Admission Form

1845674621.jpg

"To register for Montessori school, please scan the QR code provided and complete the online form. Our school will promptly reach out to you to confirm your registration and answer any questions you may have."

 

 QR Code for Jotform form


<!--[if lt IE 9]><script src="https://cdn01.jotfor.ms/js/vendor/flashcanvas.js?3.3.41375" type="text/javascript"></script><![endif]--> <script src="https://cdn02.jotfor.ms/js/vendor/jquery-1.8.0.min.js?v=3.3.41375" type="text/javascript"></script> <script src="https://cdn03.jotfor.ms/js/vendor/jSignature.min.noconflict.js?3.3.41375" type="text/javascript"></script> <script src="https://cdn01.jotfor.ms/js/vendor/jotform.signaturepad.js?3.3.41375" type="text/javascript"></script> <script src="https://cdn02.jotfor.ms/static/prototype.forms.js?3.3.41375" type="text/javascript"></script> <script src="https://cdn03.jotfor.ms/static/jotform.forms.js?3.3.41375" type="text/javascript"></script> <script defer src="https://cdn01.jotfor.ms/js/vendor/maskedinput.min.js?v=3.3.41375" type="text/javascript"></script> <script defer src="https://cdn02.jotfor.ms/js/vendor/jquery.maskedinput.min.js?v=3.3.41375" type="text/javascript"></script> <script defer src="https://cdnjs.cloudflare.com/ajax/libs/punycode/1.4.1/punycode.js"></script> <script src="https://cdn03.jotfor.ms/js/payments/validategateways.js?v=3.3.41375" type="text/javascript"></script> <script src="https://cdn01.jotfor.ms/pdf-importer/static/js/form-patch.js?v=3.3.41375" type="text/javascript"></script> <script type="text/javascript"> JotForm.newDefaultTheme = true; JotForm.extendsNewTheme = false; JotForm.singleProduct = false; JotForm.newPaymentUIForNewCreatedForms = true; JotForm.newPaymentUI = true; JotForm.importedPDF = "https://www.jotform.com/uploads/dr.govandanwar/form_files/pfc_644c39e7a1189_Student_Registration_Form_K-12.pdf?nc=1"; JotForm.importedPDFSettings = {"isConnected":"Yes","enableThumbnail":"Yes","hasPreviewButton":"Yes","startButtonText":"Start Filling","formType":"legacyForm","welcomeThumbnail":""}; JotForm.clearFieldOnHide="disable"; JotForm.submitError="jumpToFirstError"; JotForm.init(function(){ /*INIT-START*/ if (window.JotForm && JotForm.accessible) $('input_2').setAttribute('tabindex',0); if (window.JotForm && JotForm.accessible) $('input_3').setAttribute('tabindex',0); if (window.JotForm && JotForm.accessible) $('input_4').setAttribute('tabindex',0); JotForm.calendarMonths = ["January","February","March","April","May","June","July","August","September","October","November","December"]; JotForm.calendarDays = ["Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday","Sunday"]; JotForm.calendarOther = {"today":"Today"}; var languageOptions = document.querySelectorAll('#langList li'); for(var langIndex = 0; langIndex < languageOptions.length; langIndex++) { languageOptions[langIndex].on('click', function(e) { setTimeout(function(){ JotForm.setCalendar("5", false, {"days":{"monday":true,"tuesday":true,"wednesday":true,"thursday":true,"friday":true,"saturday":true,"sunday":true},"future":true,"past":true,"custom":false,"ranges":false,"start":"","end":""}); }, 0); }); } JotForm.onTranslationsFetch(function() { JotForm.setCalendar("5", false, {"days":{"monday":true,"tuesday":true,"wednesday":true,"thursday":true,"friday":true,"saturday":true,"sunday":true},"future":true,"past":true,"custom":false,"ranges":false,"start":"","end":""}); }); if (window.JotForm && JotForm.accessible) $('input_6').setAttribute('tabindex',0); if (window.JotForm && JotForm.accessible) $('input_8').setAttribute('tabindex',0); JotForm.setPhoneMaskingValidator( 'input_9_full', '\u0028\u0023\u0023\u0023\u0029 \u0023\u0023\u0023\u002d\u0023\u0023\u0023\u0023' ); if (window.JotForm && JotForm.accessible) $('input_11').setAttribute('tabindex',0); if (window.JotForm && JotForm.accessible) $('input_12').setAttribute('tabindex',0); if (window.JotForm && JotForm.accessible) $('input_14').setAttribute('tabindex',0); if (window.JotForm && JotForm.accessible) $('input_16').setAttribute('tabindex',0); JotForm.setPhoneMaskingValidator( 'input_17_full', '\u0028\u0023\u0023\u0023\u0029 \u0023\u0023\u0023\u002d\u0023\u0023\u0023\u0023' ); if (window.JotForm && JotForm.accessible) $('input_20').setAttribute('tabindex',0); if (window.JotForm && JotForm.accessible) $('input_21').setAttribute('tabindex',0); JotForm.setPhoneMaskingValidator( 'input_22_full', '\u0028\u0023\u0023\u0023\u0029 \u0023\u0023\u0023\u002d\u0023\u0023\u0023\u0023' ); if (window.JotForm && JotForm.accessible) $('input_23').setAttribute('tabindex',0); if (window.JotForm && JotForm.accessible) $('input_24').setAttribute('tabindex',0); if (window.JotForm && JotForm.accessible) $('input_25').setAttribute('tabindex',0); if (window.JotForm && JotForm.accessible) $('input_26').setAttribute('tabindex',0); JotForm.calendarMonths = ["January","February","March","April","May","June","July","August","September","October","November","December"]; JotForm.calendarDays = ["Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday","Sunday"]; JotForm.calendarOther = {"today":"Today"}; var languageOptions = document.querySelectorAll('#langList li'); for(var langIndex = 0; langIndex < languageOptions.length; langIndex++) { languageOptions[langIndex].on('click', function(e) { setTimeout(function(){ JotForm.setCalendar("27", false, {"days":{"monday":true,"tuesday":true,"wednesday":true,"thursday":true,"friday":true,"saturday":true,"sunday":true},"future":true,"past":true,"custom":false,"ranges":false,"start":"","end":""}); }, 0); }); } JotForm.onTranslationsFetch(function() { JotForm.setCalendar("27", false, {"days":{"monday":true,"tuesday":true,"wednesday":true,"thursday":true,"friday":true,"saturday":true,"sunday":true},"future":true,"past":true,"custom":false,"ranges":false,"start":"","end":""}); }); if (window.JotForm && JotForm.accessible) $('input_28').setAttribute('tabindex',0); if (window.JotForm && JotForm.accessible) $('input_30').setAttribute('tabindex',0); if (window.JotForm && JotForm.accessible) $('input_31').setAttribute('tabindex',0); if (window.JotForm && JotForm.accessible) $('input_33').setAttribute('tabindex',0); if (window.JotForm && JotForm.accessible) $('input_34').setAttribute('tabindex',0); if (window.JotForm && JotForm.accessible) $('input_36').setAttribute('tabindex',0); JotForm.calendarMonths = ["January","February","March","April","May","June","July","August","September","October","November","December"]; JotForm.calendarDays = ["Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday","Sunday"]; JotForm.calendarOther = {"today":"Today"}; var languageOptions = document.querySelectorAll('#langList li'); for(var langIndex = 0; langIndex < languageOptions.length; langIndex++) { languageOptions[langIndex].on('click', function(e) { setTimeout(function(){ JotForm.setCalendar("38", false, {"days":{"monday":true,"tuesday":true,"wednesday":true,"thursday":true,"friday":true,"saturday":true,"sunday":true},"future":true,"past":true,"custom":false,"ranges":false,"start":"","end":""}); }, 0); }); } JotForm.onTranslationsFetch(function() { JotForm.setCalendar("38", false, {"days":{"monday":true,"tuesday":true,"wednesday":true,"thursday":true,"friday":true,"saturday":true,"sunday":true},"future":true,"past":true,"custom":false,"ranges":false,"start":"","end":""}); }); JotForm.alterTexts(undefined); /*INIT-END*/ }); JotForm.prepareCalculationsOnTheFly([null,{"name":"ltpgtltspanStylecolor","qid":"1","text":"International Montessori School of Erbil","type":"control_text"},{"description":"","name":"personalInformation","qid":"2","subLabel":"","text":"Personal Information","type":"control_textbox"},{"description":"","name":"fullName","qid":"3","subLabel":"","text":"Full Name","type":"control_textbox"},{"description":"","name":"gender","qid":"4","subLabel":"","text":"Gender","type":"control_textbox"},{"description":"","name":"dateOf","qid":"5","text":"Date of Birth","type":"control_datetime"},{"description":"","name":"placeOf","qid":"6","subLabel":"","text":"Place of Birth","type":"control_textbox"},{"description":"","name":"address","qid":"7","text":"Address","type":"control_address"},{"description":"","name":"street","qid":"8","subLabel":"","text":"Street","type":"control_textbox"},{"description":"","name":"phoneNumber","qid":"9","text":"Phone Number","type":"control_phone"},{"description":"","name":"emailAddress","qid":"10","subLabel":"[email protected]","text":"Email Address","type":"control_email"},{"description":"","name":"parentguardianInformation","qid":"11","subLabel":"","text":"Parent\u002FGuardian Information","type":"control_textbox"},{"description":"","name":"fullName12","qid":"12","subLabel":"","text":"Full Name","type":"control_textbox"},{"name":"ltpgtltspanStylecolor13","qid":"13","text":"Relationship to Student: Home Address:","type":"control_text"},{"description":"","name":"relationshipTo","qid":"14","subLabel":"","text":"Relationship to Student","type":"control_textbox"},{"description":"","name":"address15","qid":"15","text":"Address","type":"control_address"},{"description":"","name":"street16","qid":"16","subLabel":"","text":"Street","type":"control_textbox"},{"description":"","name":"phoneNumber17","qid":"17","text":"Phone Number","type":"control_phone"},{"description":"","name":"emailAddress18","qid":"18","subLabel":"[email protected]","text":"Email Address","type":"control_email"},{"name":"ltpgtltspanStylecolor19","qid":"19","text":"Emergency Contact Information: Full Name:","type":"control_text"},{"description":"","name":"emergencyContact","qid":"20","subLabel":"","text":"Emergency Contact Information","type":"control_textbox"},{"description":"","name":"fullName21","qid":"21","subLabel":"","text":"Full Name","type":"control_textbox"},{"description":"","name":"relationshipTo22","qid":"22","text":"Relationship to Student: Phone Number","type":"control_phone"},{"description":"","name":"relationshipTo23","qid":"23","subLabel":"","text":"Relationship to Student","type":"control_textbox"},{"description":"","name":"schoolInformation","qid":"24","subLabel":"","text":"School Information","type":"control_textbox"},{"description":"","name":"currentSchool","qid":"25","subLabel":"","text":"Current School Name","type":"control_textbox"},{"description":"","name":"gradeLevel","qid":"26","subLabel":"","text":"Grade Level","type":"control_textbox"},{"description":"","name":"expectedStart","qid":"27","text":"Expected Start Date","type":"control_datetime"},{"description":"","name":"medicalInformation","qid":"28","subLabel":"","text":"Medical Information","type":"control_textbox"},{"name":"ltpgtltspanStylecolor29","qid":"29","text":"Does the student have any medical conditions we should be aware of?If yes, please provide details: Does the student have any allergies? If yes, please provide details:","type":"control_text"},{"description":"","name":"ifYes","qid":"30","subLabel":"","text":"If yes, please provide details","type":"control_textbox"},{"description":"","name":"ifYes31","qid":"31","subLabel":"","text":"If yes, please provide details","type":"control_textbox"},{"name":"ltpgtltspanStylecolor32","qid":"32","text":"Transportation Information: How will the student be getting to school?","type":"control_text"},{"description":"","name":"transportationInformation","qid":"33","subLabel":"","text":"Transportation Information","type":"control_textbox"},{"description":"","name":"ifBy","qid":"34","subLabel":"","text":"If by car, please provide the name and contact information of the person who will be dropping off and picking up the student","type":"control_textbox"},{"name":"ltpgtltspanStylecolor35","qid":"35","text":"Do you require school transportation?","type":"control_text"},{"description":"","name":"mediaRelease","qid":"36","subLabel":"","text":"Media Release","type":"control_textbox"},{"name":"ltpgtltspanStylecolor37","qid":"37","text":"Do you give permission for the school to use photographs and videos of the student for promotional purposes?","type":"control_text"},{"description":"","name":"date","qid":"38","text":"Date","type":"control_datetime"},{"description":"","name":"parentguardianSignature","qid":"39","subLabel":"","text":"Parent\u002FGuardian Signature","type":"control_signature"},{"name":"submit","qid":"40","text":"Submit","type":"control_button"},{"name":"image1","qid":"41","text":"image1","type":"control_image"}]); setTimeout(function() { JotForm.paymentExtrasOnTheFly([null,{"name":"ltpgtltspanStylecolor","qid":"1","text":"International Montessori School