{"id":19,"date":"2025-09-17T20:09:15","date_gmt":"2025-09-17T20:09:15","guid":{"rendered":"https:\/\/taonline.org\/v3\/?page_id=19"},"modified":"2025-09-18T21:25:23","modified_gmt":"2025-09-18T21:25:23","slug":"vol-health-form","status":"publish","type":"page","link":"https:\/\/taonline.org\/v3\/vol-health-form\/","title":{"rendered":"Volunteer Health Form"},"content":{"rendered":"<style id=\"wpforms-css-vars-70-block-596b04a9-95a5-47aa-9060-95352fb74c74\">\n\t\t\t\t#wpforms-70.wpforms-block-596b04a9-95a5-47aa-9060-95352fb74c74 {\n\t\t\t\t--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-block wpforms-block-596b04a9-95a5-47aa-9060-95352fb74c74 wpforms-render-modern\" id=\"wpforms-70\"><form id=\"wpforms-form-70\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"70\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/v3\/wp-json\/wp\/v2\/pages\/19\" data-token=\"1c2ccc12390547586e079aee5e7423c8\" data-token-time=\"1776372341\"><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-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#066aab\" data-scroll=\"1\" role=\"progressbar\" aria-valuenow=\"1\" aria-valuemin=\"1\" aria-valuemax=\"3\" tabindex=\"-1\"><span class=\"wpforms-page-indicator-page-title\" data-page-1-title=\"Instructor \/ Volunteer Form\">Instructor \/ Volunteer Form<\/span><span class=\"wpforms-page-indicator-page-title-sep\" > &#8211; <\/span><span class=\"wpforms-page-indicator-steps\">Step <span class=\"wpforms-page-indicator-steps-current\">1<\/span> of 3<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:33.333333333333%;background-color:#066aab\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-70-field_66-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"66\"><\/div><div id=\"wpforms-70-field_19-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"19\"><div id=\"wpforms-70-field_19\" class=\"wpforms-field-large wpforms-field-row\" aria-errormessage=\"wpforms-70-field_19-error\"><h4>Therapeutic Adventures, Inc.<\/h4>\n<p class=\"p1\"><strong>CONFIDENTIALITY\/PRIVACY NOTICE<\/strong> &#8211; This document contains information that is confidential and\/or legally privileged. The contents provided are intended to provide registered Therapeutic Adventures &#8211; instructors\/adaptive guides with necessary information so that programs can be safely administered.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-70-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><fieldset><legend class=\"wpforms-field-label\">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-two-fifths\"><input type=\"text\" id=\"wpforms-70-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" aria-errormessage=\"wpforms-70-field_0-error\" required><label for=\"wpforms-70-field_0\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-fifth\"><input type=\"text\" id=\"wpforms-70-field_0-middle\" class=\"wpforms-field-name-middle\" name=\"wpforms[fields][0][middle]\" aria-errormessage=\"wpforms-70-field_0-middle-error\" ><label for=\"wpforms-70-field_0-middle\" class=\"wpforms-field-sublabel after\">Middle<\/label><\/div><div class=\"wpforms-field-row-block wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-70-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" aria-errormessage=\"wpforms-70-field_0-last-error\" required><label for=\"wpforms-70-field_0-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-70-field_21-container\" class=\"wpforms-field wpforms-field-divider wpforms-field-divider-hide_line\" data-field-id=\"21\"><h3 id=\"wpforms-70-field_21\" aria-errormessage=\"wpforms-70-field_21-error\">HEALTH \/ MEDICAL INFORMATION<\/h3><\/div><div id=\"wpforms-70-field_44-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-id=\"44\"><fieldset><legend class=\"wpforms-field-label\">Currently taking any medications? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-70-field_44\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_44_1\" name=\"wpforms[fields][44][]\" value=\"Yes\" aria-errormessage=\"wpforms-70-field_44_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_44_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_44_2\" name=\"wpforms[fields][44][]\" value=\"No\" aria-errormessage=\"wpforms-70-field_44_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_44_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-70-field_46-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"46\"><label class=\"wpforms-field-label\" for=\"wpforms-70-field_46\">If YES, please list all, including over-the-counter medications:<\/label><textarea id=\"wpforms-70-field_46\" class=\"wpforms-field-medium\" name=\"wpforms[fields][46]\" aria-errormessage=\"wpforms-70-field_46-error\" ><\/textarea><\/div><div id=\"wpforms-70-field_45-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-id=\"45\"><fieldset><legend class=\"wpforms-field-label\">Have you had surgery in the last 6 months? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-70-field_45\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_45_1\" name=\"wpforms[fields][45][]\" value=\"Yes\" aria-errormessage=\"wpforms-70-field_45_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_45_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_45_2\" name=\"wpforms[fields][45][]\" value=\"No\" aria-errormessage=\"wpforms-70-field_45_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_45_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-70-field_47-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"47\"><label class=\"wpforms-field-label\" for=\"wpforms-70-field_47\">If YES, please describe.