivie<\/option><option value='Bonaire, Saint-Eustache et Saba' >Bonaire, Saint-Eustache et Saba<\/option><option value='Bosnie-Herz\u00e9govine' >Bosnie-Herz\u00e9govine<\/option><option value='Botswana' >Botswana<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Br\u00e9sil' >Br\u00e9sil<\/option><option value='Bulgarie' >Bulgarie<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='B\u00e9nin' >B\u00e9nin<\/option><option value='Cambodge' >Cambodge<\/option><option value='Cameroun' >Cameroun<\/option><option value='Canada' selected='selected'>Canada<\/option><option value='Cap-Vert' >Cap-Vert<\/option><option value='Chili' >Chili<\/option><option value='Chine' >Chine<\/option><option value='Chypre' >Chypre<\/option><option value='Colombie' >Colombie<\/option><option value='Comores' >Comores<\/option><option value='Congo' >Congo<\/option><option value='Cor\u00e9e (R\u00e9publique de)' >Cor\u00e9e (R\u00e9publique de)<\/option><option value='Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)' >Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatie' >Croatie<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='C\u00f4te d\u2019Ivoire' >C\u00f4te d\u2019Ivoire<\/option><option value='Danemark' >Danemark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominique' >Dominique<\/option><option value='Espagne' >Espagne<\/option><option value='Estonie' >Estonie<\/option><option value='Eswatini' >Eswatini<\/option><option value='Fidji' >Fidji<\/option><option value='Finlande' >Finlande<\/option><option value='France' >France<\/option><option value='F\u00e9d\u00e9ration Russe' >F\u00e9d\u00e9ration Russe<\/option><option value='Gabon' >Gabon<\/option><option value='Gambie' >Gambie<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Grenade' >Grenade<\/option><option value='Groenland' >Groenland<\/option><option value='Gr\u00e8ce' >Gr\u00e8ce<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guin\u00e9e' >Guin\u00e9e<\/option><option value='Guin\u00e9e \u00e9quatoriale' >Guin\u00e9e \u00e9quatoriale<\/option><option value='Guin\u00e9e-Bissau' >Guin\u00e9e-Bissau<\/option><option value='Guyane' >Guyane<\/option><option value='Guyane' >Guyane<\/option><option value='G\u00e9orgie' >G\u00e9orgie<\/option><option value='G\u00e9orgie du Sud et \u00celes Sandwich du Sud' >G\u00e9orgie du Sud et \u00celes Sandwich du Sud<\/option><option value='Ha\u00efti' >Ha\u00efti<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hongrie' >Hongrie<\/option><option value='Inde' >Inde<\/option><option value='Indon\u00e9sie' >Indon\u00e9sie<\/option><option value='Irak' >Irak<\/option><option value='Iran' >Iran<\/option><option value='Irlande' >Irlande<\/option><option value='Islande' >Islande<\/option><option value='Isra\u00ebl' >Isra\u00ebl<\/option><option value='Italie' >Italie<\/option><option value='Jama\u00efque' >Jama\u00efque<\/option><option value='Japon' >Japon<\/option><option value='Jersey' >Jersey<\/option><option value='Jordanie' >Jordanie<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kirghizistan' >Kirghizistan<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kowe\u00eft' >Kowe\u00eft<\/option><option value='La Barbade' >La Barbade<\/option><option value='La R\u00e9union' >La R\u00e9union<\/option><option value='Lesotho' >Lesotho<\/option><option value='Lettonie' >Lettonie<\/option><option value='Liban' >Liban<\/option><option value='Liberia' >Liberia<\/option><option value='Libye' >Libye<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lituanie' >Lituanie<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Mac\u00e9doine du Nord' >Mac\u00e9doine du Nord<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malaisie' >Malaisie<\/option><option value='Malawi' >Malawi<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malte' >Malte<\/option><option value='Maroc' >Maroc<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritanie' >Mauritanie<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexique' >Mexique<\/option><option value='Micron\u00e9sie' >Micron\u00e9sie<\/option><option value='Moldavie' >Moldavie<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolie' >Mongolie<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mont\u00e9n\u00e9gro' >Mont\u00e9n\u00e9gro<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibie' >Namibie<\/option><option value='Nauru' >Nauru<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nig\u00e9ria' >Nig\u00e9ria<\/option><option value='Niu\u00e9' >Niu\u00e9<\/option><option value='Norv\u00e8ge' >Norv\u00e8ge<\/option><option value='Nouvelle-Cal\u00e9donie' >Nouvelle-Cal\u00e9donie<\/option><option value='Nouvelle-Z\u00e9lande' >Nouvelle-Z\u00e9lande<\/option><option value='N\u00e9pal' >N\u00e9pal<\/option><option value='Oman' >Oman<\/option><option value='Ouganda' >Ouganda<\/option><option value='Ouzb\u00e9kistan' >Ouzb\u00e9kistan<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Panama' >Panama<\/option><option