{"id":860,"date":"2019-07-23T13:26:49","date_gmt":"2019-07-23T13:26:49","guid":{"rendered":"http:\/\/box5866.temp.domains\/~handshol\/?page_id=860"},"modified":"2026-06-25T13:00:33","modified_gmt":"2026-06-25T13:00:33","slug":"camp-healing-hearts","status":"publish","type":"page","link":"https:\/\/handsholdinghearts.org\/staging\/6443\/camp-healing-hearts\/","title":{"rendered":"Camp Healing Hearts | Hands Holding Hearts"},"content":{"rendered":"[vc_row type=&#8221;full_width_background&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; bg_color=&#8221;#0e5e86&#8243; scene_position=&#8221;center&#8221; top_padding=&#8221;80&#8243; bottom_padding=&#8221;80&#8243; text_color=&#8221;light&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; row_position_desktop=&#8221;default&#8221; row_position_tablet=&#8221;inherit&#8221; row_position_phone=&#8221;inherit&#8221; overflow=&#8221;visible&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221; el_class=&#8221;hhh-camp-hero&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; flex_gap_desktop=&#8221;10px&#8221; column_element_direction_desktop=&#8221;default&#8221; column_element_spacing=&#8221;default&#8221; desktop_text_alignment=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_backdrop_filter=&#8221;none&#8221; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; column_position=&#8221;default&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; animation_type=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][vc_column_text css=&#8221;&#8221; text_direction=&#8221;default&#8221;]\n<div style=\"display: flex; flex-wrap: wrap; gap: 40px; align-items: center; max-width: 1140px; margin: 0 auto;\">\n<div style=\"flex: 1 1 340px; min-width: 300px;\">\n<p style=\"text-transform: uppercase; letter-spacing: .14em; font-size: .85rem; font-weight: bold; color: #cfe6f2; margin: 0 0 .6em;\">A Summer Bereavement Camp for Children Ages 6\u201312<\/p>\n<h1 style=\"font-family: Georgia,serif; color: #fff; font-size: clamp(2rem,4vw,3rem); line-height: 1.15; margin: 0 0 .5em;\">Camp Healing Hearts<\/h1>\n<p style=\"font-size: 1.15rem; line-height: 1.7; color: #eaf4fa; margin: 0 0 1.4em; max-width: 560px;\">A warm, welcoming place where grieving children make friends, have fun, and gently learn to carry their feelings after the death of someone they love. Three caring days \u2014 crafts, therapy dogs, gentle activities, and a lot of heart.<\/p>\n<p style=\"margin: 0;\"><a style=\"display: inline-block; background: #E01C53; color: #fff; text-decoration: none; padding: 14px 28px; border-radius: 8px; font-weight: bold; margin: 0 12px 12px 0;\" href=\"#hhh-apply\">Apply for Camp<\/a><a style=\"display: inline-block; background: rgba(255,255,255,.12); color: #fff; text-decoration: none; padding: 14px 28px; border-radius: 8px; font-weight: bold; border: 1px solid rgba(255,255,255,.45);\" href=\"#camp-details\">See Dates &amp; Details<\/a><\/p>\n<\/div>\n<div style=\"flex: 1 1 320px; min-width: 280px;\"><img decoding=\"async\" style=\"width: 100%; height: auto; border-radius: 18px; box-shadow: 0 20px 50px -20px rgba(0,0,0,.55); display: block;\" src=\"https:\/\/handsholdinghearts.org\/staging\/6443\/wp-content\/uploads\/2026\/06\/IMG_0018-scaled.jpg\" alt=\"Smiling girl holding her decorated Camp Feeling Better bag\" \/><\/div>\n<\/div>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; row_position_desktop=&#8221;default&#8221; row_position_tablet=&#8221;inherit&#8221; row_position_phone=&#8221;inherit&#8221; overflow=&#8221;visible&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; flex_gap_desktop=&#8221;10px&#8221; column_element_direction_desktop=&#8221;default&#8221; column_element_spacing=&#8221;default&#8221; desktop_text_alignment=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_backdrop_filter=&#8221;none&#8221; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; column_position=&#8221;default&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; animation_type=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][vc_column_text]\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; bg_color=&#8221;#ffffff&#8221; scene_position=&#8221;center&#8221; top_padding=&#8221;70&#8243; bottom_padding=&#8221;55&#8243; text_color=&#8221;dark&#8221; text_align=&#8221;center&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; row_position_desktop=&#8221;default&#8221; row_position_tablet=&#8221;inherit&#8221; row_position_phone=&#8221;inherit&#8221; overflow=&#8221;visible&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221; el_class=&#8221;hhh-camp-intro&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; flex_gap_desktop=&#8221;10px&#8221; column_element_direction_desktop=&#8221;default&#8221; column_element_spacing=&#8221;default&#8221; desktop_text_alignment=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_backdrop_filter=&#8221;none&#8221; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; column_position=&#8221;default&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; animation_type=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][vc_column_text css=&#8221;&#8221; text_direction=&#8221;default&#8221;]\n<p style=\"text-transform: uppercase; letter-spacing: .12em; font-size: .8rem; font-weight: bold; color: #0e6fa3; margin: 0 0 .5em;\">You Are in the Right Place<\/p>\n<h2 style=\"font-family: Georgia,serif; color: #0e6fa3; font-size: 1.95rem; line-height: 1.2; margin: 0 0 .5em;\">A Gentle Space to Grieve, Play, and Heal<\/h2>\n<p style=\"font-size: 1.12rem; line-height: 1.75; max-width: 820px; margin: 0 auto; color: #444;\">Camp Healing Hearts is for children ages 6\u201312 who have experienced the death of a loved one. Through age-appropriate activities, art, and play, children learn that their feelings are normal, that they are not alone, and that there are healthy ways to remember the person they lost. Our caring counselors create a safe, confidential, and joyful environment \u2014 because healing and laughter belong together.<\/p>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; row_position_desktop=&#8221;default&#8221; row_position_tablet=&#8221;inherit&#8221; row_position_phone=&#8221;inherit&#8221; overflow=&#8221;visible&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; flex_gap_desktop=&#8221;10px&#8221; column_element_direction_desktop=&#8221;default&#8221; column_element_spacing=&#8221;default&#8221; desktop_text_alignment=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_backdrop_filter=&#8221;none&#8221; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; column_position=&#8221;default&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; animation_type=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][vc_column_text]\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; bg_color=&#8221;#eaf4fa&#8221; scene_position=&#8221;center&#8221; top_padding=&#8221;65&#8243; bottom_padding=&#8221;65&#8243; text_color=&#8221;dark&#8221; text_align=&#8221;center&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; row_position_desktop=&#8221;default&#8221; row_position_tablet=&#8221;inherit&#8221; row_position_phone=&#8221;inherit&#8221; overflow=&#8221;visible&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221; el_id=&#8221;camp-details&#8221; el_class=&#8221;hhh-camp-details&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; flex_gap_desktop=&#8221;10px&#8221; column_element_direction_desktop=&#8221;default&#8221; column_element_spacing=&#8221;default&#8221; desktop_text_alignment=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_backdrop_filter=&#8221;none&#8221; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; column_position=&#8221;default&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; animation_type=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][vc_column_text]\n<p style=\"text-transform: uppercase; letter-spacing: .12em; font-size: .8rem; font-weight: bold; color: #0e6fa3; margin: 0 0 .5em;\"><span id=\"camp-details\" style=\"scroll-margin-top: 120px;\">2026 Camp<\/span><\/p>\n<h2 style=\"font-family: Georgia,serif; color: #0e6fa3; font-size: 1.95rem; line-height: 1.2; margin: 0 0 .4em;\">Dates, Location &amp; Cost<\/h2>\n<p style=\"font-size: 1.1rem; line-height: 1.7; max-width: 760px; margin: 0 auto 6px; color: #444;\">Everything you need to plan ahead. Pre-registration is required, and space is limited.<\/p>\n<div style=\"display: flex; flex-wrap: wrap; gap: 24px; justify-content: center; max-width: 1120px; margin: 28px auto 0;\">\n<div style=\"flex: 1 1 280px; max-width: 340px; background: #fff; border: 1px solid #d8e6ef; border-radius: 16px; padding: 30px 24px; box-shadow: 0 10px 30px -20px rgba(18,136,201,.45); text-align: center;\">\n<h3 style=\"font-family: Georgia,serif; color: #0e6fa3; font-size: 1.25rem; margin: 14px 0 8px;\">When<\/h3>\n<p style=\"color: #444; line-height: 1.6; margin: 0;\"><strong>July 10\u201312, 2026<\/strong><br \/>\nFri Jul 10: 6\u20137 PM (orientation)<br \/>\nSat &amp; Sun, Jul 11\u201312: 9 AM\u201312 PM<\/p>\n<\/div>\n<div style=\"flex: 1 1 280px; max-width: 340px; background: #fff; border: 1px solid #d8e6ef; border-radius: 16px; padding: 30px 24px; box-shadow: 0 10px 30px -20px rgba(18,136,201,.45); text-align: center;\">\n<h3 style=\"font-family: Georgia,serif; color: #0e6fa3; font-size: 1.25rem; margin: 14px 0 8px;\">Where<\/h3>\n<p style=\"color: #444; line-height: 1.6; margin: 0;\"><strong>Friends Home &amp; Village<\/strong><br \/>\n331 Lower Dolington Rd<br \/>\nNewtown, PA 18940<\/p>\n<\/div>\n<div style=\"flex: 1 1 280px; max-width: 340px; background: #fff; border: 1px solid #d8e6ef; border-radius: 16px; padding: 30px 24px; box-shadow: 0 10px 30px -20px rgba(18,136,201,.45); text-align: center;\">\n<h3 style=\"font-family: Georgia,serif; color: #0e6fa3; font-size: 1.25rem; margin: 14px 0 8px;\">Cost<\/h3>\n<p style=\"color: #444; line-height: 1.6; margin: 0;\"><strong>$25 per child<\/strong><br \/>\nFinancial aid is available for families who qualify \u2014 cost is never a barrier.<\/p>\n<\/div>\n<\/div>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; row_position_desktop=&#8221;default&#8221; row_position_tablet=&#8221;inherit&#8221; row_position_phone=&#8221;inherit&#8221; overflow=&#8221;visible&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; flex_gap_desktop=&#8221;10px&#8221; column_element_direction_desktop=&#8221;default&#8221; column_element_spacing=&#8221;default&#8221; desktop_text_alignment=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_backdrop_filter=&#8221;none&#8221; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; column_position=&#8221;default&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; animation_type=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][vc_column_text]\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; bg_color=&#8221;#ffffff&#8221; scene_position=&#8221;center&#8221; top_padding=&#8221;70&#8243; bottom_padding=&#8221;62&#8243; text_color=&#8221;dark&#8221; text_align=&#8221;center&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; row_position_desktop=&#8221;default&#8221; row_position_tablet=&#8221;inherit&#8221; row_position_phone=&#8221;inherit&#8221; overflow=&#8221;visible&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221; el_class=&#8221;hhh-camp-gallery&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; flex_gap_desktop=&#8221;10px&#8221; column_element_direction_desktop=&#8221;default&#8221; column_element_spacing=&#8221;default&#8221; desktop_text_alignment=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_backdrop_filter=&#8221;none&#8221; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; column_position=&#8221;default&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; animation_type=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][vc_column_text]\n<div style=\"text-align: center; max-width: 820px; margin: 0 auto;\">\n<p style=\"text-transform: uppercase; letter-spacing: .14em; font-size: .78rem; font-weight: bold; color: #0e6fa3; margin: 0 0 .5em;\">A Day at Camp<\/p>\n<h2 style=\"font-family: Georgia,serif; color: #0e6fa3; font-size: 1.95rem; line-height: 1.2; margin: 0 0 .45em;\">Crafts, Comfort &amp; Friendship<\/h2>\n<p style=\"font-size: 1.08rem; line-height: 1.7; color: #444; margin: 0;\">From memory crafts and painting to therapy dogs and gentle outdoor time, every activity helps children express what they feel and connect with others who understand.