{"id":485,"date":"2019-11-15T14:01:19","date_gmt":"2019-11-15T21:01:19","guid":{"rendered":"https:\/\/www.graniteschools.org\/preschool\/?page_id=485"},"modified":"2026-06-12T12:08:13","modified_gmt":"2026-06-12T18:08:13","slug":"intake","status":"publish","type":"page","link":"https:\/\/www.graniteschools.org\/preschool\/intake\/","title":{"rendered":"Special Education Services &#8211; Request for Evaluation"},"content":{"rendered":"\n<hr class=\"wp-block-separator has-alpha-channel-opacity\" \/>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"alignright\"><img loading=\"lazy\" decoding=\"async\" width=\"300\" height=\"106\" data-attachment-id=\"308\" data-permalink=\"https:\/\/www.graniteschools.org\/preschool\/new-logo-jpg\/\" data-orig-file=\"https:\/\/www.graniteschools.org\/preschool\/wp-content\/uploads\/sites\/34\/2017\/08\/new-logo-jpg.jpg\" data-orig-size=\"826,292\" data-comments-opened=\"0\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;&quot;,&quot;orientation&quot;:&quot;0&quot;}\" data-image-title=\"new logo jpg\" data-image-description=\"\" data-image-caption=\"\" data-large-file=\"https:\/\/www.graniteschools.org\/preschool\/wp-content\/uploads\/sites\/34\/2017\/08\/new-logo-jpg.jpg\" src=\"https:\/\/www.graniteschools.org\/preschool\/wp-content\/uploads\/sites\/34\/2017\/08\/new-logo-jpg-300x106.jpg\" alt=\"granite logo\" class=\"wp-image-308\" srcset=\"https:\/\/www.graniteschools.org\/preschool\/wp-content\/uploads\/sites\/34\/2017\/08\/new-logo-jpg-300x106.jpg 300w, https:\/\/www.graniteschools.org\/preschool\/wp-content\/uploads\/sites\/34\/2017\/08\/new-logo-jpg-768x271.jpg 768w, https:\/\/www.graniteschools.org\/preschool\/wp-content\/uploads\/sites\/34\/2017\/08\/new-logo-jpg.jpg 826w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/figure>\n<\/div>\n\n\n<p class=\"wp-block-paragraph\"><strong><\/strong>If you suspect your child has a disability, complete the form below.&nbsp; Once received, our office will contact you in 2 to 3 weeks to obtain more detailed information and\/or schedule an assessment.&nbsp; If you don&#8217;t receive a call back, please contact us directly (385-646-7647).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Please check this&nbsp; <a href=\"http:\/\/maps.graniteschools.org\/schoolsearch\/\" target=\"_blank\" rel=\"noopener\">Boundary Lookup<\/a> to determine which elementary school boundary the child lives within.&nbsp; You will need this information to complete the form.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>We only provide services to students living within Granite School District boundaries.&nbsp;<\/strong>If you do not live within Granite School District boundaries, please contact your home school district:<br>Canyons School District&nbsp;&nbsp;&nbsp;&nbsp; 801-826-5000<br>Davis School District&nbsp;&nbsp;&nbsp;&nbsp; 801-402-5261<br>Jordan School District&nbsp;&nbsp;&nbsp;&nbsp; 801-567-8100<br>Murray School District&nbsp;&nbsp;&nbsp;&nbsp; 801-264-7400<br>Salt Lake School District&nbsp;&nbsp;&nbsp;&nbsp; 801-578-8599<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">After submitting this request form, you must provide the following: :<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>A copy of the child&#8217;s <strong>birth certificate<\/strong>.<\/li>\n\n\n\n<li>A copy of the child&#8217;s <strong>UTAH immunization record<\/strong>.<\/li>\n\n\n\n<li>A <strong>proof of address<\/strong> document. (A recent copy of an electricity, gas, or water bill in a parent&#8217;s name, or rental agreement or mortgage statement in a parent&#8217;s name. The proof must list the address as a &#8220;service address&#8221; or &#8220;property address&#8221; &#8212; no other proof of address will be accepted.)<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Email all documents to <a href=\"mailto:wlschulte@graniteschools.org\">wlschulte@graniteschools.org<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em><mark style=\"background-color:#fcb900\" class=\"has-inline-color\">&#8211;&gt; IT IS EXTREMELY IMPORTANT THAT YOU SUBMIT THESE DOCUMENTS AS SOON AS POSSIBLE!!<\/mark><\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The following application information will be utilized to request an evaluation and enroll your child in preschool IF they are found eligible for special education services. <strong>Completion of this application does not constitute approval of services or automatic enrollment in preschool<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">There is NO COST for any special education services Granite School District provides once your child has qualified for services; however, all students attending our preschools are required to <strong>pay a $45 non-refundable registration fee <\/strong>each year. This payment is only required if your child is found eligible for special education services and begins preschool.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">According to published guidelines from the Utah State Board of Education (USBE), preschools are <strong>exempt from standard fee waivers<\/strong>. However, we offer families of students who qualify for special education services the opportunity to apply for a fee waiver for their special education student only. If you believe you may qualify, please complete a <a href=\"https:\/\/www.graniteschools.org\/preschool\/registration-fee-waiver-application-special-education-student\/\" data-type=\"page\" data-id=\"2028\">Registration Fee Waiver Application<\/a> and include the <strong>required verification information<\/strong>. After review, a decision will be <strong>emailed<\/strong> to you. Until a decision has been made, the registration fee will not be charged.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\" \/>\n\n\n\n<h2 class=\"wp-block-heading\">Special Education Application<\/h2>\n\n\n<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 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<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_28' style='display:none'><div id='gf_28' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_28' id='gform_28'  action='\/preschool\/wp-json\/wp\/v2\/pages\/485#gf_28' data-formid='28' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_28' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_28_31\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Your Information<\/h3><\/div><fieldset id=\"field_28_326\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>What is your relationship to the child?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_326'>\n\t\t\t<div class='gchoice gchoice_28_326_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_326' type='radio' value='Parent or Legal Guardian'  id='choice_28_326_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_326_0' id='label_28_326_0' class='gform-field-label gform-field-label--type-inline'>Parent or Legal Guardian<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_326_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_326' type='radio' value='gf_other_choice'  id='choice_28_326_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_326_1' id='label_28_326_1' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_28_326_other' class='gchoice_other_control' name='input_326_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_327\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Is the parent aware of this request for services\/evaluation?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_327'>\n\t\t\t<div class='gchoice gchoice_28_327_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_327' type='radio' value='Yes'  id='choice_28_327_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_327_0' id='label_28_327_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_28_327_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_327' type='radio' value='No'  id='choice_28_327_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_327_1' id='label_28_327_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_163\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_163'><span class='gform-field-label__text'>Your First Name<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_163' id='input_28_163' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_164\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_164'><span class='gform-field-label__text'>Your Last Name<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_164' id='input_28_164' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_165\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_165'><span class='gform-field-label__text'>Your Street Address<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_165' id='input_28_165' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_166\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_166'><span class='gform-field-label__text'>Your City<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_166' id='input_28_166' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_167\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_167'><span class='gform-field-label__text'>Your Zip Code<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_167' id='input_28_167' type='text' value='' class='medium'    placeholder='99999'  aria-invalid=\"false\"   data-mask=\"99999\"\/><\/div><\/div><div id=\"field_28_36\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-full gf_left_half gfield--width-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_28_36'><span class='gform-field-label__text'>Your primary phone number<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_36' id='input_28_36' type='tel' value='' class='medium'  placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_28_35\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-full gf_right_half gfield--width-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_28_35'><span class='gform-field-label__text'>Your secondary phone number<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_35' id='input_28_35' type='tel' value='' class='medium'  placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_28_37\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_37'><span class='gform-field-label__text'>Your email address<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_37' id='input_28_37' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_28_16\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Child&#039;s Information<\/h3><\/div><div