{"id":9,"date":"2018-02-09T21:47:30","date_gmt":"2018-02-09T21:47:30","guid":{"rendered":"https:\/\/kidmeals.gllzc0ys-liquidwebsites.com\/?page_id=9"},"modified":"2026-01-16T16:16:03","modified_gmt":"2026-01-16T22:16:03","slug":"need-help","status":"publish","type":"page","link":"https:\/\/kidsmealsinc.org\/es\/need-help\/","title":{"rendered":"\u00bfNecesita ayuda?"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"9\" class=\"elementor elementor-9\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6182735 pad e-flex e-con-boxed e-con e-parent\" data-id=\"6182735\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-0bd5095 elementor-widget elementor-widget-heading\" data-id=\"0bd5095\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\">We are ready to help you!\n<\/span>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-7da4f57 pad tight read e-flex e-con-boxed e-con e-parent\" data-id=\"7da4f57\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8b4ea06 elementor-widget-mobile__width-inherit elementor-widget elementor-widget-text-editor\" data-id=\"8b4ea06\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h4>\u00a1Ahora puedes ver nuestro sitio web en espa\u00f1ol!<\/h4><p><strong>En computadora:<\/strong> Haz clic en la bandera de Estados Unidos en la esquina superior derecha y selecciona la bandera de M\u00e9xico para la versi\u00f3n en espa\u00f1ol.<\/p><p><strong>En m\u00f3vil:<\/strong> Toca las 3 l\u00edneas (men\u00fa), luego haz clic en la bandera de Estados Unidos y cambia a la bandera de M\u00e9xico<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-745380c elementor-align-center elementor-widget elementor-widget-button\" data-id=\"745380c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"\/need-help\/\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">English<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5a8e301 elementor-align-center elementor-widget elementor-widget-button\" data-id=\"5a8e301\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"\/es\/need-help\/\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Espa\u00f1ol<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-1acba9f e-grid pad e-con-boxed e-con e-parent\" data-id=\"1acba9f\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c6a4595 balance elementor-widget elementor-widget-heading\" data-id=\"c6a4595\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">WE ARE HERE TO HELP FEED YOUR CHILDREN!<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0947065 elementor-widget elementor-widget-text-editor\" data-id=\"0947065\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Kids\u2019 Meals delivers free, healthy meals, year-round, Monday-Friday to the homes of children age 5 or under who live within our 56 delivery zip codes. We also deliver 1-3 family grocery bags a week. We will also connect you with our 70+ partners to help you find support for everything from job finding, budgeting, health care, early childhood education and more.<\/p><p>Receiving our meals will not impact any other benefits you receive.<\/p><ul class=\"chalk-check-list\"><li>Free home delivered meals Monday \u2013 Friday<\/li><li>Holiday food<\/li><li>Bags of groceries throughout the year<\/li><li>Information on community resources<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-88cd03c elementor-widget elementor-widget-text-editor\" data-id=\"88cd03c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h4>To Qualify You Must:<\/h4><ol><li>Have a child under 5 in the home.<\/li><li>Qualify for Medicaid, TANF, SNAP, or WIC.<\/li><li>Live in one of the 56 delivery zip codes? <a href=\"https:\/\/kidsmealsinc.org\/wp-content\/uploads\/55-Zip-Codes-5.pdf\" target=\"_blank\" rel=\"noopener\">See Map<\/a><\/li><li>Fill out the application form below.<br \/><a class=\"button\" href=\"#application\">Client Application<\/a><\/li><\/ol>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-16aac45 elementor-widget__width-inherit elementor-widget elementor-widget-heading\" data-id=\"16aac45\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Questions? Call <em>713-695-5437<\/em> Monday-Friday 9am-3pm<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-3a3c24a pad e-flex e-con-boxed e-con e-parent\" data-id=\"3a3c24a\" data-element_type=\"container\" data-e-type=\"container\" id=\"application\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-48d7418 elementor-widget elementor-widget-text-editor\" data-id=\"48d7418\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"wpforms-head-container\"><h2 class=\"wpforms-title\">Application For Meal Deliveries<\/h2><\/div><p>To start receiving lunches, you must qualify and the application must be COMPLETELY filled out.<\/p><p>You may apply online or download &amp; email the application below.<\/p><p>If you have any questions please contact Kids\u2019 Meals at 713-695-5437 or email Clients@kidsmealsinc.org<\/p><h3>To receive lunches from Kids\u2019 Meals, you must meet 3 criteria:<\/h3><ul><li>At least one child five years old or younger must live in your home<\/li><li>You must live in one of 56 zip codes that Kids\u2019 Meals delivers to<\/li><li>Your monthly income must meet the eligibility guidelines below:<ul><li>Family of 2: $3,261<\/li><li>Family of 3: $4,109<\/li><li>Family of 4: $4,957<\/li><li>Family of 5: $5,805<\/li><li>Family of 6: $6,653<\/li><li>Family of 7: $8,349<\/li><li>Per additional Person: +$848<\/li><\/ul><\/li><\/ul><p><em>Eligibility guidelines are on a monthly basis according to the Texas Department of Agriculture, Emergency Food Assistance Program, Effective: July 1, 2025 \u2013 June 30, 2026<\/em><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0540f61 elementor-widget elementor-widget-text-editor\" data-id=\"0540f61\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h4>Online Application<\/h4>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9731960 elementor-widget elementor-widget-shortcode\" data-id=\"9731960\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><style id=\"wpforms-css-vars-11411\">\n\t\t\t\t#wpforms-11411 {\n\t\t\t\t--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-container-save-resume wpforms-render-modern\" id=\"wpforms-11411\"><form id=\"wpforms-form-11411\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"11411\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/es\/wp-json\/wp\/v2\/pages\/9\" data-token=\"79dcd927208a120a1f93cf669d815262\" data-token-time=\"1781872521\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#72b239\" data-scroll=\"1\" role=\"progressbar\" aria-valuenow=\"1\" aria-valuemin=\"1\" aria-valuemax=\"7\" tabindex=\"-1\"><span class=\"wpforms-page-indicator-page-title\" data-page-1-title=\"Qualifications\" data-page-2-title=\"Application Type\" data-page-3-title=\"Delivery and Contact Information\">Qualifications<\/span><span class=\"wpforms-page-indicator-page-title-sep\" > - <\/span><span class=\"wpforms-page-indicator-steps\">Step <span class=\"wpforms-page-indicator-steps-current\">1<\/span> of 7<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:14.2857142857%;background-color:#72b239\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-11411-field_8-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"8\"><\/div><div id=\"wpforms-11411-field_112-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"112\"><h3 id=\"wpforms-11411-field_112\" aria-errormessage=\"wpforms-11411-field_112-error\">First, let&#039;s see if you qualify for the Kids&#039; Meals program<\/h3><\/div><div id=\"wpforms-11411-field_113-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"113\"><fieldset><legend class=\"wpforms-field-label\">Do you have a child in your family who is 5 years old or younger? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_113\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_113_1\" name=\"wpforms[fields][113]\" value=\"Yes\" aria-errormessage=\"wpforms-11411-field_113_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_113_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_113_2\" name=\"wpforms[fields][113]\" value=\"No\" aria-errormessage=\"wpforms-11411-field_113_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_113_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-11411-field_110-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-id=\"110\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-11411-field_110\">What is your zip code? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-11411-field_110\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][110]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'> <\/option><option value=\"My zip code is not listed\"  class=\"choice-60 depth-1\"  >My zip code is not listed<\/option><option value=\"77003\"  class=\"choice-4 depth-1\"  >77003<\/option><option value=\"77004\"  class=\"choice-5 depth-1\"  >77004<\/option><option value=\"77007\"  class=\"choice-61 depth-1\"  >77007<\/option><option value=\"77008\"  class=\"choice-7 depth-1\"  >77008<\/option><option value=\"77009\"  class=\"choice-8 depth-1\"  >77009<\/option><option value=\"77011\"  class=\"choice-9 depth-1\"  >77011<\/option><option value=\"77012\"  class=\"choice-10 depth-1\"  >77012<\/option><option value=\"77016\"  class=\"choice-11 depth-1\"  >77016<\/option><option value=\"77018\"  class=\"choice-12 depth-1\"  >77018<\/option><option value=\"77020\"  class=\"choice-14 depth-1\"  >77020<\/option><option value=\"77021\"  class=\"choice-15 depth-1\"  >77021<\/option><option value=\"77022\"  class=\"choice-16 depth-1\"  >77022<\/option><option value=\"77023\"  class=\"choice-17 depth-1\"  >77023<\/option><option value=\"77026\"  class=\"choice-18 depth-1\"  >77026<\/option><option value=\"77028\"  class=\"choice-19 depth-1\"  >77028<\/option><option value=\"77029\"  class=\"choice-20 depth-1\"  >77029<\/option><option value=\"77033\"  class=\"choice-21 depth-1\"  >77033<\/option><option value=\"77035\"  class=\"choice-22 depth-1\"  >77035<\/option><option value=\"77036\"  class=\"choice-23 depth-1\"  >77036<\/option><option value=\"77037\"  class=\"choice-24 depth-1\"  >77037<\/option><option value=\"77038\"  class=\"choice-25 depth-1\"  >77038<\/option><option value=\"77039\"  class=\"choice-26 depth-1\"  >77039<\/option><option value=\"77040\"  class=\"choice-27 depth-1\"  >77040<\/option><option value=\"77041\"  class=\"choice-28 depth-1\"  >77041<\/option><option value=\"77042\"  class=\"choice-29 depth-1\"  >77042<\/option><option value=\"77043\"  class=\"choice-62 depth-1\"  >77043<\/option><option value=\"77045\"  class=\"choice-30 depth-1\"  >77045<\/option><option value=\"77051\"  class=\"choice-31 depth-1\"  >77051<\/option><option value=\"77055\"  class=\"choice-32 depth-1\"  >77055<\/option><option value=\"77057\"  class=\"choice-33 depth-1\"  >77057<\/option><option value=\"77060\"  class=\"choice-34 depth-1\"  >77060<\/option><option value=\"77063\"  class=\"choice-35 depth-1\"  >77063<\/option><option value=\"77071\"  class=\"choice-36 depth-1\"  >77071<\/option><option value=\"77074\"  class=\"choice-37 depth-1\"  >77074<\/option><option value=\"77076\"  class=\"choice-38 depth-1\"  >77076<\/option><option value=\"77078\"  class=\"choice-39 depth-1\"  >77078<\/option><option value=\"77080\"  class=\"choice-40 depth-1\"  >77080<\/option><option value=\"77081\"  class=\"choice-41 depth-1\"  >77081<\/option><option value=\"77086\"  class=\"choice-42 depth-1\"  >77086<\/option><option value=\"77087\"  class=\"choice-43 depth-1\"  >77087<\/option><option value=\"77088\"  class=\"choice-44 depth-1\"  >77088<\/option><option value=\"77091\"  class=\"choice-45 depth-1\"  >77091<\/option><option value=\"77092\"  class=\"choice-46 depth-1\"  >77092<\/option><option value=\"77093\"  class=\"choice-47 depth-1\"  >77093<\/option><option value=\"77096\"  class=\"choice-48 depth-1\"  >77096<\/option><option value=\"77547\"  class=\"choice-49 depth-1\"  >77547<\/option><option value=\"77302\"  class=\"choice-50 depth-1\"  >77302<\/option><option value=\"77354\"  class=\"choice-51 depth-1\"  >77354<\/option><option value=\"77355\"  class=\"choice-52 depth-1\"  >77355<\/option><option value=\"77362\"  class=\"choice-53 depth-1\"  >77362<\/option><option value=\"77375\"  class=\"choice-54 depth-1\"  >77375<\/option><option value=\"77380\"  class=\"choice-55 depth-1\"  >77380<\/option><option value=\"77381\"  class=\"choice-56 depth-1\"  >77381<\/option><option value=\"77382\"  class=\"choice-57 depth-1\"  >77382<\/option><option value=\"77385\"  class=\"choice-58 depth-1\"  >77385<\/option><option value=\"77386\"  class=\"choice-59 depth-1\"  >77386<\/option><\/select><div id=\"wpforms-11411-field_110-description\" class=\"wpforms-field-description\">In order to receive lunches from Kids' Meals, you must live in one of the 55 zip codes listed and live inside of Beltway 8.