value='Papouasie-Nouvelle-Guin\u00e9e' >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value='Paraguay' >Paraguay<\/option><option value='Pays-Bas' >Pays-Bas<\/option><option value='Philippines' >Philippines<\/option><option value='Pologne' >Pologne<\/option><option value='Polyn\u00e9sie fran\u00e7aise' >Polyn\u00e9sie fran\u00e7aise<\/option><option value='Porto Rico' >Porto Rico<\/option><option value='Portugal' >Portugal<\/option><option value='P\u00e9rou' >P\u00e9rou<\/option><option value='Qatar' >Qatar<\/option><option value='Roumanie' >Roumanie<\/option><option value='Royaume-Uni' >Royaume-Uni<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9publique Dominicaine' >R\u00e9publique Dominicaine<\/option><option value='R\u00e9publique Tch\u00e8que' >R\u00e9publique Tch\u00e8que<\/option><option value='R\u00e9publique arabe syrienne' >R\u00e9publique arabe syrienne<\/option><option value='R\u00e9publique centrafricaine' >R\u00e9publique centrafricaine<\/option><option value='R\u00e9publique d\u00e9mocratique du Congo' >R\u00e9publique d\u00e9mocratique du Congo<\/option><option value='R\u00e9publique d\u00e9mocratique populaire du Laos' >R\u00e9publique d\u00e9mocratique populaire du Laos<\/option><option value='Sahara occidental' >Sahara occidental<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre et Miquelon' >Saint Pierre et Miquelon<\/option><option value='Saint-Christophe-et-Nevis' >Saint-Christophe-et-Nevis<\/option><option value='Saint-Marin' >Saint-Marin<\/option><option value='Saint-Si\u00e8ge' >Saint-Si\u00e8ge<\/option><option value='Saint-Vincent-et-les Grenadines' >Saint-Vincent-et-les Grenadines<\/option><option value='Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha' >Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha<\/option><option value='Sainte-Lucie' >Sainte-Lucie<\/option><option value='Salvador' >Salvador<\/option><option value='Samoa' >Samoa<\/option><option value='Samoa am\u00e9ricaines' >Samoa am\u00e9ricaines<\/option><option value='Sao Tom\u00e9 et Principe' >Sao Tom\u00e9 et Principe<\/option><option value='Serbie' >Serbie<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapour' >Singapour<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovaquie' >Slovaquie<\/option><option value='Slov\u00e9nie' >Slov\u00e9nie<\/option><option value='Somalie' >Somalie<\/option><option value='Soudan' >Soudan<\/option><option value='Soudan du Sud' >Soudan du Sud<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Suisse' >Suisse<\/option><option value='Suriname' >Suriname<\/option><option value='Su\u00e8de' >Su\u00e8de<\/option><option value='S\u00e9n\u00e9gal' >S\u00e9n\u00e9gal<\/option><option value='Tadjikistan' >Tadjikistan<\/option><option value='Tanzanie (R\u00e9publique-Unie de)' >Tanzanie (R\u00e9publique-Unie de)<\/option><option value='Ta\u00efwan' >Ta\u00efwan<\/option><option value='Tchad' >Tchad<\/option><option value='Terres Australes Fran\u00e7aises' >Terres Australes Fran\u00e7aises<\/option><option value='Territoire britannique de l\u2019oc\u00e9an Indien' >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value='Tha\u00eflande' >Tha\u00eflande<\/option><option value='Timor oriental' >Timor oriental<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinit\u00e9 et Tobago' >Trinit\u00e9 et Tobago<\/option><option value='Tunisie' >Tunisie<\/option><option value='Turkm\u00e9nistan' >Turkm\u00e9nistan<\/option><option value='Turquie' >Turquie<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Ukraine' >Ukraine<\/option><option value='Uruguay' >Uruguay<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Wallis et Futuna' >Wallis et Futuna<\/option><option value='Y\u00e9men' >Y\u00e9men<\/option><option value='Zambie' >Zambie<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c9gypte' >\u00c9gypte<\/option><option value='\u00c9mirats arabes unis' >\u00c9mirats arabes unis<\/option><option value='\u00c9quateur' >\u00c9quateur<\/option><option value='\u00c9rythr\u00e9e' >\u00c9rythr\u00e9e<\/option><option value='\u00c9tat palestinien' >\u00c9tat palestinien<\/option><option value='\u00c9tats-Unis' >\u00c9tats-Unis<\/option><option value='\u00c9thiopie' >\u00c9thiopie<\/option><option value='\u00cele Bouvet' >\u00cele Bouvet<\/option><option value='\u00cele Christmas' >\u00cele Christmas<\/option><option value='\u00cele Maurice' >\u00cele Maurice<\/option><option value='\u00cele Norfolk' >\u00cele Norfolk<\/option><option value='\u00cele de Man' >\u00cele de Man<\/option><option value='\u00celes Cayman' >\u00celes Cayman<\/option><option value='\u00celes Cocos' >\u00celes Cocos<\/option><option value='\u00celes Cook' >\u00celes Cook<\/option><option value='\u00celes Falkland' >\u00celes Falkland<\/option><option value='\u00celes F\u00e9ro\u00e9' >\u00celes F\u00e9ro\u00e9<\/option><option value='\u00celes Heard et McDonald' >\u00celes Heard et McDonald<\/option><option value='\u00celes Mariannes du Nord' >\u00celes Mariannes du Nord<\/option><option value='\u00celes Marshall' >\u00celes Marshall<\/option><option value='\u00celes