<\/p>\n<\/div>\n<div class=\"hhh-mgal\"><img decoding=\"async\" src=\"https:\/\/handsholdinghearts.org\/staging\/6443\/wp-content\/uploads\/2026\/06\/hhh-camp-2018-two-boys-smiling.webp\" alt=\"Two smiling boys at Hands Holding Hearts camp\" \/><img decoding=\"async\" src=\"https:\/\/handsholdinghearts.org\/staging\/6443\/wp-content\/uploads\/2026\/06\/hhh-camp-feeling-better-bag-decorating.webp\" alt=\"A child decorating a Camp Feeling Better tote bag\" \/><img decoding=\"async\" src=\"https:\/\/handsholdinghearts.org\/staging\/6443\/wp-content\/uploads\/2026\/06\/hhh-camp-craft-painting.webp\" alt=\"A girl painting at a camp craft table\" \/><img decoding=\"async\" src=\"https:\/\/handsholdinghearts.org\/staging\/6443\/wp-content\/uploads\/2026\/06\/hhh-caregiver-resources-71.webp\" alt=\"A smiling girl hugging a therapy dog at camp\" \/><img decoding=\"async\" src=\"https:\/\/handsholdinghearts.org\/staging\/6443\/wp-content\/uploads\/2026\/06\/hhh-camp-2018-children-with-pony.webp\" alt=\"Children meeting a pony during a camp activity\" \/><img decoding=\"async\" src=\"https:\/\/handsholdinghearts.org\/staging\/6443\/wp-content\/uploads\/2026\/06\/hhh-camp-children-gardening.webp\" alt=\"Children planting in a garden during a camp activity\" \/><img decoding=\"async\" src=\"https:\/\/handsholdinghearts.org\/staging\/6443\/wp-content\/uploads\/2026\/06\/hhh-caregiver-resources-77.webp\" alt=\"A volunteer helping a child with a craft project at camp\" \/><img decoding=\"async\" src=\"https:\/\/handsholdinghearts.org\/staging\/6443\/wp-content\/uploads\/2026\/06\/hhh-camp-2018-group-photo.webp\" alt=\"Campers gathered together at Hands Holding Hearts camp\" \/><\/div>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; row_position_desktop=&#8221;default&#8221; row_position_tablet=&#8221;inherit&#8221; row_position_phone=&#8221;inherit&#8221; overflow=&#8221;visible&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; flex_gap_desktop=&#8221;10px&#8221; column_element_direction_desktop=&#8221;default&#8221; column_element_spacing=&#8221;default&#8221; desktop_text_alignment=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_backdrop_filter=&#8221;none&#8221; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; column_position=&#8221;default&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; animation_type=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][vc_column_text]\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; bg_color=&#8221;#f6f8fa&#8221; scene_position=&#8221;center&#8221; top_padding=&#8221;70&#8243; bottom_padding=&#8221;70&#8243; text_color=&#8221;dark&#8221; text_align=&#8221;center&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; row_position_desktop=&#8221;default&#8221; row_position_tablet=&#8221;inherit&#8221; row_position_phone=&#8221;inherit&#8221; overflow=&#8221;visible&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221; el_class=&#8221;hhh-camp-steps&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; flex_gap_desktop=&#8221;10px&#8221; column_element_direction_desktop=&#8221;default&#8221; column_element_spacing=&#8221;default&#8221; desktop_text_alignment=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_backdrop_filter=&#8221;none&#8221; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; column_position=&#8221;default&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; animation_type=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][vc_column_text]\n<p style=\"text-transform: uppercase; letter-spacing: .12em; font-size: .8rem; font-weight: bold; color: #0e6fa3; margin: 0 0 .5em;\">How It Works<\/p>\n<h2 style=\"font-family: Georgia,serif; color: #0e6fa3; font-size: 1.95rem; line-height: 1.2; margin: 0 0 .4em;\">Three Simple Steps to Enroll<\/h2>\n<p style=\"font-size: 1.1rem; line-height: 1.7; max-width: 800px; margin: 0 auto; color: #444;\">Campers are accepted on a first-come, first-served basis after a brief screening interview confirms each child is emotionally ready. Priority is given to children who have not yet attended one of our camps.<\/p>\n<div style=\"display: flex; flex-wrap: wrap; gap: 24px; justify-content: center; max-width: 1120px; margin: 28px auto 0;\">\n<div style=\"flex: 1 1 300px; max-width: 340px; background: #fff; border: 1px solid #e4eaf0; border-radius: 16px; padding: 30px 24px; box-shadow: 0 10px 30px -20px rgba(18,136,201,.45); text-align: center; display: flex; flex-direction: column;\">\n<div style=\"width: 46px; height: 46px; border-radius: 50%; background: #0E6FA3; color: #fff; font-weight: bold; font-size: 1.25rem; line-height: 46px; margin: 0 auto 14px;\">1<\/div>\n<h3 style=\"font-family: Georgia,serif; color: #0e6fa3; font-size: 1.2rem; margin: 0 0 8px;\">Complete the Forms<\/h3>\n<p style=\"color: #444; line-height: 1.6; margin: 0; flex: 1;\">Complete the camp application and the release form online below. It helps us understand your family\u2019s story and how best to support your child.<\/p>\n<\/div>\n<div style=\"flex: 1 1 300px; max-width: 340px; background: #fff; border: 1px solid #e4eaf0; border-radius: 16px; padding: 30px 24px; box-shadow: 0 10px 30px -20px rgba(18,136,201,.45); text-align: center; display: flex; flex-direction: column;\">\n<div style=\"width: 46px; height: 46px; border-radius: 50%; background: #22A94B; color: #fff; font-weight: bold; font-size: 1.25rem; line-height: 46px; margin: 0 auto 14px;\">2<\/div>\n<h3 style=\"font-family: Georgia,serif; color: #0e6fa3; font-size: 1.2rem; margin: 0 0 8px;\">Return &amp; Screening<\/h3>\n<p style=\"color: #444; line-height: 1.6; margin: 0; flex: 1;\">Return your application by email or mail. We\u2019ll reach out to schedule a short, caring screening interview to make sure camp is the right fit right now.<\/p>\n<\/div>\n<div style=\"flex: 1 1 300px; max-width: 340px; background: #fff; border: 1px solid #e4eaf0; border-radius: 16px; padding: 30px 24px; box-shadow: 0 10px 30px -20px rgba(18,136,201,.45); text-align: center; display: flex; flex-direction: column;\">\n<div style=\"width: 46px; height: 46px; border-radius: 50%; background: #E01C53; color: #fff; font-weight: bold; font-size: 1.25rem; line-height: 46px; margin: 0 auto 14px;\">3<\/div>\n<h3 style=\"font-family: Georgia,serif; color: #0e6fa3; font-size: 1.2rem; margin: 0 0 8px;\">Confirm &amp; Attend<\/h3>\n<p style=\"color: #444; line-height: 1.6; margin: 0; flex: 1;\">Once a spot is confirmed, you\u2019ll receive everything you need for the big days. Then come ready for crafts, friendship, and gentle healing.<\/p>\n<\/div>\n<\/div>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; row_position_desktop=&#8221;default&#8221; row_position_tablet=&#8221;inherit&#8221; row_position_phone=&#8221;inherit&#8221; overflow=&#8221;visible&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; flex_gap_desktop=&#8221;10px&#8221; column_element_direction_desktop=&#8221;default&#8221; column_element_spacing=&#8221;default&#8221; desktop_text_alignment=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_backdrop_filter=&#8221;none&#8221; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; column_position=&#8221;default&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; animation_type=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][vc_column_text]\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; scene_position=&#8221;center&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; overflow=&#8221;visible&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_position=&#8221;all&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_shadow=&#8221;none&#8221; width=&#8221;1\/1&#8243; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][vc_column_text]\n<div id=\"hhh-apply\">\n<style>#hhh-apply{max-width:1180px;margin:14px auto;background:#eef6fb;border-radius:22px;padding:50px 26px}#hhh-apply .hhh-apply-head{max-width:760px;margin:0 auto 8px;text-align:center}#hhh-apply .hhh-eyebrow{text-transform:uppercase;letter-spacing:.12em;font-size:.8rem;font-weight:bold;color:#1288c9;margin:0 0 .5em}#hhh-apply .hhh-apply-head h2{font-family:Georgia,serif;color:#0e6fa3;font-size:2rem;line-height:1.2;margin:0 0 .4em}#hhh-apply .hhh-apply-head p{color:#5b6b78;line-height:1.7;margin:0}#hhh-apply .hhh-tabin{position:absolute;width:1px;height:1px;opacity:0;pointer-events:none}#hhh-apply .hhh-tabs{display:flex;gap:12px;justify-content:center;max-width:880px;margin:24px auto 0;flex-wrap:wrap}#hhh-apply .hhh-tab{display:inline-flex;align-items:center;gap:10px;cursor:pointer;background:#fff;border:2px solid #d8e6ef;color:#0e6fa3;font-weight:600;font-size:1.05rem;padding:13px 26px;border-radius:999px;transition:all .15s;user-select:none}#hhh-apply .hhh-tab:hover{border-color:#1288c9}#hhh-apply .hhh-tabnum{display:inline-flex;align-items:center;justify-content:center;width:26px;height:26px;border-radius:50%;background:#eaf4fa;color:#0e6fa3;font-size:.95rem;font-weight:700}#hhh-apply .hhh-panel{display:none}#hhh-apply>p:has(#hhhtab1:checked)~.hhh-panel1{display:block}#hhh-apply>p:has(#hhhtab2:checked)~.hhh-panel2{display:block}#hhh-apply>p:has(#hhhtab1:checked)~.hhh-tabs .hhh-tab1,#hhh-apply>p:has(#hhhtab2:checked)~.hhh-tabs .hhh-tab2{background:#0e6fa3;border-color:#0e6fa3;color:#fff}#hhh-apply>p:has(#hhhtab1:checked)~.hhh-tabs .hhh-tab1 .hhh-tabnum,#hhh-apply>p:has(#hhhtab2:checked)~.hhh-tabs .hhh-tab2 .hhh-tabnum{background:rgba(255,255,255,.25);color:#fff}#hhh-apply .hhh-form-card{background:#fff;border:1px solid #e1ecf4;border-radius:18px;box-shadow:0 18px 44px -28px rgba(18,136,201,.5);padding:34px 30px;max-width:880px;margin:24px auto 0}#hhh-apply .hhh-form-card>h3{font-family:Georgia,serif;color:#0e6fa3;font-size:1.5rem;margin:0 0 .3em}#hhh-apply .hhh-form-card .hhh-sub{color:#5b6b78;line-height:1.7;margin:0 0 1.3em}#hhh-apply .hhh-next{margin:20px 0 0;text-align:center;color:#0e6fa3}#hhh-apply .wpforms-field-label{color:#0e6fa3;font-weight:600}#hhh-apply .wpforms-required-label{color:#e01c53}#hhh-apply input[type=text],#hhh-apply input[type=email],#hhh-apply input[type=tel],#hhh-apply input[type=number],#hhh-apply input[type=date],#hhh-apply input[type=url],#hhh-apply select,#hhh-apply textarea{width:100%;border:1px solid #d3e2ee;border-radius:10px;padding:12px 14px;font-size:1rem;background:#fbfdfe;box-sizing:border-box;transition:border-color .15s,box-shadow .15s}#hhh-apply input:focus,#hhh-apply select:focus,#hhh-apply textarea:focus{border-color:#1288c9;box-shadow:0 0 0 3px rgba(18,136,201,.15);outline:none}#hhh-apply .wpforms-field{margin-bottom:18px}#hhh-apply .wpforms-field-divider{border-top:1px dashed #cfe0ee;padding-top:14px;margin-top:6px}#hhh-apply .wpforms-field-divider h3{font-family:Georgia,serif;color:#073049;font-size:1.2rem;margin:0}#hhh-apply .wpforms-field-description{color:#7a8a96;font-size:.9rem}#hhh-apply button[type=submit]{background:#e01c53;color:#fff;border:none;border-radius:999px;padding:15px 42px;font-size:1.05rem;font-weight:600;cursor:pointer;transition:background .15s,transform .15s}#hhh-apply button[type=submit]:hover{background:#b81546;transform:translateY(-1px)}#hhh-apply .wpforms-confirmation-container-full{background:#eaf7ef;border:1px solid #bfe6cd;border-radius:12px;color:#1c6b3a;padding:18px}#hhh-apply .wpforms-image-choices-item label.wpforms-field-label-inline{display:inline-block !important;border:2px solid #d3e2ee !important;border-radius:10px !important;padding:8px 16px !important;background:#fff !important;color:#0e6fa3 !important;font-weight:600 !important;cursor:pointer;transition:all .12s}#hhh-apply .wpforms-image-choices-item input:checked + label.wpforms-field-label-inline,#hhh-apply .wpforms-image-choices-item label.wpforms-field-label-inline:has(input:checked){background:#0e6fa3 !important;border-color:#0e6fa3 !important;color:#fff !important;box-shadow:0 6px 16px -8px rgba(14,111,163,.6) !important}#hhh-apply .wpforms-image-choices-item input:checked + label .wpforms-image-choices-label,#hhh-apply .wpforms-image-choices-item label:has(input:checked) .wpforms-image-choices-label{color:#fff !important}#hhh-apply .wpforms-recaptcha-container{height:auto !important;min-height:78px !important;margin-bottom:14px !important;overflow:visible !important}#hhh-apply .wpforms-submit-container{clear:both !important}<\/style>\n<div class=\"hhh-apply-head\">\n<p class=\"hhh-eyebrow\">Apply Online<\/p>\n<h2>Two Forms to Complete<\/h2>\n<p>Enrolling takes two short forms, and <strong>both are required<\/strong>. Start with the camp application, then complete the release &amp; consent. Use the buttons below to switch between them.<\/p>\n<\/div>\n<p><input id=\"hhhtab1\" class=\"hhh-tabin\" checked=\"checked\" name=\"hhhtab\" type=\"radio\" \/><br \/>\n<input id=\"hhhtab2\" class=\"hhh-tabin\" name=\"hhhtab\" type=\"radio\" \/><\/p>\n<div class=\"hhh-tabs\"><label class=\"hhh-tab hhh-tab1\" for=\"hhhtab1\"><span class=\"hhh-tabnum\">1<\/span> Camp Application<\/label><label class=\"hhh-tab hhh-tab2\" for=\"hhhtab2\"><span class=\"hhh-tabnum\">2<\/span> Release &amp; Consent<\/label><\/div>\n<div class=\"hhh-panel hhh-panel1\">\n<div class=\"hhh-form-card\">\n<h3>Camp Healing Hearts Application<\/h3>\n<p class=\"hhh-sub\">Tell us about your child and your family\u2019s story so we can support them well. Everything you share stays confidential.