of Erbil","type":"control_text"},{"description":"","name":"personalInformation","qid":"2","subLabel":"","text":"Personal Information","type":"control_textbox"},{"description":"","name":"fullName","qid":"3","subLabel":"","text":"Full Name","type":"control_textbox"},{"description":"","name":"gender","qid":"4","subLabel":"","text":"Gender","type":"control_textbox"},{"description":"","name":"dateOf","qid":"5","text":"Date of Birth","type":"control_datetime"},{"description":"","name":"placeOf","qid":"6","subLabel":"","text":"Place of Birth","type":"control_textbox"},{"description":"","name":"address","qid":"7","text":"Address","type":"control_address"},{"description":"","name":"street","qid":"8","subLabel":"","text":"Street","type":"control_textbox"},{"description":"","name":"phoneNumber","qid":"9","text":"Phone Number","type":"control_phone"},{"description":"","name":"emailAddress","qid":"10","subLabel":"[email protected]","text":"Email Address","type":"control_email"},{"description":"","name":"parentguardianInformation","qid":"11","subLabel":"","text":"Parent\u002FGuardian Information","type":"control_textbox"},{"description":"","name":"fullName12","qid":"12","subLabel":"","text":"Full Name","type":"control_textbox"},{"name":"ltpgtltspanStylecolor13","qid":"13","text":"Relationship to Student: Home Address:","type":"control_text"},{"description":"","name":"relationshipTo","qid":"14","subLabel":"","text":"Relationship to Student","type":"control_textbox"},{"description":"","name":"address15","qid":"15","text":"Address","type":"control_address"},{"description":"","name":"street16","qid":"16","subLabel":"","text":"Street","type":"control_textbox"},{"description":"","name":"phoneNumber17","qid":"17","text":"Phone Number","type":"control_phone"},{"description":"","name":"emailAddress18","qid":"18","subLabel":"[email protected]","text":"Email Address","type":"control_email"},{"name":"ltpgtltspanStylecolor19","qid":"19","text":"Emergency Contact Information: Full Name:","type":"control_text"},{"description":"","name":"emergencyContact","qid":"20","subLabel":"","text":"Emergency Contact Information","type":"control_textbox"},{"description":"","name":"fullName21","qid":"21","subLabel":"","text":"Full Name","type":"control_textbox"},{"description":"","name":"relationshipTo22","qid":"22","text":"Relationship to Student: Phone Number","type":"control_phone"},{"description":"","name":"relationshipTo23","qid":"23","subLabel":"","text":"Relationship to Student","type":"control_textbox"},{"description":"","name":"schoolInformation","qid":"24","subLabel":"","text":"School Information","type":"control_textbox"},{"description":"","name":"currentSchool","qid":"25","subLabel":"","text":"Current School Name","type":"control_textbox"},{"description":"","name":"gradeLevel","qid":"26","subLabel":"","text":"Grade Level","type":"control_textbox"},{"description":"","name":"expectedStart","qid":"27","text":"Expected Start Date","type":"control_datetime"},{"description":"","name":"medicalInformation","qid":"28","subLabel":"","text":"Medical Information","type":"control_textbox"},{"name":"ltpgtltspanStylecolor29","qid":"29","text":"Does the student have any medical conditions we should be aware of?If yes, please provide details: Does the student have any allergies? If yes, please provide details:","type":"control_text"},{"description":"","name":"ifYes","qid":"30","subLabel":"","text":"If yes, please provide details","type":"control_textbox"},{"description":"","name":"ifYes31","qid":"31","subLabel":"","text":"If yes, please provide details","type":"control_textbox"},{"name":"ltpgtltspanStylecolor32","qid":"32","text":"Transportation Information: How will the student be getting to school?","type":"control_text"},{"description":"","name":"transportationInformation","qid":"33","subLabel":"","text":"Transportation Information","type":"control_textbox"},{"description":"","name":"ifBy","qid":"34","subLabel":"","text":"If by car, please provide the name and contact information of the person who will be dropping off and picking up the student","type":"control_textbox"},{"name":"ltpgtltspanStylecolor35","qid":"35","text":"Do you require school transportation?","type":"control_text"},{"description":"","name":"mediaRelease","qid":"36","subLabel":"","text":"Media Release","type":"control_textbox"},{"name":"ltpgtltspanStylecolor37","qid":"37","text":"Do you give permission for the school to use photographs and videos of the student for promotional purposes?","type":"control_text"},{"description":"","name":"date","qid":"38","text":"Date","type":"control_datetime"},{"description":"","name":"parentguardianSignature","qid":"39","subLabel":"","text":"Parent\u002FGuardian Signature","type":"control_signature"},{"name":"submit","qid":"40","text":"Submit","type":"control_button"},{"name":"image1","qid":"41","text":"image1","type":"control_image"}]);}, 20); </script> <style type="text/css">@media print{.form-section{display:inline!important}.form-pagebreak{display:none!important}.form-section-closed{height:auto!important}.page-section{position:initial!important}}</style> <link type="text/css" rel="stylesheet" href="https://cdn01.jotfor.ms/themes/CSS/5e6b428acc8c4e222d1beb91.css?v=3.3.41375"/> <link type="text/css" rel="stylesheet" href="https://cdn02.jotfor.ms/css/styles/payment/payment_styles.css?3.3.41375" /> <link type="text/css" rel="stylesheet" href="https://cdn03.jotfor.ms/css/styles/payment/payment_feature.css?3.3.41375" /> <form class="jotform-form" action="https://submit.jotform.com/submit/231177256510047" method="post" name="form_231177256510047" id="231177256510047" accept-charset="utf-8" autocomplete="on"><input type="hidden" name="formID" value="231177256510047" /><input type="hidden" id="JWTContainer" value="" /><input type="hidden" id="cardinalOrderNumber" value="" /> <div role="main" class="form-all"> <ul class="form-section page-section"> <li class="form-line" data-type="control_text" id="id_1"> <div id="cid_1" class="form-input-wide" data-layout="full"> <div id="text_1" class="form-html" data-component="text" tabindex="0"> <p><span style="color: #000000;">International Montessori School of Erbil</span></p> </div> </div> </li> <li class="form-line" data-type="control_image" id="id_41"> <div