<\/div><\/div><div id=\"wpforms-11411-field_91-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"91\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"1\" data-formid=\"11411\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-11411-field_2-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"2\"><fieldset><legend class=\"wpforms-field-label\">Type of Application <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_2\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_2_1\" name=\"wpforms[fields][2]\" value=\"I am APPLYING for the first time\" aria-errormessage=\"wpforms-11411-field_2_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_2_1\">I am APPLYING for the first time<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_2_2\" name=\"wpforms[fields][2]\" value=\"I am RENEWING my application\" aria-errormessage=\"wpforms-11411-field_2_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_2_2\">I am RENEWING my application<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_2_3\" name=\"wpforms[fields][2]\" value=\"I am CHANGING my address\" aria-errormessage=\"wpforms-11411-field_2_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_2_3\">I am CHANGING my address<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_2_4\" name=\"wpforms[fields][2]\" value=\"I am ADDING a child\" aria-errormessage=\"wpforms-11411-field_2_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_2_4\">I am ADDING a child<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-11411-field_143-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-hide wpforms-conditional-trigger\" data-field-id=\"143\"><fieldset><legend class=\"wpforms-field-label\">How did you hear about Kids&#039; Meals? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_143\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_143_1\" name=\"wpforms[fields][143]\" value=\"Driver\/Hope Provider\" aria-errormessage=\"wpforms-11411-field_143_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_143_1\">Driver\/Hope Provider<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_143_2\" name=\"wpforms[fields][143]\" value=\"Social Service\" aria-errormessage=\"wpforms-11411-field_143_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_143_2\">Social Service<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_143_8\" name=\"wpforms[fields][143]\" value=\"FindHelp.org\" aria-errormessage=\"wpforms-11411-field_143_8-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_143_8\">FindHelp.org<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_143_3\" name=\"wpforms[fields][143]\" value=\"Community Event\" aria-errormessage=\"wpforms-11411-field_143_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_143_3\">Community Event<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_143_4\" name=\"wpforms[fields][143]\" value=\"Social Media\" aria-errormessage=\"wpforms-11411-field_143_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_143_4\">Social Media<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_143_5\" name=\"wpforms[fields][143]\" value=\"Website\/Google Search\" aria-errormessage=\"wpforms-11411-field_143_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_143_5\">Website\/Google Search<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_143_6\" name=\"wpforms[fields][143]\" value=\"Neighbor\/Friend\" aria-errormessage=\"wpforms-11411-field_143_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_143_6\">Neighbor\/Friend<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_143_7\" name=\"wpforms[fields][143]\" value=\"Other\" aria-errormessage=\"wpforms-11411-field_143_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_143_7\">Other<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-11411-field_142-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"142\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-11411-field_142\">Who referred you?<\/label><input type=\"text\" id=\"wpforms-11411-field_142\" class=\"wpforms-field-medium\" name=\"wpforms[fields][142]\" aria-errormessage=\"wpforms-11411-field_142-error\" ><\/div><div id=\"wpforms-11411-field_7-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"7\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"2\" data-formid=\"11411\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Back<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"2\" data-formid=\"11411\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3  \" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-11411-field_19-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"19\"><h3 id=\"wpforms-11411-field_19\" aria-errormessage=\"wpforms-11411-field_19-error\">Delivery and Contact Information<\/h3><\/div><div id=\"wpforms-11411-field_16-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-11411-field_16\">1. Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-11411-field_16\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][16]\" spellcheck=\"false\" aria-errormessage=\"wpforms-11411-field_16-error\" required><\/div><div id=\"wpforms-11411-field_123-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"123\"><div id=\"wpforms-11411-field_123\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-11411-field_123-error\"><h4>Parent 1<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-11411-field_145-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"145\"><fieldset><legend class=\"wpforms-field-label\">Parent 1 Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-11411-field_145\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][145][first]\" aria-errormessage=\"wpforms-11411-field_145-error\" required><label for=\"wpforms-11411-field_145\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-11411-field_145-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][145][last]\" aria-errormessage=\"wpforms-11411-field_145-last-error\" required><label for=\"wpforms-11411-field_145-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-11411-field_10-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"10\"><fieldset><legend class=\"wpforms-field-label\">3. Parent 1 - DOB <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][10][date][m]\" id=\"wpforms-11411-field_10-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\" aria-label=\"Month\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][10][date][d]\" id=\"wpforms-11411-field_10-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\" aria-label=\"Day\"  required><option value=\"\" class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][10][date][y]\" id=\"wpforms-11411-field_10-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\" aria-label=\"Year\"  required><option value=\"\" class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><div id=\"wpforms-11411-field_10-description\" class=\"wpforms-field-description\">Date of Birth<\/div><\/fieldset><\/div><div id=\"wpforms-11411-field_128-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"128\"><div id=\"wpforms-11411-field_128\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-11411-field_128-error\"><h4>Parent 2<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-11411-field_146-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"146\"><fieldset><legend class=\"wpforms-field-label\">Parent 2 Name<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-11411-field_146\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][146][first]\" aria-errormessage=\"wpforms-11411-field_146-error\" ><label