<\/p>\n<style id=\"wpforms-css-vars-3252\">\n\t\t\t\t#wpforms-3252 {\n\t\t\t\t--wpforms-container-padding: 0px;\n--wpforms-container-border-width: 1px;\n--wpforms-container-border-radius: 3px;\n--wpforms-background-color: rgba(0, 0, 0, 0);\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-3252\"><form id=\"wpforms-form-3252\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"3252\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/staging\/6443\/wp-json\/wp\/v2\/pages\/860\" data-token=\"224d3ad9bcca1ddef1511a116d290850\" data-token-time=\"1782599109\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-3252-field_3-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"3\"><fieldset><legend class=\"wpforms-field-label\">Child&#039;s Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-3252-field_3\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][3][first]\" aria-errormessage=\"wpforms-3252-field_3-error\" required><label for=\"wpforms-3252-field_3\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-3252-field_3-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][3][last]\" aria-errormessage=\"wpforms-3252-field_3-last-error\" required><label for=\"wpforms-3252-field_3-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-3252-field_5-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_5\">Age <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-3252-field_5\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][5]\" step=\"any\" aria-errormessage=\"wpforms-3252-field_5-error\" required><\/div><div id=\"wpforms-3252-field_6-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_6\">Grade<\/label><input type=\"text\" id=\"wpforms-3252-field_6\" class=\"wpforms-field-small\" name=\"wpforms[fields][6]\" aria-errormessage=\"wpforms-3252-field_6-error\" ><\/div><div id=\"wpforms-3252-field_8-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_8\">Cultural or Ethnic Heritage<\/label><input type=\"text\" id=\"wpforms-3252-field_8\" class=\"wpforms-field-large\" name=\"wpforms[fields][8]\" aria-errormessage=\"wpforms-3252-field_8-error\" ><\/div><div id=\"wpforms-3252-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_9\">Sexual Identity<\/label><input type=\"text\" id=\"wpforms-3252-field_9\" class=\"wpforms-field-large\" name=\"wpforms[fields][9]\" aria-errormessage=\"wpforms-3252-field_9-error\" aria-describedby=\"wpforms-3252-field_9-description\" ><div id=\"wpforms-3252-field_9-description\" class=\"wpforms-field-description\">Optional. Share only if you would like us to be aware.<\/div><\/div><div id=\"wpforms-3252-field_15-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"15\"><fieldset><legend class=\"wpforms-field-label\">Parent \/ Guardian Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-3252-field_15\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][15][first]\" aria-errormessage=\"wpforms-3252-field_15-error\" required><label for=\"wpforms-3252-field_15\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-3252-field_15-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][15][last]\" aria-errormessage=\"wpforms-3252-field_15-last-error\" required><label for=\"wpforms-3252-field_15-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-3252-field_16-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_16\">Parent&#039;s Email Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-3252-field_16\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][16]\" spellcheck=\"false\" aria-errormessage=\"wpforms-3252-field_16-error\" required><\/div><div id=\"wpforms-3252-field_18-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_18\">Guidance Counselor<\/label><input type=\"text\" id=\"wpforms-3252-field_18\" class=\"wpforms-field-large\" name=\"wpforms[fields][18]\" aria-errormessage=\"wpforms-3252-field_18-error\" ><\/div><div id=\"wpforms-3252-field_19-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_19\">Name of School<\/label><input type=\"text\" id=\"wpforms-3252-field_19\" class=\"wpforms-field-large\" name=\"wpforms[fields][19]\" aria-errormessage=\"wpforms-3252-field_19-error\" ><\/div><div id=\"wpforms-3252-field_21-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_21\">Referred by<\/label><input type=\"text\" id=\"wpforms-3252-field_21\" class=\"wpforms-field-large\" name=\"wpforms[fields][21]\" aria-errormessage=\"wpforms-3252-field_21-error\" ><\/div><div id=\"wpforms-3252-field_23-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_23\">Age at Death<\/label><input type=\"text\" id=\"wpforms-3252-field_23\" class=\"wpforms-field-large\" name=\"wpforms[fields][23]\" aria-errormessage=\"wpforms-3252-field_23-error\" ><\/div><div id=\"wpforms-3252-field_25-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_25\">Who has died? (Name &amp; relationship) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-3252-field_25\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][25]\" aria-errormessage=\"wpforms-3252-field_25-error\" required><\/textarea><\/div><div id=\"wpforms-3252-field_26-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"26\"><fieldset><legend class=\"wpforms-field-label\">Did the child attend the funeral?<\/legend><ul id=\"wpforms-3252-field_26\" class=\"wpforms-image-choices wpforms-image-choices-modern\"><li class=\"choice-1 depth-1 wpforms-image-choices-item\"><input type=\"radio\" id=\"wpforms-3252-field_26_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][26]\" value=\"Yes\" aria-errormessage=\"wpforms-3252-field_26_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_26_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1 wpforms-image-choices-item\"><input type=\"radio\" id=\"wpforms-3252-field_26_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][26]\" value=\"No\" aria-errormessage=\"wpforms-3252-field_26_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_26_2\">No<\/label><\/li><li class=\"choice-3 depth-1 wpforms-image-choices-item\"><input type=\"radio\" id=\"wpforms-3252-field_26_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][26]\" value=\"Not applicable\" aria-errormessage=\"wpforms-3252-field_26_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_26_3\">Not applicable<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3252-field_27-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_27\">What have you told your child about what happens when\/after people die?<\/label><textarea id=\"wpforms-3252-field_27\" class=\"wpforms-field-large\" name=\"wpforms[fields][27]\" aria-errormessage=\"wpforms-3252-field_27-error\" ><\/textarea><\/div>\t\t<div id=\"wpforms-3252-field_63-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"63\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-3252-field_63\" >would present have<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-3252-field_63\" class=\"wpforms-field-medium\" name=\"wpforms[fields][63]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-3252-field_28-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_28\">Do you have specific spiritual or religious beliefs pertaining to death?<\/label><textarea id=\"wpforms-3252-field_28\" class=\"wpforms-field-large\" name=\"wpforms[fields][28]\" aria-errormessage=\"wpforms-3252-field_28-error\" ><\/textarea><\/div><div id=\"wpforms-3252-field_29-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_29\">Who is in your child&#039;s family? (Siblings? Both parents? Grandparents?)<\/label><textarea id=\"wpforms-3252-field_29\" class=\"wpforms-field-large\" name=\"wpforms[fields][29]\" aria-errormessage=\"wpforms-3252-field_29-error\" ><\/textarea><\/div><div id=\"wpforms-3252-field_30-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_30\">What support does your child have? (Family, friends, school, neighbors, pediatrician, spiritual)<\/label><textarea id=\"wpforms-3252-field_30\" class=\"wpforms-field-large\" name=\"wpforms[fields][30]\" aria-errormessage=\"wpforms-3252-field_30-error\" ><\/textarea><\/div><div id=\"wpforms-3252-field_31-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_31\">Is anyone significant (family \/ close friend) seriously ill?<\/label><textarea id=\"wpforms-3252-field_31\" class=\"wpforms-field-large\" name=\"wpforms[fields][31]\" aria-errormessage=\"wpforms-3252-field_31-error\" ><\/textarea><\/div><div id=\"wpforms-3252-field_32-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"32\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_32\">How would you describe your child (in one sentence) before the death?<\/label><textarea id=\"wpforms-3252-field_32\" class=\"wpforms-field-large\" name=\"wpforms[fields][32]\" aria-errormessage=\"wpforms-3252-field_32-error\" ><\/textarea><\/div><div id=\"wpforms-3252-field_33-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_33\">How would you describe your child now?<\/label><textarea id=\"wpforms-3252-field_33\" class=\"wpforms-field-large\" name=\"wpforms[fields][33]\" aria-errormessage=\"wpforms-3252-field_33-error\" ><\/textarea><\/div><div id=\"wpforms-3252-field_34-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_34\">What changes have you seen in your child \/ children since the death(s)?<\/label><textarea id=\"wpforms-3252-field_34\" class=\"wpforms-field-large\" name=\"wpforms[fields][34]\" aria-errormessage=\"wpforms-3252-field_34-error\" ><\/textarea><\/div><div id=\"wpforms-3252-field_35-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"35\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_35\">Are you and\/or your child in counseling or therapy? If yes, with whom? (include contact information)<\/label><textarea id=\"wpforms-3252-field_35\" class=\"wpforms-field-large\" name=\"wpforms[fields][35]\" aria-errormessage=\"wpforms-3252-field_35-error\" ><\/textarea><\/div><div id=\"wpforms-3252-field_36-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_36\">Are there problems that are of particular concern to you about your child?<\/label><textarea id=\"wpforms-3252-field_36\" class=\"wpforms-field-large\" name=\"wpforms[fields][36]\" aria-errormessage=\"wpforms-3252-field_36-error\" ><\/textarea><\/div><div id=\"wpforms-3252-field_37-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"37\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_37\">Please note specific concerns that you would like us to address during this session.<\/label><textarea id=\"wpforms-3252-field_37\" class=\"wpforms-field-large\" name=\"wpforms[fields][37]\" aria-errormessage=\"wpforms-3252-field_37-error\" ><\/textarea><\/div><div id=\"wpforms-3252-field_38-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"38\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_38\">How has your child coped in the past with difficult situations?<\/label><textarea id=\"wpforms-3252-field_38\" class=\"wpforms-field-large\" name=\"wpforms[fields][38]\" aria-errormessage=\"wpforms-3252-field_38-error\" ><\/textarea><\/div><div id=\"wpforms-3252-field_40-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"40\"><fieldset><legend class=\"wpforms-field-label\">Has your child \/ family experienced any of the following? (check all that apply)<\/legend><ul id=\"wpforms-3252-field_40\" class=\"wpforms-image-choices wpforms-image-choices-modern\"><li class=\"choice-1 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_40_1\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_40_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][40][]\" value=\"Divorce or separation\" aria-errormessage=\"wpforms-3252-field_40_1-error\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Divorce or separation<\/span><\/label><\/li><li class=\"choice-2 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_40_2\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_40_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][40][]\" value=\"Ended relationship(s)\" aria-errormessage=\"wpforms-3252-field_40_2-error\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Ended relationship(s)<\/span><\/label><\/li><li class=\"choice-3 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_40_3\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_40_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][40][]\" value=\"Moving to a new house or community\" aria-errormessage=\"wpforms-3252-field_40_3-error\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Moving to a new house or community<\/span><\/label><\/li><li class=\"choice-4 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_40_4\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_40_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][40][]\" value=\"Changing schools\" aria-errormessage=\"wpforms-3252-field_40_4-error\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Changing schools<\/span><\/label><\/li><li class=\"choice-5 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_40_5\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_40_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][40][]\" value=\"Friends moving away\" aria-errormessage=\"wpforms-3252-field_40_5-error\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Friends moving away<\/span><\/label><\/li><li class=\"choice-6 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_40_6\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_40_6\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][40][]\" value=\"Miscarriages \/ Stillbirths\" aria-errormessage=\"wpforms-3252-field_40_6-error\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Miscarriages \/ Stillbirths<\/span><\/label><\/li><li class=\"choice-7 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_40_7\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_40_7\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][40][]\" value=\"Other deaths\" aria-errormessage=\"wpforms-3252-field_40_7-error\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Other deaths<\/span><\/label><\/li><li class=\"choice-8 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_40_8\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_40_8\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][40][]\" value=\"Pet death\" aria-errormessage=\"wpforms-3252-field_40_8-error\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Pet death<\/span><\/label><\/li><li class=\"choice-9 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_40_9\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_40_9\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][40][]\" value=\"Parents changing jobs\" aria-errormessage=\"wpforms-3252-field_40_9-error\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Parents changing jobs<\/span><\/label><\/li><li class=\"choice-10 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_40_10\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_40_10\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][40][]\" value=\"Fire or theft loss\" aria-errormessage=\"wpforms-3252-field_40_10-error\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Fire or theft loss<\/span><\/label><\/li><li class=\"choice-11 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_40_11\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_40_11\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][40][]\" value=\"Other traumas\" aria-errormessage=\"wpforms-3252-field_40_11-error\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Other traumas<\/span><\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3252-field_41-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"41\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_41\">Please explain any items checked above, including approximate dates.<\/label><textarea id=\"wpforms-3252-field_41\" class=\"wpforms-field-large\" name=\"wpforms[fields][41]\" aria-errormessage=\"wpforms-3252-field_41-error\" ><\/textarea><\/div><div id=\"wpforms-3252-field_44-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"44\"><fieldset><legend class=\"wpforms-field-label\">School \u2014 present BEFORE the illness\/death (check all that apply)<\/legend><ul id=\"wpforms-3252-field_44\" class=\"wpforms-image-choices wpforms-image-choices-modern\"><li class=\"choice-1 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_44_1\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_44_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][44][]\" value=\"Getting homework done\" aria-errormessage=\"wpforms-3252-field_44_1-error\" aria-describedby=\"wpforms-3252-field_44-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Getting homework done<\/span><\/label><\/li><li class=\"choice-2 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_44_2\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_44_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][44][]\" value=\"Using bad language\" aria-errormessage=\"wpforms-3252-field_44_2-error\" aria-describedby=\"wpforms-3252-field_44-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Using bad language<\/span><\/label><\/li><li class=\"choice-3 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_44_3\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_44_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][44][]\" value=\"Disruptions in class\" aria-errormessage=\"wpforms-3252-field_44_3-error\" aria-describedby=\"wpforms-3252-field_44-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Disruptions in class<\/span><\/label><\/li><li class=\"choice-4 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_44_4\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_44_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][44][]\" value=\"Not getting along with classmates\" aria-errormessage=\"wpforms-3252-field_44_4-error\" aria-describedby=\"wpforms-3252-field_44-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Not getting along with classmates<\/span><\/label><\/li><li class=\"choice-5 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_44_5\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_44_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][44][]\" value=\"Not paying attention in class\" aria-errormessage=\"wpforms-3252-field_44_5-error\" aria-describedby=\"wpforms-3252-field_44-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Not paying attention in class<\/span><\/label><\/li><li class=\"choice-6 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_44_6\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_44_6\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][44][]\" value=\"Daydreaming\" aria-errormessage=\"wpforms-3252-field_44_6-error\" aria-describedby=\"wpforms-3252-field_44-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Daydreaming<\/span><\/label><\/li><li class=\"choice-7 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_44_7\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_44_7\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][44][]\" value=\"Cannot concentrate\" aria-errormessage=\"wpforms-3252-field_44_7-error\" aria-describedby=\"wpforms-3252-field_44-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Cannot concentrate<\/span><\/label><\/li><li class=\"choice-8 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_44_8\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_44_8\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][44][]\" value=\"Overly tired or sleepy\" aria-errormessage=\"wpforms-3252-field_44_8-error\" aria-describedby=\"wpforms-3252-field_44-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Overly tired or sleepy<\/span><\/label><\/li><li class=\"choice-9 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_44_9\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_44_9\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][44][]\" value=\"Dropping out of school\" aria-errormessage=\"wpforms-3252-field_44_9-error\" aria-describedby=\"wpforms-3252-field_44-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Dropping out of school<\/span><\/label><\/li><li class=\"choice-10 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_44_10\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_44_10\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][44][]\" value=\"Grades dropping\" aria-errormessage=\"wpforms-3252-field_44_10-error\" aria-describedby=\"wpforms-3252-field_44-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Grades dropping<\/span><\/label><\/li><li class=\"choice-11 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_44_11\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_44_11\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][44][]\" value=\"Skipping school\" aria-errormessage=\"wpforms-3252-field_44_11-error\" aria-describedby=\"wpforms-3252-field_44-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Skipping school<\/span><\/label><\/li><li class=\"choice-12 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_44_12\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_44_12\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][44][]\" value=\"Absence from school\" aria-errormessage=\"wpforms-3252-field_44_12-error\" aria-describedby=\"wpforms-3252-field_44-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Absence from school<\/span><\/label><\/li><li class=\"choice-13 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_44_13\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_44_13\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][44][]\" value=\"Other\" aria-errormessage=\"wpforms-3252-field_44_13-error\" aria-describedby=\"wpforms-3252-field_44-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Other<\/span><\/label><\/li><\/ul><div id=\"wpforms-3252-field_44-description\" class=\"wpforms-field-description\">Check all that apply.<\/div><\/fieldset><\/div><div id=\"wpforms-3252-field_45-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"45\"><fieldset><legend class=\"wpforms-field-label\">School \u2014 present AFTER the illness\/death (check all that apply)<\/legend><ul id=\"wpforms-3252-field_45\" class=\"wpforms-image-choices wpforms-image-choices-modern\"><li class=\"choice-1 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_45_1\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_45_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][45][]\" value=\"Getting homework done\" aria-errormessage=\"wpforms-3252-field_45_1-error\" aria-describedby=\"wpforms-3252-field_45-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Getting homework done<\/span><\/label><\/li><li class=\"choice-2 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_45_2\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_45_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][45][]\" value=\"Using bad language\" aria-errormessage=\"wpforms-3252-field_45_2-error\" aria-describedby=\"wpforms-3252-field_45-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Using bad language<\/span><\/label><\/li><li class=\"choice-3 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_45_3\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_45_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][45][]\" value=\"Disruptions in class\" aria-errormessage=\"wpforms-3252-field_45_3-error\" aria-describedby=\"wpforms-3252-field_45-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Disruptions in class<\/span><\/label><\/li><li class=\"choice-4 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_45_4\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_45_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][45][]\" value=\"Not getting along with classmates\" aria-errormessage=\"wpforms-3252-field_45_4-error\" aria-describedby=\"wpforms-3252-field_45-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Not getting along with classmates<\/span><\/label><\/li><li class=\"choice-5 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_45_5\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_45_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][45][]\" value=\"Not paying attention in class\" aria-errormessage=\"wpforms-3252-field_45_5-error\" aria-describedby=\"wpforms-3252-field_45-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Not paying attention in class<\/span><\/label><\/li><li class=\"choice-6 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_45_6\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_45_6\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][45][]\" value=\"Daydreaming\" aria-errormessage=\"wpforms-3252-field_45_6-error\" aria-describedby=\"wpforms-3252-field_45-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Daydreaming<\/span><\/label><\/li><li class=\"choice-7 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_45_7\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_45_7\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][45][]\" value=\"Cannot concentrate\" aria-errormessage=\"wpforms-3252-field_45_7-error\" aria-describedby=\"wpforms-3252-field_45-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Cannot concentrate<\/span><\/label><\/li><li class=\"choice-8 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_45_8\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_45_8\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][45][]\" value=\"Overly tired or sleepy\" aria-errormessage=\"wpforms-3252-field_45_8-error\" aria-describedby=\"wpforms-3252-field_45-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Overly tired or sleepy<\/span><\/label><\/li><li class=\"choice-9 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_45_9\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_45_9\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][45][]\" value=\"Dropping out of school\" aria-errormessage=\"wpforms-3252-field_45_9-error\" aria-describedby=\"wpforms-3252-field_45-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Dropping out of school<\/span><\/label><\/li><li class=\"choice-10 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_45_10\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_45_10\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][45][]\" value=\"Grades dropping\" aria-errormessage=\"wpforms-3252-field_45_10-error\" aria-describedby=\"wpforms-3252-field_45-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Grades dropping<\/span><\/label><\/li><li class=\"choice-11 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_45_11\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_45_11\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][45][]\" value=\"Skipping school\" aria-errormessage=\"wpforms-3252-field_45_11-error\" aria-describedby=\"wpforms-3252-field_45-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Skipping school<\/span><\/label><\/li><li class=\"choice-12 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_45_12\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_45_12\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][45][]\" value=\"Absence from school\" aria-errormessage=\"wpforms-3252-field_45_12-error\" aria-describedby=\"wpforms-3252-field_45-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Absence from school<\/span><\/label><\/li><li class=\"choice-13 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_45_13\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_45_13\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][45][]\" value=\"Other\" aria-errormessage=\"wpforms-3252-field_45_13-error\" aria-describedby=\"wpforms-3252-field_45-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Other<\/span><\/label><\/li><\/ul><div id=\"wpforms-3252-field_45-description\" class=\"wpforms-field-description\">Check all that apply.