<\/label><textarea id=\"wpforms-70-field_47\" class=\"wpforms-field-medium\" name=\"wpforms[fields][47]\" aria-errormessage=\"wpforms-70-field_47-error\" ><\/textarea><\/div><div id=\"wpforms-70-field_48-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-id=\"48\"><fieldset><legend class=\"wpforms-field-label\">Have you ever had a serious disease? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-70-field_48\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_48_1\" name=\"wpforms[fields][48][]\" value=\"Yes\" aria-errormessage=\"wpforms-70-field_48_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_48_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_48_2\" name=\"wpforms[fields][48][]\" value=\"No\" aria-errormessage=\"wpforms-70-field_48_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_48_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-70-field_49-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"49\"><label class=\"wpforms-field-label\" for=\"wpforms-70-field_49\">If YES, please describe.<\/label><textarea id=\"wpforms-70-field_49\" class=\"wpforms-field-medium\" name=\"wpforms[fields][49]\" aria-errormessage=\"wpforms-70-field_49-error\" ><\/textarea><\/div><div id=\"wpforms-70-field_65-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"65\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"1\" data-formid=\"70\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-70-field_50-container\" class=\"wpforms-field wpforms-field-divider wpforms-field-divider-hide_line\" data-field-id=\"50\"><h3 id=\"wpforms-70-field_50\" aria-errormessage=\"wpforms-70-field_50-error\">MEDICAL HISTORY<\/h3><\/div><div id=\"wpforms-70-field_70-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-3-columns\" data-field-id=\"70\"><fieldset><legend class=\"wpforms-field-label\">Please check any that apply. If YES, please describe below.<\/legend><ul id=\"wpforms-70-field_70\"><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_70_8\" name=\"wpforms[fields][70][]\" value=\"Allergy to Bees (I carry Epi-Pen \/ Bee sting kit\" aria-errormessage=\"wpforms-70-field_70_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_70_8\">Allergy to Bees (I carry Epi-Pen \/ Bee sting kit<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_70_4\" name=\"wpforms[fields][70][]\" value=\"Chest Pain \/ Angina\" aria-errormessage=\"wpforms-70-field_70_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_70_4\">Chest Pain \/ Angina<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_70_1\" name=\"wpforms[fields][70][]\" value=\"Diabetes\" aria-errormessage=\"wpforms-70-field_70_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_70_1\">Diabetes<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_70_6\" name=\"wpforms[fields][70][]\" value=\"Food Allergies\" aria-errormessage=\"wpforms-70-field_70_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_70_6\">Food Allergies<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_70_2\" name=\"wpforms[fields][70][]\" value=\"Heart Murmur\" aria-errormessage=\"wpforms-70-field_70_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_70_2\">Heart Murmur<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_70_7\" name=\"wpforms[fields][70][]\" value=\"High Blood Pressure\" aria-errormessage=\"wpforms-70-field_70_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_70_7\">High Blood Pressure<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_70_5\" name=\"wpforms[fields][70][]\" value=\"Reactions to Medications \/ Drugs\" aria-errormessage=\"wpforms-70-field_70_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_70_5\">Reactions to Medications \/ Drugs<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_70_3\" name=\"wpforms[fields][70][]\" value=\"Special Dietary Needs\" aria-errormessage=\"wpforms-70-field_70_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_70_3\">Special Dietary Needs<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_70_9\" name=\"wpforms[fields][70][]\" value=\"Other (specify)\" aria-errormessage=\"wpforms-70-field_70_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_70_9\">Other (specify)<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-70-field_51-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"51\"><label class=\"wpforms-field-label\" for=\"wpforms-70-field_51\">Please Specify:<\/label><textarea id=\"wpforms-70-field_51\" class=\"wpforms-field-medium\" name=\"wpforms[fields][51]\" aria-errormessage=\"wpforms-70-field_51-error\" ><\/textarea><\/div><div id=\"wpforms-70-field_69-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-3-columns\" data-field-id=\"69\"><fieldset><legend class=\"wpforms-field-label\">Please check any that apply. If YES, please describe below.