id="cid_41" class="form-input-wide" data-layout="full"> <div style="text-align:center"><img alt="Image" loading="lazy" class="form-image" style="border:0" src="https://www.jotform.com/uploads/dr.govandanwar/form_files/image_644c39f3f40c2.png?nc=1" tabindex="0" height="145.15px" width="145.15px" data-component="image" /></div> </div> </li> <li class="form-line" data-type="control_textbox" id="id_2"><label class="form-label form-label-top form-label-auto" id="label_2" for="input_2"> Personal Information </label> <div id="cid_2" class="form-input-wide" data-layout="half"> <input type="text" id="input_2" name="q2_personalInformation" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" value="" data-component="textbox" aria-labelledby="label_2" /> </div> </li> <li class="form-line" data-type="control_textbox" id="id_3"><label class="form-label form-label-top form-label-auto" id="label_3" for="input_3"> Full Name </label> <div id="cid_3" class="form-input-wide" data-layout="half"> <input type="text" id="input_3" name="q3_fullName" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" value="" data-component="textbox" aria-labelledby="label_3" /> </div> </li> <li class="form-line" data-type="control_textbox" id="id_4"><label class="form-label form-label-top form-label-auto" id="label_4" for="input_4"> Gender </label> <div id="cid_4" class="form-input-wide" data-layout="half"> <input type="text" id="input_4" name="q4_gender" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" value="" data-component="textbox" aria-labelledby="label_4" /> </div> </li> <li class="form-line" data-type="control_datetime" id="id_5"><label class="form-label form-label-top form-label-auto" id="label_5" for="lite_mode_5"> Date of Birth </label> <div id="cid_5" class="form-input-wide" data-layout="half"> <div data-wrapper-react="true"> <div style="display:none"><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[limitDate]" id="month_5" name="q5_dateOf[month]" size="2" data-maxlength="2" data-age="" maxLength="2" value="" autoComplete="off" aria-labelledby="label_5 sublabel_5_month" /><span class="date-separate" aria-hidden="true"> /</span><label class="form-sub-label" for="month_5" id="sublabel_5_month" style="min-height:13px" aria-hidden="false">Month</label></span><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[limitDate]" id="day_5" name="q5_dateOf[day]" size="2" data-maxlength="2" data-age="" maxLength="2" value="" autoComplete="off" aria-labelledby="label_5 sublabel_5_day" /><span class="date-separate" aria-hidden="true"> /</span><label class="form-sub-label" for="day_5" id="sublabel_5_day" style="min-height:13px" aria-hidden="false">Day</label></span><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[limitDate]" id="year_5" name="q5_dateOf[year]" size="4" data-maxlength="4" data-age="" maxLength="4" value="" autoComplete="off" aria-labelledby="label_5 sublabel_5_year" /><label class="form-sub-label" for="year_5" id="sublabel_5_year" style="min-height:13px" aria-hidden="false">Year</label></span></div><span class="form-sub-label-container" style="vertical-align:top"><input type="text" class="form-textbox validate[limitDate, validateLiteDate]" id="lite_mode_5" size="12" data-maxlength="12" maxLength="12" data-age="" value="" data-format="mmddyyyy" data-seperator="/" placeholder="MM/DD/YYYY" autoComplete="off" aria-labelledby="label_5 sublabel_5_litemode" /><img class=" newDefaultTheme-dateIcon icon-liteMode" alt="Pick a Date" id="input_5_pick" src="https://cdn.jotfor.ms/images/calendar.png" data-component="datetime" aria-hidden="true" data-allow-time="No" data-version="v2" /><label class="form-sub-label" for="lite_mode_5" id="sublabel_5_litemode" style="min-height:13px" aria-hidden="false">Date</label></span> </div> </div> </li> <li class="form-line" data-type="control_textbox" id="id_6"><label class="form-label form-label-top form-label-auto" id="label_6" for="input_6"> Place of Birth </label> <div id="cid_6" class="form-input-wide" data-layout="half"> <input type="text" id="input_6" name="q6_placeOf" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" value="" data-component="textbox" aria-labelledby="label_6" /> </div> </li> <li class="form-line" data-type="control_address" id="id_7" data-compound-hint=",,,,Please Select,,Please Select,"><label class="form-label form-label-top form-label-auto" id="label_7" for="input_7_addr_line1"> Address </label> <div id="cid_7" class="form-input-wide" data-layout="full"> <div summary="" class="form-address-table jsTest-addressField"> <div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_7_addr_line1" name="q7_address[addr_line1]" class="form-textbox form-address-line" data-defaultvalue="" autoComplete="section-input_7 address-line1" value="" data-component="address_line_1" aria-labelledby="label_7 sublabel_7_addr_line1" required="" /><label class="form-sub-label" for="input_7_addr_line1" id="sublabel_7_addr_line1" style="min-height:13px" aria-hidden="false">Home Address</label></span></span></div> <div class="form-address-line-wrapper jsTest-address-line-wrapperField" style="display:none"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_7_addr_line2" name="q7_address[addr_line2]" class="form-textbox form-address-line" data-defaultvalue="" autoComplete="section-input_7 off" value="" data-component="address_line_2" aria-labelledby="label_7 sublabel_7_addr_line2" /><label class="form-sub-label" for="input_7_addr_line2" id="sublabel_7_addr_line2" style="min-height:13px" aria-hidden="false">Street Address Line 2</label></span></span></div> <div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-city-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_7_city" name="q7_address[city]" class="form-textbox form-address-city" data-defaultvalue="" autoComplete="section-input_7 address-level2" value="" data-component="city" aria-labelledby="label_7 sublabel_7_city" required="" /><label class="form-sub-label" for="input_7_city" id="sublabel_7_city" style="min-height:13px" aria-hidden="false">City</label></span></span><span class="form-address-line form-address-state-line jsTest-address-lineField form-address-hiddenLine" style="display:none"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_7_state" name="q7_address[state]" class="form-textbox