id=\"field_28_172\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_172'><span class='gform-field-label__text'>Child&#039;s Legal FIRST Name (Primer Nombre)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_172' id='input_28_172' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_173\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_173'><span class='gform-field-label__text'>Child&#039;s Legal MIDDLE Name<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_173' id='input_28_173' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_174\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_174'><span class='gform-field-label__text'>Child&#039;s Legal LAST Name (Apellido)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_174' id='input_28_174' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_28_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Child&#039;s Gender<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_18'>\n\t\t\t<div class='gchoice gchoice_28_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='F'  id='choice_28_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_18_0' id='label_28_18_0' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='M'  id='choice_28_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_18_1' id='label_28_18_1' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_133\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datefield gfield--width-full gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Child&#039;s Birthdate<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div id='input_28_133' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_28_133_1_container'>\n                                        <input type='number' maxlength='2' name='input_133[]' id='input_28_133_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                        <label for='input_28_133_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                    <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_28_133_2_container'>\n                                        <input type='number' maxlength='2' name='input_133[]' id='input_28_133_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                        <label for='input_28_133_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                    <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_28_133_3_container'>\n                                        <input type='number' maxlength='4' name='input_133[]' id='input_28_133_3' value=''   aria-required='true'   placeholder='YYYY' min='1920' max='2027' step='1'\/>\n                                        <label for='input_28_133_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                   <\/div>\n                               <\/div><\/fieldset><fieldset id=\"field_28_190\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Child&#039;s Age on September 1, 2026:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_190'>\n\t\t\t<div class='gchoice gchoice_28_190_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_190' type='radio' value='2 years old'  id='choice_28_190_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_190_0' id='label_28_190_0' class='gform-field-label gform-field-label--type-inline'>2 years old<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_190_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_190' type='radio' value='3 years old'  id='choice_28_190_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_190_1' id='label_28_190_1' class='gform-field-label gform-field-label--type-inline'>3 years old<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_190_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_190' type='radio' value='4 years old'  id='choice_28_190_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_190_2' id='label_28_190_2' class='gform-field-label gform-field-label--type-inline'>4 years old<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_190_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_190' type='radio' value='5 years old'  id='choice_28_190_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_190_3' id='label_28_190_3' class='gform-field-label gform-field-label--type-inline'>5 years old<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_325\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p class=\"gfield_label\"><FONT COLOR=\"ff0000\">STOP!  The child is too old to receive Preschool-age special education services.  Please contact Elementary Special Education at 385-646-4650.  (Do not submit this form.)<FONT COLOR=\"000000\"><\/p><\/div><fieldset id=\"field_28_328\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Has the child ever had an IEP (received special education services)?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_328'>\n\t\t\t<div class='gchoice gchoice_28_328_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_328' type='radio' value='Yes'  id='choice_28_328_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_328_0' id='label_28_328_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_28_328_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_328' type='radio' value='No'  id='choice_28_328_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_328_1' id='label_28_328_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_330\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Has the child previously been tested by Granite Preschool Services?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_330'>\n\t\t\t<div class='gchoice gchoice_28_330_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_330' type='radio' value='Yes'  id='choice_28_330_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_330_0' id='label_28_330_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_28_330_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_330' type='radio' value='No'  id='choice_28_330_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_330_1' id='label_28_330_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_331\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_331'><span class='gform-field-label__text'>When?<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_331' id='input_28_331' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_28_332\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Is the child currently receiving services or have they ever received services from another Early Intervention Program or DDI?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_332'>\n\t\t\t<div class='gchoice gchoice_28_332_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_332' type='radio' value='Yes'  id='choice_28_332_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_332_0' id='label_28_332_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_28_332_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_332' type='radio' value='No'  id='choice_28_332_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_332_1' id='label_28_332_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_347\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_347'><span class='gform-field-label__text'>If yes, where?<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_347' id='input_28_347' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_333\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_333'><span class='gform-field-label__text'>Did you have a transition meeting with DDI and Granite School District?<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_333' id='input_28_333' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_334\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_334'><span class='gform-field-label__text'>Which elementary school boundaries does the child live within?<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_334' id='input_28_334' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_329\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_329'><span class='gform-field-label__text'>Briefly describe your main concern with this child&#039;s development:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_329' id='input_28_329' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_28_316\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Participation Agreement<\/h3><\/div><fieldset id=\"field_28_317\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>The school year begins in August\/September and continues through May. The preschool program is four days per week for 4-year-olds, or two days per week for 3-year-olds, and REGULAR ATTENDANCE IS EXPECTED. If your child misses days, you must notify the teacher and state the reason for the absence.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_28_317'><div class='gchoice gchoice_28_317_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_317.1' type='checkbox'  value='I understand and agree to the attendance policy'  id='choice_28_317_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_317_1' id='label_28_317_1' class='gform-field-label gform-field-label--type-inline'>I understand and agree to the attendance policy<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_318\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Parent participation is an important part of a child&#039;s educational success. Therefore, parents are strongly encouraged to attend parent-teacher conferences two times per year, and to attend parent\/family education opportunities to enhance their child&#039;s development of literacy and math skills.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_28_318'><div class='gchoice gchoice_28_318_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_318.1' type='checkbox'  value='I understand parent participation'  id='choice_28_318_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_318_1' id='label_28_318_1' class='gform-field-label gform-field-label--type-inline'>I understand parent participation<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_319\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Students who enroll in this program will be tested periodically throughout the school year to monitor academic progress.