<\/div><\/fieldset><\/div><div id=\"wpforms-3252-field_46-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"46\"><fieldset><legend class=\"wpforms-field-label\">Friends \u2014 present BEFORE the illness\/death (check all that apply)<\/legend><ul id=\"wpforms-3252-field_46\" class=\"wpforms-image-choices wpforms-image-choices-modern\"><li class=\"choice-1 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_46_1\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_46_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][46][]\" value=\"Frequent fighting with them\" aria-errormessage=\"wpforms-3252-field_46_1-error\" aria-describedby=\"wpforms-3252-field_46-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Frequent fighting with them<\/span><\/label><\/li><li class=\"choice-2 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_46_2\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_46_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][46][]\" value=\"Lack of interest in friends\" aria-errormessage=\"wpforms-3252-field_46_2-error\" aria-describedby=\"wpforms-3252-field_46-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Lack of interest in friends<\/span><\/label><\/li><li class=\"choice-3 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_46_3\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_46_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][46][]\" value=\"Decrease in phone calls\" aria-errormessage=\"wpforms-3252-field_46_3-error\" aria-describedby=\"wpforms-3252-field_46-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Decrease in phone calls<\/span><\/label><\/li><li class=\"choice-4 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_46_4\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_46_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][46][]\" value=\"Giving away belongings\" aria-errormessage=\"wpforms-3252-field_46_4-error\" aria-describedby=\"wpforms-3252-field_46-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Giving away belongings<\/span><\/label><\/li><li class=\"choice-5 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_46_5\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_46_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][46][]\" value=\"Other\" aria-errormessage=\"wpforms-3252-field_46_5-error\" aria-describedby=\"wpforms-3252-field_46-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Other<\/span><\/label><\/li><\/ul><div id=\"wpforms-3252-field_46-description\" class=\"wpforms-field-description\">Check all that apply.<\/div><\/fieldset><\/div><div id=\"wpforms-3252-field_47-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"47\"><fieldset><legend class=\"wpforms-field-label\">Friends \u2014 present AFTER the illness\/death (check all that apply)<\/legend><ul id=\"wpforms-3252-field_47\" class=\"wpforms-image-choices wpforms-image-choices-modern\"><li class=\"choice-1 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_47_1\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_47_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][47][]\" value=\"Frequent fighting with them\" aria-errormessage=\"wpforms-3252-field_47_1-error\" aria-describedby=\"wpforms-3252-field_47-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Frequent fighting with them<\/span><\/label><\/li><li class=\"choice-2 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_47_2\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_47_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][47][]\" value=\"Lack of interest in friends\" aria-errormessage=\"wpforms-3252-field_47_2-error\" aria-describedby=\"wpforms-3252-field_47-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Lack of interest in friends<\/span><\/label><\/li><li class=\"choice-3 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_47_3\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_47_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][47][]\" value=\"Decrease in phone calls\" aria-errormessage=\"wpforms-3252-field_47_3-error\" aria-describedby=\"wpforms-3252-field_47-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Decrease in phone calls<\/span><\/label><\/li><li class=\"choice-4 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_47_4\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_47_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][47][]\" value=\"Giving away belongings\" aria-errormessage=\"wpforms-3252-field_47_4-error\" aria-describedby=\"wpforms-3252-field_47-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Giving away belongings<\/span><\/label><\/li><li class=\"choice-5 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_47_5\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_47_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][47][]\" value=\"Other\" aria-errormessage=\"wpforms-3252-field_47_5-error\" aria-describedby=\"wpforms-3252-field_47-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Other<\/span><\/label><\/li><\/ul><div id=\"wpforms-3252-field_47-description\" class=\"wpforms-field-description\">Check all that apply.<\/div><\/fieldset><\/div><div id=\"wpforms-3252-field_48-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"48\"><fieldset><legend class=\"wpforms-field-label\">Home \u2014 present BEFORE the illness\/death (check all that apply)<\/legend><ul id=\"wpforms-3252-field_48\" class=\"wpforms-image-choices wpforms-image-choices-modern\"><li class=\"choice-1 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_48_1\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_48_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][48][]\" value=\"Fighting with siblings\" aria-errormessage=\"wpforms-3252-field_48_1-error\" aria-describedby=\"wpforms-3252-field_48-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Fighting with siblings<\/span><\/label><\/li><li class=\"choice-2 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_48_2\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_48_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][48][]\" value=\"Disrespectful of parents\" aria-errormessage=\"wpforms-3252-field_48_2-error\" aria-describedby=\"wpforms-3252-field_48-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Disrespectful of parents<\/span><\/label><\/li><li class=\"choice-3 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_48_3\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_48_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][48][]\" value=\"Eating problems\" aria-errormessage=\"wpforms-3252-field_48_3-error\" aria-describedby=\"wpforms-3252-field_48-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Eating problems<\/span><\/label><\/li><li class=\"choice-4 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_48_4\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_48_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][48][]\" value=\"Sleeping problems\" aria-errormessage=\"wpforms-3252-field_48_4-error\" aria-describedby=\"wpforms-3252-field_48-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Sleeping problems<\/span><\/label><\/li><li class=\"choice-5 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_48_5\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_48_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][48][]\" value=\"Physical complaints\" aria-errormessage=\"wpforms-3252-field_48_5-error\" aria-describedby=\"wpforms-3252-field_48-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Physical complaints<\/span><\/label><\/li><li class=\"choice-6 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_48_6\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_48_6\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][48][]\" value=\"Withdrawal from activities\/friends\/parents\" aria-errormessage=\"wpforms-3252-field_48_6-error\" aria-describedby=\"wpforms-3252-field_48-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Withdrawal from activities\/friends\/parents<\/span><\/label><\/li><li class=\"choice-7 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_48_7\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_48_7\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][48][]\" value=\"Crying frequently\" aria-errormessage=\"wpforms-3252-field_48_7-error\" aria-describedby=\"wpforms-3252-field_48-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Crying frequently<\/span><\/label><\/li><li class=\"choice-8 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_48_8\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_48_8\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][48][]\" value=\"Feeling responsible for death \/ guilt\" aria-errormessage=\"wpforms-3252-field_48_8-error\" aria-describedby=\"wpforms-3252-field_48-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Feeling responsible for death \/ guilt<\/span><\/label><\/li><li class=\"choice-9 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_48_9\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_48_9\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][48][]\" value=\"Increased anger\" aria-errormessage=\"wpforms-3252-field_48_9-error\" aria-describedby=\"wpforms-3252-field_48-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Increased anger<\/span><\/label><\/li><li class=\"choice-10 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_48_10\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_48_10\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][48][]\" value=\"Looking sad\" aria-errormessage=\"wpforms-3252-field_48_10-error\" aria-describedby=\"wpforms-3252-field_48-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Looking sad<\/span><\/label><\/li><li class=\"choice-11 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_48_11\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_48_11\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][48][]\" value=\"Talking about dying \/ being with the deceased\" aria-errormessage=\"wpforms-3252-field_48_11-error\" aria-describedby=\"wpforms-3252-field_48-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Talking about dying \/ being with the deceased<\/span><\/label><\/li><li class=\"choice-12 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_48_12\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_48_12\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][48][]\" value=\"Refusing to talk about the deceased\" aria-errormessage=\"wpforms-3252-field_48_12-error\" aria-describedby=\"wpforms-3252-field_48-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Refusing to talk about the deceased<\/span><\/label><\/li><li class=\"choice-13 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_48_13\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_48_13\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][48][]\" value=\"Clinging behavior\" aria-errormessage=\"wpforms-3252-field_48_13-error\" aria-describedby=\"wpforms-3252-field_48-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Clinging behavior<\/span><\/label><\/li><li class=\"choice-14 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_48_14\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_48_14\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][48][]\" value=\"Bed wetting\" aria-errormessage=\"wpforms-3252-field_48_14-error\" aria-describedby=\"wpforms-3252-field_48-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Bed wetting<\/span><\/label><\/li><li class=\"choice-15 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_48_15\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_48_15\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][48][]\" value=\"Thumb sucking\" aria-errormessage=\"wpforms-3252-field_48_15-error\" aria-describedby=\"wpforms-3252-field_48-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Thumb sucking<\/span><\/label><\/li><li class=\"choice-16 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_48_16\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_48_16\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][48][]\" value=\"Baby talk\" aria-errormessage=\"wpforms-3252-field_48_16-error\" aria-describedby=\"wpforms-3252-field_48-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Baby talk<\/span><\/label><\/li><li class=\"choice-17 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_48_17\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_48_17\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][48][]\" value=\"Behavior &quot;too good&quot; \/ overachieving\" aria-errormessage=\"wpforms-3252-field_48_17-error\" aria-describedby=\"wpforms-3252-field_48-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Behavior \"too good\" \/ overachieving<\/span><\/label><\/li><li class=\"choice-18 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_48_18\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_48_18\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][48][]\" value=\"Other\" aria-errormessage=\"wpforms-3252-field_48_18-error\" aria-describedby=\"wpforms-3252-field_48-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Other<\/span><\/label><\/li><\/ul><div id=\"wpforms-3252-field_48-description\" class=\"wpforms-field-description\">Check all that apply.