for=\"wpforms-11411-field_146\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-11411-field_146-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][146][last]\" aria-errormessage=\"wpforms-11411-field_146-last-error\" ><label for=\"wpforms-11411-field_146-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-11411-field_12-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"12\"><fieldset><legend class=\"wpforms-field-label\">5. Parent 2 - Date of Birth<\/legend><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][12][date][m]\" id=\"wpforms-11411-field_12-month\" class=\"wpforms-field-date-time-date-month\" aria-label=\"Month\" ><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][12][date][d]\" id=\"wpforms-11411-field_12-day\" class=\"wpforms-field-date-time-date-day\" aria-label=\"Day\" ><option value=\"\" class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][12][date][y]\" id=\"wpforms-11411-field_12-year\" class=\"wpforms-field-date-time-date-year\" aria-label=\"Year\" ><option value=\"\" class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/fieldset><\/div><div id=\"wpforms-11411-field_13-container\" class=\"wpforms-field wpforms-field-address wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"13\"><fieldset><legend class=\"wpforms-field-label\">6. Home Address - Where should the lunches be delivered? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-11411-field_13\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][13][address1]\" placeholder=\"Street number and name\" aria-errormessage=\"wpforms-11411-field_13-error\" required><label for=\"wpforms-11411-field_13\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-11411-field_13-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][13][address2]\" placeholder=\"Apartment or Trailer number\" aria-errormessage=\"wpforms-11411-field_13-address2-error\" ><label for=\"wpforms-11411-field_13-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-11411-field_13-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][13][city]\" aria-errormessage=\"wpforms-11411-field_13-city-error\" required><label for=\"wpforms-11411-field_13-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-11411-field_13-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][13][state]\" aria-errormessage=\"wpforms-11411-field_13-state-error\" required><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\"  selected='selected'>Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-11411-field_13-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-11411-field_13-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][13][postal]\" aria-errormessage=\"wpforms-11411-field_13-postal-error\" required><label for=\"wpforms-11411-field_13-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-11411-field_15-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-11411-field_15\">7. Phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-11411-field_15\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][15]\" aria-label=\"7. Phone\" aria-errormessage=\"wpforms-11411-field_15-error\" aria-describedby=\"wpforms-11411-field_15-description\" required><div id=\"wpforms-11411-field_15-description\" class=\"wpforms-field-description\">If you do not have a phone number enter \"No phone\"<\/div><\/div><div id=\"wpforms-11411-field_14-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"14\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"3\" data-formid=\"11411\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Back<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"3\" data-formid=\"11411\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-4  \" data-page=\"4\" style=\"display:none;\"><div id=\"wpforms-11411-field_18-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"18\"><h3 id=\"wpforms-11411-field_18\" aria-errormessage=\"wpforms-11411-field_18-error\">About Your Family<\/h3><\/div><div id=\"wpforms-11411-field_99-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-hide wpforms-field-select-style-classic\" data-field-id=\"99\"><label class=\"wpforms-field-label\" for=\"wpforms-11411-field_99\">8. Monthly Income Category <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-11411-field_99\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][99]\" required=\"required\"><option value=\"Under $3,152\"  class=\"choice-1 depth-1\"  >Under $3,152<\/option><option value=\"Under $3,981\"  class=\"choice-2 depth-1\"  >Under $3,981<\/option><option value=\"Under $4,810\"  class=\"choice-3 depth-1\"  >Under $4,810<\/option><option value=\"Under $5,640\"  class=\"choice-4 depth-1\"  >Under $5,640<\/option><option value=\"Under $6,469\"  class=\"choice-5 depth-1\"  >Under $6,469<\/option><option value=\"Under $7,299\"  class=\"choice-6 depth-1\"  >Under $7,299<\/option><\/select><\/div><div id=\"wpforms-11411-field_20-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-11411-field_20\">9. Monthly Household Income <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-11411-field_20\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][20]\" aria-errormessage=\"wpforms-11411-field_20-error\" required><\/div><div id=\"wpforms-11411-field_100-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-hide wpforms-conditional-trigger\" data-field-id=\"100\"><fieldset><legend class=\"wpforms-field-label\">10. Household Type <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_100\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_100_1\" name=\"wpforms[fields][100]\" value=\"Single Parent\/Female\" aria-errormessage=\"wpforms-11411-field_100_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_100_1\">Single Parent\/Female<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_100_2\" name=\"wpforms[fields][100]\" value=\"Single Parent\/Male\" aria-errormessage=\"wpforms-11411-field_100_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_100_2\">Single Parent\/Male<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_100_3\" name=\"wpforms[fields][100]\" value=\"Married\/Two-Parent Household\" aria-errormessage=\"wpforms-11411-field_100_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_100_3\">Married\/Two-Parent Household<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_100_4\" name=\"wpforms[fields][100]\" value=\"Grandparents\" aria-errormessage=\"wpforms-11411-field_100_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_100_4\">Grandparents<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_100_6\" name=\"wpforms[fields][100]\" value=\"Aunt and\/or Uncle\" aria-errormessage=\"wpforms-11411-field_100_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_100_6\">Aunt and\/or