apricot.socialsolutions.com
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Submitted URL: https://qrco.de/STYNRegistration?utm_source=All+emails&utm_campaign=60a339c9c6-EMAIL_CAMPAIGN_2022_01_18_08_18_C...
Effective URL: https://apricot.socialsolutions.com/document/edit/id/new/form_id/258
Submission: On October 19 via manual from MX — Scanned from DE
Effective URL: https://apricot.socialsolutions.com/document/edit/id/new/form_id/258
Submission: On October 19 via manual from MX — Scanned from DE
Form analysis 1 forms found in the DOM
Name: record_entry — POST /document/save/document_id/new
<form id="record_entry" name="record_entry" class="" method="post" action="/document/save/document_id/new" enctype="multipart/form-data" data-form-reference-tag="" data-duplicate-validation-failed="">
<input type="text" class="hidden" id="form_id" name="form_id" value="258">
<input type="text" class="hidden" id="referral_id" name="referral_id" value="">
<input type="text" class="hidden" id="dupeFlag" name="dupeFlag" value="true">
<input type="text" class="hidden" id="document_id" name="document_id" value="new">
<input type="text" class="hidden" id="row_id" name="row_id" value="">
<input type="text" class="hidden" id="parent_id" name="parent_id" value="">
<input type="text" class="hidden" id="tier1_id" name="tier1_id" value="0">
<input type="text" class="hidden" id="tier1_name" name="tier1_name" value="#SacYouthTownNights Registration Form">
<input type="text" class="hidden" id="is_bulk" name="is_bulk" value="">
<input type="text" class="hidden" id="audit" name="audit" value="">
<input type="text" class="hidden" id="changed_fields" name="changed_fields" value="">
<input type="text" class="hidden" id="program_ids" name="program_ids" value="[]">
<input type="text" class="hidden" id="new_owner" name="new_owner" value="">
<input type="text" class="hidden" id="link_json" name="link_json" value="">
<input type="text" class="hidden" id="errors" name="errors" value="">
<input type="text" class="hidden" id="unique_key" name="unique_key" value="1b04b736b381679153a946e1cfcd494e">
<input type="text" class="hidden" id="aff_type" name="aff_type" value="">
<input type="text" class="hidden" id="is_application" name="is_application" value="">
<input type="text" class="hidden" id="wizard_linked_document" name="wizard_linked_document" value="">
<input type="text" class="hidden" id="wizard_link_js" name="wizard_link_js" value="">
<input type="text" class="hidden" id="wizard_windowApricot" name="wizard_windowApricot" value="">
<input type="text" class="hidden" id="display_name_field_id" name="display_name_field_id" value="">
<input type="text" class="hidden" id="parent_program_ids" name="parent_program_ids" value="">
<input type="text" class="hidden" id="possible_program_ids" name="possible_program_ids" value="">
<input type="text" class="hidden" id="idempotent_id" name="idempotent_id" value="4694-65428-634f57574fb87">
<input type="text" class="hidden" id="add_caseload_owner" name="add_caseload_owner" value="[]">
<input type="text" class="hidden" id="remove_caseload_owner" name="remove_caseload_owner" value="[]">
<section class="recordSection ">
<h2 tabindex="0" onclick="popOver.toggleView($('section_1674'),$('section_1674_arrow'), 'auto')" onkeyup="if (event.keyCode === 13 ) popOver.toggleView($('section_1674'),$('section_1674_arrow'), 'auto')"> Intro <span id="section_1674_arrow"
class="arrow icon-arrow-white-large-open"></span>
</h2>
<div id="section_1674" class="x-scrollable " data-guid="">
<div class="fieldGrid">
<div class="section-row">
<div class="field-cell" data-id="9038" data-reference-tag="" data-type-id="28">
<!-- Label Only Field -->
<fieldset class="no-legend ">
<p style="text-align: center;"><span style="font-size:14px;"><span style="font-family:Trebuchet MS,Helvetica,sans-serif;"><strong>Welcome SacTownYouthNights @ the QSpot!</strong></span></span></p>
<p style="text-align: center;">If you are under the age of 25, please complete this form. </p>
<p style="text-align: center;">Rotate your device to landscape to improve your user experience.</p>
<input type="hidden" guid="1d331c0d-c640-4994-a86c-51adb62b75e2">
</fieldset>
</div>
</div>
</div>
</div>
</section>
<section class="recordSection hidden">
<h2 tabindex="0" onclick="popOver.toggleView($('section_1613'),$('section_1613_arrow'), 'auto')" onkeyup="if (event.keyCode === 13 ) popOver.toggleView($('section_1613'),$('section_1613_arrow'), 'auto')"> Internal Information <span
id="section_1613_arrow" class="arrow icon-arrow-white-large-closed"></span>
</h2>
<div id="section_1613" class="x-scrollable closed" data-guid="">
<div class="fieldGrid">
<div class="section-row">
<div class="field-cell" data-id="8699" data-reference-tag="" data-type-id="36">
<!-- System ID -->
<fieldset class="">
<legend> Record ID <span class="ic__sprite ic__dupe"></span></legend>
<input type="text" id="document_id" guid="0225a304-2175-4c00-bd39-6a27db307ee7" title="Record ID" tabindex="0" userview="Record ID" value="--" readonly="" class="systemField duplicate validation-passed">
</fieldset>
</div>
</div>
<div class="section-row">
<div class="field-cell" data-id="8700" data-reference-tag="" data-type-id="17">
<!-- Date Field -->
<fieldset class="" style="min-width: 120px;">
<legend>
<label for="field_8700">Completion Date <span class="ic__sprite ic__lock"></span></label>
</legend>
<div class="clearBreak"></div>
<input type="text" id="field_8700" name="field_8700" guid="ddf0d63c-176b-47f5-821a-02889cc7b2b3" tabindex="0" title="Completion Date" userview="Completion Date" value="10/18/2022" readonly="" class="validate-date validation-passed"
placeholder="MM/DD/YYYY">
<input type="hidden" name="field_8700_dateType" id="field_8700_dateType">
</fieldset>
</div>
</div>
<div class="section-row">
<div class="field-cell" data-id="8701" data-reference-tag="" data-type-id="30">
<!--US Time Field-->
<fieldset class="">
<legend>
<label for="field_8701">Completion Time <span class="ic__sprite ic__lock"></span></label>
</legend>
<div class="clearBreak"></div>
<input type="text" id="field_8701" name="field_8701" guid="bc8ff3e5-389b-41ca-99da-4c6372e67b90" tabindex="0" title="Completion Time" userview="Completion Time" value="" maxlength="5" readonly="" disabled=""
class="time autotab validation-passed" format="time" time_type="12" placeholder="5:30">
<label for="field_8701_ampm" class="hidden">Completion Time A M P M</label> <select id="field_8701_ampm" class="optional-always " name="field_8701_ampm" readonly="" disabled="" tabindex="0" guid="bc8ff3e5-389b-41ca-99da-4c6372e67b90">
<option value="AM" selected="">AM</option>
<option value="PM">PM</option>
</select>
<button id="field_8701_now_button" name="now" type="button" class="time_default_now hidden small" onclick="return false">Now</button>
</fieldset>
</div>
</div>
</div>
</div>
</section>
<section class="recordSection hidden">
<h2 tabindex="0" onclick="popOver.toggleView($('section_1618'),$('section_1618_arrow'), 'auto')" onkeyup="if (event.keyCode === 13 ) popOver.toggleView($('section_1618'),$('section_1618_arrow'), 'auto')"> Sac Pride Introduction <span
id="section_1618_arrow" class="arrow icon-arrow-white-large-closed"></span>
</h2>
<div id="section_1618" class="x-scrollable closed" data-guid="">
<div class="fieldGrid">
<div class="section-row">
<div class="field-cell" data-id="8726" data-reference-tag="" data-type-id="28">
<!-- Label Only Field -->
<fieldset class="no-legend ">
<p><span style="font-size:20px;"><strong>Welcome to <span style="color:#d35400;">Sac</span><span style="color:#f39c12;">ram</span><span style="color:#f1c40f;">en</span><span style="color:#2ecc71;">to </span><span
style="color:#3498db;">Pr</span>i<span style="color:#8e44ad;">de</span> 2022!</strong></span></p>
<p>Complete this form (it should take 5 mins or less) and present the email confirmation you receive to a QSpot Attendant to receive your bracelet. The bracelet gains you access to food and prizes throughout the festival.</p>
<ul>
<li>We are only offering bracelets to youth under the age of 25. If you are older, please do not complete this form.</li>
<li>If you are completing this form on your phone, we recommend rotating to landscape for an improved user experience.</li>
<li>To submit your form, scroll to the top and select "Submit" under Record Options in the upper right hand corner.</li>
<li>Be sure to check your junk mail for casey.maloney@saccenter.org if you don't receive your confirmation email within a few seconds after you submit your form.</li>
</ul>
<input type="hidden" guid="58418945-caac-44ea-afca-b298d505f898">
</fieldset>
</div>
</div>
</div>
</div>
</section>
<section class="recordSection hidden">
<h2 tabindex="0" onclick="popOver.toggleView($('section_1623'),$('section_1623_arrow'), 'auto')" onkeyup="if (event.keyCode === 13 ) popOver.toggleView($('section_1623'),$('section_1623_arrow'), 'auto')"> Special Message <span
id="section_1623_arrow" class="arrow icon-arrow-white-large-closed"></span>
</h2>
<div id="section_1623" class="x-scrollable closed" data-guid="">
<div class="fieldGrid">
<div class="section-row">
<div class="field-cell" data-id="8759" data-reference-tag="" data-type-id="28">
<!-- Label Only Field -->
<fieldset class="no-legend ">
<p><span style="color:#d35400;"><span style="font-size:20px;"><strong>If you are older than 24, please do not submit this form.</strong></span></span></p>
<p> </p>
<input type="hidden" guid="7246326a-6a05-4cfd-bba9-7c0a23ea65e6">
</fieldset>
</div>
</div>
</div>
</div>
</section>
<section class="recordSection ">
<h2 tabindex="0" onclick="popOver.toggleView($('section_1615'),$('section_1615_arrow'), 'auto')" onkeyup="if (event.keyCode === 13 ) popOver.toggleView($('section_1615'),$('section_1615_arrow'), 'auto')"> Contact Information <span
id="section_1615_arrow" class="arrow icon-arrow-white-large-open"></span>
</h2>
<div id="section_1615" class="x-scrollable " data-guid="">
<div class="fieldGrid">
<div class="section-row">
<div class="field-cell" data-id="8707" data-reference-tag="" data-type-id="5">
<!--Name field-->
<fieldset class="">
<legend>
<label><span class="requiredIcon">*</span>What is your name? </label>
<span class="ic__sprite ic__dupe"></span>
</legend>
<input type="text" id="field_8707_first" name="field_8707_first" guid="f1d8ac18-3808-4012-947d-67c0ca90adb7" tabindex="0" title="What is your name? First Name" userview="What is your name? First Name" placeholder="First"