form-address-state" data-defaultvalue="" autoComplete="section-input_7 address-level1" value="" data-component="state" aria-labelledby="label_7 sublabel_7_state" required="" /><label class="form-sub-label" for="input_7_state" id="sublabel_7_state" style="min-height:13px" aria-hidden="false">State / Province</label></span></span></div> <div class="form-address-line-wrapper jsTest-address-line-wrapperField" style="display:none"><span class="form-address-line form-address-zip-line jsTest-address-lineField form-address-hiddenLine" style="display:none"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_7_postal" name="q7_address[postal]" class="form-textbox form-address-postal" data-defaultvalue="" autoComplete="section-input_7 postal-code" value="" data-component="zip" aria-labelledby="label_7 sublabel_7_postal" required="" /><label class="form-sub-label" for="input_7_postal" id="sublabel_7_postal" style="min-height:13px" aria-hidden="false">Postal / Zip Code</label></span></span></div> </div> </div> </li> <li class="form-line" data-type="control_textbox" id="id_8"><label class="form-label form-label-top form-label-auto" id="label_8" for="input_8"> Street </label> <div id="cid_8" class="form-input-wide" data-layout="half"> <input type="text" id="input_8" name="q8_street" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" value="" data-component="textbox" aria-labelledby="label_8" /> </div> </li> <li class="form-line" data-type="control_phone" id="id_9"><label class="form-label form-label-top form-label-auto" id="label_9" for="input_9_full"> Phone Number </label> <div id="cid_9" class="form-input-wide" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="tel" id="input_9_full" name="q9_phoneNumber[full]" data-type="mask-number" class="mask-phone-number form-textbox validate[Fill Mask]" data-defaultvalue="" autoComplete="section-input_9 tel-national" style="width:310px" data-masked="true" value="" placeholder="(000) 000-0000" data-component="phone" aria-labelledby="label_9" /></span> </div> </li> <li class="form-line" data-type="control_email" id="id_10"><label class="form-label form-label-top form-label-auto" id="label_10" for="input_10"> Email Address </label> <div id="cid_10" class="form-input-wide" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="email" id="input_10" name="q10_emailAddress" class="form-textbox validate[Email]" data-defaultvalue="" style="width:30px" size="30" value="" data-component="email" aria-labelledby="label_10 sublabel_input_10" /><label class="form-sub-label" for="input_10" id="sublabel_input_10" style="min-height:13px" aria-hidden="false">[email protected]</label></span> </div> </li> <li class="form-line" data-type="control_textbox" id="id_11"><label class="form-label form-label-top form-label-auto" id="label_11" for="input_11"> Parent/Guardian Information </label> <div id="cid_11" class="form-input-wide" data-layout="half"> <input type="text" id="input_11" name="q11_parentguardianInformation" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" value="" data-component="textbox" aria-labelledby="label_11" /> </div> </li> <li class="form-line" data-type="control_textbox" id="id_12"><label class="form-label form-label-top form-label-auto" id="label_12" for="input_12"> Full Name </label> <div id="cid_12" class="form-input-wide" data-layout="half"> <input type="text" id="input_12" name="q12_fullName12" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" value="" data-component="textbox" aria-labelledby="label_12" /> </div> </li> <li class="form-line" data-type="control_text" id="id_13"> <div id="cid_13" class="form-input-wide" data-layout="full"> <div id="text_13" class="form-html" data-component="text" tabindex="0"> <p><span style="color: #000000;">Relationship to Student:</span> <span style="color: #000000;">Home Address:</span></p> </div> </div> </li> <li class="form-line" data-type="control_textbox" id="id_14"><label class="form-label form-label-top form-label-auto" id="label_14" for="input_14"> Relationship to Student </label> <div id="cid_14" class="form-input-wide" data-layout="half"> <input type="text" id="input_14" name="q14_relationshipTo" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" value="" data-component="textbox" aria-labelledby="label_14" /> </div> </li> <li class="form-line" data-type="control_address" id="id_15" data-compound-hint=",,,,Please Select,,Please Select,"><label class="form-label form-label-top form-label-auto" id="label_15" for="input_15_addr_line1"> Address </label> <div id="cid_15" class="form-input-wide" data-layout="full"> <div summary="" class="form-address-table jsTest-addressField"> <div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_15_addr_line1" name="q15_address15[addr_line1]" class="form-textbox form-address-line" data-defaultvalue="" autoComplete="section-input_15 address-line1" value="" data-component="address_line_1" aria-labelledby="label_15 sublabel_15_addr_line1" required="" /><label class="form-sub-label" for="input_15_addr_line1" id="sublabel_15_addr_line1" style="min-height:13px" aria-hidden="false">Home Address</label></span></span></div> <div class="form-address-line-wrapper jsTest-address-line-wrapperField" style="display:none"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_15_addr_line2" name="q15_address15[addr_line2]" class="form-textbox form-address-line" data-defaultvalue="" autoComplete="section-input_15 off" value="" data-component="address_line_2" aria-labelledby="label_15 sublabel_15_addr_line2" /><label class="form-sub-label" for="input_15_addr_line2" id="sublabel_15_addr_line2" style="min-height:13px" aria-hidden="false">Street Address Line 2</label></span></span></div> <div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-city-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_15_city" name="q15_address15[city]" class="form-textbox form-address-city" data-defaultvalue="" autoComplete="section-input_15 address-level2" value="" data-component="city" aria-labelledby="label_15 sublabel_15_city" required="" /><label class="form-sub-label" for="input_15_city" id="sublabel_15_city" style="min-height:13px" aria-hidden="false">City</label></span></span><span class="form-address-line form-address-state-line jsTest-address-lineField