<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_28_319'><div class='gchoice gchoice_28_319_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_319.1' type='checkbox'  value='I understand and agree my child will be assessed'  id='choice_28_319_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_319_1' id='label_28_319_1' class='gform-field-label gform-field-label--type-inline'>I understand and agree my child will be assessed<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_320\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Health and Human Services Client Rights Acknowledgement<\/h3><\/div><fieldset id=\"field_28_297\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Do you agree the &quot;CCL Client Rights&quot; information has been provided via the Preschool Services website (www.graniteschools.org\/preschool) and you understand its contents?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_28_297'><div class='gchoice gchoice_28_297_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_297.1' type='checkbox'  value='Yes, I understand client rights'  id='choice_28_297_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_297_1' id='label_28_297_1' class='gform-field-label gform-field-label--type-inline'>Yes, I understand client rights<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_321\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Disclosure Notification for School Readiness Initiative Grantees Acknowledgement<\/h3><\/div><fieldset id=\"field_28_299\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Do you agree the &quot;Disclosure Notification for School Readiness Initiative Grantees&quot; information has been provided via the Preschool Services website (www.graniteschools.org\/preschool) and you understand its contents?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_28_299'><div class='gchoice gchoice_28_299_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_299.1' type='checkbox'  value='Yes, I understand the disclosure notification'  id='choice_28_299_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_299_1' id='label_28_299_1' class='gform-field-label gform-field-label--type-inline'>Yes, I understand the disclosure notification<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_322\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Hearing and Vision Screening Acknowledgement<\/h3><\/div><fieldset id=\"field_28_300\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>The State of Utah mandates periodic hearing and vision screening. Granite School District performs school-wide hearing and vision screenings in each school per State Board rules and Department of Health regulations. Special education students as well as students that have been referred by teachers and parents may be screened more frequently. I understand that to exempt my child from screening, I must submit a request in writing to the Preschool Services School Nurses.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_28_300'><div class='gchoice gchoice_28_300_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_300.1' type='checkbox'  value='I understand the exemption policy'  id='choice_28_300_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_300_1' id='label_28_300_1' class='gform-field-label gform-field-label--type-inline'>I understand the exemption policy<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_323\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Head Injury Policy Acknowledgement<\/h3><\/div><fieldset id=\"field_28_301\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Do you agree the &quot;Head Injury Policy&quot; information has been provided via the Preschool Services website (www.graniteschools.org\/preschool) and you understand its contents?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_28_301'><div class='gchoice gchoice_28_301_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_301.1' type='checkbox'  value='Yes, I understand the head injury policy'  id='choice_28_301_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_301_1' id='label_28_301_1' class='gform-field-label gform-field-label--type-inline'>Yes, I understand the head injury policy<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_298\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Application Information<\/h3><\/div><fieldset id=\"field_28_135\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Does your family qualify for free or reduced lunch?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_28_135'><div class='gchoice gchoice_28_135_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_135.1' type='checkbox'  value='Yes - free or reduced lunch qualified'  id='choice_28_135_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_135_1' id='label_28_135_1' class='gform-field-label gform-field-label--type-inline'>Yes &#8211; free or reduced lunch qualified<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_135_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_135.2' type='checkbox'  value='No, not free or reduced lunch qualified'  id='choice_28_135_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_135_2' id='label_28_135_2' class='gform-field-label gform-field-label--type-inline'>No, not free or reduced lunch qualified<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_28_135_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_135.3' type='checkbox'  value='I don&#039;t know'  id='choice_28_135_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_135_3' id='label_28_135_3' class='gform-field-label gform-field-label--type-inline'>I don&#8217;t know<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_178\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>How many people live in your household?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_178'>\n\t\t\t<div class='gchoice gchoice_28_178_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_178' type='radio' value='2'  id='choice_28_178_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_178_0' id='label_28_178_0' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_178_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_178' type='radio' value='3'  id='choice_28_178_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_178_1' id='label_28_178_1' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_178_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_178' type='radio' value='4'  id='choice_28_178_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_178_2' id='label_28_178_2' class='gform-field-label gform-field-label--type-inline'>4<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_178_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_178' type='radio' value='5'  id='choice_28_178_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_178_3' id='label_28_178_3' class='gform-field-label gform-field-label--type-inline'>5<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_178_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_178' type='radio' value='6'  id='choice_28_178_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_178_4' id='label_28_178_4' class='gform-field-label gform-field-label--type-inline'>6<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_178_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_178' type='radio' value='7'  id='choice_28_178_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_178_5' id='label_28_178_5' class='gform-field-label gform-field-label--type-inline'>7<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_178_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_178' type='radio' value='8'  id='choice_28_178_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_178_6' id='label_28_178_6' class='gform-field-label gform-field-label--type-inline'>8<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_178_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_178' type='radio' value='more than 8'  id='choice_28_178_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_178_7' id='label_28_178_7' class='gform-field-label gform-field-label--type-inline'>more than 8<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_179\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Is the gross (before tax) household income less than $3,336 per month?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_179'>\n\t\t\t<div class='gchoice gchoice_28_179_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_179' type='radio' value='yes'  id='choice_28_179_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_179_0' id='label_28_179_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_28_179_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_179' type='radio' value='no'  id='choice_28_179_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_179_1' id='label_28_179_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_180\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Is the gross (before tax) household income less than $4,211 per month?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_180'>\n\t\t\t<div class='gchoice gchoice_28_180_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_180' type='radio' value='yes'  id='choice_28_180_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_180_0' id='label_28_180_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_28_180_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_180' type='radio' value='no'  id='choice_28_180_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_180_1' id='label_28_180_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_181\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Is the gross (before tax) household income less than $5,087 per month?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_181'>\n\t\t\t<div class='gchoice gchoice_28_181_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_181' type='radio' value='yes'  id='choice_28_181_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_181_0' id='label_28_181_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_28_181_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_181' type='radio' value='no'  id='choice_28_181_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_181_1' id='label_28_181_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_182\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Is the gross (before tax) household income less than $5,963 per month?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_182'>\n\t\t\t<div class='gchoice gchoice_28_182_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_182' type='radio' value='yes'  id='choice_28_182_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_182_0' id='label_28_182_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_28_182_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_182' type='radio' value='no'  id='choice_28_182_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_182_1' id='label_28_182_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_183\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Is the gross (before tax) household income less than $6,839 per month?