class="name required duplicate validation-failed" value="" validation_type="name" maxlength="50">
<input type="text" id="field_8707_middle" name="field_8707_middle" guid="f1d8ac18-3808-4012-947d-67c0ca90adb7" tabindex="0" title="What is your name? Middle Name" userview="What is your name? Middle Name" placeholder="Middle"
class="name duplicate optional-always validation-passed" value="" validation_type="name" maxlength="50">
<input type="text" id="field_8707_last" name="field_8707_last" guid="f1d8ac18-3808-4012-947d-67c0ca90adb7" tabindex="0" title="What is your name? Last Name" userview="What is your name? Last Name" placeholder="Last"
class="name required duplicate validation-failed" value="" validation_type="name" maxlength="50">
<div id="advice-required-field_8707_last" class="validation-advice" role="alert" style="display: none;">This field is required.</div>
</fieldset>
</div>
</div>
<div class="section-row">
<div class="field-cell" data-id="8715" data-reference-tag="" data-type-id="26">
<!--Checkbox List Field-->
<fieldset class="">
<legend id="field_8715_checkboxes" userview="Check if you have a different name that you use legally.">
<label for="field_8715">Check if you have a different name that you use legally. </label>
</legend>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8715_0">
<input type="checkbox" id="field_8715_0" name="field_8715[]" guid="e7cbc3f2-2341-471e-8bc1-0a69afb8c220" tabindex="0" title="Check if you have a different name that you use legally." class=" multi_input_format"
userview="Check if you have a different name that you use legally." value="I use a different name legally." onchange="toggleOther('field_8715')">
<span> I use a different name legally. </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format hidden" for="field_8715_1">
<input type="checkbox" id="field_8715_1" name="field_8715[]" guid="e7cbc3f2-2341-471e-8bc1-0a69afb8c220" tabindex="0" title="Check if you have a different name that you use legally." class=" multi_input_format"
data-is-other-button="true" userview="Check if you have a different name that you use legally." value="" onchange="toggleOther('field_8715')">
<span> Other </span>
</label>
<div class="clearBreak"></div>
<div>
<input type="text" value="" tabindex="0" id="field_8715_other" name="field_8715_other" guid="e7cbc3f2-2341-471e-8bc1-0a69afb8c220" class="multi_input_other_format hidden " placeholder="Other Value" validation_type="other"
readonly="">
</div>
</fieldset>
</div>
</div>
<div class="section-row">
<div class="field-cell" data-id="8716" data-reference-tag="" data-type-id="5">
<!--Name field-->
<fieldset class="hidden">
<legend>
<label>What is your legal name? </label>
</legend>
<input type="text" id="field_8716_first" name="field_8716_first" guid="b803d8c8-a734-4559-a3e7-8d0035cedc43" tabindex="0" title="What is your legal name? First Name" userview="What is your legal name? First Name" placeholder="First"
class="name " value="" validation_type="name" maxlength="50">
<input type="text" id="field_8716_middle" name="field_8716_middle" guid="b803d8c8-a734-4559-a3e7-8d0035cedc43" tabindex="0" title="What is your legal name? Middle Name" userview="What is your legal name? Middle Name"
placeholder="Middle" class="name optional-always" value="" validation_type="name" maxlength="50">
<input type="text" id="field_8716_last" name="field_8716_last" guid="b803d8c8-a734-4559-a3e7-8d0035cedc43" tabindex="0" title="What is your legal name? Last Name" userview="What is your legal name? Last Name" placeholder="Last"
class="name " value="" validation_type="name" maxlength="50">
</fieldset>
</div>
</div>
<div class="section-row">
<div class="field-cell" data-id="8710" data-reference-tag="" data-type-id="26">
<!--Checkbox List Field-->
<fieldset class="">
<legend id="field_8710_checkboxes" userview="What are your pronouns? Check all that apply">
<label for="field_8710"><span class="requiredIcon">*</span>What are your pronouns? Check all that apply </label>
</legend>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8710_0">
<input type="checkbox" id="field_8710_0" name="field_8710[]" guid="472c1e9e-6ba4-4e0d-8d02-12f543ee1bd9" tabindex="0" title="What are your pronouns? Check all that apply" class="required multi_input_format validation-failed"
userview="What are your pronouns? Check all that apply" value="He/Him/His" onchange="toggleOther('field_8710')">
<span> He/Him/His </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8710_1">
<input type="checkbox" id="field_8710_1" name="field_8710[]" guid="472c1e9e-6ba4-4e0d-8d02-12f543ee1bd9" tabindex="0" title="What are your pronouns? Check all that apply" class="required multi_input_format validation-failed"
userview="What are your pronouns? Check all that apply" value="She/Her/Hers" onchange="toggleOther('field_8710')">
<span> She/Her/Hers </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8710_2">
<input type="checkbox" id="field_8710_2" name="field_8710[]" guid="472c1e9e-6ba4-4e0d-8d02-12f543ee1bd9" tabindex="0" title="What are your pronouns? Check all that apply" class="required multi_input_format validation-failed"
userview="What are your pronouns? Check all that apply" value="They/Them/Theirs" onchange="toggleOther('field_8710')">
<span> They/Them/Theirs </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8710_3">
<input type="checkbox" id="field_8710_3" name="field_8710[]" guid="472c1e9e-6ba4-4e0d-8d02-12f543ee1bd9" tabindex="0" title="What are your pronouns? Check all that apply" class="required multi_input_format validation-failed"
data-is-other-button="true" userview="What are your pronouns? Check all that apply" value="" onchange="toggleOther('field_8710')">
<span> Other </span>
</label>
<div class="clearBreak"></div>
<div>
<input type="text" value="" tabindex="0" id="field_8710_other" name="field_8710_other" guid="472c1e9e-6ba4-4e0d-8d02-12f543ee1bd9" class="multi_input_other_format hidden required validation-passed" placeholder="Other Value"
validation_type="other">
</div>
<div id="advice-required-field_8710_3" class="validation-advice" role="alert" style="display: none;">This field is required.</div>
</fieldset>
</div>
</div>
<div class="section-row">
<div class="field-cell" data-id="8709" data-reference-tag="" data-type-id="58">
<!--Calculation Field-->
<fieldset class="hidden">
<legend>
<label for="field_8709">Current Age </label>
</legend>
<input type="text" id="field_8709" name="field_8709" guid="b636f72c-fb3e-4473-b62c-e244ce07e1d0" title="Current Age" userview="Current Age" value="" class="numeric minValue: maxValue: validation-passed" tabindex="0" readonly=""
style="background: rgb(255, 255, 255);">
<input type="hidden" id="field_8709_calc_fields" value="ddf0d63c-176b-47f5-821a-02889cc7b2b3|5b815f65-7f48-42f1-98e2-50b8bfabf396|Years">
<div class="inputError"></div>
</fieldset>
</div>
</div>
<div class="section-row">
<div class="field-cell" data-id="8708" data-reference-tag="" data-type-id="17">
<!-- Date Field -->
<fieldset class="" style="min-width: 120px;">
<legend>
<label for="field_8708"><span class="requiredIcon">*</span>What is your birthdate? </label>
<span class="ic__sprite ic__dupe"></span>
</legend>
<div class="clearBreak"></div>
<input type="text" id="field_8708" name="field_8708" guid="5b815f65-7f48-42f1-98e2-50b8bfabf396" tabindex="0" title="What is your birthdate?" userview="What is your birthdate?" value=""
class="required validate-date DatePicker duplicate validation-failed" placeholder="MM/DD/YYYY">
<input type="hidden" name="field_8708_dateType" id="field_8708_dateType">
<div id="advice-required-field_8708" class="validation-advice" role="alert" style="display: none;">This field is required.</div><span class="ic__sprite ic__calendar"></span>
</fieldset>
</div>
</div>
<div class="section-row">
<div class="field-cell" data-id="8758" data-reference-tag="" data-type-id="26">
<!--Checkbox List Field-->
<fieldset class="">
<legend id="field_8758_checkboxes" userview="Check here if you cannot provide a phone number">
<label for="field_8758">Check here if you cannot provide a phone number </label>
</legend>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8758_0">
<input type="checkbox" id="field_8758_0" name="field_8758[]" guid="495baae8-66f3-4821-af1e-dffef4ac2aa5" tabindex="0" title="Check here if you cannot provide a phone number" class=" multi_input_format"
userview="Check here if you cannot provide a phone number" value="I cannot provide a phone number." onchange="toggleOther('field_8758')">
<span> I cannot provide a phone number. </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format hidden" for="field_8758_1">
<input type="checkbox" id="field_8758_1" name="field_8758[]" guid="495baae8-66f3-4821-af1e-dffef4ac2aa5" tabindex="0" title="Check here if you cannot provide a phone number" class=" multi_input_format" data-is-other-button="true"
userview="Check here if you cannot provide a phone number" value="" onchange="toggleOther('field_8758')">
<span> Other </span>
</label>
<div class="clearBreak"></div>
<div>
<input type="text" value="" tabindex="0" id="field_8758_other" name="field_8758_other" guid="495baae8-66f3-4821-af1e-dffef4ac2aa5" class="multi_input_other_format hidden " placeholder="Other Value" validation_type="other"
readonly="">
</div>
</fieldset>
</div>
</div>
<div class="section-row">
<div class="field-cell" data-id="8713" data-reference-tag="" data-type-id="19">
<!--Phone Field-->
<fieldset class="showfield-2417">
<legend>
<label><span class="requiredIcon">*</span>What's your phone number? </label>
</legend>
<div class="clearBreak"></div>
<label for="field_8713_p1" class="hidden">What's your phone number? 0</label> <input type="phone" id="field_8713_p1" name="field_8713_p1" guid="1151c724-cce6-4853-b072-9e6fd644d557" tabindex="0" title="Area code"
userview="What's your phone number? 0" maxlength="3" value="" class="phone USphone autotab required required-2417 validation-failed">
<label for="field_8713_p2" class="hidden">What's your phone number? 1</label> <input type="phone" id="field_8713_p2" name="field_8713_p2" guid="1151c724-cce6-4853-b072-9e6fd644d557" tabindex="0" title="Prefix"
userview="What's your phone number? 1" maxlength="3" value="" class="phone USphone autotab required required-2417 validation-failed">
<label for="field_8713_p3" class="hidden">What's your phone number? 2</label> <input type="phone" id="field_8713_p3" name="field_8713_p3" guid="1151c724-cce6-4853-b072-9e6fd644d557" tabindex="0" title="Line number"