Uncle<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_100_7\" name=\"wpforms[fields][100]\" value=\"Other\" aria-errormessage=\"wpforms-11411-field_100_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_100_7\">Other<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-11411-field_118-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"118\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-11411-field_118\">10a. If other, please explain: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-11411-field_118\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][118]\" aria-errormessage=\"wpforms-11411-field_118-error\" required><\/div><div id=\"wpforms-11411-field_101-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"101\"><fieldset><legend class=\"wpforms-field-label\">11. Primary Language <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_101\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_101_1\" name=\"wpforms[fields][101]\" value=\"Spanish\" aria-errormessage=\"wpforms-11411-field_101_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_101_1\">Spanish<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_101_2\" name=\"wpforms[fields][101]\" value=\"English\" aria-errormessage=\"wpforms-11411-field_101_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_101_2\">English<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_101_3\" name=\"wpforms[fields][101]\" value=\"Other\" aria-errormessage=\"wpforms-11411-field_101_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_101_3\">Other<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-11411-field_26-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-hide wpforms-conditional-trigger\" data-field-id=\"26\"><fieldset><legend class=\"wpforms-field-label\">12. How many children live in your home? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_26\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_26_1\" name=\"wpforms[fields][26]\" value=\"1\" aria-errormessage=\"wpforms-11411-field_26_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_26_1\">1<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_26_2\" name=\"wpforms[fields][26]\" value=\"2\" aria-errormessage=\"wpforms-11411-field_26_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_26_2\">2<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_26_4\" name=\"wpforms[fields][26]\" value=\"3\" aria-errormessage=\"wpforms-11411-field_26_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_26_4\">3<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_26_5\" name=\"wpforms[fields][26]\" value=\"4\" aria-errormessage=\"wpforms-11411-field_26_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_26_5\">4<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_26_6\" name=\"wpforms[fields][26]\" value=\"5\" aria-errormessage=\"wpforms-11411-field_26_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_26_6\">5<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_26_7\" name=\"wpforms[fields][26]\" value=\"6\" aria-errormessage=\"wpforms-11411-field_26_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_26_7\">6<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_26_8\" name=\"wpforms[fields][26]\" value=\"7\" aria-errormessage=\"wpforms-11411-field_26_8-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_26_8\">7<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-11411-field_106-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"106\"><fieldset><legend class=\"wpforms-field-label\">13. Youngest Child&#039;s Date of Birth <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][106][date][m]\" id=\"wpforms-11411-field_106-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\" aria-label=\"Month\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][106][date][d]\" id=\"wpforms-11411-field_106-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\" aria-label=\"Day\"  required><option value=\"\" class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][106][date][y]\" id=\"wpforms-11411-field_106-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\" aria-label=\"Year\"  required><option value=\"\" class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/fieldset><\/div><div id=\"wpforms-11411-field_89-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"89\"><label class=\"wpforms-field-label\" for=\"wpforms-11411-field_89\">Gate Code\/Entry Code<\/label><input type=\"text\" id=\"wpforms-11411-field_89\" class=\"wpforms-field-medium\" name=\"wpforms[fields][89]\" aria-errormessage=\"wpforms-11411-field_89-error\" ><\/div><div id=\"wpforms-11411-field_27-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"27\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"4\" data-formid=\"11411\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Back<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"4\" data-formid=\"11411\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-5  \" data-page=\"5\" style=\"display:none;\"><div id=\"wpforms-11411-field_30-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"30\"><h3 id=\"wpforms-11411-field_30\" aria-errormessage=\"wpforms-11411-field_30-error\">Child 1<\/h3><\/div><div id=\"wpforms-11411-field_28-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"28\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_29-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"29\"><fieldset><legend class=\"wpforms-field-label\">Child 1 Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-11411-field_29\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][29][first]\" aria-errormessage=\"wpforms-11411-field_29-error\" required><label for=\"wpforms-11411-field_29\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-11411-field_29-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][29][last]\" aria-errormessage=\"wpforms-11411-field_29-last-error\" required><label for=\"wpforms-11411-field_29-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_32-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"32\"><fieldset><legend class=\"wpforms-field-label\">Date of Birth <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][32][date][m]\" id=\"wpforms-11411-field_32-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\" aria-label=\"Month\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][32][date][d]\" id=\"wpforms-11411-field_32-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\" aria-label=\"Day\"  required><option value=\"\" class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][32][date][y]\" id=\"wpforms-11411-field_32-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\" aria-label=\"Year\"  required><option value=\"\" class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_31-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"31\"><fieldset><legend class=\"wpforms-field-label\">Gender <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_31\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_31_1\" name=\"wpforms[fields][31]\" value=\"Male\" aria-errormessage=\"wpforms-11411-field_31_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_31_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_31_2\" name=\"wpforms[fields][31]\" value=\"Female\" aria-errormessage=\"wpforms-11411-field_31_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_31_2\">Female<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_135-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"135\"><fieldset><legend class=\"wpforms-field-label\">Ethnicity <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_135\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_135_1\" name=\"wpforms[fields][135]\" value=\"African American\" aria-errormessage=\"wpforms-11411-field_135_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_135_1\">African American<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_135_2\" name=\"wpforms[fields][135]\" value=\"Hispanic\/Latino\" aria-errormessage=\"wpforms-11411-field_135_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_135_2\">Hispanic\/Latino<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_135_3\" name=\"wpforms[fields][135]\" value=\"Asian\" aria-errormessage=\"wpforms-11411-field_135_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_135_3\">Asian<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_135_4\" name=\"wpforms[fields][135]\" value=\"White\" aria-errormessage=\"wpforms-11411-field_135_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_135_4\">White<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_135_5\" name=\"wpforms[fields][135]\" value=\"Other\" aria-errormessage=\"wpforms-11411-field_135_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_135_5\">Other<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_148-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"148\"><fieldset><legend class=\"wpforms-field-label\">Your Relationship to This Child<\/legend><ul id=\"wpforms-11411-field_148\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-11411-field_148_1\" name=\"wpforms[fields][148]\" value=\"Parent\" aria-errormessage=\"wpforms-11411-field_148_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_148_1\">Parent<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_148_2\" name=\"wpforms[fields][148]\" value=\"Grandparent\" aria-errormessage=\"wpforms-11411-field_148_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_148_2\">Grandparent<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_148_4\" name=\"wpforms[fields][148]\" value=\"Aunt or Uncle\" aria-errormessage=\"wpforms-11411-field_148_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_148_4\">Aunt or Uncle<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_148_5\" name=\"wpforms[fields][148]\" value=\"Caregiver\" aria-errormessage=\"wpforms-11411-field_148_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_148_5\">Caregiver<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><\/div><\/div><\/div><\/div><div id=\"wpforms-11411-field_40-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"40\" style=\"display:none;\"><h3 id=\"wpforms-11411-field_40\" aria-errormessage=\"wpforms-11411-field_40-error\">Child 2<\/h3><\/div><div id=\"wpforms-11411-field_35-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"35\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_36-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"36\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Child 2 Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-11411-field_36\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][36][first]\" aria-errormessage=\"wpforms-11411-field_36-error\" required><label for=\"wpforms-11411-field_36\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-11411-field_36-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][36][last]\" aria-errormessage=\"wpforms-11411-field_36-last-error\" required><label for=\"wpforms-11411-field_36-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_38-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"38\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Date of Birth <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][38][date][m]\" id=\"wpforms-11411-field_38-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\" aria-label=\"Month\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][38][date][d]\" id=\"wpforms-11411-field_38-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\" aria-label=\"Day\"  required><option value=\"\" class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][38][date][y]\" id=\"wpforms-11411-field_38-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\" aria-label=\"Year\"  required><option value=\"\" class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_37-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"37\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Gender <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_37\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_37_1\" name=\"wpforms[fields][37]\" value=\"Male\" aria-errormessage=\"wpforms-11411-field_37_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_37_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_37_2\" name=\"wpforms[fields][37]\" value=\"Female\" aria-errormessage=\"wpforms-11411-field_37_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_37_2\">Female<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_136-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"136\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Ethnicity <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_136\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_136_1\" name=\"wpforms[fields][136]\" value=\"African American\" aria-errormessage=\"wpforms-11411-field_136_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_136_1\">African American<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_136_2\" name=\"wpforms[fields][136]\" value=\"Hispanic\/Latino\" aria-errormessage=\"wpforms-11411-field_136_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_136_2\">Hispanic\/Latino<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_136_3\" name=\"wpforms[fields][136]\" value=\"Asian\" aria-errormessage=\"wpforms-11411-field_136_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_136_3\">Asian<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_136_4\" name=\"wpforms[fields][136]\" value=\"White\" aria-errormessage=\"wpforms-11411-field_136_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_136_4\">White<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_136_5\" name=\"wpforms[fields][136]\" value=\"Other\" aria-errormessage=\"wpforms-11411-field_136_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_136_5\">Other<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_149-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"149\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Your