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_183'>\n\t\t\t<div class='gchoice gchoice_28_183_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_183' type='radio' value='yes'  id='choice_28_183_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_183_0' id='label_28_183_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_28_183_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_183' type='radio' value='no'  id='choice_28_183_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_183_1' id='label_28_183_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_184\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Is the gross (before tax) household income less than $7,714 per month?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_184'>\n\t\t\t<div class='gchoice gchoice_28_184_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_184' type='radio' value='yes'  id='choice_28_184_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_184_0' id='label_28_184_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_28_184_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_184' type='radio' value='no'  id='choice_28_184_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_184_1' id='label_28_184_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_185\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Is the gross (before tax) household income less than $8,590 per month?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_185'>\n\t\t\t<div class='gchoice gchoice_28_185_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_185' type='radio' value='yes'  id='choice_28_185_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_185_0' id='label_28_185_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_28_185_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_185' type='radio' value='no'  id='choice_28_185_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_185_1' id='label_28_185_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_259\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>How many of these circumstances apply to your preschooler?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_28_259'><b>READ THE LIST BELOW AND COUNT HOW MANY OF THESE CIRCUMSTANCES APPLY TO YOUR PRESCHOOLER:<\/b>\n<ul>\n  <li>Child born to mother who was 18 years old or younger<\/li>\n  <li>A member of child&#8217;s household is incarcerated<\/li>\n  <li>Child lives in a neighborhood with high violence\/crime<\/li>\n  <li>One or both parents have a low reading ability<\/li>\n  <li>Family has moved at least once in the last year<\/li>\n  <li>Child has ever been in foster care<\/li>\n  <li>Lives in a household with multiple families<\/li>\n  <li>Child exposed to physical abuse or domestic violence in the home at any time in their life<\/li>\n  <li>Child exposed to substance abuse (drugs or alcohol) in the home at any point in their life<\/li>\n  <li>Child exposed to stressful life events (death, chronic illness or mental health issues of a parent or sibling)<\/li>\n  <li>Language spoken in the home most often is NOT English<\/li>\n  <li>A parent of the child did not graduate from high school<\/li>\n<\/ul>\n<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_259'>\n\t\t\t<div class='gchoice gchoice_28_259_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_259' type='radio' value='0'  id='choice_28_259_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_28_259\"   \/>\n\t\t\t\t\t<label for='choice_28_259_0' id='label_28_259_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_259_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_259' type='radio' value='1'  id='choice_28_259_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_259_1' id='label_28_259_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_259_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_259' type='radio' value='2'  id='choice_28_259_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_259_2' id='label_28_259_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_259_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_259' type='radio' value='3'  id='choice_28_259_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_259_3' id='label_28_259_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_259_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_259' type='radio' value='4'  id='choice_28_259_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_259_4' id='label_28_259_4' class='gform-field-label gform-field-label--type-inline'>4<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_259_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_259' type='radio' value='5'  id='choice_28_259_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_259_5' id='label_28_259_5' class='gform-field-label gform-field-label--type-inline'>5<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_259_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_259' type='radio' value='6'  id='choice_28_259_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_259_6' id='label_28_259_6' class='gform-field-label gform-field-label--type-inline'>6<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_259_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_259' type='radio' value='7'  id='choice_28_259_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_259_7' id='label_28_259_7' class='gform-field-label gform-field-label--type-inline'>7<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_259_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_259' type='radio' value='8'  id='choice_28_259_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_259_8' id='label_28_259_8' class='gform-field-label gform-field-label--type-inline'>8<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_259_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_259' type='radio' value='9'  id='choice_28_259_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_259_9' id='label_28_259_9' class='gform-field-label gform-field-label--type-inline'>9<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_259_10'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_259' type='radio' value='10'  id='choice_28_259_10' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_259_10' id='label_28_259_10' class='gform-field-label gform-field-label--type-inline'>10<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_259_11'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_259' type='radio' value='11'  id='choice_28_259_11' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_259_11' id='label_28_259_11' class='gform-field-label gform-field-label--type-inline'>11<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_259_12'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_259' type='radio' value='12'  id='choice_28_259_12' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_259_12' id='label_28_259_12' class='gform-field-label gform-field-label--type-inline'>12<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_274\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Is the child currently in Foster Care?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_274'>\n\t\t\t<div class='gchoice gchoice_28_274_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_274' type='radio' value='no'  id='choice_28_274_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_274_0' id='label_28_274_0' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_274_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_274' type='radio' value='yes'  id='choice_28_274_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_274_1' id='label_28_274_1' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_273\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Is your child an English Learner? (see definition below)?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_273'>\n\t\t\t<div class='gchoice gchoice_28_273_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_273' type='radio' value='no'  id='choice_28_273_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_28_273\"   \/>\n\t\t\t\t\t<label for='choice_28_273_0' id='label_28_273_0' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_273_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_273' type='radio' value='yes'  id='choice_28_273_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_273_1' id='label_28_273_1' class='gform-field-label gform-field-label--type-inline'>yes<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_28_273'>The child:<\/br>\n&#8211; was not born in the United States, or whose native language is NOT English, or<\/br>\n&#8211; is a Native American or Alaska Native, or a native resident of the outlying areas and comes from an environment where a language other than English has had a significant impact on their level of English Language proficiency, or<\/br>\n&#8211; is migratory, whose native language is NOT English and who comes from an environment where a language other than English is dominant<\/br>\nAND<\/br>\nhas difficulties in speaking reading, writing, or understanding the English language that may be sufficient to deny the child the ability to meet challenging state academic standards or successfully achieve in English-instructed classrooms, or the opportunity to participate fully in society.