userview="What's your phone number? 2" maxlength="4" value="" class="phone USphone autotab required required-2417 validation-failed"> ext. <label for="field_8713_p4" class="hidden">What's your phone number? 3</label> <input
type="phone" id="field_8713_p4" name="field_8713_p4" guid="1151c724-cce6-4853-b072-9e6fd644d557" tabindex="0" title="Extension" userview="What's your phone number? 3" maxlength="10" value=""
class="phone USphone optional-always autotab validation-passed">
<div id="advice-required-field_8713_p3" class="validation-advice" role="alert" style="display: block;">This field is required.</div>
</fieldset>
</div>
</div>
<div class="section-row">
<div class="field-cell" data-id="8714" data-reference-tag="" data-type-id="11">
<!--Email Field-->
<fieldset class="">
<legend>
<label for="field_8714"><span class="requiredIcon">*</span>What's your email address? </label>
</legend>
<!-- display input -->
<span id="edit_field_8714" class="hidden"> <a tabindex="0" href="mailto:" target="_blank"></a>
<button tabindex="0" id="field_8714_change_button" type="button" onkeypress="if(event.keyCode==13) editEmail('email_field_8714')" onclick="editEmail('email_field_8714')" class="button--outlined small optional-always">Change</button>
</span>
<!-- real input -->
<span id="edit_input_field_8714" class="">
<input type="email" id="field_8714" name="field_8714" guid="c88b4bfb-0015-4da7-b408-5e66acb92e17" tabindex="0" title="What's your email address?" userview="What's your email address?" value="" maxlength="100"
placeholder="customer_care@apricot.info" class="required validate-email validation-failed" autocomplete="off" format="email">
</span>
<div id="advice-required-field_8714" class="validation-advice" role="alert" style="display: none;">This field is required.</div>
</fieldset>
</div>
</div>
<div class="section-row">
<div class="field-cell" data-id="8712" data-reference-tag="" data-type-id="26">
<!--Checkbox List Field-->
<fieldset class="">
<legend id="field_8712_checkboxes" userview="If you are currently facing homelessness or housing instability, check all that apply.">
<label for="field_8712">If you are currently facing homelessness or housing instability, check all that apply. </label>
</legend>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8712_0">
<input type="checkbox" id="field_8712_0" name="field_8712[]" guid="f0aee0e7-99d4-46f1-b4a5-20ecbd2e6643" tabindex="0" title="If you are currently facing homelessness or housing instability, check all that apply."
class=" multi_input_format" userview="If you are currently facing homelessness or housing instability, check all that apply." value="I am currently facing homelessness or housing instability." onchange="toggleOther('field_8712')">
<span> I am currently facing homelessness or housing instability. </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8712_1">
<input type="checkbox" id="field_8712_1" name="field_8712[]" guid="f0aee0e7-99d4-46f1-b4a5-20ecbd2e6643" tabindex="0" title="If you are currently facing homelessness or housing instability, check all that apply."
class=" multi_input_format" userview="If you are currently facing homelessness or housing instability, check all that apply." value="I would like to sign up on the Center Housing Wait List." onchange="toggleOther('field_8712')">
<span> I would like to sign up on the Center Housing Wait List. </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format hidden" for="field_8712_2">
<input type="checkbox" id="field_8712_2" name="field_8712[]" guid="f0aee0e7-99d4-46f1-b4a5-20ecbd2e6643" tabindex="0" title="If you are currently facing homelessness or housing instability, check all that apply."
class=" multi_input_format" data-is-other-button="true" userview="If you are currently facing homelessness or housing instability, check all that apply." value="" onchange="toggleOther('field_8712')">
<span> Other </span>
</label>
<div class="clearBreak"></div>
<div>
<input type="text" value="" tabindex="0" id="field_8712_other" name="field_8712_other" guid="f0aee0e7-99d4-46f1-b4a5-20ecbd2e6643" class="multi_input_other_format hidden " placeholder="Other Value" validation_type="other"
readonly="">
</div>
</fieldset>
</div>
</div>
<div class="section-row">
<div class="field-cell" data-id="9037" data-reference-tag="" data-type-id="2">
<!--Numeric Field-->
<fieldset class="hidden showfield-2497 showfield-2498" style="display: block;">
<legend>
<label for="field_9037"><span class="requiredIcon">*</span>What is your Home Zip Code. </label>
</legend>
<input type="text" id="field_9037" name="field_9037" guid="b03902b3-dab1-48d5-aae8-a113931cde8f" tabindex="0" title="What is your Home Zip Code." userview="What is your Home Zip Code." value=""
class="numeric validate-int-limit validate-integer minValue: maxValue: required required-2498 validation-failed" placeholder="00" format="integer">
<div id="advice-required-field_9037" class="validation-advice" role="alert" style="display: block;">This field is required.</div>
</fieldset>
</div>
</div>
</div>
</div>
</section>
<section class="recordSection ">
<h2 tabindex="0" onclick="popOver.toggleView($('section_1616'),$('section_1616_arrow'), 'auto')" onkeyup="if (event.keyCode === 13 ) popOver.toggleView($('section_1616'),$('section_1616_arrow'), 'auto')"> Emergency Contact Information <span
id="section_1616_arrow" class="arrow icon-arrow-white-large-open"></span>
</h2>
<div id="section_1616" class="x-scrollable " data-guid="">
<div class="fieldGrid">
<div class="section-row">
<div class="field-cell" data-id="8727" data-reference-tag="" data-type-id="26">
<!--Checkbox List Field-->
<fieldset class="showfield-2374">
<legend id="field_8727_checkboxes" userview="Check here to decline to provide Emergency Contact Information">
<label for="field_8727"><span class="requiredIcon">*</span>Check here to decline to provide Emergency Contact Information </label>
</legend>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8727_0">
<input type="checkbox" id="field_8727_0" name="field_8727[]" guid="7b7d05bd-4fb2-4bed-a8d0-e7240ae41acc" tabindex="0" title="Check here to decline to provide Emergency Contact Information"
class="multi_input_format required required-2374 validation-failed" userview="Check here to decline to provide Emergency Contact Information" value="I refuse to provide Emergency Contact Information"
onchange="toggleOther('field_8727')">
<span> I refuse to provide Emergency Contact Information </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format hidden" for="field_8727_1">
<input type="checkbox" id="field_8727_1" name="field_8727[]" guid="7b7d05bd-4fb2-4bed-a8d0-e7240ae41acc" tabindex="0" title="Check here to decline to provide Emergency Contact Information"
class="multi_input_format required required-2374 validation-passed" data-is-other-button="true" userview="Check here to decline to provide Emergency Contact Information" value="" onchange="toggleOther('field_8727')">
<span> Other </span>
</label>
<div class="clearBreak"></div>
<div>
<input type="text" value="" tabindex="0" id="field_8727_other" name="field_8727_other" guid="7b7d05bd-4fb2-4bed-a8d0-e7240ae41acc" class="multi_input_other_format hidden required required-2374 validation-passed"
placeholder="Other Value" validation_type="other" readonly="">
</div>
<div id="advice-required-field_8727_0" class="validation-advice" role="alert" style="display: block;">This field is required.</div>
</fieldset>
</div>
</div>
<div class="section-row">
<div class="field-cell" data-id="8717" data-reference-tag="" data-type-id="5">
<!--Name field-->
<fieldset class="showfield-2374">
<legend>
<label><span class="requiredIcon">*</span>Emergency Contact Name </label>
</legend>
<input type="text" id="field_8717_first" name="field_8717_first" guid="a7c27b60-d0f6-42b7-a572-fc85ad1518e4" tabindex="0" title="Emergency Contact Name First Name" userview="Emergency Contact Name First Name" placeholder="First"
class="name required required-2374 validation-failed" value="" validation_type="name" maxlength="50">
<input type="text" id="field_8717_middle" name="field_8717_middle" guid="a7c27b60-d0f6-42b7-a572-fc85ad1518e4" tabindex="0" title="Emergency Contact Name Middle Name" userview="Emergency Contact Name Middle Name" placeholder="Middle"
class="name optional-always" value="" validation_type="name" maxlength="50">
<input type="text" id="field_8717_last" name="field_8717_last" guid="a7c27b60-d0f6-42b7-a572-fc85ad1518e4" tabindex="0" title="Emergency Contact Name Last Name" userview="Emergency Contact Name Last Name" placeholder="Last"
class="name required required-2374 validation-failed" value="" validation_type="name" maxlength="50">
<div id="advice-required-field_8717_last" class="validation-advice" role="alert" style="display: block;">This field is required.</div>
</fieldset>
</div>
</div>
<div class="section-row">
<div class="field-cell" data-id="8718" data-reference-tag="" data-type-id="1">
<!-- Text Field -->
<fieldset class="showfield-2374">
<legend>
<label for="field_8718"><span class="requiredIcon">*</span>Your relationship to the Emergency Contact </label>
</legend>
<input type="text" id="field_8718" name="field_8718" guid="49406f45-cbe1-4e44-951c-1c4b084b868b" tabindex="0" title="Your relationship to the Emergency Contact" userview="Your relationship to the Emergency Contact" value=""
class="text maxChars: required required-2374 validation-failed" placeholder="" maxlength="">
<div id="advice-required-field_8718" class="validation-advice" role="alert" style="display: block;">This field is required.</div>
</fieldset>
</div>
</div>
<div class="section-row">
<div class="field-cell" data-id="8719" data-reference-tag="" data-type-id="19">
<!--Phone Field-->
<fieldset class="showfield-2374">
<legend>
<label><span class="requiredIcon">*</span>Emergency Contact Phone Number </label>
</legend>
<div class="clearBreak"></div>
<label for="field_8719_p1" class="hidden">Emergency Contact Phone Number 0</label> <input type="phone" id="field_8719_p1" name="field_8719_p1" guid="62cee9f1-ead1-458f-87f5-5cbd90cc427a" tabindex="0" title="Phone Number"
userview="Emergency Contact Phone Number 0" maxlength="23" value="" class="phone Globalphone autotab required required-2374 validation-failed">
<div id="advice-required-field_8719_p1" class="validation-advice" role="alert" style="display: block;">This field is required.</div>
