{"id":44891,"date":"2023-03-17T18:53:01","date_gmt":"2023-03-17T18:53:01","guid":{"rendered":"https:\/\/woundedwarriors.ca\/?page_id=44891"},"modified":"2025-01-30T17:18:13","modified_gmt":"2025-01-30T17:18:13","slug":"new-form-test-page","status":"publish","type":"page","link":"https:\/\/woundedwarriors.ca\/fr\/new-form-test-page\/","title":{"rendered":"New form test page"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework camp-form_wrapper' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_1' style='display:none'>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Warrior Kids Camp Registration<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1' class='camp-form' action='\/fr\/wp-json\/wp\/v2\/pages\/44891' data-formid='1' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_1_47\" 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 Camp Contact<\/h3><div class='gsection_description' id='gfield_description_1_47'>IF FOR ANY REASON YOU NEED TO CONTACT THE WARRIOR KIDS CAMP DIRECTORS:\n\n\nHelena Hawryluk PhD, RSW (she\/her)\nEmail: helena@woundedwarriors.ca\n\nJerris Popik, MSW, RSW (she\/her)\nEmail: Jerris@woundedwarriors.ca<\/div><\/div><div id=\"field_1_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_1_20'>Please Select a 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_1_20' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Teen Ranch - Orangeville, ON - May 2 & 3, 2026' >Teen Ranch - Orangeville, ON - May 2 & 3, 2026<\/option><option value='Green Bay Camp - Kelowna, BC - May 23 & 24, 2026' >Green Bay Camp - Kelowna, BC - May 23 & 24, 2026<\/option><option value='Camp Van Es - Edmonton, AB - June 20 & 21, 2026' >Camp Van Es - Edmonton, AB - June 20 & 21, 2026<\/option><\/select><\/div><\/div><fieldset id=\"field_1_70\" 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' >Camp Information<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_1_70' tabindex='0'>ABOUT THE WARRIOR KIDS CAMP <br \/>\n<br \/>\nThis one-of-a-kind program combines the essential knowledge around the impact operational stress injuries can have on children and youth in families with a Veteran or First Responder parent. The Warrior Kids Camp is a two-day in person overnight camp delivered at various locations in Canada.<br \/>\n<br \/>\nKids Groups Galaxy Defenders- ages 8-10 years old<br \/>\n<br \/>\nTeens Group Global Guardians - Ages 11-16 years old<br \/>\n<br \/>\nCamp Overview<br \/>\n<br \/>\nDay One <br \/>\n\u2022\tCamper Drop Off 9 :00am<br \/>\n\u2022\tCamp Begins! 9:30 am<br \/>\n\u2022\tSuperhero Challenges - Mindmazing! and Understanding about Operational Stress Injuries<br \/>\n\u2022\tLunch <br \/>\n\u2022\tField Trip Dreamcatcher Animal Therapy Ranch<br \/>\n\u2022\tSwimming <br \/>\n\u2022\tSupper<br \/>\n\u2022\tWide Game and Camp Fire and Outdoor Games<br \/>\n\u2022\tMovie and Bedtime<br \/>\n<br \/>\nDay Two <br \/>\n\u2022\tStress Buster Challenges - Painting to Music, Yoga and Positive Affirmation Rocks<br \/>\n\u2022\tClosing Ceremony 1:00 pm Sharp- All Parents are invited to join in this closing celebration!<br \/>\n\u2022\tCamp Officially Ends 1:30 pm<br \/>\nWe will be sending out a packing list closer to your camp date!<\/div><div class='ginput_container ginput_container_consent'><input name='input_70.1' id='input_1_70_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_1_70\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_1_70_1' >I have read the Camp Overview<\/label><input type='hidden' name='input_70.2' value='I have read the Camp Overview' class='gform_hidden' \/><input type='hidden' name='input_70.3' value='6' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_1_44\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full 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' >Clinical Background and Referrals<\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_1_44' tabindex='0'>HELPING CHILDREN AND YOUTH UNDERSTAND THE SECONDARY EFFECTS OF OPERATIONAL STRESS<br \/>\n<br \/>\nAn Operational Stress Injury (OSI) is a term used to describe any persistent psychological difficulty resulting from occupational duties. OSIs include diagnosed medical conditions such as anxiety, depression and post traumatic stress disorders (PTSD), as well as a range of less severe conditions. We do not require a formal diagnosis with a psychological injury however we do require a recognition within the family unit that a parent has been impacted by an OSI. Examples of this is Post Traumatic Stress or Post Traumatic Stress Disorder, Anxiety, Depression, Addictions, Sleep Related concerns.<br \/>\n<br \/>\nPlease 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_44.1' id='input_1_44_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_1_44\"  aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_1_44_1' >I understand<\/label><input type='hidden' name='input_44.2' value='I understand' class='gform_hidden' \/><input type='hidden' name='input_44.3' value='6' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_1_71\" 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\">Family and Participant Info<\/h3><div class='gsection_description' id='gfield_description_1_71'> The information gathered below is so we can learn more about your child(ren) and your family to prepare for the best Warrior Kids Program experience. Once this form is completed it will be kept confidential, only shared between the Warrior Kids Program Directors (Jerris Popik and Dr Helena Hawryluk).