<\/div><\/fieldset><fieldset id=\"field_28_11\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Child&#039;s PRIMARY Race \/ Ethnicity<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_11'>\n\t\t\t<div class='gchoice gchoice_28_11_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='A'  id='choice_28_11_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_11_0' id='label_28_11_0' class='gform-field-label gform-field-label--type-inline'>Asian<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_11_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='B'  id='choice_28_11_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_11_1' id='label_28_11_1' class='gform-field-label gform-field-label--type-inline'>Black<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_11_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='C'  id='choice_28_11_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_11_2' id='label_28_11_2' class='gform-field-label gform-field-label--type-inline'>Caucasian<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_11_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='H'  id='choice_28_11_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_11_3' id='label_28_11_3' class='gform-field-label gform-field-label--type-inline'>Hispanic \/ Latino<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_11_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='P'  id='choice_28_11_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_11_4' id='label_28_11_4' class='gform-field-label gform-field-label--type-inline'>Pacific Islander<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_11_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='I'  id='choice_28_11_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_11_5' id='label_28_11_5' class='gform-field-label gform-field-label--type-inline'>Native American \/ Alaskan Native<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_6\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Has this child been enrolled in our program or on our waiting list before?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_6'>\n\t\t\t<div class='gchoice gchoice_28_6_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Yes'  id='choice_28_6_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_6_0' id='label_28_6_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_28_6_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='No'  id='choice_28_6_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_6_1' id='label_28_6_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_19\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_19'><span class='gform-field-label__text'>What language does the child speak most often? (If they do not yet speak, what language is most often spoken at home?)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_28_19' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_21\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_21'><span class='gform-field-label__text'>What language did the child learn first? (If they do not yet speak, what language is most often spoken at home?)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_28_21' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_20\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_20'><span class='gform-field-label__text'>Does the student have the opportunity to hear\/speak another language? If so, which language:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_28_20' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_290\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_290'><span class='gform-field-label__text'>What is the primary language used in the home, regardless of the language spoken by the student?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_290' id='input_28_290' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_28_285\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>What language do you prefer for school-to-home information?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_285'>\n\t\t\t<div class='gchoice gchoice_28_285_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_285' type='radio' value='English'  id='choice_28_285_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_285_0' id='label_28_285_0' class='gform-field-label gform-field-label--type-inline'>English<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_285_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_285' type='radio' value='Spanish'  id='choice_28_285_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_285_1' id='label_28_285_1' class='gform-field-label gform-field-label--type-inline'>Spanish<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_28_15\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>With whom does the child live?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_15'>\n\t\t\t<div class='gchoice gchoice_28_15_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='Both Mother and Father'  id='choice_28_15_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_15_0' id='label_28_15_0' class='gform-field-label gform-field-label--type-inline'>Both Mother and Father<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_15_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='Mother'  id='choice_28_15_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_15_1' id='label_28_15_1' class='gform-field-label gform-field-label--type-inline'>Mother<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_15_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='Father'  id='choice_28_15_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_15_2' id='label_28_15_2' class='gform-field-label gform-field-label--type-inline'>Father<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_15_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='gf_other_choice'  id='choice_28_15_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_15_3' id='label_28_15_3' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_28_15_other' class='gchoice_other_control' name='input_15_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_17\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Primary Contact Information (Parent or Legal Guardian)<\/h3><\/div><div id=\"field_28_337\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_337'><span class='gform-field-label__text'>Primary Contact&#039;s First Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_337' id='input_28_337' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_159\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_159'><span class='gform-field-label__text'>Primary Contact&#039;s Last Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_159' id='input_28_159' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_160\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_160'><span class='gform-field-label__text'>Primary Contact&#039;s Street Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_160' id='input_28_160' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_266\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_266'><span class='gform-field-label__text'>Apartment #<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_266' id='input_28_266' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_161\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_161'><span class='gform-field-label__text'>Primary Contact&#039;s City<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_161' id='input_28_161' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_162\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_162'><span class='gform-field-label__text'>Primary Contact&#039;s Zip Code<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_162' id='input_28_162' type='text' value='' class='medium'    placeholder='99999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"99999\"\/><\/div><\/div><div id=\"field_28_26\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_26'><span class='gform-field-label__text'>Primary Contact&#039;s Relationship to Student<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_26' id='input_28_26' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_28\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-full gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_28'><span class='gform-field-label__text'>Primary Contact&#039;s Cell Phone Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_28' id='input_28_28' type='tel' value='' class='medium'  placeholder='(999) 999-9999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_28_27\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-full gf_right_half gfield--width-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_28_27'><span class='gform-field-label__text'>Primary Contact&#039;s Home Phone Number<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_27' id='input_28_27' type='tel' value='' class='medium'  placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_28_29\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-full gf_right_half gfield--width-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_28_29'><span class='gform-field-label__text'>Primary Contact&#039;s Work Phone Number<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_29' id='input_28_29' type='tel' value='' class='medium'  placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><fieldset id=\"field_28_30\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Primary Contact&#039;s Email Address &#8211; THIS IS IMPORTANT: Most preschool communication will be sent via parent portal and\/or email. To assist you in creating a parent portal account, we must have an accurate email address.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_28_30_container'>\n                                <span id='input_28_30_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_30' id='input_28_30' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_28_30' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_28_30_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_30_2' id='input_28_30_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_28_30_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_28_336\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Secondary Contact Information (Parent or Legal Guardian)<\/h3><\/div><div id=\"field_28_158\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_158'><span class='gform-field-label__text'>Secondary Contact&#039;s First Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_158' id='input_28_158' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_338\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_338'><span class='gform-field-label__text'>Secondary Contact&#039;s Last Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_338' id='input_28_338' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_339\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_339'><span class='gform-field-label__text'>Secondary Contact&#039;s Street Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_339' id='input_28_339' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_340\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_340'><span class='gform-field-label__text'>Secondary Contact&#039;s City<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_340' id='input_28_340' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_341\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_341'><span