</fieldset>
</div>
</div>
<div class="section-row">
<div class="field-cell" data-id="8720" data-reference-tag="" data-type-id="11">
<!--Email Field-->
<fieldset class="showfield-2374">
<legend>
<label for="field_8720"><span class="requiredIcon">*</span>Emergency Contact Email Address </label>
</legend>
<!-- display input -->
<span id="edit_field_8720" class="hidden"> <a tabindex="0" href="mailto:" target="_blank"></a>
<button tabindex="0" id="field_8720_change_button" type="button" onkeypress="if(event.keyCode==13) editEmail('email_field_8720')" onclick="editEmail('email_field_8720')" class="button--outlined small optional-always">Change</button>
</span>
<!-- real input -->
<span id="edit_input_field_8720" class="">
<input type="email" id="field_8720" name="field_8720" guid="0a863bc2-bbee-4ae5-b8d2-a33bfb9abca3" tabindex="0" title="Emergency Contact Email Address" userview="Emergency Contact Email Address" value="" maxlength="100"
placeholder="customer_care@apricot.info" class="validate-email required required-2374 validation-failed" autocomplete="off" format="email">
</span>
<div id="advice-required-field_8720" class="validation-advice" role="alert" style="display: block;">This field is required.</div>
</fieldset>
</div>
</div>
</div>
</div>
</section>
<section class="recordSection ">
<h2 tabindex="0" onclick="popOver.toggleView($('section_1617'),$('section_1617_arrow'), 'auto')" onkeyup="if (event.keyCode === 13 ) popOver.toggleView($('section_1617'),$('section_1617_arrow'), 'auto')"> Demographic Questions <span
id="section_1617_arrow" class="arrow icon-arrow-white-large-open"></span>
</h2>
<div id="section_1617" class="x-scrollable " data-guid="">
<div class="fieldGrid">
<div class="section-row">
<div class="field-cell" data-id="8721" data-reference-tag="" data-type-id="26">
<!--Checkbox List Field-->
<fieldset class="">
<legend id="field_8721_checkboxes" userview="What is/are your Race(s)? Check all that apply">
<label for="field_8721"><span class="requiredIcon">*</span>What is/are your Race(s)? Check all that apply </label>
</legend>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8721_0">
<input type="checkbox" id="field_8721_0" name="field_8721[]" guid="c5e96fed-3e87-41b6-9dc6-ba75091c1bc7" tabindex="0" title="What is/are your Race(s)? Check all that apply" class="required multi_input_format validation-failed"
userview="What is/are your Race(s)? Check all that apply" value="African American/Black" onchange="toggleOther('field_8721')">
<span> African American/Black </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8721_1">
<input type="checkbox" id="field_8721_1" name="field_8721[]" guid="c5e96fed-3e87-41b6-9dc6-ba75091c1bc7" tabindex="0" title="What is/are your Race(s)? Check all that apply" class="required multi_input_format validation-failed"
userview="What is/are your Race(s)? Check all that apply" value="American Indian/Alaska Native" onchange="toggleOther('field_8721')">
<span> American Indian/Alaska Native </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8721_2">
<input type="checkbox" id="field_8721_2" name="field_8721[]" guid="c5e96fed-3e87-41b6-9dc6-ba75091c1bc7" tabindex="0" title="What is/are your Race(s)? Check all that apply" class="required multi_input_format validation-failed"
userview="What is/are your Race(s)? Check all that apply" value="Asian Indian" onchange="toggleOther('field_8721')">
<span> Asian Indian </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8721_3">
<input type="checkbox" id="field_8721_3" name="field_8721[]" guid="c5e96fed-3e87-41b6-9dc6-ba75091c1bc7" tabindex="0" title="What is/are your Race(s)? Check all that apply" class="required multi_input_format validation-failed"
userview="What is/are your Race(s)? Check all that apply" value="Cambodian" onchange="toggleOther('field_8721')">
<span> Cambodian </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8721_4">
<input type="checkbox" id="field_8721_4" name="field_8721[]" guid="c5e96fed-3e87-41b6-9dc6-ba75091c1bc7" tabindex="0" title="What is/are your Race(s)? Check all that apply" class="required multi_input_format validation-failed"
userview="What is/are your Race(s)? Check all that apply" value="Caucasian/White" onchange="toggleOther('field_8721')">
<span> Caucasian/White </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8721_5">
<input type="checkbox" id="field_8721_5" name="field_8721[]" guid="c5e96fed-3e87-41b6-9dc6-ba75091c1bc7" tabindex="0" title="What is/are your Race(s)? Check all that apply" class="required multi_input_format validation-failed"
userview="What is/are your Race(s)? Check all that apply" value="Chinese" onchange="toggleOther('field_8721')">
<span> Chinese </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8721_6">
<input type="checkbox" id="field_8721_6" name="field_8721[]" guid="c5e96fed-3e87-41b6-9dc6-ba75091c1bc7" tabindex="0" title="What is/are your Race(s)? Check all that apply" class="required multi_input_format validation-failed"
userview="What is/are your Race(s)? Check all that apply" value="Filipino" onchange="toggleOther('field_8721')">
<span> Filipino </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8721_7">
<input type="checkbox" id="field_8721_7" name="field_8721[]" guid="c5e96fed-3e87-41b6-9dc6-ba75091c1bc7" tabindex="0" title="What is/are your Race(s)? Check all that apply" class="required multi_input_format validation-failed"
userview="What is/are your Race(s)? Check all that apply" value="Hawaiian" onchange="toggleOther('field_8721')">
<span> Hawaiian </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8721_8">
<input type="checkbox" id="field_8721_8" name="field_8721[]" guid="c5e96fed-3e87-41b6-9dc6-ba75091c1bc7" tabindex="0" title="What is/are your Race(s)? Check all that apply" class="required multi_input_format validation-failed"
userview="What is/are your Race(s)? Check all that apply" value="Hmong" onchange="toggleOther('field_8721')">
<span> Hmong </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8721_9">
<input type="checkbox" id="field_8721_9" name="field_8721[]" guid="c5e96fed-3e87-41b6-9dc6-ba75091c1bc7" tabindex="0" title="What is/are your Race(s)? Check all that apply" class="required multi_input_format validation-failed"
userview="What is/are your Race(s)? Check all that apply" value="Japanese" onchange="toggleOther('field_8721')">
<span> Japanese </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8721_10">
<input type="checkbox" id="field_8721_10" name="field_8721[]" guid="c5e96fed-3e87-41b6-9dc6-ba75091c1bc7" tabindex="0" title="What is/are your Race(s)? Check all that apply" class="required multi_input_format validation-failed"
userview="What is/are your Race(s)? Check all that apply" value="Korean" onchange="toggleOther('field_8721')">
<span> Korean </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8721_11">
<input type="checkbox" id="field_8721_11" name="field_8721[]" guid="c5e96fed-3e87-41b6-9dc6-ba75091c1bc7" tabindex="0" title="What is/are your Race(s)? Check all that apply" class="required multi_input_format validation-failed"
userview="What is/are your Race(s)? Check all that apply" value="Laotian" onchange="toggleOther('field_8721')">
<span> Laotian </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8721_12">
<input type="checkbox" id="field_8721_12" name="field_8721[]" guid="c5e96fed-3e87-41b6-9dc6-ba75091c1bc7" tabindex="0" title="What is/are your Race(s)? Check all that apply" class="required multi_input_format validation-failed"
userview="What is/are your Race(s)? Check all that apply" value="Latino/a/x" onchange="toggleOther('field_8721')">
<span> Latino/a/x </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8721_13">
<input type="checkbox" id="field_8721_13" name="field_8721[]" guid="c5e96fed-3e87-41b6-9dc6-ba75091c1bc7" tabindex="0" title="What is/are your Race(s)? Check all that apply" class="required multi_input_format validation-failed"
userview="What is/are your Race(s)? Check all that apply" value="Mien" onchange="toggleOther('field_8721')">
<span> Mien </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8721_14">
<input type="checkbox" id="field_8721_14" name="field_8721[]" guid="c5e96fed-3e87-41b6-9dc6-ba75091c1bc7" tabindex="0" title="What is/are your Race(s)? Check all that apply" class="required multi_input_format validation-failed"
userview="What is/are your Race(s)? Check all that apply" value="Other Pacific Islander" onchange="toggleOther('field_8721')">
<span> Other Pacific Islander </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8721_15">
<input type="checkbox" id="field_8721_15" name="field_8721[]" guid="c5e96fed-3e87-41b6-9dc6-ba75091c1bc7" tabindex="0" title="What is/are your Race(s)? Check all that apply" class="required multi_input_format validation-failed"
userview="What is/are your Race(s)? Check all that apply" value="Samoan" onchange="toggleOther('field_8721')">
<span> Samoan </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8721_16">
<input type="checkbox" id="field_8721_16" name="field_8721[]" guid="c5e96fed-3e87-41b6-9dc6-ba75091c1bc7" tabindex="0" title="What is/are your Race(s)? Check all that apply" class="required multi_input_format validation-failed"
userview="What is/are your Race(s)? Check all that apply" value="Vietnamese" onchange="toggleOther('field_8721')">
<span> Vietnamese </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8721_17">
<input type="checkbox" id="field_8721_17" name="field_8721[]" guid="c5e96fed-3e87-41b6-9dc6-ba75091c1bc7" tabindex="0" title="What is/are your Race(s)? Check all that apply" class="required multi_input_format validation-failed"
data-is-other-button="true" userview="What is/are your Race(s)? Check all that apply" value="" onchange="toggleOther('field_8721')">
<span> Other </span>
</label>
<div class="clearBreak"></div>
<div>
<input type="text" value="" tabindex="0" id="field_8721_other" name="field_8721_other" guid="c5e96fed-3e87-41b6-9dc6-ba75091c1bc7" class="multi_input_other_format hidden required validation-passed" placeholder="Other Value"
validation_type="other">
</div>
<div id="advice-required-field_8721_17" class="validation-advice" role="alert" style="display: none;">This field is required.</div>
</fieldset>
</div>
</div>
<div class="section-row">
<div class="field-cell" data-id="8722" data-reference-tag="" data-type-id="26">
<!--Checkbox List Field-->
<fieldset class="">
<legend id="field_8722_checkboxes" userview="What is your Gender Identity? Check all that apply.">