Pitcairn' >\u00celes Pitcairn<\/option><option value='\u00celes Salomon' >\u00celes Salomon<\/option><option value='\u00celes Turques et Ca\u00efques' >\u00celes Turques et Ca\u00efques<\/option><option value='\u00celes Vierges am\u00e9ricaines' >\u00celes Vierges am\u00e9ricaines<\/option><option value='\u00celes Vierges britanniques' >\u00celes Vierges britanniques<\/option><option value='\u00celes de Svalbard et Jan Mayen' >\u00celes de Svalbard et Jan Mayen<\/option><option value='\u00celes mineures am\u00e9ricaines' >\u00celes mineures am\u00e9ricaines<\/option><option value='\u00celes \u00c5land' >\u00celes \u00c5land<\/option> <\/select>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_2_25\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Participant Information<\/h3><\/div><fieldset id=\"field_2_29\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Child Information (click + to add more)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">First Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Last Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Age<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Date of Birth<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Food Allergies<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_29_cell1 gform-grid-col' data-label='First Name'><input aria-invalid='false' aria-required=\"true\"  aria-label='First Name, Ligne 1' data-aria-label-template='First Name, Ligne {0}' type='text' name='input_29[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_29_cell2 gform-grid-col' data-label='Last Name'><input aria-invalid='false' aria-required=\"true\"  aria-label='Last Name, Ligne 1' data-aria-label-template='Last Name, Ligne {0}' type='text' name='input_29[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_29_cell3 gform-grid-col' data-label='Age'><input aria-invalid='false' aria-required=\"true\"  aria-label='Age, Ligne 1' data-aria-label-template='Age, Ligne {0}' type='text' name='input_29[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_29_cell4 gform-grid-col' data-label='Date of Birth'><input aria-invalid='false' aria-required=\"true\"  aria-label='Date of Birth, Ligne 1' data-aria-label-template='Date of Birth, Ligne {0}' type='text' name='input_29[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_29_cell5 gform-grid-col' data-label='Food Allergies'><input aria-invalid='false' aria-required=\"true\"  aria-label='Food Allergies, Ligne 1' data-aria-label-template='Food Allergies, Ligne {0}' type='text' name='input_29[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Ajouter une autre ligne' onclick='gformAddListItem(this, 0)'>Ajouter<\/button>   <button type='button'  class='delete_list_item' aria-label='Supprimer la ligne 1' data-aria-label-template='Supprimer la ligne {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Retirer<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_2_11\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_11'>How did you hear about this program?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_11' id='input_2_11' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Social Media' >Social Media<\/option><option value='Google' >Google<\/option><option value='Word of Mouth' >Word of Mouth<\/option><option value='Past Participant' >Past Participant<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><fieldset id=\"field_2_38\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Parent Information - Consent and Confidentiality<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_2_38' tabindex='0'>Once your registration is completed an email will go out to you approximately 4 weeks prior to the start of the program to book an intake phone call appointment with one or both parents. This telephone intake appointment will ensure everyone is ready to begin this Warrior Kids Program journey!<br \/>\n<br \/>\nThe Virtual Warrior Kids Program is offered via the Zoom Conferencing Program and is a 6 week resilience promoting psycho-educational program designed to help kids who have a parent with an operational stress injury (military, Veteran, First Responders) build positive relationships with peers, gain knowledge of the injury, and new coping skills that will help them continue to thrive within their family and community.