{"id":2902,"date":"2022-12-29T12:11:58","date_gmt":"2022-12-29T12:11:58","guid":{"rendered":"https:\/\/roxydavisfoundation.org\/?page_id=2902"},"modified":"2023-12-21T09:10:50","modified_gmt":"2023-12-21T09:10:50","slug":"register-to-volunteer","status":"publish","type":"page","link":"https:\/\/roxydavisfoundation.org\/register-to-volunteer\/","title":{"rendered":"Register to Volunteer in 2024"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_unknown gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_27' style='display:none'>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">2024 Volunteer Indemnity<\/h2>\n                            <p class='gform_description'><p>2024 Volunteer Indemnity\r\n  <br>\r\n<\/p>\r\n<p>We ask all Volunteers to update their personal details annually or as they change - this will ensure:<\/p>\r\n<ol>\r\n   <li>*All personal details are current and correct<\/li>\r\n   <li>*Based on this information we are able to understand the needs of the participant<\/li>\r\n  <li>*Everyone will have access to and agree to the Terms and Conditions which include details on safety, media and the Child and Vulnerable Adult Protection Policy<\/li>\r\n<\/ol><\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_27'  action='\/wp-json\/wp\/v2\/pages\/2902' data-formid='27' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_27' class='gform_fields top_label form_sublabel_below description_below'><fieldset id=\"field_27_49\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_27_49\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Volunteer&#039;s Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_27_49'>\n                            \n                            <span id='input_27_49_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_27_49_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                    <input type='text' name='input_49.3' id='input_27_49_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_27_49_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_27_49_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                            <input type='text' name='input_49.6' id='input_27_49_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_27_2\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_2\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_27_2_container'>\n                                <span id='input_27_2_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_2' id='input_27_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_27_2' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_27_2_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_2_2' id='input_27_2_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_27_2_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_27_3\" class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_3\" ><label class='gfield_label gform-field-label' for='input_27_3'>Mobile Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_3' id='input_27_3' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_27_18\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_18\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_city has_country ginput_container_address gform-grid-row' id='input_27_18' >\n                        <span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_27_18_3_container' >\n                                    <input type='text' name='input_18.3' id='input_27_18_3' value=''    aria-required='true'    \/>\n                                    <label for='input_27_18_3' id='input_27_18_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_18.4' id='input_27_18_4' value=''\/><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_27_18_6_container' >\n                                        <select name='input_18.6' id='input_27_18_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' selected='selected'>South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_27_18_6' id='input_27_18_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_27_35\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_35\" ><label class='gfield_label gform-field-label' for='input_27_35'>Date of birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_35' id='input_27_35' type='text' value='' class='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_27_35_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_27_35_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_27_35' class='gform_hidden' value='https:\/\/roxydavisfoundation.org\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_27_66\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_66\" ><legend class='gfield_label gform-field-label' >Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_27_66'>\n\t\t\t<div class='gchoice gchoice_27_66_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='Female'  id='choice_27_66_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_27_66_0' id='label_27_66_0' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_27_66_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='Male'  id='choice_27_66_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_27_66_1' id='label_27_66_1' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_27_66_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='gf_other_choice'  id='choice_27_66_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_27_66_2' id='label_27_66_2' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_27_66_other' class='gchoice_other_control' name='input_66_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_27_80\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_80\" ><legend class='gfield_label gform-field-label' >Race<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_27_80'>\n\t\t\t<div class='gchoice gchoice_27_80_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='African'  id='choice_27_80_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_27_80_0' id='label_27_80_0' class='gform-field-label gform-field-label--type-inline'>African<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_27_80_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='Coloured'  id='choice_27_80_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_27_80_1' id='label_27_80_1' class='gform-field-label gform-field-label--type-inline'>Coloured<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_27_80_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='Indian \/ Asian'  id='choice_27_80_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_27_80_2' id='label_27_80_2' class='gform-field-label gform-field-label--type-inline'>Indian \/ Asian<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_27_80_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='White'  id='choice_27_80_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_27_80_3' id='label_27_80_3' class='gform-field-label gform-field-label--type-inline'>White<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_27_80_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='gf_other_choice'  id='choice_27_80_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_27_80_4' id='label_27_80_4' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_27_80_other' class='gchoice_other_control' name='input_80_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_27_60\" class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_60\" ><label class='gfield_label gform-field-label' for='input_27_60'>Any medical conditions or details we should be aware of?