<\/div><\/fieldset><\/div><div id=\"wpforms-3252-field_49-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"49\"><fieldset><legend class=\"wpforms-field-label\">Home \u2014 present AFTER the illness\/death (check all that apply)<\/legend><ul id=\"wpforms-3252-field_49\" class=\"wpforms-image-choices wpforms-image-choices-modern\"><li class=\"choice-1 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_49_1\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_49_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][49][]\" value=\"Fighting with siblings\" aria-errormessage=\"wpforms-3252-field_49_1-error\" aria-describedby=\"wpforms-3252-field_49-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Fighting with siblings<\/span><\/label><\/li><li class=\"choice-2 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_49_2\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_49_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][49][]\" value=\"Disrespectful of parents\" aria-errormessage=\"wpforms-3252-field_49_2-error\" aria-describedby=\"wpforms-3252-field_49-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Disrespectful of parents<\/span><\/label><\/li><li class=\"choice-3 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_49_3\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_49_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][49][]\" value=\"Eating problems\" aria-errormessage=\"wpforms-3252-field_49_3-error\" aria-describedby=\"wpforms-3252-field_49-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Eating problems<\/span><\/label><\/li><li class=\"choice-4 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_49_4\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_49_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][49][]\" value=\"Sleeping problems\" aria-errormessage=\"wpforms-3252-field_49_4-error\" aria-describedby=\"wpforms-3252-field_49-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Sleeping problems<\/span><\/label><\/li><li class=\"choice-5 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_49_5\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_49_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][49][]\" value=\"Physical complaints\" aria-errormessage=\"wpforms-3252-field_49_5-error\" aria-describedby=\"wpforms-3252-field_49-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Physical complaints<\/span><\/label><\/li><li class=\"choice-6 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_49_6\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_49_6\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][49][]\" value=\"Withdrawal from activities\/friends\/parents\" aria-errormessage=\"wpforms-3252-field_49_6-error\" aria-describedby=\"wpforms-3252-field_49-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Withdrawal from activities\/friends\/parents<\/span><\/label><\/li><li class=\"choice-7 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_49_7\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_49_7\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][49][]\" value=\"Crying frequently\" aria-errormessage=\"wpforms-3252-field_49_7-error\" aria-describedby=\"wpforms-3252-field_49-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Crying frequently<\/span><\/label><\/li><li class=\"choice-8 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_49_8\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_49_8\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][49][]\" value=\"Feeling responsible for death \/ guilt\" aria-errormessage=\"wpforms-3252-field_49_8-error\" aria-describedby=\"wpforms-3252-field_49-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Feeling responsible for death \/ guilt<\/span><\/label><\/li><li class=\"choice-9 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_49_9\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_49_9\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][49][]\" value=\"Increased anger\" aria-errormessage=\"wpforms-3252-field_49_9-error\" aria-describedby=\"wpforms-3252-field_49-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Increased anger<\/span><\/label><\/li><li class=\"choice-10 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_49_10\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_49_10\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][49][]\" value=\"Looking sad\" aria-errormessage=\"wpforms-3252-field_49_10-error\" aria-describedby=\"wpforms-3252-field_49-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Looking sad<\/span><\/label><\/li><li class=\"choice-11 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_49_11\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_49_11\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][49][]\" value=\"Talking about dying \/ being with the deceased\" aria-errormessage=\"wpforms-3252-field_49_11-error\" aria-describedby=\"wpforms-3252-field_49-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Talking about dying \/ being with the deceased<\/span><\/label><\/li><li class=\"choice-12 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_49_12\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_49_12\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][49][]\" value=\"Refusing to talk about the deceased\" aria-errormessage=\"wpforms-3252-field_49_12-error\" aria-describedby=\"wpforms-3252-field_49-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Refusing to talk about the deceased<\/span><\/label><\/li><li class=\"choice-13 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_49_13\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_49_13\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][49][]\" value=\"Clinging behavior\" aria-errormessage=\"wpforms-3252-field_49_13-error\" aria-describedby=\"wpforms-3252-field_49-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Clinging behavior<\/span><\/label><\/li><li class=\"choice-14 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_49_14\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_49_14\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][49][]\" value=\"Bed wetting\" aria-errormessage=\"wpforms-3252-field_49_14-error\" aria-describedby=\"wpforms-3252-field_49-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Bed wetting<\/span><\/label><\/li><li class=\"choice-15 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_49_15\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_49_15\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][49][]\" value=\"Thumb sucking\" aria-errormessage=\"wpforms-3252-field_49_15-error\" aria-describedby=\"wpforms-3252-field_49-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Thumb sucking<\/span><\/label><\/li><li class=\"choice-16 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_49_16\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_49_16\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][49][]\" value=\"Baby talk\" aria-errormessage=\"wpforms-3252-field_49_16-error\" aria-describedby=\"wpforms-3252-field_49-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Baby talk<\/span><\/label><\/li><li class=\"choice-17 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_49_17\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_49_17\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][49][]\" value=\"Behavior &quot;too good&quot; \/ overachieving\" aria-errormessage=\"wpforms-3252-field_49_17-error\" aria-describedby=\"wpforms-3252-field_49-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Behavior \"too good\" \/ overachieving<\/span><\/label><\/li><li class=\"choice-18 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_49_18\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_49_18\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][49][]\" value=\"Other\" aria-errormessage=\"wpforms-3252-field_49_18-error\" aria-describedby=\"wpforms-3252-field_49-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Other<\/span><\/label><\/li><\/ul><div id=\"wpforms-3252-field_49-description\" class=\"wpforms-field-description\">Check all that apply.<\/div><\/fieldset><\/div><div id=\"wpforms-3252-field_50-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"50\"><fieldset><legend class=\"wpforms-field-label\">Dreams \u2014 present BEFORE the illness\/death (check all that apply)<\/legend><ul id=\"wpforms-3252-field_50\" class=\"wpforms-image-choices wpforms-image-choices-modern\"><li class=\"choice-1 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_50_1\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_50_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][50][]\" value=\"About the deceased\" aria-errormessage=\"wpforms-3252-field_50_1-error\" aria-describedby=\"wpforms-3252-field_50-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">About the deceased<\/span><\/label><\/li><li class=\"choice-2 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_50_2\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_50_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][50][]\" value=\"About death in general\" aria-errormessage=\"wpforms-3252-field_50_2-error\" aria-describedby=\"wpforms-3252-field_50-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">About death in general<\/span><\/label><\/li><li class=\"choice-3 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_50_3\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_50_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][50][]\" value=\"Recurring dreams\" aria-errormessage=\"wpforms-3252-field_50_3-error\" aria-describedby=\"wpforms-3252-field_50-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Recurring dreams<\/span><\/label><\/li><li class=\"choice-4 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_50_4\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_50_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][50][]\" value=\"Nightmares\" aria-errormessage=\"wpforms-3252-field_50_4-error\" aria-describedby=\"wpforms-3252-field_50-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Nightmares<\/span><\/label><\/li><li class=\"choice-5 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_50_5\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_50_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][50][]\" value=\"Other\" aria-errormessage=\"wpforms-3252-field_50_5-error\" aria-describedby=\"wpforms-3252-field_50-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Other<\/span><\/label><\/li><\/ul><div id=\"wpforms-3252-field_50-description\" class=\"wpforms-field-description\">Check all that apply.