<label for="field_8722"><span class="requiredIcon">*</span>What is your Gender Identity? Check all that apply. </label>
</legend>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8722_0">
<input type="checkbox" id="field_8722_0" name="field_8722[]" guid="94651b68-9a4d-4ccb-9ab4-e6eed7b99ace" tabindex="0" title="What is your Gender Identity? Check all that apply." class="required multi_input_format validation-failed"
userview="What is your Gender Identity? Check all that apply." value="Agender" onchange="toggleOther('field_8722')">
<span> Agender </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8722_1">
<input type="checkbox" id="field_8722_1" name="field_8722[]" guid="94651b68-9a4d-4ccb-9ab4-e6eed7b99ace" tabindex="0" title="What is your Gender Identity? Check all that apply." class="required multi_input_format validation-failed"
userview="What is your Gender Identity? Check all that apply." value="Cisgender Man" onchange="toggleOther('field_8722')">
<span> Cisgender Man </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8722_2">
<input type="checkbox" id="field_8722_2" name="field_8722[]" guid="94651b68-9a4d-4ccb-9ab4-e6eed7b99ace" tabindex="0" title="What is your Gender Identity? Check all that apply." class="required multi_input_format validation-failed"
userview="What is your Gender Identity? Check all that apply." value="Cisgender Woman" onchange="toggleOther('field_8722')">
<span> Cisgender Woman </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8722_3">
<input type="checkbox" id="field_8722_3" name="field_8722[]" guid="94651b68-9a4d-4ccb-9ab4-e6eed7b99ace" tabindex="0" title="What is your Gender Identity? Check all that apply." class="required multi_input_format validation-failed"
userview="What is your Gender Identity? Check all that apply." value="Genderfluid" onchange="toggleOther('field_8722')">
<span> Genderfluid </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8722_4">
<input type="checkbox" id="field_8722_4" name="field_8722[]" guid="94651b68-9a4d-4ccb-9ab4-e6eed7b99ace" tabindex="0" title="What is your Gender Identity? Check all that apply." class="required multi_input_format validation-failed"
userview="What is your Gender Identity? Check all that apply." value="Genderqueer" onchange="toggleOther('field_8722')">
<span> Genderqueer </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8722_5">
<input type="checkbox" id="field_8722_5" name="field_8722[]" guid="94651b68-9a4d-4ccb-9ab4-e6eed7b99ace" tabindex="0" title="What is your Gender Identity? Check all that apply." class="required multi_input_format validation-failed"
userview="What is your Gender Identity? Check all that apply." value="Nonbinary" onchange="toggleOther('field_8722')">
<span> Nonbinary </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8722_6">
<input type="checkbox" id="field_8722_6" name="field_8722[]" guid="94651b68-9a4d-4ccb-9ab4-e6eed7b99ace" tabindex="0" title="What is your Gender Identity? Check all that apply." class="required multi_input_format validation-failed"
userview="What is your Gender Identity? Check all that apply." value="Transgender Man" onchange="toggleOther('field_8722')">
<span> Transgender Man </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8722_7">
<input type="checkbox" id="field_8722_7" name="field_8722[]" guid="94651b68-9a4d-4ccb-9ab4-e6eed7b99ace" tabindex="0" title="What is your Gender Identity? Check all that apply." class="required multi_input_format validation-failed"
userview="What is your Gender Identity? Check all that apply." value="Transgender Woman" onchange="toggleOther('field_8722')">
<span> Transgender Woman </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8722_8">
<input type="checkbox" id="field_8722_8" name="field_8722[]" guid="94651b68-9a4d-4ccb-9ab4-e6eed7b99ace" tabindex="0" title="What is your Gender Identity? Check all that apply." class="required multi_input_format validation-failed"
userview="What is your Gender Identity? Check all that apply." value="Two Spirit" onchange="toggleOther('field_8722')">
<span> Two Spirit </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8722_9">
<input type="checkbox" id="field_8722_9" name="field_8722[]" guid="94651b68-9a4d-4ccb-9ab4-e6eed7b99ace" tabindex="0" title="What is your Gender Identity? Check all that apply." class="required multi_input_format validation-failed"
userview="What is your Gender Identity? Check all that apply." value="Unsure" onchange="toggleOther('field_8722')">
<span> Unsure </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8722_10">
<input type="checkbox" id="field_8722_10" name="field_8722[]" guid="94651b68-9a4d-4ccb-9ab4-e6eed7b99ace" tabindex="0" title="What is your Gender Identity? Check all that apply." class="required multi_input_format validation-failed"
data-is-other-button="true" userview="What is your Gender Identity? Check all that apply." value="" onchange="toggleOther('field_8722')">
<span> Other </span>
</label>
<div class="clearBreak"></div>
<div>
<input type="text" value="" tabindex="0" id="field_8722_other" name="field_8722_other" guid="94651b68-9a4d-4ccb-9ab4-e6eed7b99ace" class="multi_input_other_format hidden required validation-passed" placeholder="Other Value"
validation_type="other">
</div>
<div id="advice-required-field_8722_10" class="validation-advice" role="alert" style="display: none;">This field is required.</div>
</fieldset>
</div>
</div>
<div class="section-row">
<div class="field-cell" data-id="8723" data-reference-tag="" data-type-id="26">
<!--Checkbox List Field-->
<fieldset class="">
<legend id="field_8723_checkboxes" userview="What is your sexual orientation? Check all that apply.">
<label for="field_8723"><span class="requiredIcon">*</span>What is your sexual orientation? Check all that apply. </label>
</legend>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8723_0">
<input type="checkbox" id="field_8723_0" name="field_8723[]" guid="9a573a6d-adac-4ffb-aa17-a843a1d6dde8" tabindex="0" title="What is your sexual orientation? Check all that apply." class="required multi_input_format validation-failed"
userview="What is your sexual orientation? Check all that apply." value="Asexual" onchange="toggleOther('field_8723')">
<span> Asexual </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8723_1">
<input type="checkbox" id="field_8723_1" name="field_8723[]" guid="9a573a6d-adac-4ffb-aa17-a843a1d6dde8" tabindex="0" title="What is your sexual orientation? Check all that apply." class="required multi_input_format validation-failed"
userview="What is your sexual orientation? Check all that apply." value="Bisexual" onchange="toggleOther('field_8723')">
<span> Bisexual </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8723_2">
<input type="checkbox" id="field_8723_2" name="field_8723[]" guid="9a573a6d-adac-4ffb-aa17-a843a1d6dde8" tabindex="0" title="What is your sexual orientation? Check all that apply." class="required multi_input_format validation-failed"
userview="What is your sexual orientation? Check all that apply." value="Demisexual" onchange="toggleOther('field_8723')">
<span> Demisexual </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8723_3">
<input type="checkbox" id="field_8723_3" name="field_8723[]" guid="9a573a6d-adac-4ffb-aa17-a843a1d6dde8" tabindex="0" title="What is your sexual orientation? Check all that apply." class="required multi_input_format validation-failed"
userview="What is your sexual orientation? Check all that apply." value="Fluid" onchange="toggleOther('field_8723')">
<span> Fluid </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8723_4">
<input type="checkbox" id="field_8723_4" name="field_8723[]" guid="9a573a6d-adac-4ffb-aa17-a843a1d6dde8" tabindex="0" title="What is your sexual orientation? Check all that apply." class="required multi_input_format validation-failed"
userview="What is your sexual orientation? Check all that apply." value="Gay" onchange="toggleOther('field_8723')">
<span> Gay </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8723_5">
<input type="checkbox" id="field_8723_5" name="field_8723[]" guid="9a573a6d-adac-4ffb-aa17-a843a1d6dde8" tabindex="0" title="What is your sexual orientation? Check all that apply." class="required multi_input_format validation-failed"
userview="What is your sexual orientation? Check all that apply." value="Graysexual" onchange="toggleOther('field_8723')">
<span> Graysexual </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8723_6">
<input type="checkbox" id="field_8723_6" name="field_8723[]" guid="9a573a6d-adac-4ffb-aa17-a843a1d6dde8" tabindex="0" title="What is your sexual orientation? Check all that apply." class="required multi_input_format validation-failed"
userview="What is your sexual orientation? Check all that apply." value="Heterosexual/Straight" onchange="toggleOther('field_8723')">
<span> Heterosexual/Straight </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8723_7">
<input type="checkbox" id="field_8723_7" name="field_8723[]" guid="9a573a6d-adac-4ffb-aa17-a843a1d6dde8" tabindex="0" title="What is your sexual orientation? Check all that apply." class="required multi_input_format validation-failed"
userview="What is your sexual orientation? Check all that apply." value="Lesbian" onchange="toggleOther('field_8723')">
<span> Lesbian </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8723_8">
<input type="checkbox" id="field_8723_8" name="field_8723[]" guid="9a573a6d-adac-4ffb-aa17-a843a1d6dde8" tabindex="0" title="What is your sexual orientation? Check all that apply." class="required multi_input_format validation-failed"
userview="What is your sexual orientation? Check all that apply." value="Pansexual" onchange="toggleOther('field_8723')">
<span> Pansexual </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8723_9">
<input type="checkbox" id="field_8723_9" name="field_8723[]" guid="9a573a6d-adac-4ffb-aa17-a843a1d6dde8" tabindex="0" title="What is your sexual orientation? Check all that apply." class="required multi_input_format validation-failed"
userview="What is your sexual orientation? Check all that apply." value="Queer" onchange="toggleOther('field_8723')">
<span> Queer </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8723_10">
<input type="checkbox" id="field_8723_10" name="field_8723[]" guid="9a573a6d-adac-4ffb-aa17-a843a1d6dde8" tabindex="0" title="What is your sexual orientation? Check all that apply."