<\/div><\/div><fieldset id=\"field_1_46\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-half 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' >Warrior Kid Information (click + to add more)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_1_46'>Please fill out for each child attending camp<\/div><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=\"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_46_cell1 gform-grid-col' data-label='First Name'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_1_46\" aria-label='First Name, Ligne 1' data-aria-label-template='First Name, Ligne {0}' type='text' name='input_46[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_46_cell2 gform-grid-col' data-label='Last Name'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_1_46\" aria-label='Last Name, Ligne 1' data-aria-label-template='Last Name, Ligne {0}' type='text' name='input_46[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_46_cell3 gform-grid-col' data-label='Age'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_1_46\" aria-label='Age, Ligne 1' data-aria-label-template='Age, Ligne {0}' type='text' name='input_46[]' 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><fieldset id=\"field_1_72\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half 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' >Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_72'>\n\t\t\t<div class='gchoice gchoice_1_72_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='Male'  id='choice_1_72_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_72_0' id='label_1_72_0' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_72_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='Female'  id='choice_1_72_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_72_1' id='label_1_72_1' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_73\" class=\"gfield gfield--type-list gfield--input-type-list 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' >Warrior Kid Information (click + to add more)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_1_73'>Please fill out for each child attending camp<\/div><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\">Date of Birth<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Health Card Number<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Food Allergies<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Preferred pronoun<\/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_73_cell1 gform-grid-col' data-label='Date of Birth'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_1_73\" aria-label='Date of Birth, Ligne 1' data-aria-label-template='Date of Birth, Ligne {0}' type='text' name='input_73[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_73_cell2 gform-grid-col' data-label='Health Card Number'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_1_73\" aria-label='Health Card Number, Ligne 1' data-aria-label-template='Health Card Number, Ligne {0}' type='text' name='input_73[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_73_cell3 gform-grid-col' data-label='Food Allergies'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_1_73\" aria-label='Food Allergies, Ligne 1' data-aria-label-template='Food Allergies, Ligne {0}' type='text' name='input_73[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_73_cell4 gform-grid-col' data-label='Preferred pronoun'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_1_73\" aria-label='Preferred pronoun, Ligne 1' data-aria-label-template='Preferred pronoun, Ligne {0}' type='text' name='input_73[]' 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><fieldset id=\"field_1_1\" class=\"gfield gfield--type-name gfield--input-type-name 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' >Parent Name Primary<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_1'>\n                            \n                            <span id='input_1_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_1_1_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_1.3' id='input_1_1_3' value=''   aria-required='true'    autocomplete=\"given-name\" \/>\n                                                <\/span>\n                            \n                            <span id='input_1_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_1_1_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_1.6' id='input_1_1_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_1_51\" class=\"gfield gfield--type-name gfield--input-type-name 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' >Parent Name Secondary<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_51'>\n                            \n                            <span id='input_1_51_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_1_51_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_51.3' id='input_1_51_3' value=''   aria-required='true'    autocomplete=\"given-name\" \/>\n                                                <\/span>\n                            \n                            <span id='input_1_51_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_1_51_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_51.6' id='input_1_51_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_1_52\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio 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' >Parent Relationship Status<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_52'>\n\t\t\t<div class='gchoice gchoice_1_52_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='Married'  id='choice_1_52_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_52_0' id='label_1_52_0' class='gform-field-label gform-field-label--type-inline'>Married<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_52_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='Seperated'  id='choice_1_52_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_52_1' id='label_1_52_1' class='gform-field-label gform-field-label--type-inline'>Seperated<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_52_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='Common Law'  id='choice_1_52_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_52_2' id='label_1_52_2' class='gform-field-label gform-field-label--type-inline'>Common Law<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_52_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='Other'  id='choice_1_52_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_52_3' id='label_1_52_3' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_23\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half 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_1_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_1_23' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Military' >Military<\/option><option