<\/div><\/fieldset><\/div><div id=\"wpforms-3252-field_51-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"51\"><fieldset><legend class=\"wpforms-field-label\">Dreams \u2014 present AFTER the illness\/death (check all that apply)<\/legend><ul id=\"wpforms-3252-field_51\" class=\"wpforms-image-choices wpforms-image-choices-modern\"><li class=\"choice-1 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_51_1\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_51_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][51][]\" value=\"About the deceased\" aria-errormessage=\"wpforms-3252-field_51_1-error\" aria-describedby=\"wpforms-3252-field_51-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">About the deceased<\/span><\/label><\/li><li class=\"choice-2 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_51_2\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_51_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][51][]\" value=\"About death in general\" aria-errormessage=\"wpforms-3252-field_51_2-error\" aria-describedby=\"wpforms-3252-field_51-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">About death in general<\/span><\/label><\/li><li class=\"choice-3 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_51_3\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_51_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][51][]\" value=\"Recurring dreams\" aria-errormessage=\"wpforms-3252-field_51_3-error\" aria-describedby=\"wpforms-3252-field_51-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Recurring dreams<\/span><\/label><\/li><li class=\"choice-4 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_51_4\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_51_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][51][]\" value=\"Nightmares\" aria-errormessage=\"wpforms-3252-field_51_4-error\" aria-describedby=\"wpforms-3252-field_51-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Nightmares<\/span><\/label><\/li><li class=\"choice-5 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_51_5\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_51_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][51][]\" value=\"Other\" aria-errormessage=\"wpforms-3252-field_51_5-error\" aria-describedby=\"wpforms-3252-field_51-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Other<\/span><\/label><\/li><\/ul><div id=\"wpforms-3252-field_51-description\" class=\"wpforms-field-description\">Check all that apply.<\/div><\/fieldset><\/div><div id=\"wpforms-3252-field_52-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"52\"><fieldset><legend class=\"wpforms-field-label\">Fears \u2014 present BEFORE the illness\/death (check all that apply)<\/legend><ul id=\"wpforms-3252-field_52\" class=\"wpforms-image-choices wpforms-image-choices-modern\"><li class=\"choice-1 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_52_1\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_52_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][52][]\" value=\"Of the dark\" aria-errormessage=\"wpforms-3252-field_52_1-error\" aria-describedby=\"wpforms-3252-field_52-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Of the dark<\/span><\/label><\/li><li class=\"choice-2 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_52_2\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_52_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][52][]\" value=\"Death\" aria-errormessage=\"wpforms-3252-field_52_2-error\" aria-describedby=\"wpforms-3252-field_52-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Death<\/span><\/label><\/li><li class=\"choice-3 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_52_3\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_52_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][52][]\" value=\"Other parent dying\" aria-errormessage=\"wpforms-3252-field_52_3-error\" aria-describedby=\"wpforms-3252-field_52-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Other parent dying<\/span><\/label><\/li><li class=\"choice-4 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_52_4\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_52_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][52][]\" value=\"Someone breaking in at night\" aria-errormessage=\"wpforms-3252-field_52_4-error\" aria-describedby=\"wpforms-3252-field_52-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Someone breaking in at night<\/span><\/label><\/li><li class=\"choice-5 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_52_5\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_52_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][52][]\" value=\"New experiences\" aria-errormessage=\"wpforms-3252-field_52_5-error\" aria-describedby=\"wpforms-3252-field_52-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">New experiences<\/span><\/label><\/li><li class=\"choice-6 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_52_6\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_52_6\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][52][]\" value=\"Loud noises\" aria-errormessage=\"wpforms-3252-field_52_6-error\" aria-describedby=\"wpforms-3252-field_52-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Loud noises<\/span><\/label><\/li><li class=\"choice-7 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_52_7\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_52_7\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][52][]\" value=\"Of going to sleep\" aria-errormessage=\"wpforms-3252-field_52_7-error\" aria-describedby=\"wpforms-3252-field_52-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Of going to sleep<\/span><\/label><\/li><li class=\"choice-8 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_52_8\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_52_8\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][52][]\" value=\"Being taken \/ kidnapped\" aria-errormessage=\"wpforms-3252-field_52_8-error\" aria-describedby=\"wpforms-3252-field_52-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Being taken \/ kidnapped<\/span><\/label><\/li><li class=\"choice-9 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_52_9\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_52_9\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][52][]\" value=\"Other\" aria-errormessage=\"wpforms-3252-field_52_9-error\" aria-describedby=\"wpforms-3252-field_52-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Other<\/span><\/label><\/li><\/ul><div id=\"wpforms-3252-field_52-description\" class=\"wpforms-field-description\">Check all that apply.<\/div><\/fieldset><\/div><div id=\"wpforms-3252-field_53-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"53\"><fieldset><legend class=\"wpforms-field-label\">Fears \u2014 present AFTER the illness\/death (check all that apply)<\/legend><ul id=\"wpforms-3252-field_53\" class=\"wpforms-image-choices wpforms-image-choices-modern\"><li class=\"choice-1 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_53_1\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_53_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][53][]\" value=\"Of the dark\" aria-errormessage=\"wpforms-3252-field_53_1-error\" aria-describedby=\"wpforms-3252-field_53-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Of the dark<\/span><\/label><\/li><li class=\"choice-2 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_53_2\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_53_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][53][]\" value=\"Death\" aria-errormessage=\"wpforms-3252-field_53_2-error\" aria-describedby=\"wpforms-3252-field_53-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Death<\/span><\/label><\/li><li class=\"choice-3 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_53_3\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_53_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][53][]\" value=\"Other parent dying\" aria-errormessage=\"wpforms-3252-field_53_3-error\" aria-describedby=\"wpforms-3252-field_53-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Other parent dying<\/span><\/label><\/li><li class=\"choice-4 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_53_4\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_53_4\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][53][]\" value=\"Someone breaking in at night\" aria-errormessage=\"wpforms-3252-field_53_4-error\" aria-describedby=\"wpforms-3252-field_53-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Someone breaking in at night<\/span><\/label><\/li><li class=\"choice-5 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_53_5\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_53_5\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][53][]\" value=\"New experiences\" aria-errormessage=\"wpforms-3252-field_53_5-error\" aria-describedby=\"wpforms-3252-field_53-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">New experiences<\/span><\/label><\/li><li class=\"choice-6 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_53_6\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_53_6\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][53][]\" value=\"Loud noises\" aria-errormessage=\"wpforms-3252-field_53_6-error\" aria-describedby=\"wpforms-3252-field_53-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Loud noises<\/span><\/label><\/li><li class=\"choice-7 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_53_7\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_53_7\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][53][]\" value=\"Of going to sleep\" aria-errormessage=\"wpforms-3252-field_53_7-error\" aria-describedby=\"wpforms-3252-field_53-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Of going to sleep<\/span><\/label><\/li><li class=\"choice-8 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_53_8\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_53_8\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][53][]\" value=\"Being taken \/ kidnapped\" aria-errormessage=\"wpforms-3252-field_53_8-error\" aria-describedby=\"wpforms-3252-field_53-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Being taken \/ kidnapped<\/span><\/label><\/li><li class=\"choice-9 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_53_9\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_53_9\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][53][]\" value=\"Other\" aria-errormessage=\"wpforms-3252-field_53_9-error\" aria-describedby=\"wpforms-3252-field_53-description\" tabindex=\"-1\"  ><span class=\"wpforms-image-choices-label\">Other<\/span><\/label><\/li><\/ul><div id=\"wpforms-3252-field_53-description\" class=\"wpforms-field-description\">Check all that apply.<\/div><\/fieldset><\/div><div id=\"wpforms-3252-field_54-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_54\">Any other areas of concern or notes<\/label><textarea id=\"wpforms-3252-field_54\" class=\"wpforms-field-large\" name=\"wpforms[fields][54]\" aria-errormessage=\"wpforms-3252-field_54-error\" ><\/textarea><\/div><div id=\"wpforms-3252-field_57-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"57\"><fieldset><legend class=\"wpforms-field-label\">Agreement <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-3252-field_57\" class=\"wpforms-field-required wpforms-image-choices wpforms-image-choices-modern\"><li class=\"choice-1 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_57_1\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3252-field_57_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][57][]\" value=\"I have read and agree to the Informed Consent, Release, and Indemnification Agreement above.\" aria-errormessage=\"wpforms-3252-field_57_1-error\" tabindex=\"-1\" required ><span class=\"wpforms-image-choices-label\">I have read and agree to the Informed Consent, Release, and Indemnification Agreement above.<\/span><\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3252-field_58-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"58\"><fieldset><legend class=\"wpforms-field-label\">Photo \/ Video Permission <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-3252-field_58\" class=\"wpforms-field-required wpforms-image-choices wpforms-image-choices-modern\"><li class=\"choice-1 depth-1 wpforms-image-choices-item\"><input type=\"radio\" id=\"wpforms-3252-field_58_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][58]\" value=\"I give permission for Hands Holding Hearts to photograph\/videotape my child for educational or promotional purposes.\" aria-errormessage=\"wpforms-3252-field_58_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_58_1\">I give permission for Hands Holding Hearts to photograph\/videotape my child for educational or promotional purposes.<\/label><\/li><li class=\"choice-2 depth-1 wpforms-image-choices-item\"><input type=\"radio\" id=\"wpforms-3252-field_58_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][58]\" value=\"I do NOT give permission for photos\/video of my child.\" aria-errormessage=\"wpforms-3252-field_58_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3252-field_58_2\">I do NOT give permission for photos\/video of my child.