Relationship to This Child <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_149\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-11411-field_149_1\" name=\"wpforms[fields][149]\" value=\"Parent\" aria-errormessage=\"wpforms-11411-field_149_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_149_1\">Parent<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_149_2\" name=\"wpforms[fields][149]\" value=\"Grandparent\" aria-errormessage=\"wpforms-11411-field_149_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_149_2\">Grandparent<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_149_3\" name=\"wpforms[fields][149]\" value=\"Aunt or Uncle\" aria-errormessage=\"wpforms-11411-field_149_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_149_3\">Aunt or Uncle<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_149_4\" name=\"wpforms[fields][149]\" value=\"Caregiver\" aria-errormessage=\"wpforms-11411-field_149_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_149_4\">Caregiver<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><\/div><\/div><\/div><\/div><div id=\"wpforms-11411-field_47-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"47\" style=\"display:none;\"><h3 id=\"wpforms-11411-field_47\" aria-errormessage=\"wpforms-11411-field_47-error\">Child 3<\/h3><\/div><div id=\"wpforms-11411-field_48-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"48\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_49-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"49\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Child 3 Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-11411-field_49\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][49][first]\" aria-errormessage=\"wpforms-11411-field_49-error\" required><label for=\"wpforms-11411-field_49\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-11411-field_49-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][49][last]\" aria-errormessage=\"wpforms-11411-field_49-last-error\" required><label for=\"wpforms-11411-field_49-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_51-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"51\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Date of Birth <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][51][date][m]\" id=\"wpforms-11411-field_51-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\" aria-label=\"Month\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][51][date][d]\" id=\"wpforms-11411-field_51-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\" aria-label=\"Day\"  required><option value=\"\" class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][51][date][y]\" id=\"wpforms-11411-field_51-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\" aria-label=\"Year\"  required><option value=\"\" class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_50-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"50\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Gender <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_50\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_50_1\" name=\"wpforms[fields][50]\" value=\"Male\" aria-errormessage=\"wpforms-11411-field_50_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_50_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_50_2\" name=\"wpforms[fields][50]\" value=\"Female\" aria-errormessage=\"wpforms-11411-field_50_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_50_2\">Female<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_137-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"137\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Ethnicity <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_137\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_137_1\" name=\"wpforms[fields][137]\" value=\"African American\" aria-errormessage=\"wpforms-11411-field_137_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_137_1\">African American<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_137_2\" name=\"wpforms[fields][137]\" value=\"Hispanic\/Latino\" aria-errormessage=\"wpforms-11411-field_137_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_137_2\">Hispanic\/Latino<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_137_3\" name=\"wpforms[fields][137]\" value=\"Asian\" aria-errormessage=\"wpforms-11411-field_137_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_137_3\">Asian<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_137_4\" name=\"wpforms[fields][137]\" value=\"White\" aria-errormessage=\"wpforms-11411-field_137_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_137_4\">White<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_137_5\" name=\"wpforms[fields][137]\" value=\"Other\" aria-errormessage=\"wpforms-11411-field_137_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_137_5\">Other<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_150-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"150\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Your Relationship to this Child <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_150\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-11411-field_150_1\" name=\"wpforms[fields][150]\" value=\"Parent\" aria-errormessage=\"wpforms-11411-field_150_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_150_1\">Parent<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_150_2\" name=\"wpforms[fields][150]\" value=\"Grandparent\" aria-errormessage=\"wpforms-11411-field_150_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_150_2\">Grandparent<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_150_3\" name=\"wpforms[fields][150]\" value=\"Aunt\/Uncle\" aria-errormessage=\"wpforms-11411-field_150_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_150_3\">Aunt\/Uncle<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_150_4\" name=\"wpforms[fields][150]\" value=\"Caregiver\" aria-errormessage=\"wpforms-11411-field_150_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_150_4\">Caregiver<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><\/div><\/div><\/div><\/div><div id=\"wpforms-11411-field_53-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"53\" style=\"display:none;\"><h3 id=\"wpforms-11411-field_53\" aria-errormessage=\"wpforms-11411-field_53-error\">Child 4<\/h3><\/div><div id=\"wpforms-11411-field_54-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"54\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_55-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"55\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Child 