class="required multi_input_format validation-failed" userview="What is your sexual orientation? Check all that apply." value="Unsure" onchange="toggleOther('field_8723')">
<span> Unsure </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8723_11">
<input type="checkbox" id="field_8723_11" name="field_8723[]" guid="9a573a6d-adac-4ffb-aa17-a843a1d6dde8" tabindex="0" title="What is your sexual orientation? Check all that apply."
class="required multi_input_format validation-failed" data-is-other-button="true" userview="What is your sexual orientation? Check all that apply." value="" onchange="toggleOther('field_8723')">
<span> Other </span>
</label>
<div class="clearBreak"></div>
<div>
<input type="text" value="" tabindex="0" id="field_8723_other" name="field_8723_other" guid="9a573a6d-adac-4ffb-aa17-a843a1d6dde8" class="multi_input_other_format hidden required validation-passed" placeholder="Other Value"
validation_type="other">
</div>
<div id="advice-required-field_8723_11" class="validation-advice" role="alert" style="display: none;">This field is required.</div>
</fieldset>
</div>
</div>
<div class="section-row">
<div class="field-cell" data-id="8765" data-reference-tag="" data-type-id="77">
<!--Radio List Field-->
<fieldset class="hidden">
<legend id="field_8765_radiobutton" userview="LGBTQ+?">
<label>LGBTQ+? </label>
</legend>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8765_0">
<input type="radio" id="field_8765_0" name="field_8765" guid="ccfb4b8f-f3f6-4674-8b00-73fe592a52a6" tabindex="0" title="LGBTQ+?" style="display:block; margin-left: -20px; margin-top:2px;" userview="LGBTQ+?" value="1"
class=" multi_input_format" onchange="toggleOther('field_8765')">
<span> Yes </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8765_1">
<input type="radio" id="field_8765_1" name="field_8765" guid="ccfb4b8f-f3f6-4674-8b00-73fe592a52a6" tabindex="0" title="LGBTQ+?" style="display:block; margin-left: -20px; margin-top:2px;" userview="LGBTQ+?" value="0"
class=" multi_input_format" onchange="toggleOther('field_8765')">
<span> No </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format hidden" for="field_8765_2">
<input type="radio" id="field_8765_2" name="field_8765" guid="ccfb4b8f-f3f6-4674-8b00-73fe592a52a6" tabindex="0" title="LGBTQ+?" style="display:block; margin-left: -20px; margin-top:2px;" userview="LGBTQ+?" value=""
class=" multi_input_format" data-is-other-button="true" onchange="toggleOther('field_8765')">
<span> Other </span>
</label>
<div class="clearBreak"></div>
<input type="text" value="" tabindex="0" id="field_8765_other" name="field_8765_other" guid="ccfb4b8f-f3f6-4674-8b00-73fe592a52a6" class="multi_input_other_format hidden " placeholder="Other Value" validation_type="other" readonly="">
</fieldset>
</div>
</div>
<div class="section-row">
<div class="field-cell" data-id="8724" data-reference-tag="" data-type-id="22">
<!--Select List Field-->
<fieldset class="">
<legend>
<label for="field_8724"><span class="requiredIcon">*</span>What is the language you speak at home? </label>
</legend>
<select id="field_8724" name="field_8724" guid="429f8e9b-1f7f-486d-97b9-a57d1ee11c9f" tabindex="0" title="What is the language you speak at home?" userview="What is the language you speak at home?" value=""
class="required validation-failed" onchange="toggleOther('field_8724')">
<option value="">--Please Select--</option>
<option value="English">English</option>
<option value="Spanish">Spanish</option>
<option value="Arabic">Arabic</option>
<option value="Armenian">Armenian</option>
<option value="ASL">ASL</option>
<option value="Cambodian">Cambodian</option>
<option value="Cantonese">Cantonese</option>
<option value="Farsi">Farsi</option>
<option value="French">French</option>
<option value="Hebrew">Hebrew</option>
<option value="Hmong">Hmong</option>
<option value="Ilocano">Ilocano</option>
<option value="Italian">Italian</option>
<option value="Japanese">Japanese</option>
<option value="Korean">Korean</option>
<option value="Lao">Lao</option>
<option value="Mandarin">Mandarin</option>
<option value="Mien">Mien</option>
<option value="Oth Chinese">Oth Chinese</option>
<option value="Polish">Polish</option>
<option value="Portuguese">Portuguese</option>
<option value="Russian">Russian</option>
<option value="Samoan">Samoan</option>
<option value="Tagalog">Tagalog</option>
<option value="Thai">Thai</option>
<option value="Turkish">Turkish</option>
<option value="Unk/Not Reported">Unk/Not Reported</option>
<option value="Vietnamese">Vietnamese</option>
<option value="">Other</option>
</select>
<div class="clearBreak" style="height: 4px;"></div>
<input type="text" value="" tabindex="0" id="field_8724_other" name="field_8724_other" guid="429f8e9b-1f7f-486d-97b9-a57d1ee11c9f" class="multi_input_other_format hidden required validation-passed" placeholder="Other Value"
validation_type="other">
<div id="advice-required-field_8724" class="validation-advice" role="alert" style="display: none;">This field is required.</div>
</fieldset>
</div>
</div>
<div class="section-row">
<div class="field-cell" data-id="8725" data-reference-tag="" data-type-id="26">
<!--Checkbox List Field-->
<fieldset class="">
<legend id="field_8725_checkboxes" userview="So we can learn more about the specific needs of our community, please check all the categories below that apply to you.">
<label for="field_8725"><span class="requiredIcon">*</span>So we can learn more about the specific needs of our community, please check all the categories below that apply to you. </label>
</legend>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8725_0">
<input type="checkbox" id="field_8725_0" name="field_8725[]" guid="4f795489-e49d-4134-b04c-55e569f8f8e5" tabindex="0"
title="So we can learn more about the specific needs of our community, please check all the categories below that apply to you." class="required multi_input_format validation-failed"
userview="So we can learn more about the specific needs of our community, please check all the categories below that apply to you." value="Veteran" onchange="toggleOther('field_8725')">
<span> Veteran </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8725_1">
<input type="checkbox" id="field_8725_1" name="field_8725[]" guid="4f795489-e49d-4134-b04c-55e569f8f8e5" tabindex="0"
title="So we can learn more about the specific needs of our community, please check all the categories below that apply to you." class="required multi_input_format validation-failed"
userview="So we can learn more about the specific needs of our community, please check all the categories below that apply to you." value="Refugee/Asylum Seeker" onchange="toggleOther('field_8725')">
<span> Refugee/Asylum Seeker </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8725_2">
<input type="checkbox" id="field_8725_2" name="field_8725[]" guid="4f795489-e49d-4134-b04c-55e569f8f8e5" tabindex="0"
title="So we can learn more about the specific needs of our community, please check all the categories below that apply to you." class="required multi_input_format validation-failed"
userview="So we can learn more about the specific needs of our community, please check all the categories below that apply to you." value="Currently Experiencing Homelessness" onchange="toggleOther('field_8725')">
<span> Currently Experiencing Homelessness </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8725_3">
<input type="checkbox" id="field_8725_3" name="field_8725[]" guid="4f795489-e49d-4134-b04c-55e569f8f8e5" tabindex="0"
title="So we can learn more about the specific needs of our community, please check all the categories below that apply to you." class="required multi_input_format validation-failed"
userview="So we can learn more about the specific needs of our community, please check all the categories below that apply to you." value="Experienced Homelessness at any time in the last 12 months"
onchange="toggleOther('field_8725')">
<span> Experienced Homelessness at any time in the last 12 months </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8725_4">
<input type="checkbox" id="field_8725_4" name="field_8725[]" guid="4f795489-e49d-4134-b04c-55e569f8f8e5" tabindex="0"
title="So we can learn more about the specific needs of our community, please check all the categories below that apply to you." class="required multi_input_format validation-failed"
userview="So we can learn more about the specific needs of our community, please check all the categories below that apply to you." value="Experienced Incarceration at any time in the last 12 months"
onchange="toggleOther('field_8725')">
<span> Experienced Incarceration at any time in the last 12 months </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8725_5">
<input type="checkbox" id="field_8725_5" name="field_8725[]" guid="4f795489-e49d-4134-b04c-55e569f8f8e5" tabindex="0"
title="So we can learn more about the specific needs of our community, please check all the categories below that apply to you." class="required multi_input_format validation-failed"
userview="So we can learn more about the specific needs of our community, please check all the categories below that apply to you." value="Child of someone who was ever incarcerated" onchange="toggleOther('field_8725')">
<span> Child of someone who was ever incarcerated </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8725_6">