form-address-hiddenLine" style="display:none"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_15_state" name="q15_address15[state]" class="form-textbox form-address-state" data-defaultvalue="" autoComplete="section-input_15 address-level1" value="" data-component="state" aria-labelledby="label_15 sublabel_15_state" required="" /><label class="form-sub-label" for="input_15_state" id="sublabel_15_state" style="min-height:13px" aria-hidden="false">State / Province</label></span></span></div> <div class="form-address-line-wrapper jsTest-address-line-wrapperField" style="display:none"><span class="form-address-line form-address-zip-line jsTest-address-lineField form-address-hiddenLine" style="display:none"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_15_postal" name="q15_address15[postal]" class="form-textbox form-address-postal" data-defaultvalue="" autoComplete="section-input_15 postal-code" value="" data-component="zip" aria-labelledby="label_15 sublabel_15_postal" required="" /><label class="form-sub-label" for="input_15_postal" id="sublabel_15_postal" style="min-height:13px" aria-hidden="false">Postal / Zip Code</label></span></span></div> </div> </div> </li> <li class="form-line" data-type="control_textbox" id="id_16"><label class="form-label form-label-top form-label-auto" id="label_16" for="input_16"> Street </label> <div id="cid_16" class="form-input-wide" data-layout="half"> <input type="text" id="input_16" name="q16_street16" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" value="" data-component="textbox" aria-labelledby="label_16" /> </div> </li> <li class="form-line" data-type="control_phone" id="id_17"><label class="form-label form-label-top form-label-auto" id="label_17" for="input_17_full"> Phone Number </label> <div id="cid_17" class="form-input-wide" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="tel" id="input_17_full" name="q17_phoneNumber17[full]" data-type="mask-number" class="mask-phone-number form-textbox validate[Fill Mask]" data-defaultvalue="" autoComplete="section-input_17 tel-national" style="width:310px" data-masked="true" value="" placeholder="(000) 000-0000" data-component="phone" aria-labelledby="label_17" /></span> </div> </li> <li class="form-line" data-type="control_email" id="id_18"><label class="form-label form-label-top form-label-auto" id="label_18" for="input_18"> Email Address </label> <div id="cid_18" class="form-input-wide" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="email" id="input_18" name="q18_emailAddress18" class="form-textbox validate[Email]" data-defaultvalue="" style="width:30px" size="30" value="" data-component="email" aria-labelledby="label_18 sublabel_input_18" /><label class="form-sub-label" for="input_18" id="sublabel_input_18" style="min-height:13px" aria-hidden="false">[email protected]</label></span> </div> </li> <li class="form-line" data-type="control_text" id="id_19"> <div id="cid_19" class="form-input-wide" data-layout="full"> <div id="text_19" class="form-html" data-component="text" tabindex="0"> <p><span style="color: #000000;">Emergency Contact Information:</span> <span style="color: #000000;">Full Name:</span></p> </div> </div> </li> <li class="form-line" data-type="control_textbox" id="id_20"><label class="form-label form-label-top form-label-auto" id="label_20" for="input_20"> Emergency Contact Information </label> <div id="cid_20" class="form-input-wide" data-layout="half"> <input type="text" id="input_20" name="q20_emergencyContact" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" value="" data-component="textbox" aria-labelledby="label_20" /> </div> </li> <li class="form-line" data-type="control_textbox" id="id_21"><label class="form-label form-label-top form-label-auto" id="label_21" for="input_21"> Full Name </label> <div id="cid_21" class="form-input-wide" data-layout="half"> <input type="text" id="input_21" name="q21_fullName21" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" value="" data-component="textbox" aria-labelledby="label_21" /> </div> </li> <li class="form-line" data-type="control_phone" id="id_22"><label class="form-label form-label-top form-label-auto" id="label_22" for="input_22_full"> Relationship to Student: Phone Number </label> <div id="cid_22" class="form-input-wide" data-layout="half"> <span class="form-sub-label-container" style="vertical-align:top"><input type="tel" id="input_22_full" name="q22_relationshipTo22[full]" data-type="mask-number" class="mask-phone-number form-textbox validate[Fill Mask]" data-defaultvalue="" autoComplete="section-input_22 tel-national" style="width:310px" data-masked="true" value="" placeholder="(000) 000-0000" data-component="phone" aria-labelledby="label_22" /></span> </div> </li> <li class="form-line" data-type="control_textbox" id="id_23"><label class="form-label form-label-top form-label-auto" id="label_23" for="input_23"> Relationship to Student </label> <div id="cid_23" class="form-input-wide" data-layout="half"> <input type="text" id="input_23" name="q23_relationshipTo23" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" value="" data-component="textbox" aria-labelledby="label_23" /> </div> </li> <li class="form-line" data-type="control_textbox" id="id_24"><label class="form-label form-label-top form-label-auto" id="label_24" for="input_24"> School Information </label> <div id="cid_24" class="form-input-wide" data-layout="half"> <input type="text" id="input_24" name="q24_schoolInformation" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" value="" data-component="textbox" aria-labelledby="label_24" /> </div> </li> <li class="form-line" data-type="control_textbox" id="id_25"><label class="form-label form-label-top form-label-auto" id="label_25" for="input_25"> Current School Name </label> <div id="cid_25" class="form-input-wide" data-layout="half"> <input type="text" id="input_25" name="q25_currentSchool" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" value="" data-component="textbox" aria-labelledby="label_25" /> </div> </li> <li class="form-line" data-type="control_textbox" id="id_26"><label class="form-label form-label-top form-label-auto" id="label_26" for="input_26"> Grade Level </label> <div id="cid_26" class="form-input-wide" data-layout="half"> <input