<\/div><div class='ginput_container ginput_container_consent'><input name='input_38.1' id='input_2_38_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_2_38\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_2_38_1' >I have read and agree to the above terms<\/label><input type='hidden' name='input_38.2' value='I have read and agree to the above terms' class='gform_hidden' \/><input type='hidden' name='input_38.3' value='1' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_2_37\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Parent Information - Date and Times<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_2_37' tabindex='0'>Please review the dates and times (time zones) that your child\/youth is registered in, the program runs for 6 weeks 1 hour a week and it is important for the program goals and group dynamics that your child attend each session. <\/div><div class='ginput_container ginput_container_consent'><input name='input_37.1' id='input_2_37_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_2_37\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_2_37_1' >I have read and agree to the above terms<\/label><input type='hidden' name='input_37.2' value='I have read and agree to the above terms' class='gform_hidden' \/><input type='hidden' name='input_37.3' value='1' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_2_39\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Confidentiality<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_2_39' tabindex='0'>Although participants will be asked to maintain confidentiality in the group, they are free to discuss their own thoughts and feelings with whomever they choose after the group as long as no identifying information is shared. This means nothing about names, family members, address, etc. is shared.<br \/>\nDespite this atmosphere of confidentiality, there are a few limits to confidentiality as outlined below:<br \/>\n1.\t The program facilitators have a legal obligation to report suspected child abuse (this includes physical, sexual, and emotional abuse).<br \/>\n2.\tIf the program facilitators have reason to believe that a person is in danger to him\/her self (suicide) or others (homicide), the staff must notify someone who has the ability to protect the person at risk.<\/div><div class='ginput_container ginput_container_consent'><input name='input_39.1' id='input_2_39_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_2_39\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_2_39_1' >I have read the above and by checking this box have confirmed that I understand the confidentiality policy<\/label><input type='hidden' name='input_39.2' value='I have read the above and by checking this box have confirmed that I understand the confidentiality policy' class='gform_hidden' \/><input type='hidden' name='input_39.3' value='1' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_2_40\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Parent Requirements for Setting up your Child for Success!<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_2_40' tabindex='0'>\u2022\tBefore the program please consider a quiet space and a private location with limited interruptions or distractions. <br \/>\n\u2022\tYour child\u2019s space should be away from the hustle and bustle of the household if possible. <br \/>\n\u2022\tPlease note that although using the video feature\/camera is not mandatory we strongly encourage participants to have their camera on at the beginning of the session and during group discussion\/interactive activities in order to support developing relationships with others in the group and build connection. <\/div><div class='ginput_container ginput_container_consent'><input name='input_40.1' id='input_2_40_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_2_40\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_2_40_1' >I have read and agree to provide the following to support my child\/ren<\/label><input type='hidden' name='input_40.2' value='I have read and agree to provide the following to support my child\/ren' class='gform_hidden' \/><input type='hidden' name='input_40.3' value='1' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_2_42\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Parent Requirements for Setting up your Child for Success!<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_2_42' tabindex='0'>\u2022\tBefore the program please consider a quiet space and a private location with limited interruptions or distractions. <br \/>\n\u2022\tYour child\u2019s space should be away from the hustle and bustle of the household if possible. <br \/>\n\u2022\tPlease note that although using the video feature\/camera is not mandatory we strongly encourage participants to have their camera on at the beginning of the session and during group discussion\/interactive activities in order to support developing relationships with others in the group and build connection. <\/div><div class='ginput_container ginput_container_consent'><input name='input_42.1' id='input_2_42_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_2_42\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_2_42_1' >I have read and agree to provide the following to support my child\/ren<\/label><input type='hidden' name='input_42.2' value='I have read and agree to provide the following to support my child\/ren' class='gform_hidden' \/><input type='hidden' name='input_42.3' value='1' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_2_41\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Parent Requirements for Setting up your Child for Success!