<input type="checkbox" id="field_8725_6" name="field_8725[]" guid="4f795489-e49d-4134-b04c-55e569f8f8e5" tabindex="0"
title="So we can learn more about the specific needs of our community, please check all the categories below that apply to you." class="required multi_input_format validation-failed"
userview="So we can learn more about the specific needs of our community, please check all the categories below that apply to you." value="Current or Former Foster Youth" onchange="toggleOther('field_8725')">
<span> Current or Former Foster Youth </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8725_7">
<input type="checkbox" id="field_8725_7" name="field_8725[]" guid="4f795489-e49d-4134-b04c-55e569f8f8e5" tabindex="0"
title="So we can learn more about the specific needs of our community, please check all the categories below that apply to you." class="required multi_input_format validation-failed"
userview="So we can learn more about the specific needs of our community, please check all the categories below that apply to you." value="Family Member with a Mental Illness" onchange="toggleOther('field_8725')">
<span> Family Member with a Mental Illness </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8725_8">
<input type="checkbox" id="field_8725_8" name="field_8725[]" guid="4f795489-e49d-4134-b04c-55e569f8f8e5" tabindex="0"
title="So we can learn more about the specific needs of our community, please check all the categories below that apply to you." class="required multi_input_format validation-failed"
userview="So we can learn more about the specific needs of our community, please check all the categories below that apply to you." value="Living with a Disability" onchange="toggleOther('field_8725')">
<span> Living with a Disability </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8725_9">
<input type="checkbox" id="field_8725_9" name="field_8725[]" guid="4f795489-e49d-4134-b04c-55e569f8f8e5" tabindex="0"
title="So we can learn more about the specific needs of our community, please check all the categories below that apply to you." class="required multi_input_format validation-failed"
userview="So we can learn more about the specific needs of our community, please check all the categories below that apply to you." value="None of these" onchange="toggleOther('field_8725')">
<span> None of these </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format hidden" for="field_8725_10">
<input type="checkbox" id="field_8725_10" name="field_8725[]" guid="4f795489-e49d-4134-b04c-55e569f8f8e5" tabindex="0"
title="So we can learn more about the specific needs of our community, please check all the categories below that apply to you." class="required multi_input_format validation-passed" data-is-other-button="true"
userview="So we can learn more about the specific needs of our community, please check all the categories below that apply to you." value="" onchange="toggleOther('field_8725')">
<span> Other </span>
</label>
<div class="clearBreak"></div>
<div>
<input type="text" value="" tabindex="0" id="field_8725_other" name="field_8725_other" guid="4f795489-e49d-4134-b04c-55e569f8f8e5" class="multi_input_other_format hidden required validation-passed" placeholder="Other Value"
validation_type="other" readonly="">
</div>
<div id="advice-required-field_8725_9" class="validation-advice" role="alert" style="display: none;">This field is required.</div>
</fieldset>
</div>
</div>
</div>
</div>
</section>
<section class="recordSection hidden">
<h2 tabindex="0" onclick="popOver.toggleView($('section_1621'),$('section_1621_arrow'), 'auto')" onkeyup="if (event.keyCode === 13 ) popOver.toggleView($('section_1621'),$('section_1621_arrow'), 'auto')"> Opt in to an Additional Offer <span
id="section_1621_arrow" class="arrow icon-arrow-white-large-open"></span>
</h2>
<div id="section_1621" class="x-scrollable " data-guid="">
<div class="fieldGrid">
<div class="section-row">
<div class="field-cell" data-id="8729" data-reference-tag="" data-type-id="26">
<!--Checkbox List Field-->
<fieldset class="">
<legend id="field_8729_checkboxes" userview="You may be eligible for a $25 VISA gift card for completing a survey for the Center.">
<label for="field_8729">You may be eligible for a $25 VISA gift card for completing a survey for the Center. </label>
</legend>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8729_0">
<input type="checkbox" id="field_8729_0" name="field_8729[]" guid="6b523cdc-17ea-4950-bbd6-2ef1ed1f4757" tabindex="0" title="You may be eligible for a $25 VISA gift card for completing a survey for the Center."
class=" multi_input_format" userview="You may be eligible for a $25 VISA gift card for completing a survey for the Center." value="Yes, please email me link to the survey" onchange="toggleOther('field_8729')">
<span> Yes, please email me link to the survey </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format " for="field_8729_1">
<input type="checkbox" id="field_8729_1" name="field_8729[]" guid="6b523cdc-17ea-4950-bbd6-2ef1ed1f4757" tabindex="0" title="You may be eligible for a $25 VISA gift card for completing a survey for the Center."
class=" multi_input_format" userview="You may be eligible for a $25 VISA gift card for completing a survey for the Center." value="No thank you; I'm not interested." onchange="toggleOther('field_8729')">
<span> No thank you; I'm not interested. </span>
</label>
<label class="fieldCheckboxLabel multi_input_label_format hidden" for="field_8729_2">
<input type="checkbox" id="field_8729_2" name="field_8729[]" guid="6b523cdc-17ea-4950-bbd6-2ef1ed1f4757" tabindex="0" title="You may be eligible for a $25 VISA gift card for completing a survey for the Center."
class=" multi_input_format" data-is-other-button="true" userview="You may be eligible for a $25 VISA gift card for completing a survey for the Center." value="" onchange="toggleOther('field_8729')">
<span> Other </span>
</label>
<div class="clearBreak"></div>
<div>
<input type="text" value="" tabindex="0" id="field_8729_other" name="field_8729_other" guid="6b523cdc-17ea-4950-bbd6-2ef1ed1f4757" class="multi_input_other_format hidden " placeholder="Other Value" validation_type="other"
readonly="">
</div>
</fieldset>
</div>
</div>
</div>
</div>
</section>
<section class="recordSection hidden">
<h2 tabindex="0" onclick="popOver.toggleView($('section_1620'),$('section_1620_arrow'), 'auto')" onkeyup="if (event.keyCode === 13 ) popOver.toggleView($('section_1620'),$('section_1620_arrow'), 'auto')"> Further Instructions <span
id="section_1620_arrow" class="arrow icon-arrow-white-large-open"></span>
</h2>
<div id="section_1620" class="x-scrollable " data-guid="">
<div class="fieldGrid">
<div class="section-row">
<div class="field-cell" data-id="9039" data-reference-tag="" data-type-id="28">
<!-- Label Only Field -->
<fieldset class="no-legend ">
<p style="text-align: center;">Complete your registration: scroll to the top of the form and click Submit in the upper right, under Record Options.</p>
<p style="text-align: center;">If you do not receive an email confirmation in the next few moments, check your junkmail folder.</p>
<p style="text-align: center;">Staff may ask to see your email confirmation at the event to confirm event registration.</p>
<input type="hidden" guid="ab133fc2-86e6-44f8-b5aa-124083e400f9">
</fieldset>
</div>
</div>
</div>
</div>
</section>
<section class="recordSection hidden">
<h2 tabindex="0" onclick="popOver.toggleView($('section_1614'),$('section_1614_arrow'), 'auto')" onkeyup="if (event.keyCode === 13 ) popOver.toggleView($('section_1614'),$('section_1614_arrow'), 'auto')"> System Fields <span
id="section_1614_arrow" class="arrow icon-arrow-white-large-closed"></span>
</h2>
<div id="section_1614" class="x-scrollable closed" data-guid="">
<div class="fieldGrid">
<div class="section-row">
<div class="field-cell" data-id="8702" data-reference-tag="" data-type-id="34">
<!-- System Date Field -->
<fieldset class="">
<legend> Modification Date </legend>
<input type="text" id="mod_time" name="mod_time" guid="9f37ba0b-a40a-4433-ad23-022675fa8e02" title="Modification Date" tabindex="0" userview="Modification Date" value="--" readonly="" class="systemField medlarge">
</fieldset>
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="8703" data-reference-tag="" data-type-id="35">
<!-- System User Field -->
<fieldset class="">
<legend> Modified By </legend>
<input type="text" id="mod_user" name="mod_user" guid="459249ca-74dc-40ac-b5ba-399940827797" title="Modified By" userview="Modified By" tabindex="0" value="--" readonly="" class="systemField">
</fieldset>
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="8704" data-reference-tag="" data-type-id="34">
<!-- System Date Field -->
<fieldset class="">
<legend> Creation Date </legend>
<input type="text" id="creation_time" name="creation_time" guid="c91b057e-7983-429d-9954-0e94e22d40cf" title="Creation Date" tabindex="0" userview="Creation Date" value="--" readonly="" class="systemField medlarge">
</fieldset>
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="8705" data-reference-tag="" data-type-id="35">
<!-- System User Field -->
<fieldset class="">
<legend> Created By </legend>
<input type="text" id="creation_user" name="creation_user" guid="a4e4c8fb-8d38-49fd-a8e9-830096040f29" title="Created By" userview="Created By" tabindex="0" value="--" readonly="" class="systemField">