class='gform-field-label__text'>Secondary Contact&#039;s Zip Code<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_341' id='input_28_341' type='text' value='' class='medium'    placeholder='99999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"99999\"\/><\/div><\/div><div id=\"field_28_342\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_342'><span class='gform-field-label__text'>Secondary Contact&#039;s Relationship to Student<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_342' id='input_28_342' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_343\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-full gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_343'><span class='gform-field-label__text'>Secondary Contact&#039;s Cell Phone Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_343' id='input_28_343' type='tel' value='' class='medium'  placeholder='(999) 999-9999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_28_344\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-full gf_right_half gfield--width-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_28_344'><span class='gform-field-label__text'>Secondary Contact&#039;s Home Phone Number<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_344' id='input_28_344' type='tel' value='' class='medium'  placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_28_345\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-full gf_right_half gfield--width-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_28_345'><span class='gform-field-label__text'>Secondary Contact&#039;s Work Phone Number<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_345' id='input_28_345' type='tel' value='' class='medium'  placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><fieldset id=\"field_28_346\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Secondary Contact&#039;s Email Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_28_346_container'>\n                                <span id='input_28_346_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_346' id='input_28_346' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_28_346' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_28_346_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_346_2' id='input_28_346_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_28_346_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_28_58\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Emergency Information<\/h3><\/div><div id=\"field_28_119\" class=\"gfield gfield--type-html gfield--input-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\"  ><p class=\"gfield_label\">Please provide up to three emergency contacts other than those listed above.<\/p><\/div><div id=\"field_28_117\" class=\"gfield gfield--type-text gfield--input-type-text gf_middle_third gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_117'><span class='gform-field-label__text'>Emergency Contact&#039;s Full Name (please list someone not listed above)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_117' id='input_28_117' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_168\" class=\"gfield gfield--type-text gfield--input-type-text gf_middle_third gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_168'><span class='gform-field-label__text'>Emergency Contact&#039;s Relationship to Student<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_168' id='input_28_168' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_118\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gf_right_third gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_118'><span class='gform-field-label__text'>Emergency Contact&#039;s Phone Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_118' id='input_28_118' type='tel' value='' class='medium'  placeholder='(999) 999-9999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><fieldset id=\"field_28_277\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Is this emergency contact also permitted to pick up the student from school?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_277'>\n\t\t\t<div class='gchoice gchoice_28_277_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_277' type='radio' value='yes'  id='choice_28_277_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_277_0' id='label_28_277_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_28_277_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_277' type='radio' value='no'  id='choice_28_277_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_277_1' id='label_28_277_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_170\" class=\"gfield gfield--type-text gfield--input-type-text gf_middle_third gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_170'><span class='gform-field-label__text'>Full Name &#8211; Emergency Contact 2<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_170' id='input_28_170' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_122\" class=\"gfield gfield--type-text gfield--input-type-text gf_middle_third gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_122'><span class='gform-field-label__text'>Relationship to Student<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_122' id='input_28_122' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_124\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gf_right_third gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_124'><span class='gform-field-label__text'>Phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_124' id='input_28_124' type='tel' value='' class='medium'  placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><fieldset id=\"field_28_278\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Is this emergency contact also permitted to pick up the student from school?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_278'>\n\t\t\t<div class='gchoice gchoice_28_278_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_278' type='radio' value='yes'  id='choice_28_278_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_278_0' id='label_28_278_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_28_278_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_278' type='radio' value='no'  id='choice_28_278_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_278_1' id='label_28_278_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_263\" class=\"gfield gfield--type-text gfield--input-type-text gf_middle_third gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_263'><span class='gform-field-label__text'>Full Name &#8211; Emergency Contact 3<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_263' id='input_28_263' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_262\" class=\"gfield gfield--type-text gfield--input-type-text gf_middle_third gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_262'><span class='gform-field-label__text'>Relationship to Student<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_262' id='input_28_262' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_28_125\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gf_right_third gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_125'><span class='gform-field-label__text'>Phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_125' id='input_28_125' type='tel' value='' class='medium'  placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><fieldset id=\"field_28_279\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Is this emergency contact also permitted to pick up the student from school?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_279'>\n\t\t\t<div class='gchoice gchoice_28_279_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_279' type='radio' value='yes'  id='choice_28_279_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_279_0' id='label_28_279_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_28_279_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_279' type='radio' value='no'  id='choice_28_279_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_279_1' id='label_28_279_1' class='gform-field-label gform-field-label--type-inline'>no<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_63\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Restrictions<\/h3><\/div><div id=\"field_28_286\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_286'><span class='gform-field-label__text'>Pick Up Restrictions &#8211; NOT allowed to pick up student<\/span><\/label><div class='gfield_description' id='gfield_description_28_286'><strong>If you have a LEGAL DOCUMENT restricting someone from contact with your child, please list that person here and provide a copy of the document along with the other required registration materials. If there is no legal document, do not list anyone here. <\/strong>Please include the person&#8217;s name, relationship to the student, and phone number if available. Use a separate line for each person. <\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_286' id='input_28_286' class='textarea large'  aria-describedby=\"gfield_description_28_286\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_28_65\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Health Information<\/h3><\/div><fieldset id=\"field_28_66\" class=\"gfield gfield--type-list gfield--input-type-list field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Physician and\/or Specialist Details<\/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\">Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Phone #<\/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_66_cell1 gform-grid-col' data-label='Name'><input aria-invalid='false'   aria-label='Name, Row 1' data-aria-label-template='Name, Row {0}' type='text' name='input_66[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_66_cell2 gform-grid-col' data-label='Phone #'><input aria-invalid='false'   aria-label='Phone #, Row 1' data-aria-label-template='Phone #, Row {0}' type='text' name='input_66[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type='button'  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_28_67\" class=\"gfield gfield--type-html gfield--input-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\"  ><strong>Does your child have any of the following?<\/strong><\/div><fieldset id=\"field_28_68\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Allergies (Foods, Medications, etc.)