value='Veteran' >Veteran<\/option><option value='Fire Fighter' >Fire Fighter<\/option><option value='Paramedic' >Paramedic<\/option><option value='Corrections' >Corrections<\/option><option value='Police' >Police<\/option><option value='Retired First Responder' >Retired First Responder<\/option><\/select><\/div><\/div><fieldset id=\"field_1_21\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half 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' >Parent Name with Operational Stress Injury (If different)<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_21'>\n                            \n                            <span id='input_1_21_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_1_21_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_21.3' id='input_1_21_3' value=''   aria-required='false'    autocomplete=\"given-name\" \/>\n                                                <\/span>\n                            \n                            <span id='input_1_21_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_1_21_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_21.6' id='input_1_21_6' value=''   aria-required='false'    autocomplete=\"family-name\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_1_2\" class=\"gfield gfield--type-email gfield--input-type-email 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' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_1_2_container'>\n                                <span id='input_1_2_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_1_2' class='gform-field-label gform-field-label--type-sub '>Saisissez un e-mail<\/label>\n                                    <input class='' type='email' name='input_2' id='input_1_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                                <\/span>\n                                <span id='input_1_2_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_1_2_2' class='gform-field-label gform-field-label--type-sub '>Confirmez l\u2019e-mail<\/label>\n                                    <input class='' type='email' name='input_2_2' id='input_1_2_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_1_35\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_35'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_35' id='input_1_35' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1_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_1_24' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_24_1_container' >\n                                        <label for='input_1_24_1' id='input_1_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_1_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_1_24_2_container' >\n                                        <label for='input_1_24_2' id='input_1_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_1_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_1_24_3_container' >\n                                    <label for='input_1_24_3' id='input_1_24_3_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                    <input type='text' name='input_24.3' id='input_1_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_1_24_4_container' >\n                                        <label for='input_1_24_4' id='input_1_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_1_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_1_24_5_container' >\n                                    <label for='input_1_24_5' id='input_1_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_1_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_1_24_6_container' >\n                                        <label for='input_1_24_6' id='input_1_24_6_label' class='gform-field-label gform-field-label--type-sub '>Pays<\/label>\n                                        <select name='input_24.6' id='input_1_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_1_25\" 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\">Emergency Contact<\/h3><div class='gsection_description' id='gfield_description_1_25'>Please ensure this information is up to date for start of the program so we can use this to get in touch with the emergency contact at any time during our Warrior Kids Camp.<\/div><\/div><fieldset id=\"field_1_53\" class=\"gfield gfield--type-name gfield--input-type-name 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' >The name of an emergency contact we can call (outside of parents\/guardians) incase we can not get a hold of parents during camp.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_53'>\n                            \n                            <span id='input_1_53_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_1_53_3' class='gform-field-label gform-field-label--type-sub '>First and Last Name<\/label>\n                                                    <input type='text' name='input_53.3' id='input_1_53_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_1_53_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_1_53_6' class='gform-field-label gform-field-label--type-sub '>Phone Number<\/label>\n                                                            <input type='text' name='input_53.6' id='input_1_53_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_1_54\" class=\"gfield gfield--type-name gfield--input-type-name 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&#039;s NAME and ALBERTA\/BC\/ONTARIO HEALTHCARE NUMBER (please list ALL children&#039;s names and Health Numbers below)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_54'>\n                            \n                            <span id='input_1_54_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_1_54_3' class='gform-field-label gform-field-label--type-sub '>Child's Name<\/label>\n                                                    <input type='text' name='input_54.3' id='input_1_54_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_1_54_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_1_54_6' class='gform-field-label gform-field-label--type-sub '>Health Card Number<\/label>\n                                                            <input type='text' name='input_54.6' id='input_1_54_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_1_31\" 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\">Allergies\/Special Health or Behaviour Considerations<\/h3><\/div><fieldset id=\"field_1_56\" 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 field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do any of your children attending have food allergies<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_1_56'>Please indicate for each child you are registering for any food allergies for the meals provided during the camp program AND behavioural or medical issues that may help us best adapt our program delivery.