{"id":13814,"date":"2019-04-11T13:06:55","date_gmt":"2019-04-11T13:06:55","guid":{"rendered":"http:\/\/cwsdemo.thearc.org\/thearc-v1\/?page_id=13814"},"modified":"2021-11-19T13:59:09","modified_gmt":"2021-11-19T18:59:09","slug":"sign-up-detail-form","status":"publish","type":"page","link":"https:\/\/cwsdemo.thearc.org\/thearc-v3\/sign-up-detail-form\/","title":{"rendered":"Sign up detail form"},"content":{"rendered":"\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-6dem1i-865a031e6a0081e10f422b7c96f6cbcf\">\n.flex_column.av-6dem1i-865a031e6a0081e10f422b7c96f6cbcf{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-6dem1i-865a031e6a0081e10f422b7c96f6cbcf av_one_fifth  avia-builder-el-0  el_before_av_three_fifth  avia-builder-el-first  first flex_column_div av-zero-column-padding  '     ><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" 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av-jucnhs8r-94e32d0cb9174b1ff7b14dbc52d59af2 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><script>\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 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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<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_12' style='display:none'><form method='post' enctype='multipart\/form-data'  id='gform_12'  action='\/thearc-v3\/wp-json\/wp\/v2\/pages\/13814' data-formid='12' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_12' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_12_4\" class=\"gfield gfield--type-section gsection cyan_header field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Please confirm your contact information:<\/h2><\/li><li id=\"field_12_1\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><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_12_1'>\n                            \n                            <span id='input_12_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_12_1_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                    <input type='text' name='input_1.3' id='input_12_1_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_12_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_12_1_6' class='gform-field-label gform-field-label--type-sub '>Last Name<\/label>\n                                                            <input type='text' name='input_1.6' id='input_12_1_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/li><li id=\"field_12_2\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_2'><span class='gform-field-label__text'>Email Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_2' id='input_12_2' type='email' value='' class='small'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_12_3\" class=\"gfield gfield--type-address field_sublabel_above gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Address<\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state ginput_container_address gform-grid-row' id='input_12_3' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_12_3_1_container' >\n                                        <label for='input_12_3_1' id='input_12_3_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_3.1' id='input_12_3_1' value=''    aria-required='false'    \/>\n                                   <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_12_3_3_container' >\n                                    <label for='input_12_3_3' id='input_12_3_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_3.3' id='input_12_3_3' value=''    aria-required='false'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_12_3_4_container' >\n                                        <label for='input_12_3_4' id='input_12_3_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_3.4' id='input_12_3_4'     aria-required='false'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><input type='hidden' class='gform_hidden' name='input_3.6' id='input_12_3_6' value='US' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_12_19\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_above gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_zip ginput_container_address gform-grid-row' id='input_12_19' >\n                        <input type='hidden' class='gform_hidden' name='input_19.4' id='input_12_19_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_12_19_5_container' >\n                                    <label for='input_12_19_5' id='input_12_19_5_label' class='gform-field-label gform-field-label--type-sub '>Zip Code<\/label>\n                                    <input type='text' name='input_19.5' id='input_12_19_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_19.6' id='input_12_19_6' value='US' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_12_22\" class=\"gfield gfield--type-select gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_22'><span class='gform-field-label__text'>Phone Number<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_22' id='input_12_22' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Select type' >Select type<\/option><option value='Cell' >Cell<\/option><option value='Home' >Home<\/option><option value='Work' >Work<\/option><\/select><\/div><\/li><li id=\"field_12_21\" class=\"gfield gfield--type-phone gfield--phone-format-standard gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_21'><span class='gform-field-label__text'>Cell<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_21' id='input_12_21' type='tel' value='' class='medium'  placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/li><li id=\"field_12_24\" class=\"gfield gfield--type-phone gfield--phone-format-standard gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_24'><span class='gform-field-label__text'>Home<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_24' id='input_12_24' type='tel' value='' class='medium'  placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/li><li id=\"field_12_23\" class=\"gfield gfield--type-phone gfield--phone-format-standard gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_23'><span class='gform-field-label__text'>Work<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_23' id='input_12_23' type='tel' value='' class='medium'  placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/li><li id=\"field_12_18\" class=\"gfield gfield--type-section gsection cyan_header field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Tell us more about yourself:<\/h2><\/li><li id=\"field_12_13\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class=\"gfield_label\" style=\"margin-top:10px; margin-bottom:0px;\">This will help us provide you with the most relevant information and services.<\/label><\/li><li id=\"field_12_26\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Which of the following best describes you? (Select as many as apply.)<\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_12_26'><li class='gchoice gchoice_12_26_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.1' type='checkbox'  value='Person with an intellectual or developmental disability (I\/DD)'  id='choice_12_26_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_26_1' id='label_12_26_1' class='gform-field-label gform-field-label--type-inline'>Person with an intellectual or developmental disability (I\/DD)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_26_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.2' type='checkbox'  value='Parent of a person with I\/DD'  id='choice_12_26_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_26_2' id='label_12_26_2' class='gform-field-label gform-field-label--type-inline'>Parent of a person with I\/DD<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_26_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.3' type='checkbox'  value='Sibling of a person with I\/DD'  id='choice_12_26_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_26_3' id='label_12_26_3' class='gform-field-label gform-field-label--type-inline'>Sibling of a person with I\/DD<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_26_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.4' type='checkbox'  value='Other relative or friend of a person with I\/DD'  id='choice_12_26_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_26_4' id='label_12_26_4' class='gform-field-label gform-field-label--type-inline'>Other relative or friend of a person with I\/DD<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_26_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.5' type='checkbox'  value='Staff member at a chapter of The Arc'  