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_60' id='input_27_60' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_27_84\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_84\" ><label class='gfield_label gform-field-label' for='input_27_84'>Profession<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_84' id='input_27_84' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_27_81\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_81\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >I&#039;d like to offer my services for....<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_27_81'><div class='gchoice gchoice_27_81_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.1' type='checkbox'  value='Admin'  id='choice_27_81_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_27_81_1' id='label_27_81_1' class='gform-field-label gform-field-label--type-inline'>Admin<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_27_81_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.2' type='checkbox'  value='Copy writing \/ general editing'  id='choice_27_81_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_27_81_2' id='label_27_81_2' class='gform-field-label gform-field-label--type-inline'>Copy writing \/ general editing<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_27_81_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.3' type='checkbox'  value='Event Coordination \/ Registration'  id='choice_27_81_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_27_81_3' id='label_27_81_3' class='gform-field-label gform-field-label--type-inline'>Event Coordination \/ Registration<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_27_81_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.4' type='checkbox'  value='Fundraising e.g. Back a Buddy and events'  id='choice_27_81_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_27_81_4' id='label_27_81_4' class='gform-field-label gform-field-label--type-inline'>Fundraising e.g. Back a Buddy and events<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_27_81_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.5' type='checkbox'  value='IT - user management'  id='choice_27_81_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_27_81_5' id='label_27_81_5' class='gform-field-label gform-field-label--type-inline'>IT - user management<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_27_81_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.6' type='checkbox'  value='Marketing'  id='choice_27_81_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_27_81_6' id='label_27_81_6' class='gform-field-label gform-field-label--type-inline'>Marketing<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_27_81_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.7' type='checkbox'  value='Photography \/ Digital Stories'  id='choice_27_81_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_27_81_7' id='label_27_81_7' class='gform-field-label gform-field-label--type-inline'>Photography \/ Digital Stories<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_27_81_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.8' type='checkbox'  value='Social Media'  id='choice_27_81_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_27_81_8' id='label_27_81_8' class='gform-field-label gform-field-label--type-inline'>Social Media<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_27_81_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.9' type='checkbox'  value='Support on land at events'  id='choice_27_81_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_27_81_9' id='label_27_81_9' class='gform-field-label gform-field-label--type-inline'>Support on land at events<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_27_81_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.11' type='checkbox'  value='Support in water at events'  id='choice_27_81_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_27_81_11' id='label_27_81_11' class='gform-field-label gform-field-label--type-inline'>Support in water at events<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_27_81_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.12' type='checkbox'  value='Transport for participants'  id='choice_27_81_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_27_81_12' id='label_27_81_12' class='gform-field-label gform-field-label--type-inline'>Transport for participants<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_27_81_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.13' type='checkbox'  value='Therapy - Mental support'  id='choice_27_81_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_27_81_13' id='label_27_81_13' class='gform-field-label gform-field-label--type-inline'>Therapy - Mental support<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_27_81_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.14' type='checkbox'  value='Therapy - Occupational support'  id='choice_27_81_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_27_81_14' id='label_27_81_14' class='gform-field-label gform-field-label--type-inline'>Therapy - Occupational support<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_27_81_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.15' type='checkbox'  value='Therapy - Physio support'  id='choice_27_81_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_27_81_15' id='label_27_81_15' class='gform-field-label gform-field-label--type-inline'>Therapy - Physio support<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_27_81_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.16' type='checkbox'  value='Website updates'  id='choice_27_81_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_27_81_16' id='label_27_81_16' class='gform-field-label gform-field-label--type-inline'>Website updates<\/label>\n\t\t\t\t\t\t\t<\/div><button type=\"button\" id=\"button_81_select_all\" class=\"gfield_choice_all_toggle gform-theme-button--size-sm\" onclick=\"gformToggleCheckboxes( this )\" data-checked=\"0\" data-label-select=\"Select All\" data-label-deselect=\"Deselect All\">Select All<\/button><\/div><\/div><\/fieldset><fieldset id=\"field_27_83\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_83\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Availability<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_27_83'><div class='gchoice gchoice_27_83_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_83.1' type='checkbox'  value='Ad hoc'  id='choice_27_83_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_27_83_1' id='label_27_83_1' class='gform-field-label gform-field-label--type-inline'>Ad hoc<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_27_83_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_83.2' type='checkbox'  value='Few hours a week'  id='choice_27_83_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_27_83_2' id='label_27_83_2' class='gform-field-label gform-field-label--type-inline'>Few hours a week<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_27_83_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_83.3' type='checkbox'  value='Weekends only'  id='choice_27_83_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_27_83_3' id='label_27_83_3' class='gform-field-label gform-field-label--type-inline'>Weekends only<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_27_64\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_64\" ><label class='gfield_label gform-field-label' for='input_27_64'>Anything else you&#039;d like us to know?