<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_56'>\n\t\t\t<div class='gchoice gchoice_1_56_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='Yes'  id='choice_1_56_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_56\"   \/>\n\t\t\t\t\t<label for='choice_1_56_0' id='label_1_56_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_1_56_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='No'  id='choice_1_56_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_56_1' id='label_1_56_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_32\" 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_1_32'>Please list the names of the child and their food allergies<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_32' id='input_1_32' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_1_58\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do any of your children attending require an EPI Pen?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_58'>\n\t\t\t<div class='gchoice gchoice_1_58_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='Yes'  id='choice_1_58_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_58_0' id='label_1_58_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_1_58_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='No'  id='choice_1_58_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_58_1' id='label_1_58_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_62\" class=\"gfield gfield--type-list gfield--input-type-list 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' >Name of Child requiring EPI Pen (click + to add more)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_1_62'>Please fill out for each child attending camp<\/div><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=\"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_62_cell1 gform-grid-col' data-label='First Name'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_1_62\" aria-label='First Name, Ligne 1' data-aria-label-template='First Name, Ligne {0}' type='text' name='input_62[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_62_cell2 gform-grid-col' data-label='Last Name'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_1_62\" aria-label='Last Name, Ligne 1' data-aria-label-template='Last Name, Ligne {0}' type='text' name='input_62[]' 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><fieldset id=\"field_1_61\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Do any of your children Medication while at camp?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_61'>\n\t\t\t<div class='gchoice gchoice_1_61_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Yes'  id='choice_1_61_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_61_0' id='label_1_61_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_1_61_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='No'  id='choice_1_61_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_61_1' id='label_1_61_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_63\" class=\"gfield gfield--type-list gfield--input-type-list 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' >Name of Child & Meiccal Directions (Name, when taken)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_1_63'>Please list any medications and instructions for medication use during camp (ie. my child is allergic to horses and will bring medication in case he\/she needs it).\n\nPlease be as clear as possible - which child needs the medication - how often etc.<\/div><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\">Medication name and directions<\/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_63_cell1 gform-grid-col' data-label='First Name'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_1_63\" aria-label='First Name, Ligne 1' data-aria-label-template='First Name, Ligne {0}' type='text' name='input_63[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_63_cell2 gform-grid-col' data-label='Medication name and directions'><input aria-invalid='false' aria-required=\"true\" aria-describedby=\"gfield_description_1_63\" aria-label='Medication name and directions, Ligne 1' data-aria-label-template='Medication name and directions, Ligne {0}' type='text' name='input_63[]' 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><fieldset id=\"field_1_64\" 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 field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Does your child have any behavioural considerations for us to support them during this camp ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_1_64'>high anxiety, extremely shy, autism, learning disabilities etc.)