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_68'>\n\t\t\t<div class='gchoice gchoice_28_68_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='Yes'  id='choice_28_68_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_68_0' id='label_28_68_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_28_68_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='No'  id='choice_28_68_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_68_1' id='label_28_68_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_80\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_80'><span class='gform-field-label__text'>Allergy Details<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_80' id='input_28_80' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_28_69\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Does child have an Epi Pen \/ Antishistmane?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_69'>\n\t\t\t<div class='gchoice gchoice_28_69_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='Yes'  id='choice_28_69_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_69_0' id='label_28_69_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_28_69_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='No'  id='choice_28_69_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_69_1' id='label_28_69_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_81\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_81'><span class='gform-field-label__text'>Epi Pen \/ Antihistamine Details<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_81' id='input_28_81' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_28_70\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Asthma<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_70'>\n\t\t\t<div class='gchoice gchoice_28_70_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='Yes'  id='choice_28_70_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_70_0' id='label_28_70_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_28_70_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='No'  id='choice_28_70_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_70_1' id='label_28_70_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_82\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_82'><span class='gform-field-label__text'>Asthma Details<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_82' id='input_28_82' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_28_71\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Is a &quot;rescue&quot; inhaler needed in the class?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_71'>\n\t\t\t<div class='gchoice gchoice_28_71_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_71' type='radio' value='Yes'  id='choice_28_71_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_71_0' id='label_28_71_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_28_71_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_71' type='radio' value='No'  id='choice_28_71_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_71_1' id='label_28_71_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_83\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_83'><span class='gform-field-label__text'>Inhaler Details<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_83' id='input_28_83' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_28_72\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>G-tube<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_72'>\n\t\t\t<div class='gchoice gchoice_28_72_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='Yes'  id='choice_28_72_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_72_0' id='label_28_72_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_28_72_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='No'  id='choice_28_72_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_72_1' id='label_28_72_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_84\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_84'><span class='gform-field-label__text'>G-tube Details<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_84' id='input_28_84' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_28_186\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Chronic condition \/ medical diagnosis<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_186'>\n\t\t\t<div class='gchoice gchoice_28_186_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_186' type='radio' value='Yes'  id='choice_28_186_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_186_0' id='label_28_186_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_28_186_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_186' type='radio' value='No'  id='choice_28_186_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_186_1' id='label_28_186_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_187\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_187'><span class='gform-field-label__text'>Condition \/ Diagonisis Details<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_187' id='input_28_187' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_28_73\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Diabetes<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_73'>\n\t\t\t<div class='gchoice gchoice_28_73_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Yes'  id='choice_28_73_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_73_0' id='label_28_73_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_28_73_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='No'  id='choice_28_73_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_73_1' id='label_28_73_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_85\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_85'><span class='gform-field-label__text'>Diabetes Details<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_85' id='input_28_85' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_28_74\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Heart or circulatory disorder<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_74'>\n\t\t\t<div class='gchoice gchoice_28_74_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Yes'  id='choice_28_74_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_74_0' id='label_28_74_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_28_74_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='No'  id='choice_28_74_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_74_1' id='label_28_74_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_86\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_86'><span class='gform-field-label__text'>Heart Details<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_86' id='input_28_86' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_28_75\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Musculoskeletal\/mobility disorder<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_75'>\n\t\t\t<div class='gchoice gchoice_28_75_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='Yes'  id='choice_28_75_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_75_0' id='label_28_75_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_28_75_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='No'  id='choice_28_75_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_75_1' id='label_28_75_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_87\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_87'><span class='gform-field-label__text'>Musculoskeletal\/Mobility Details<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_87' id='input_28_87' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_28_76\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Seizures<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_76'>\n\t\t\t<div class='gchoice gchoice_28_76_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='Yes'  id='choice_28_76_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_76_0' id='label_28_76_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_28_76_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='No'  id='choice_28_76_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_76_1' id='label_28_76_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_88\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_88'><span class='gform-field-label__text'>Seizures Details (list type &amp; daily medications)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_88' id='input_28_88' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_28_77\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Visual\/hearing impairment<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_77'>\n\t\t\t<div class='gchoice gchoice_28_77_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_77' type='radio' value='Yes'  id='choice_28_77_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_77_0' id='label_28_77_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_28_77_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_77' type='radio' value='No'  id='choice_28_77_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_77_1' id='label_28_77_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_89\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_89'><span class='gform-field-label__text'>Visual\/Hearing Details<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_89' id='input_28_89' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_28_78\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Other health problems<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_78'>\n\t\t\t<div class='gchoice gchoice_28_78_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_78' type='radio' value='Yes'  id='choice_28_78_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_78_0' id='label_28_78_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_28_78_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_78' type='radio' value='No'  id='choice_28_78_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_78_1' id='label_28_78_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_90\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_90'><span class='gform-field-label__text'>Other Details<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_90' id='input_28_90' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_28_79\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_list_inline gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Daily Medications<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_79'>\n\t\t\t<div class='gchoice gchoice_28_79_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='Yes'  id='choice_28_79_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_79_0' id='label_28_79_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_28_79_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='No'  id='choice_28_79_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_79_1' id='label_28_79_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_91\" class=\"gfield gfield--type-text gfield--input-type-text gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_91'><span class='gform-field-label__text'>Medications Details<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_91' id='input_28_91' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_28_146\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>How did you hear about our program?