id='choice_12_26_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_26_5' id='label_12_26_5' class='gform-field-label gform-field-label--type-inline'>Staff member at a chapter of The Arc<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_26_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.6' type='checkbox'  value='Professional in the disability field'  id='choice_12_26_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_26_6' id='label_12_26_6' class='gform-field-label gform-field-label--type-inline'>Professional in the disability field<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_26_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.7' type='checkbox'  value='Disability service provider'  id='choice_12_26_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_26_7' id='label_12_26_7' class='gform-field-label gform-field-label--type-inline'>Disability service provider<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_26_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.8' type='checkbox'  value='Educator or other school staff'  id='choice_12_26_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_26_8' id='label_12_26_8' class='gform-field-label gform-field-label--type-inline'>Educator or other school staff<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_26_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.9' type='checkbox'  value='Financial professional'  id='choice_12_26_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_26_9' id='label_12_26_9' class='gform-field-label gform-field-label--type-inline'>Financial professional<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_26_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.11' type='checkbox'  value='Law enforcement professional'  id='choice_12_26_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_26_11' id='label_12_26_11' class='gform-field-label gform-field-label--type-inline'>Law enforcement professional<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_26_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.12' type='checkbox'  value='Legal professional'  id='choice_12_26_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_26_12' id='label_12_26_12' class='gform-field-label gform-field-label--type-inline'>Legal professional<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_26_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.13' type='checkbox'  value='Health care professional'  id='choice_12_26_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_26_13' id='label_12_26_13' class='gform-field-label gform-field-label--type-inline'>Health care professional<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_26_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.14' type='checkbox'  value='Researcher'  id='choice_12_26_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_26_14' id='label_12_26_14' class='gform-field-label gform-field-label--type-inline'>Researcher<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_26_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.15' type='checkbox'  value='Other'  id='choice_12_26_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_26_15' id='label_12_26_15' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_12_17\" class=\"gfield gfield--type-text gf_left_half field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_17'><span class='gform-field-label__text'>Other (Connection to I\/DD)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_12_17' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_12_14\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_14'><span class='gform-field-label__text'>Job Title<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_12_14' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_12_15\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_15'><span class='gform-field-label__text'>Company<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_12_15' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_12_6\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_6'><span class='gform-field-label__text'>Birthdate of person with I\/DD<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_12_6'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_6'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_12_6' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_12_6' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_12_6' aria-label='Birthdate of person with I\/DD: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/li><li id=\"field_12_20\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>What race\/ethnicity do you identify as?<\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_12_20'><li class='gchoice gchoice_12_20_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.1' type='checkbox'  value='Asian or Pacific Islander'  id='choice_12_20_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_20_1' id='label_12_20_1' class='gform-field-label gform-field-label--type-inline'>Asian or Pacific Islander<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_20_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.2' type='checkbox'  value='Black or African American'  id='choice_12_20_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_20_2' id='label_12_20_2' class='gform-field-label gform-field-label--type-inline'>Black or African American<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_20_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.3' type='checkbox'  value='Hispanic or Latinx'  id='choice_12_20_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_20_3' id='label_12_20_3' class='gform-field-label gform-field-label--type-inline'>Hispanic or Latinx<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_20_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.4' type='checkbox'  value='Middle Eastern or Arab'  id='choice_12_20_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_20_4' id='label_12_20_4' class='gform-field-label gform-field-label--type-inline'>Middle Eastern or Arab<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_20_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.5' type='checkbox'  value='Native American or American Indian'  id='choice_12_20_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_20_5' id='label_12_20_5' class='gform-field-label gform-field-label--type-inline'>Native American or American Indian<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_20_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.6' type='checkbox'  value='White or Caucasian'  id='choice_12_20_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_20_6' id='label_12_20_6' class='gform-field-label gform-field-label--type-inline'>White or Caucasian<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_20_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.7' type='checkbox'  value='Prefer Not to Answer'  id='choice_12_20_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_20_7' id='label_12_20_7' class='gform-field-label gform-field-label--type-inline'>Prefer Not to Answer<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_20_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.8' type='checkbox'  value='Other'  id='choice_12_20_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_20_8' id='label_12_20_8' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_12_25\" class=\"gfield gfield--type-text gf_left_half field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_25'><span class='gform-field-label__text'>Other (Race)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_12_25' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_12' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_12' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_12' id='gform_theme_12' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_12' id='gform_style_settings_12' value='[]' \/>\n       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You may unsubscribe from these communications at any time. For more information, check out our <a href=\"https:\/\/arcmulti.wpengine.com\/privacy-notice\/\">privacy policy<\/a>.<\/em><\/sup><\/p>\n<\/div><\/section>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":36,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":"","_members_access_role":[],"_members_access_error":"","_links_to":"","_links_to_target":""},"class_list":["post-13814","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Sign up detail form - The Arc of the US - Version 3<\/title>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Sign up detail form - 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