<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_2_41' tabindex='0'>\u2022\tWe have created this program with the evidence that children need their own space outside of their parents to learn, listen and ask questions about mental health in order to best support their needs. With this in mind please support the program goals by allowing your child to maintain a comfortable space away from parents to complete this program. If you have any questions or concerns about this please contact Warrrior Kids Program Directors, Jerris Popik or Dr Helena Hawryluk or discuss this during your intake call with the directors prior to the start.<\/div><div class='ginput_container ginput_container_consent'><input name='input_41.1' id='input_2_41_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_2_41\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_2_41_1' >I have read and agree to provide a private and comfortable space for my child<\/label><input type='hidden' name='input_41.2' value='I have read and agree to provide a private and comfortable space for my child' class='gform_hidden' \/><input type='hidden' name='input_41.3' value='1' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_2_43\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Parent Requirements for Setting up your Child for Success!<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_2_43' tabindex='0'>\u2022\tDuring the program we ask that you are in a nearby room and are accessible by phone should your child require behavior modification, technological issues occur, or in the event that your child may require additional emotional support. <\/div><div class='ginput_container ginput_container_consent'><input name='input_43.1' id='input_2_43_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_2_43\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_2_43_1' >I have read and agree to the above<\/label><input type='hidden' name='input_43.2' value='I have read and agree to the above' class='gform_hidden' \/><input type='hidden' name='input_43.3' value='1' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_2_48\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Family Information<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_2_48'>Has the OSI been formally recognized in the family?\n(Don't worry if you haven't been able to find the right way to explain this to your children. We can help with that during our intake call and first family meeting!)<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_48'>\n\t\t\t<div class='gchoice gchoice_2_48_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='Yes'  id='choice_2_48_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_2_48\"   \/>\n\t\t\t\t\t<label for='choice_2_48_0' id='label_2_48_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_48_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='No'  id='choice_2_48_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_48_1' id='label_2_48_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_48_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_48' type='radio' value='Not sure'  id='choice_2_48_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_48_2' id='label_2_48_2' class='gform-field-label gform-field-label--type-inline'>Not sure<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_49\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_49'>What are you hoping for your child\/teen to get out of attending this program?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_49' id='input_2_49' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_2_50\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_50'>Do you have any concerns about your child\/ren attending this program?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_50' id='input_2_50' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_2_51\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Parent Requirements for Setting up your Child for Success!<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_2_51' tabindex='0'>Please note the purpose of this program is to provide psycho-education around OSI's, introduce coping tools and strengthen peer connections between children also impacted by a parental OSI.This is not a clinical treatment program to provide direct mental health interventions. We can help provide referrals for supports that meet those needs after intake is completed or at any time during the program involvement. <\/div><div class='ginput_container ginput_container_consent'><input name='input_51.1' id='input_2_51_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_2_51\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_2_51_1' >I have read and understand the above information<span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/label><input type='hidden' name='input_51.2' value='I have read and understand the above information' class='gform_hidden' \/><input type='hidden' name='input_51.3' value='1' class='gform_hidden' \/><\/div><\/fieldset><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_2' class='gform_button button' 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