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_28_146'>\n\t\t\t<div class='gchoice gchoice_28_146_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_146' type='radio' value='Flyer'  id='choice_28_146_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_146_0' id='label_28_146_0' class='gform-field-label gform-field-label--type-inline'>Flyer<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_146_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_146' type='radio' value='Internet'  id='choice_28_146_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_146_1' id='label_28_146_1' class='gform-field-label gform-field-label--type-inline'>Internet<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_146_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_146' type='radio' value='Returning Student'  id='choice_28_146_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_146_2' id='label_28_146_2' class='gform-field-label gform-field-label--type-inline'>Returning Student<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_146_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_146' type='radio' value='Referred by Someone'  id='choice_28_146_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_146_3' id='label_28_146_3' class='gform-field-label gform-field-label--type-inline'>Referred by Someone<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_146_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_146' type='radio' value='Elementary School Sign\/Web Page\/Newsletter'  id='choice_28_146_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_146_4' id='label_28_146_4' class='gform-field-label gform-field-label--type-inline'>Elementary School Sign\/Web Page\/Newsletter<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_28_146_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_146' type='radio' value='gf_other_choice'  id='choice_28_146_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_28_146_5' id='label_28_146_5' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_28_146_other' class='gchoice_other_control' name='input_146_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_324\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Attestation<\/h3><\/div><fieldset id=\"field_28_302\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Is all information contained in this application is true and accurate to the best of your knowledge?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_28_302'><div class='gchoice gchoice_28_302_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_302.1' type='checkbox'  value='Yes, the information is true'  id='choice_28_302_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_28_302_1' id='label_28_302_1' class='gform-field-label gform-field-label--type-inline'>Yes, the information is true<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_28_335\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_28_335'><span class='gform-field-label__text'>Additional comments or information:<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_335' id='input_28_335' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_28_126\" class=\"gfield gfield--type-html gfield--input-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\"  ><p>After clicking the &#8216;Submit&#8217; button below, please wait until you see a confirmation page. Do not refresh.<\/p><\/div><div id=\"field_28_306\" class=\"gfield gfield--type-html gfield--input-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\"  ><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_28' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit<\/button> <input type='hidden' name='gform_ajax' value='form_id=28&amp;title=&amp;description=&amp;tabindex=0&amp;theme=gravity-theme&amp;styles={&quot;inputPrimaryColor&quot;:&quot;#204ce5&quot;}&amp;hash=83566492d4676d0926a9e85bbe77a508' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_28' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_28' id='gform_theme_28' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_28' id='gform_style_settings_28' value='{&quot;inputPrimaryColor&quot;:&quot;#204ce5&quot;}' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_28' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='28' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='mR6i2JF2mwFZXAkUjyWoSZx5SaMrhOEHKv3RLAEiRgVd5L5KTlknqS9BbHMTX8nWeBAQTy0yOHCTvPIfPkX4zNtEvi7znR+2bEWlauXhrLq\/BAI=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_28' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_28' id='gform_target_page_number_28' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_28' id='gform_source_page_number_28' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div>\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_28' id='gform_ajax_frame_28' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n\t\t                <script>\ngform.initializeOnLoaded( function() {jQuery('#gform_ajax_frame_28').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_28');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_28').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){form_content.find('form').css('opacity', 0);jQuery('#gform_wrapper_28').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_28').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_28').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_28').offset().top - mt); }, 50 );var current_page = jQuery('#gform_source_page_number_28').val();jQuery(document).trigger('gform_page_loaded', [28, current_page]);window['gf_submitting_28'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_28').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_28').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [28]);window['gf_submitting_28'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_28').text());}else{jQuery('#gform_28').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"28\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);        if (event && event.defaultPrevented) {                return;        }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_28\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_28\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_28\" );        let postRenderFired = false;        function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            gform.core.triggerPostRenderEvents( 28, current_page );            if ( visibilityTestDiv ) {                visibilityTestDiv.parentNode.removeChild( visibilityTestDiv );            }        }        function debounce( func, wait, immediate ) {            var timeout;            return function() {                var context = this, args = arguments;                var later = function() {                    timeout = null;                    if ( !immediate ) func.apply( context, args );                };                var callNow = immediate && !timeout;                clearTimeout( timeout );                timeout = setTimeout( later, wait );                if ( callNow ) func.apply( context, args );            };        }        const debouncedTriggerPostRender = debounce( function() {            triggerPostRender();        }, 200 );        if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) {            const observer = new MutationObserver( ( mutations ) => {                mutations.forEach( ( mutation ) => {                    if ( mutation.type === 'attributes' && visibilityTestDiv.offsetParent !== null ) {                        debouncedTriggerPostRender();                        observer.disconnect();                    }                });            });            observer.observe( document.body, {                attributes: true,                childList: false,                subtree: true,                attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} );\n<\/script>\n","protected":false},"excerpt":{"rendered":"<p>If you suspect your child has a disability, complete the form below.&nbsp; Once received, our office will contact you in 2 to 3 weeks to obtain more detailed information and\/or schedule an assessment.&nbsp; If you don&#8217;t receive a call back, please contact us directly (385-646-7647). Please check this&nbsp; Boundary Lookup to determine which elementary school [&hellip;]<\/p>\n","protected":false},"author":23,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"inline_featured_image":false,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","_gsd_hide_title":false,"footnotes":"","_members_access_role":[],"_members_access_error":""},"class_list":["post-485","page","type-page","status-publish","entry"],"featured_image_src":null,"featured_image_src_square":null,"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.graniteschools.org\/preschool\/wp-json\/wp\/v2\/pages\/485","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.graniteschools.org\/preschool\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.graniteschools.org\/preschool\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.graniteschools.org\/preschool\/wp-json\/wp\/v2\/users\/23"}],"replies":[{"embeddable":true,"href":"https:\/\/www.graniteschools.org\/preschool\/wp-json\/wp\/v2\/comments?post=485"}],"version-history":[{"count":9,"href":"https:\/\/www.graniteschools.org\/preschool\/wp-json\/wp\/v2\/pages\/485\/revisions"}],"predecessor-version":[{"id":2317,"href":"https:\/\/www.graniteschools.org\/preschool\/wp-json\/wp\/v2\/pages\/485\/revisions\/2317"}],"wp:attachment":[{"href":"https:\/\/www.graniteschools.org\/preschool\/wp-json\/wp\/v2\/media?parent=485"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}