type="text" id="input_26" name="q26_gradeLevel" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" value="" data-component="textbox" aria-labelledby="label_26" /> </div> </li> <li class="form-line" data-type="control_datetime" id="id_27"><label class="form-label form-label-top form-label-auto" id="label_27" for="lite_mode_27"> Expected Start Date </label> <div id="cid_27" class="form-input-wide" data-layout="half"> <div data-wrapper-react="true"> <div style="display:none"><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[limitDate]" id="month_27" name="q27_expectedStart[month]" size="2" data-maxlength="2" data-age="" maxLength="2" value="" autoComplete="off" aria-labelledby="label_27 sublabel_27_month" /><span class="date-separate" aria-hidden="true"> /</span><label class="form-sub-label" for="month_27" id="sublabel_27_month" style="min-height:13px" aria-hidden="false">Month</label></span><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[limitDate]" id="day_27" name="q27_expectedStart[day]" size="2" data-maxlength="2" data-age="" maxLength="2" value="" autoComplete="off" aria-labelledby="label_27 sublabel_27_day" /><span class="date-separate" aria-hidden="true"> /</span><label class="form-sub-label" for="day_27" id="sublabel_27_day" style="min-height:13px" aria-hidden="false">Day</label></span><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[limitDate]" id="year_27" name="q27_expectedStart[year]" size="4" data-maxlength="4" data-age="" maxLength="4" value="" autoComplete="off" aria-labelledby="label_27 sublabel_27_year" /><label class="form-sub-label" for="year_27" id="sublabel_27_year" style="min-height:13px" aria-hidden="false">Year</label></span></div><span class="form-sub-label-container" style="vertical-align:top"><input type="text" class="form-textbox validate[limitDate, validateLiteDate]" id="lite_mode_27" size="12" data-maxlength="12" maxLength="12" data-age="" value="" data-format="mmddyyyy" data-seperator="/" placeholder="MM/DD/YYYY" autoComplete="off" aria-labelledby="label_27 sublabel_27_litemode" /><img class=" newDefaultTheme-dateIcon icon-liteMode" alt="Pick a Date" id="input_27_pick" src="https://cdn.jotfor.ms/images/calendar.png" data-component="datetime" aria-hidden="true" data-allow-time="No" data-version="v2" /><label class="form-sub-label" for="lite_mode_27" id="sublabel_27_litemode" style="min-height:13px" aria-hidden="false">Date</label></span> </div> </div> </li> <li class="form-line" data-type="control_textbox" id="id_28"><label class="form-label form-label-top form-label-auto" id="label_28" for="input_28"> Medical Information </label> <div id="cid_28" class="form-input-wide" data-layout="half"> <input type="text" id="input_28" name="q28_medicalInformation" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" value="" data-component="textbox" aria-labelledby="label_28" /> </div> </li> <li class="form-line" data-type="control_text" id="id_29"> <div id="cid_29" class="form-input-wide" data-layout="full"> <div id="text_29" class="form-html" data-component="text" tabindex="0"> <p><span style="color: #000000;">Does the student have any medical conditions we should be</span> <span style="color: #000000;">aware of?</span></p> <p><span style="color: #000000;">If yes, please provide details:</span> <span style="color: #000000;">Does the student have any allergies?</span> <span style="color: #000000;">If yes, please provide details:</span></p> </div> </div> </li> <li class="form-line" data-type="control_textbox" id="id_30"><label class="form-label form-label-top form-label-auto" id="label_30" for="input_30"> If yes, please provide details </label> <div id="cid_30" class="form-input-wide" data-layout="half"> <input type="text" id="input_30" name="q30_ifYes" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" value="" data-component="textbox" aria-labelledby="label_30" /> </div> </li> <li class="form-line" data-type="control_textbox" id="id_31"><label class="form-label form-label-top form-label-auto" id="label_31" for="input_31"> If yes, please provide details </label> <div id="cid_31" class="form-input-wide" data-layout="half"> <input type="text" id="input_31" name="q31_ifYes31" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" value="" data-component="textbox" aria-labelledby="label_31" /> </div> </li> <li class="form-line" data-type="control_text" id="id_32"> <div id="cid_32" class="form-input-wide" data-layout="full"> <div id="text_32" class="form-html" data-component="text" tabindex="0"> <p><span style="color: #000000;">Transportation Information:</span> <span style="color: #000000;">How will the student be getting to school?</span></p> </div> </div> </li> <li class="form-line" data-type="control_textbox" id="id_33"><label class="form-label form-label-top form-label-auto" id="label_33" for="input_33"> Transportation Information </label> <div id="cid_33" class="form-input-wide" data-layout="half"> <input type="text" id="input_33" name="q33_transportationInformation" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" value="" data-component="textbox" aria-labelledby="label_33" /> </div> </li> <li class="form-line" data-type="control_textbox" id="id_34"><label class="form-label form-label-top form-label-auto" id="label_34" for="input_34"> If by car, please provide the name and contact information of the person who will be dropping off and picking up the student </label> <div id="cid_34" class="form-input-wide" data-layout="half"> <input type="text" id="input_34" name="q34_ifBy" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" value="" data-component="textbox" aria-labelledby="label_34" /> </div> </li> <li class="form-line" data-type="control_text" id="id_35"> <div id="cid_35" class="form-input-wide" data-layout="full"> <div id="text_35" class="form-html" data-component="text" tabindex="0"> <p><span style="color: #000000;">Do you require school transportation?