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_64' id='input_27_64' class='textarea medium'  aria-describedby=\"gfield_description_27_64\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_27_64'>Tell us more about yourself - any specific skills you have or contribution you would like to make to the Roxy Davis Foundation\n<\/div><\/div><fieldset id=\"field_27_82\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_82\" ><legend class='gfield_label gform-field-label' >Can you swim unaided for at least 5 minutes?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_27_82'>\n\t\t\t<div class='gchoice gchoice_27_82_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_82' type='radio' value='Yes'  id='choice_27_82_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_27_82_0' id='label_27_82_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_27_82_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_82' type='radio' value='No'  id='choice_27_82_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_27_82_1' id='label_27_82_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_27_33\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_33\" ><label class='gfield_label gform-field-label' for='input_27_33'>On a scale of 1-5, how comfortable are you in the water?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_33' id='input_27_33' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='1 - Very uncomfortable' >1 - Very uncomfortable<\/option><option value='2 - Uncomfortable' >2 - Uncomfortable<\/option><option value='3 - Undecided' >3 - Undecided<\/option><option value='4 - Comfortable' >4 - Comfortable<\/option><option value='5 - Very comfortable' >5 - Very comfortable<\/option><\/select><\/div><\/div><fieldset id=\"field_27_71\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_71\" ><legend class='gfield_label gform-field-label' >Have you volunteered with the Roxy Davis Foundation before?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_27_71'>\n\t\t\t<div class='gchoice gchoice_27_71_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_71' type='radio' value='Yes'  id='choice_27_71_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_27_71_0' id='label_27_71_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_27_71_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_71' type='radio' value='No'  id='choice_27_71_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_27_71_1' id='label_27_71_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_27_26\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_26\" ><label class='gfield_label gform-field-label' for='input_27_26'>How did you hear about the Roxy Davis Foundation?<\/label><div class='ginput_container ginput_container_text'><input name='input_26' id='input_27_26' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_27_70\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_70\" ><legend class='gfield_label gform-field-label' >I am older than 18 years<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_27_70'>\n\t\t\t<div class='gchoice gchoice_27_70_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='Yes I am 18 years or older'  id='choice_27_70_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_27_70_0' id='label_27_70_0' class='gform-field-label gform-field-label--type-inline'>Yes I am 18 years or older<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_27_70_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='No I am under 18 years, my Parent\/Guardian will sign on my behalf'  id='choice_27_70_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_27_70_1' id='label_27_70_1' class='gform-field-label gform-field-label--type-inline'>No I am under 18 years, my Parent\/Guardian will sign on my behalf<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_27_1\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_27_1\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Adult\/Parent\/Guardian Contact Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_27_1'>\n                            \n                            <span id='input_27_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_27_1_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                    <input type='text' name='input_1.3' id='input_27_1_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_27_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_27_1_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                            <input type='text' name='input_1.6' id='input_27_1_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_27_39\" class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_39\" ><label class='gfield_label gform-field-label' for='input_27_39'>Adult \/ Parent \/ Guardian Mobile Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_39' id='input_27_39' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_27_68\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_27_68\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Emergency Contact&#039;s Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_27_68'>\n                            \n                            <span id='input_27_68_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_27_68_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                    <input type='text' name='input_68.3' id='input_27_68_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_27_68_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_27_68_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                            <input type='text' name='input_68.6' id='input_27_68_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_27_69\" class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_69\" ><label class='gfield_label gform-field-label' for='input_27_69'>Emergency Contact&#039;s Mobile Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_69' id='input_27_69' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_27_76\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_76\" ><label class='gfield_label gform-field-label' for='input_27_76'>Medical Aid<\/label><div class='ginput_container ginput_container_text'><input name='input_76' id='input_27_76' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_27_78\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_78\" ><label class='gfield_label gform-field-label' for='input_27_78'>Medical Aid Membership Number<\/label><div class='ginput_container ginput_container_text'><input name='input_78' id='input_27_78' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_27_13\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_13\" ><legend class='gfield_label gform-field-label' >Would you like to receive our newsletter?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_27_13'>\n\t\t\t<div class='gchoice gchoice_27_13_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Yes' checked='checked' id='choice_27_13_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_27_13_0' id='label_27_13_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_27_13_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='No'  id='choice_27_13_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label 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