<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_64'>\n\t\t\t<div class='gchoice gchoice_1_64_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Yes'  id='choice_1_64_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1_64\"   \/>\n\t\t\t\t\t<label for='choice_1_64_0' id='label_1_64_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_1_64_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='No'  id='choice_1_64_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_64_1' id='label_1_64_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_68\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name of Child & Behavioural Considerations Description (Please be specific)<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\">Behavioural Considerations Description<\/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_68_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_68[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_68_cell2 gform-grid-col' data-label='Behavioural Considerations Description'><input aria-invalid='false' aria-required=\"true\"  aria-label='Behavioural Considerations Description, Ligne 1' data-aria-label-template='Behavioural Considerations Description, Ligne {0}' type='text' name='input_68[]' 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_1_65\" 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\">About Warrior Kids Camp Program Registration Information, Consent & Limits of Confidentiality<\/h3><div class='gsection_description' id='gfield_description_1_65'>Warrior Kids Programs are clinically designed so kids can still connect to know they are not alone, develop peer relationships and develop critical resilience skills. Once an intake is completed you will be receiving further details about the camp via email. Please do not hesitate to reach out directly if you have questions.\nAs a member of the group, it is important for each child and youth to learn how to respect the other group members\u2019 feelings and experiences. This is done by creating group guidelines in the first session that reflects the needs of the group, the most important of which is confidentiality. Confidentiality is the promise to respect other's personal stories and information. It is important in establishing and maintaining trusting and lasting relationships, and acknowledges respect for an individual's right to privacy. Although participants will be asked to maintain confidentiality.\nThere are a few limits of confidentiality and are outlined below:\n<\/div><\/div><fieldset id=\"field_1_66\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full 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' >Assumption of the Risk and Waiver of Liability Wounded Warriors Canada Warrior Kids Program<\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_1_66' tabindex='0'>PLEASE READ CAREFULLY<br \/>\nI VOLUNTARILY AGREE TO ASSUME ALL OF THE FOREGOING RISKS AND ACCEPT SOLE RESPONSIBILITY FOR ANY INJURY TO MY CHILD (INCLUDING, BUT NOT LIMITED TO, PERSONAL INJURY, DISABILITY, AND DEATH), ILLNESS, DAMAGE, LOSS, CLAIM, LIABILITY, OR EXPENSE, OF ANY KIND, THAT THEY MAY EXPERIENCE OR INCUR IN CONNECTION WITH THEIR ATTENDANCE AT THE WWC PROGRAM OR PARTICIPATION IN WWC ACTIVITIES (\u201cCLAIMS\u201d).<br \/>\nON MY BEHALF, I HEREBY RELEASE, COVENANT NOT TO SUE, DISCHARGE, AND HOLD HARMLESS WOUNDED WARRIORS CANADA, ITS EMPLOYEES, AGENTS, AND REPRESENTATIVES, OF AND FROM THE CLAIMS, INCLUDING ALL LIABILITIES, CLAIMS, ACTIONS, DAMAGES, COSTS OR EXPENSES OF ANY KIND ARISING OUT OF OR RELATING THERETO.<br \/>\nI ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS \u201cWAIVER\u201d AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO INDEMNIFY AND HOLD HARMLESS WOUNDED WARRIORS CANADA AND ALL OF ITS EMPLOYEES, AGENTS AND UNDERSTAND THAT THIS RELEASE INCLUDES ANY CLAIMS BASESD ON THE ACTIONS, OMISSIONS, OR NEGLIGENCE OF WOUNDED WARRIORS CANADA. <\/div><div class='ginput_container ginput_container_consent'><input name='input_66.1' id='input_1_66_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_1_66\"  aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_1_66_1' >CLICK TO CONSENT - I agree that I have read carefully this waiver and fully understand that it is a release of liability<\/label><input type='hidden' name='input_66.2' value='CLICK TO CONSENT - I agree that I have read carefully this waiver and fully understand that it is a release of liability' class='gform_hidden' \/><input type='hidden' name='input_66.3' value='6' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_1_67\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full 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' >Limits of Confidentiality<\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_1_67' tabindex='0'>1. The program facilitators have a legal obligation to report suspected child abuse (this includes physical, sexual, and emotional abuse).<br \/>\n2. If 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.<br \/>\nThis agreement confirms that you understand the confidentiality policy for the Warrior Kids Program. This agreement needs to be signed in order for your child to participate in the group.<br \/>\n<\/div><div class='ginput_container ginput_container_consent'><input name='input_67.1' id='input_1_67_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_1_67\"  aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_1_67_1' >Click to Consent<\/label><input type='hidden' name='input_67.2' value='Click to Consent' class='gform_hidden' \/><input type='hidden' name='input_67.3' value='6' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_1_45\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full 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' >Photography Consent<\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_1_45' tabindex='0'>I give my consent to have my child\/ren photographed during the camp program. Photographs would be used for educational, promotional and publicity purposes within reason.<br \/>\n<br \/>\nParent eSignature means that you have read and understand consent of your child\/ren in taking part of this program and the limits and expectations of confidentiality.<br \/>\n<br \/>\nBy checking this, you are eSigning this form and providing consent for your child\/ren to attend the Warrior Kids Camp<\/div><div class='ginput_container ginput_container_consent'><input name='input_45.1' id='input_1_45_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_1_45\"  aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_1_45_1' >I agree to the privacy policy.<\/label><input type='hidden' name='input_45.2' value='I agree to the privacy policy.' class='gform_hidden' \/><input type='hidden' name='input_45.3' value='6' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_1_11\" 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