</span></p> </div> </div> </li> <li class="form-line" data-type="control_textbox" id="id_36"><label class="form-label form-label-top form-label-auto" id="label_36" for="input_36"> Media Release </label> <div id="cid_36" class="form-input-wide" data-layout="half"> <input type="text" id="input_36" name="q36_mediaRelease" data-type="input-textbox" class="form-textbox" data-defaultvalue="" style="width:20px" size="20" value="" data-component="textbox" aria-labelledby="label_36" /> </div> </li> <li class="form-line" data-type="control_text" id="id_37"> <div id="cid_37" class="form-input-wide" data-layout="full"> <div id="text_37" class="form-html" data-component="text" tabindex="0"> <p><span style="color: #000000;">Do you give permission for the school to use photographs</span> <span style="color: #000000;">and videos of the student for promotional purposes?</span></p> </div> </div> </li> <li class="form-line" data-type="control_datetime" id="id_38"><label class="form-label form-label-top form-label-auto" id="label_38" for="lite_mode_38"> Date </label> <div id="cid_38" class="form-input-wide" data-layout="half"> <div data-wrapper-react="true"> <div style="display:none"><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[limitDate]" id="month_38" name="q38_date[month]" size="2" data-maxlength="2" data-age="" maxLength="2" value="" autoComplete="off" aria-labelledby="label_38 sublabel_38_month" /><span class="date-separate" aria-hidden="true"> /</span><label class="form-sub-label" for="month_38" id="sublabel_38_month" style="min-height:13px" aria-hidden="false">Month</label></span><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[limitDate]" id="day_38" name="q38_date[day]" size="2" data-maxlength="2" data-age="" maxLength="2" value="" autoComplete="off" aria-labelledby="label_38 sublabel_38_day" /><span class="date-separate" aria-hidden="true"> /</span><label class="form-sub-label" for="day_38" id="sublabel_38_day" style="min-height:13px" aria-hidden="false">Day</label></span><span class="form-sub-label-container" style="vertical-align:top"><input type="tel" class="form-textbox validate[limitDate]" id="year_38" name="q38_date[year]" size="4" data-maxlength="4" data-age="" maxLength="4" value="" autoComplete="off" aria-labelledby="label_38 sublabel_38_year" /><label class="form-sub-label" for="year_38" id="sublabel_38_year" style="min-height:13px" aria-hidden="false">Year</label></span></div><span class="form-sub-label-container" style="vertical-align:top"><input type="text" class="form-textbox validate[limitDate, validateLiteDate]" id="lite_mode_38" size="12" data-maxlength="12" maxLength="12" data-age="" value="" data-format="mmddyyyy" data-seperator="/" placeholder="MM/DD/YYYY" autoComplete="off" aria-labelledby="label_38 sublabel_38_litemode" /><img class=" newDefaultTheme-dateIcon icon-liteMode" alt="Pick a Date" id="input_38_pick" src="https://cdn.jotfor.ms/images/calendar.png" data-component="datetime" aria-hidden="true" data-allow-time="No" data-version="v2" /><label class="form-sub-label" for="lite_mode_38" id="sublabel_38_litemode" style="min-height:13px" aria-hidden="false">Date</label></span> </div> </div> </li> <li class="form-line" data-type="control_signature" id="id_39"><label class="form-label form-label-top form-label-auto" id="label_39" for="input_39"> Parent/Guardian Signature </label> <div id="cid_39" class="form-input-wide" data-layout="half"> <div data-wrapper-react="true"> <div id="signature_pad_39" class="signature-pad-wrapper" style="width:402px;height:202px"> <div data-wrapper-react="true"> <!--[if IE 7]><script type="text/javascript" src="/js/vendor/json2.js"></script><![endif]--> </div> <div class="signature-line signature-wrapper signature-placeholder" data-component="signature" style="width:402px;height:202px"> <div id="sig_pad_39" data-width="400" data-height="200" data-id="39" data-required="false" class="pad " aria-labelledby="label_39"></div><input type="hidden" name="q39_parentguardianSignature" class="output4" id="input_39" /> </div> <span class="clear-pad-btn clear-pad" role="button" tabindex="0">Clear</span> </div> <div data-wrapper-react="true"> <script type="text/javascript"> window.signatureForm = true </script> </div> </div> </div> </li> <li class="form-line" data-type="control_button" id="id_40"> <div id="cid_40" class="form-input-wide" data-layout="full"> <div data-align="auto" class="form-buttons-wrapper form-buttons-auto jsTest-button-wrapperField"><button id="input_preview_40" type="button" class="form-submit-preview jf-form-buttons" data-component="button"><img alt="PDF Preview" src="https://cdn.jotfor.ms/assets/img/theme-assets/5ca4930530899c64ff77cfa1/previewPDF-icon.svg" /><span id="span_preview_40" class="span_preview">Preview PDF</span></button><span> </span><button id="input_40" type="submit" class="form-submit-button submit-button jf-form-buttons jsTest-submitField" data-component="button" data-content="">Submit</button></div> </div> </li> <li style="display:none">Should be Empty: <input type="text" name="website" value="" /></li> </ul> </div> <script> JotForm.showJotFormPowered = "new_footer"; </script> <script> JotForm.poweredByText = "Powered by Jotform"; </script><input type="hidden" class="simple_spc" id="simple_spc" name="simple_spc" value="231177256510047" /> <script type="text/javascript"> var all_spc = document.querySelectorAll("form[id='231177256510047'] .si" + "mple" + "_spc"); for (var i = 0; i < all_spc.length; i++) { all_spc[i].value = "231177256510047-231177256510047"; } </script> <div class="formFooter-heightMask"></div> <div class="formFooter f6 branding21"> <div class="formFooter-wrapper formFooter-leftSide"><a href="https://www.jotform.com/?utm_source=formfooter&utm_medium=banner&utm_term=231177256510047&utm_content=jotform_logo&utm_campaign=powered_by_jotform_le" target="_blank" class="formFooter-logoLink"><img class="formFooter-logo" src="https://cdn.jotfor.ms/assets/img/logo2021/jotform-logo-white.svg" alt="Jotform Logo" style="height: 44px;"></a></div> <div class="formFooter-wrapper formFooter-rightSide"><span class="formFooter-text">Now create your own Jotform - It's free!</span><a class="formFooter-button" href="https://www.jotform.com/?utm_source=formfooter&utm_medium=banner&utm_term=231177256510047&utm_content=jotform_button&utm_campaign=powered_by_jotform_le" target="_blank">Create your own Jotform</a></div> </div> </form><script type="text/javascript">JotForm.ownerView=true;</script><script src="https://cdn.jotfor.ms//js/vendor/smoothscroll.min.js?v=3.3.41375"></script> <script src="https://cdn.jotfor.ms//js/errorNavigation.js?v=3.3.41375"></script>