<\/legend><ul id=\"wpforms-70-field_69\"><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_69_2\" name=\"wpforms[fields][69][]\" value=\"Amputation (Lower Extremity)\" aria-errormessage=\"wpforms-70-field_69_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_69_2\">Amputation (Lower Extremity)<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_69_5\" name=\"wpforms[fields][69][]\" value=\"Amputation (Upper Extremity)\" aria-errormessage=\"wpforms-70-field_69_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_69_5\">Amputation (Upper Extremity)<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_69_3\" name=\"wpforms[fields][69][]\" value=\"Blind \/ Visual Impairments\" aria-errormessage=\"wpforms-70-field_69_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_69_3\">Blind \/ Visual Impairments<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_69_6\" name=\"wpforms[fields][69][]\" value=\"Deaf \/ Hearing Impairment\" aria-errormessage=\"wpforms-70-field_69_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_69_6\">Deaf \/ Hearing Impairment<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_69_7\" name=\"wpforms[fields][69][]\" value=\"Post Concussion Syndrome (1, 2, 3, or more concussions, please specify)\" aria-errormessage=\"wpforms-70-field_69_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_69_7\">Post Concussion Syndrome (1, 2, 3, or more concussions, please specify)<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_69_1\" name=\"wpforms[fields][69][]\" value=\"Traumatic Brain Injury (TBI)\" aria-errormessage=\"wpforms-70-field_69_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_69_1\">Traumatic Brain Injury (TBI)<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_69_8\" name=\"wpforms[fields][69][]\" value=\"Traumatic Spinal Cord Injury (paraplegia, quadriplegia)\" aria-errormessage=\"wpforms-70-field_69_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_69_8\">Traumatic Spinal Cord Injury (paraplegia, quadriplegia)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_69_4\" name=\"wpforms[fields][69][]\" value=\"Traumatic Stress Disorder (PTSD)\" aria-errormessage=\"wpforms-70-field_69_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_69_4\">Traumatic Stress Disorder (PTSD)<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_69_9\" name=\"wpforms[fields][69][]\" value=\"Other (specify)\" aria-errormessage=\"wpforms-70-field_69_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_69_9\">Other (specify)<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-70-field_54-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-70-field_54\">Please Describe:<\/label><textarea id=\"wpforms-70-field_54\" class=\"wpforms-field-medium\" name=\"wpforms[fields][54]\" aria-errormessage=\"wpforms-70-field_54-error\" ><\/textarea><\/div><div id=\"wpforms-70-field_68-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"68\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"2\" data-formid=\"70\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"2\" data-formid=\"70\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3 last \" data-page=\"3\" style=\"display:none;\">\t\t<div id=\"wpforms-70-field_1-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"1\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-70-field_1\" >HISTORY your Please<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-70-field_1\" class=\"wpforms-field-medium\" name=\"wpforms[fields][1]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-70-field_57-container\" class=\"wpforms-field wpforms-field-divider wpforms-field-divider-hide_line\" data-field-id=\"57\"><h3 id=\"wpforms-70-field_57\" aria-errormessage=\"wpforms-70-field_57-error\">LIMITATIONS FOR ACTIVITY<\/h3><\/div><div id=\"wpforms-70-field_55-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-id=\"55\"><fieldset><legend class=\"wpforms-field-label\">Has any physician advised you to limit your activity? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-70-field_55\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_55_1\" name=\"wpforms[fields][55][]\" value=\"Yes\" aria-errormessage=\"wpforms-70-field_55_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_55_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_55_2\" name=\"wpforms[fields][55][]\" value=\"No\" aria-errormessage=\"wpforms-70-field_55_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_55_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-70-field_56-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"56\"><label class=\"wpforms-field-label\" for=\"wpforms-70-field_56\">If YES, please describe:<\/label><textarea id=\"wpforms-70-field_56\" class=\"wpforms-field-medium\" name=\"wpforms[fields][56]\" aria-errormessage=\"wpforms-70-field_56-error\" ><\/textarea><\/div><div id=\"wpforms-70-field_59-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-id=\"59\"><fieldset><legend class=\"wpforms-field-label\">Do you have a Hx of any back, shoulder, knee, or other joint problems? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-70-field_59\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_59_1\" name=\"wpforms[fields][59][]\" value=\"Yes\" aria-errormessage=\"wpforms-70-field_59_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_59_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-70-field_59_2\" name=\"wpforms[fields][59][]\" value=\"No\" aria-errormessage=\"wpforms-70-field_59_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-70-field_59_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-70-field_58-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"58\"><label class=\"wpforms-field-label\" for=\"wpforms-70-field_58\">If YES, please describe:<\/label><textarea id=\"wpforms-70-field_58\" class=\"wpforms-field-medium\" name=\"wpforms[fields][58]\" aria-errormessage=\"wpforms-70-field_58-error\" ><\/textarea><\/div><div id=\"wpforms-70-field_60-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"60\"><label class=\"wpforms-field-label\" for=\"wpforms-70-field_60\">Please indicate the contraindications for activity that will require special attention?<\/label><textarea id=\"wpforms-70-field_60\" class=\"wpforms-field-medium\" name=\"wpforms[fields][60]\" aria-errormessage=\"wpforms-70-field_60-error\" ><\/textarea><\/div><div id=\"wpforms-70-field_14-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"14\"><h3 id=\"wpforms-70-field_14\" aria-errormessage=\"wpforms-70-field_14-error\" aria-describedby=\"wpforms-70-field_14-description\">Emergency Information<\/h3><div id=\"wpforms-70-field_14-description\" class=\"wpforms-field-description\">(Person to notify in the event of an emergency)<\/div><\/div><div id=\"wpforms-70-field_15-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"15\"><fieldset><legend class=\"wpforms-field-label\">Primary Contact<\/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-70-field_15\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][15][first]\" aria-errormessage=\"wpforms-70-field_15-error\" ><label for=\"wpforms-70-field_15\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-70-field_15-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][15][last]\" aria-errormessage=\"wpforms-70-field_15-last-error\" ><label for=\"wpforms-70-field_15-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-70-field_10-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-70-field_10\">Phone<\/label><input type=\"tel\" id=\"wpforms-70-field_10\" class=\"wpforms-field-medium wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][10]\" aria-label=\"Phone\" aria-errormessage=\"wpforms-70-field_10-error\" ><\/div><div id=\"wpforms-70-field_36-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"36\"><fieldset><legend class=\"wpforms-field-label\">Secondary Contact<\/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-70-field_36\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][36][first]\" aria-errormessage=\"wpforms-70-field_36-error\" ><label for=\"wpforms-70-field_36\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-70-field_36-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][36][last]\" aria-errormessage=\"wpforms-70-field_36-last-error\" ><label for=\"wpforms-70-field_36-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-70-field_37-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"37\"><label class=\"wpforms-field-label\" for=\"wpforms-70-field_37\">Phone<\/label><input type=\"tel\" id=\"wpforms-70-field_37\" class=\"wpforms-field-medium wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][37]\" aria-label=\"Phone\" aria-errormessage=\"wpforms-70-field_37-error\" ><\/div><div id=\"wpforms-70-field_38-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"38\"><h3 id=\"wpforms-70-field_38\" aria-errormessage=\"wpforms-70-field_38-error\" aria-describedby=\"wpforms-70-field_38-description\">Permission to Obtain Emergency Medical Care<\/h3><div id=\"wpforms-70-field_38-description\" class=\"wpforms-field-description\">In the event of a medical emergency, I authorize <em>Therapeutic Adventures<\/em> staff to\nhospitalize, to secure proper medical treatment, and\/or order injections, anesthesia\nor surgery for me.<\/div><\/div><div id=\"wpforms-70-field_40-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"40\"><fieldset><legend class=\"wpforms-field-label\">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-70-field_40\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][40][first]\" aria-errormessage=\"wpforms-70-field_40-error\" required><label for=\"wpforms-70-field_40\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-70-field_40-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][40][last]\" 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-->","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-19","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/taonline.org\/v3\/wp-json\/wp\/v2\/pages\/19","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/taonline.org\/v3\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/taonline.org\/v3\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/taonline.org\/v3\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/taonline.org\/v3\/wp-json\/wp\/v2\/comments?post=19"}],"version-history":[{"count":3,"href":"https:\/\/taonline.org\/v3\/wp-json\/wp\/v2\/pages\/19\/revisions"}],"predecessor-version":[{"id":89,"href":"https:\/\/taonline.org\/v3\/wp-json\/wp\/v2\/pages\/19\/revisions\/89"}],"wp:attachment":[{"href":"https:\/\/taonline.org\/v3\/wp-json\/wp\/v2\/media?parent=19"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}