</fieldset>
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="" data-reference-tag="" data-type-id="">
</div>
<div class="field-cell" data-id="8706" data-reference-tag="" data-type-id="95">
<!-- System Programs -->
<fieldset class="">
<legend>
<label>Assigned Programs</label>
</legend>
<div class="systemField">
<div class="clearBreak"></div>
<ul id="assigned_programs_field_list">
<li class="system-field-program-name-display " title="Secure Web Form Dedicated User program">- Secure Web Form Dedicated User program</li>
</ul>
<input value="[65426]" id="field_8706" guid="b01829c2-53d7-4679-97b6-8e5c523f502e" readonly="" class="system-field-program-current-ids systemField large ">
</div>
<input id="restricted_program_ids" value="" class="hidden" data-permissions-form="" data-programs-form="">
<input id="current_program_ids" value="[65426]" class="hidden">
</fieldset>
</div>
</div>
</div>
</div>
</section>
<section class="recordSection hidden">
<h2 tabindex="0" onclick="popOver.toggleView($('section_1619'),$('section_1619_arrow'), 'auto')" onkeyup="if (event.keyCode === 13 ) popOver.toggleView($('section_1619'),$('section_1619_arrow'), 'auto')"> Email Trigger <span
id="section_1619_arrow" class="arrow icon-arrow-white-large-closed"></span>
</h2>
<div id="section_1619" class="x-scrollable closed" data-guid="">
<div class="fieldGrid">
<div class="section-row">
<div class="field-cell" data-id="9058" data-reference-tag="" data-type-id="40">
<!-- Email Trigger Field -->
<fieldset class="hidden" style="overflow: hidden">
<legend> Email Trigger: Event Registration Confirmation </legend>
<div id="_email_log" style="height: 0px; overflow: hidden;">
<div class="buttons">
<button type="button" onclick="popOver.toggleView($('field_9058_email_log'),$('field_9058_arrow'),'auto');">Close</button>
</div>
<input class="hidden" guid="002fe321-39a5-48f8-a8b5-5c2daa47dd00" type="text">
</div>
</fieldset>
</div>
</div>
<div class="section-row">
<div class="field-cell" data-id="8732" data-reference-tag="" data-type-id="40">
<!-- Email Trigger Field -->
<fieldset class="hidden" style="overflow: hidden">
<legend> Email Trigger to CM - opt in to Centering Black Trans Health </legend>
<div id="_email_log" style="height: 0px; overflow: hidden;">
<div class="buttons">
<button type="button" onclick="popOver.toggleView($('field_8732_email_log'),$('field_8732_arrow'),'auto');">Close</button>
</div>
<input class="hidden" guid="f6b5cfed-4e0d-46ae-87d0-9660212cb9de" type="text">
</div>
</fieldset>
</div>
</div>
<div class="section-row">
<div class="field-cell" data-id="8730" data-reference-tag="" data-type-id="40">
<!-- Email Trigger Field -->
<fieldset class="hidden" style="overflow: hidden">
<legend> Email Trigger to CM - opt into Housing Wait List </legend>
<div id="_email_log" style="height: 0px; overflow: hidden;">
<div class="buttons">
<button type="button" onclick="popOver.toggleView($('field_8730_email_log'),$('field_8730_arrow'),'auto');">Close</button>
</div>
<input class="hidden" guid="5a24f900-11e7-44d8-8fd3-637fa0fa4af7" type="text">
</div>
</fieldset>
</div>
</div>
</div>
</div>
</section>
</form>Text Content
× COLLAPSE ALL Record Options Submit Close Record Save Checklist Required Field Checks *What is your name? *What are your pronouns? Ch... *What is your birthdate? *What's your email address? *What is/are your Race(s)? ... *What is your Gender Identi... *What is your sexual orient... *So we can learn more about... *What is the language you s... Check here to decline to pr... Emergency Contact Name Your relationship to the Em... Emergency Contact Phone Num... Emergency Contact Email Add... What's your phone number? What is your Home Zip Code. Field Validation Checks Form Logic Rules Unhide Legal Name Field Set Value: Experiencing homelessness or housing insecurity Decline to provide Emergency Contact Info Remove Requirement from Phone Number Unhide Special Message/Lock Data Entry if Age >24 Set Value LGBTQ+ - Yes Set Value LGBTQ+ - No Home Zip Code: Hide if currently experiencing housing insecurity Set Value Home Zip Code 99999 if currently experiencing housing instability Unhide Opt In to Black Trans Health Survey Unhide Further Instructions Section Record History Click a link to view the changes that were made at that time. #SACYOUTHTOWNNIGHTS REGISTRATION FORM INTRO Welcome SacTownYouthNights @ the QSpot! If you are under the age of 25, please complete this form. Rotate your device to landscape to improve your user experience. INTERNAL INFORMATION Record ID Completion Date Completion Time Completion Time A M P M AM PM Now SAC PRIDE INTRODUCTION Welcome to Sacramento Pride 2022! Complete this form (it should take 5 mins or less) and present the email confirmation you receive to a QSpot Attendant to receive your bracelet. The bracelet gains you access to food and prizes throughout the festival. * We are only offering bracelets to youth under the age of 25. If you are older, please do not complete this form. * If you are completing this form on your phone, we recommend rotating to landscape for an improved user experience. * To submit your form, scroll to the top and select "Submit" under Record Options in the upper right hand corner. * Be sure to check your junk mail for casey.maloney@saccenter.org if you don't receive your confirmation email within a few seconds after you submit your form. SPECIAL MESSAGE If you are older than 24, please do not submit this form. CONTACT INFORMATION *What is your name? This field is required. Check if you have a different name that you use legally. I use a different name legally. Other What is your legal name? *What are your pronouns? Check all that apply He/Him/His She/Her/Hers They/Them/Theirs Other This field is required. Current Age *What is your birthdate? This field is required. Check here if you cannot provide a phone number I cannot provide a phone number. Other *What's your phone number? What's your phone number? 0 What's your phone number? 1 What's your phone number? 2 ext. What's your phone number? 3 This field is required. *What's your email address? Change This field is required. If you are currently facing homelessness or housing instability, check all that apply. I am currently facing homelessness or housing instability. I would like to sign up on the Center Housing Wait List. Other *What is your Home Zip Code. This field is required. EMERGENCY CONTACT INFORMATION *Check here to decline to provide Emergency Contact Information I refuse to provide Emergency Contact Information Other This field is required. *Emergency Contact Name This field is required. *Your relationship to the Emergency Contact This field is required. *Emergency Contact Phone Number Emergency Contact Phone Number 0 This field is required. *Emergency Contact Email Address Change This field is required. DEMOGRAPHIC QUESTIONS *What is/are your Race(s)? Check all that apply African American/Black American Indian/Alaska Native Asian Indian Cambodian Caucasian/White Chinese Filipino Hawaiian Hmong Japanese Korean Laotian Latino/a/x Mien Other Pacific Islander Samoan Vietnamese Other This field is required. *What is your Gender Identity? Check all that apply. Agender Cisgender Man Cisgender Woman Genderfluid Genderqueer Nonbinary Transgender Man Transgender Woman Two Spirit Unsure Other This field is required. *What is your sexual orientation? Check all that apply. Asexual Bisexual Demisexual Fluid Gay Graysexual Heterosexual/Straight Lesbian Pansexual Queer Unsure Other This field is required. LGBTQ+? Yes No Other *What is the language you speak at home? --Please Select-- English Spanish Arabic Armenian ASL Cambodian Cantonese Farsi French Hebrew Hmong Ilocano Italian Japanese Korean Lao Mandarin Mien Oth Chinese Polish Portuguese Russian Samoan Tagalog Thai Turkish Unk/Not Reported Vietnamese Other This field is required. *So we can learn more about the specific needs of our community, please check all the categories below that apply to you. Veteran Refugee/Asylum Seeker Currently Experiencing Homelessness Experienced Homelessness at any time in the last 12 months Experienced Incarceration at any time in the last 12 months Child of someone who was ever incarcerated Current or Former Foster Youth Family Member with a Mental Illness Living with a Disability None of these Other This field is required. OPT IN TO AN ADDITIONAL OFFER You may be eligible for a $25 VISA gift card for completing a survey for the Center. Yes, please email me link to the survey No thank you; I'm not interested. Other FURTHER INSTRUCTIONS Complete your registration: scroll to the top of the form and click Submit in the upper right, under Record Options. If you do not receive an email confirmation in the next few moments, check your junkmail folder. Staff may ask to see your email confirmation at the event to confirm event registration. SYSTEM FIELDS Modification Date Modified By Creation Date Created By Assigned Programs * - Secure Web Form Dedicated User program EMAIL TRIGGER Email Trigger: Event Registration Confirmation Close Email Trigger to CM - opt in to Centering Black Trans Health Close Email Trigger to CM - opt into Housing Wait List Close Confirm Cancel By accessing the Services, I agree to the Social Solutions Privacy Policy and Terms of Service. Privacy Policy | Terms of Service