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3252-field_59-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"59\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_59\">Adult Signature (type your full name) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3252-field_59\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][59]\" aria-errormessage=\"wpforms-3252-field_59-error\" required><\/div><div id=\"wpforms-3252-field_60-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"60\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_60\">Relationship to child <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3252-field_60\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][60]\" aria-errormessage=\"wpforms-3252-field_60-error\" required><\/div><div id=\"wpforms-3252-field_61-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"61\"><label class=\"wpforms-field-label\" for=\"wpforms-3252-field_61\">Child&#039;s Signature (type name, if able)<\/label><input type=\"text\" id=\"wpforms-3252-field_61\" class=\"wpforms-field-large\" name=\"wpforms[fields][61]\" aria-errormessage=\"wpforms-3252-field_61-error\" ><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-3252-field_63-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-3252-field_63-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-3252-field_63-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-turnstile\" ><div class=\"wpforms-turnstile\" data-sitekey=\"0x4AAAAAADiDaGO5X3qu4P7q\" data-action=\"FormID-3252\"><\/div><input type=\"text\" name=\"g-recaptcha-hidden\" class=\"wpforms-recaptcha-hidden\" style=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\" data-rule-turnstile=\"1\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"3252\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/handsholdinghearts.org\/staging\/6443\/wp-json\/wp\/v2\/pages\/860\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-3252\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit Application\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit Application<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/handsholdinghearts.org\/staging\/6443\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n<p class=\"hhh-next\">Finished? Tap <strong>2 \u00b7 Release &amp; Consent<\/strong> above to complete the second form.<\/p>\n<\/div>\n<\/div>\n<div class=\"hhh-panel hhh-panel2\">\n<div class=\"hhh-form-card\">\n<h3>Release, Photo &amp; Confidentiality Agreement<\/h3>\n<p class=\"hhh-sub\">Please review and sign this before your child\u2019s first day of camp.<\/p>\n<style id=\"wpforms-css-vars-3256\">\n\t\t\t\t#wpforms-3256 {\n\t\t\t\t--wpforms-container-padding: 0px;\n--wpforms-container-border-width: 1px;\n--wpforms-container-border-radius: 3px;\n--wpforms-background-color: rgba(0, 0, 0, 0);\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-3256\"><form id=\"wpforms-form-3256\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"3256\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/staging\/6443\/wp-json\/wp\/v2\/pages\/860\" data-token=\"d22233e7a8c3ff68ec8dd6216970f17d\" data-token-time=\"1782599109\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-3256-field_6-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"6\"><fieldset><legend class=\"wpforms-field-label\">Photo \/ Website Release (you must choose one) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-3256-field_6\" class=\"wpforms-field-required wpforms-image-choices wpforms-image-choices-modern\"><li class=\"choice-1 depth-1 wpforms-image-choices-item\"><input type=\"radio\" id=\"wpforms-3256-field_6_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][6]\" value=\"I DO consent to the use of photographs and audio-visual materials as described above.\" aria-errormessage=\"wpforms-3256-field_6_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3256-field_6_1\">I DO consent to the use of photographs and audio-visual materials as described above.<\/label><\/li><li class=\"choice-2 depth-1 wpforms-image-choices-item\"><input type=\"radio\" id=\"wpforms-3256-field_6_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][6]\" value=\"I DO NOT consent to the use of photographs and audio-visual materials.\" aria-errormessage=\"wpforms-3256-field_6_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3256-field_6_2\">I DO NOT consent to the use of photographs and audio-visual materials.<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3256-field_10-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"10\"><fieldset><legend class=\"wpforms-field-label\">Acceptance <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-3256-field_10\" class=\"wpforms-field-required wpforms-image-choices wpforms-image-choices-modern\"><li class=\"choice-1 depth-1 wpforms-image-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-3256-field_10_1\" tabindex=\"0\"><span class=\"wpforms-image-choices-image\"><\/span><input type=\"checkbox\" id=\"wpforms-3256-field_10_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][10][]\" value=\"I have read and understood the Release and Hold Harmless Agreement, the Photo\/Website Release (and selected the appropriate option above), the Confidentiality Agreement, and the Policy Statements.\" aria-errormessage=\"wpforms-3256-field_10_1-error\" tabindex=\"-1\" required ><span class=\"wpforms-image-choices-label\">I have read and understood the Release and Hold Harmless Agreement, the Photo\/Website Release (and selected the appropriate option above), the Confidentiality Agreement, and the Policy Statements.<\/span><\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3256-field_11-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"11\"><fieldset><legend class=\"wpforms-field-label\">I am a: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-3256-field_11\" class=\"wpforms-field-required wpforms-image-choices wpforms-image-choices-modern\"><li class=\"choice-1 depth-1 wpforms-image-choices-item\"><input type=\"radio\" id=\"wpforms-3256-field_11_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][11]\" value=\"Participant\" aria-errormessage=\"wpforms-3256-field_11_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3256-field_11_1\">Participant<\/label><\/li><li class=\"choice-2 depth-1 wpforms-image-choices-item\"><input type=\"radio\" id=\"wpforms-3256-field_11_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][11]\" value=\"Chaperone\" aria-errormessage=\"wpforms-3256-field_11_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3256-field_11_2\">Chaperone<\/label><\/li><li class=\"choice-3 depth-1 wpforms-image-choices-item\"><input type=\"radio\" id=\"wpforms-3256-field_11_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][11]\" value=\"Visitor\" aria-errormessage=\"wpforms-3256-field_11_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3256-field_11_3\">Visitor<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3256-field_12-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"12\"><fieldset><legend class=\"wpforms-field-label\">Name (Print) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-3256-field_12\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][12][first]\" aria-errormessage=\"wpforms-3256-field_12-error\" required><label for=\"wpforms-3256-field_12\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-3256-field_12-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][12][last]\" aria-errormessage=\"wpforms-3256-field_12-last-error\" required><label for=\"wpforms-3256-field_12-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-3256-field_14-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-3256-field_14\">E-Mail <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-3256-field_14\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][14]\" spellcheck=\"false\" aria-errormessage=\"wpforms-3256-field_14-error\" required><\/div><div id=\"wpforms-3256-field_16-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-3256-field_16\">Emergency Contact <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3256-field_16\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][16]\" aria-errormessage=\"wpforms-3256-field_16-error\" required><\/div><div id=\"wpforms-3256-field_18-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-3256-field_18\">Special Medical Needs or Known Allergies<\/label><textarea id=\"wpforms-3256-field_18\" class=\"wpforms-field-large\" name=\"wpforms[fields][18]\" aria-errormessage=\"wpforms-3256-field_18-error\" aria-describedby=\"wpforms-3256-field_18-description\" ><\/textarea><div id=\"wpforms-3256-field_18-description\" class=\"wpforms-field-description\">Enter \"none\" if not applicable.<\/div><\/div><div id=\"wpforms-3256-field_20-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"20\"><fieldset><legend class=\"wpforms-field-label\">I am signing as: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-3256-field_20\" class=\"wpforms-field-required wpforms-image-choices wpforms-image-choices-modern\"><li class=\"choice-1 depth-1 wpforms-image-choices-item\"><input type=\"radio\" id=\"wpforms-3256-field_20_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][20]\" value=\"Parent of a minor participant\" aria-errormessage=\"wpforms-3256-field_20_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3256-field_20_1\">Parent of a minor participant<\/label><\/li><li class=\"choice-2 depth-1 wpforms-image-choices-item\"><input type=\"radio\" id=\"wpforms-3256-field_20_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][20]\" value=\"Guardian of a minor participant\" aria-errormessage=\"wpforms-3256-field_20_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3256-field_20_2\">Guardian of a minor participant<\/label><\/li><li class=\"choice-3 depth-1 wpforms-image-choices-item\"><input type=\"radio\" id=\"wpforms-3256-field_20_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][20]\" value=\"Participant (age 18 or older)\" aria-errormessage=\"wpforms-3256-field_20_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3256-field_20_3\">Participant (age 18 or older)<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3256-field_21-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-3256-field_21\">Signature (type your full name) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3256-field_21\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][21]\" aria-errormessage=\"wpforms-3256-field_21-error\" required><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-3252-field_63-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-3252-field_63-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-3252-field_63-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-turnstile\" ><div class=\"wpforms-turnstile\" data-sitekey=\"0x4AAAAAADiDaGO5X3qu4P7q\" data-action=\"FormID-3256\"><\/div><input type=\"text\" name=\"g-recaptcha-hidden\" class=\"wpforms-recaptcha-hidden\" style=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\" data-rule-turnstile=\"1\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"3256\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/handsholdinghearts.org\/staging\/6443\/wp-json\/wp\/v2\/pages\/860\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-3256\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit &amp; Sign\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit &amp; Sign<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/handsholdinghearts.org\/staging\/6443\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n<\/div>\n<\/div>\n<\/div>\n[\/vc_column_text][\/vc_column][\/vc_row]\n[vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; bg_color=&#8221;#FCEFF3&#8243; scene_position=&#8221;center&#8221; top_padding=&#8221;60&#8243; bottom_padding=&#8221;60&#8243; text_color=&#8221;dark&#8221; text_align=&#8221;center&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; row_position_desktop=&#8221;default&#8221; row_position_tablet=&#8221;inherit&#8221; row_position_phone=&#8221;inherit&#8221; overflow=&#8221;visible&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221; el_class=&#8221;hhh-camp-sponsor&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; flex_gap_desktop=&#8221;10px&#8221; column_element_direction_desktop=&#8221;default&#8221; column_element_spacing=&#8221;default&#8221; desktop_text_alignment=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_backdrop_filter=&#8221;none&#8221; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; column_position=&#8221;default&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; animation_type=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][vc_column_text]\n<div style=\"max-width: 780px; margin: 0 auto;\">\n<p style=\"text-transform: uppercase; letter-spacing: .12em; font-size: .8rem; font-weight: bold; color: #e01c53; margin: 0 0 .5em;\">Give the Gift of Healing<\/p>\n<h2 style=\"font-family: Georgia,serif; color: #0e6fa3; font-size: 1.7rem; line-height: 1.2; margin: 0 0 .4em;\">Sponsor a Camper<\/h2>\n<p style=\"font-size: 1.08rem; line-height: 1.75; color: #444; margin: 0 0 1.3em;\">Just <strong>$25 sends one grieving child to a day of Camp Feeling Better<\/strong>. Your gift makes sure that cost is never the reason a child misses the chance to heal, play, and feel understood.<\/p>\n<p style=\"margin: 0;\"><a style=\"display: inline-block; background: #E01C53; color: #fff; text-decoration: none; padding: 13px 28px; border-radius: 8px; font-weight: bold;\" href=\"\/staging\/6443\/donate\">Sponsor a Camper<\/a><\/p>\n<\/div>\n[\/vc_column_text][\/vc_column][\/vc_row]\n","protected":false},"excerpt":{"rendered":"<p>[vc_row type=&#8221;full_width_background&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; bg_color=&#8221;#0e5e86&#8243; scene_position=&#8221;center&#8221; top_padding=&#8221;80&#8243; bottom_padding=&#8221;80&#8243; text_color=&#8221;light&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; row_position_desktop=&#8221;default&#8221; 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