4 Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-11411-field_55\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][55][first]\" aria-errormessage=\"wpforms-11411-field_55-error\" required><label for=\"wpforms-11411-field_55\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-11411-field_55-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][55][last]\" aria-errormessage=\"wpforms-11411-field_55-last-error\" required><label for=\"wpforms-11411-field_55-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_57-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"57\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Date of Birth <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][57][date][m]\" id=\"wpforms-11411-field_57-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\" aria-label=\"Month\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][57][date][d]\" id=\"wpforms-11411-field_57-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\" aria-label=\"Day\"  required><option value=\"\" class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][57][date][y]\" id=\"wpforms-11411-field_57-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\" aria-label=\"Year\"  required><option value=\"\" class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_56-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"56\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Gender <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_56\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_56_1\" name=\"wpforms[fields][56]\" value=\"Male\" aria-errormessage=\"wpforms-11411-field_56_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_56_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_56_2\" name=\"wpforms[fields][56]\" value=\"Female\" aria-errormessage=\"wpforms-11411-field_56_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_56_2\">Female<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_138-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"138\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Ethnicity <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_138\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_138_1\" name=\"wpforms[fields][138]\" value=\"African American\" aria-errormessage=\"wpforms-11411-field_138_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_138_1\">African American<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_138_2\" name=\"wpforms[fields][138]\" value=\"Hispanic\/Latino\" aria-errormessage=\"wpforms-11411-field_138_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_138_2\">Hispanic\/Latino<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_138_3\" name=\"wpforms[fields][138]\" value=\"Asian\" aria-errormessage=\"wpforms-11411-field_138_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_138_3\">Asian<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_138_4\" name=\"wpforms[fields][138]\" value=\"White\" aria-errormessage=\"wpforms-11411-field_138_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_138_4\">White<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_138_5\" name=\"wpforms[fields][138]\" value=\"Other\" aria-errormessage=\"wpforms-11411-field_138_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_138_5\">Other<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_151-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"151\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Your Relationship to this Child <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_151\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-11411-field_151_1\" name=\"wpforms[fields][151]\" value=\"Parent\" aria-errormessage=\"wpforms-11411-field_151_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_151_1\">Parent<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_151_3\" name=\"wpforms[fields][151]\" value=\"Grandparent\" aria-errormessage=\"wpforms-11411-field_151_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_151_3\">Grandparent<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_151_4\" name=\"wpforms[fields][151]\" value=\"Aunt or Uncle\" aria-errormessage=\"wpforms-11411-field_151_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_151_4\">Aunt or Uncle<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_151_5\" name=\"wpforms[fields][151]\" value=\"Caregiver\" aria-errormessage=\"wpforms-11411-field_151_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_151_5\">Caregiver<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><\/div><\/div><\/div><\/div><div id=\"wpforms-11411-field_59-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"59\" style=\"display:none;\"><h3 id=\"wpforms-11411-field_59\" aria-errormessage=\"wpforms-11411-field_59-error\">Child 5<\/h3><\/div><div id=\"wpforms-11411-field_60-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"60\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_61-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"61\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Child 5 Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-11411-field_61\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][61][first]\" aria-errormessage=\"wpforms-11411-field_61-error\" required><label for=\"wpforms-11411-field_61\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-11411-field_61-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][61][last]\" aria-errormessage=\"wpforms-11411-field_61-last-error\" required><label for=\"wpforms-11411-field_61-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_63-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"63\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Date of Birth <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][63][date][m]\" id=\"wpforms-11411-field_63-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\" aria-label=\"Month\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][63][date][d]\" id=\"wpforms-11411-field_63-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\" aria-label=\"Day\"  required><option value=\"\" class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][63][date][y]\" id=\"wpforms-11411-field_63-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\" aria-label=\"Year\"  required><option value=\"\" class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_62-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"62\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Gender <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_62\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_62_1\" name=\"wpforms[fields][62]\" value=\"Male\" aria-errormessage=\"wpforms-11411-field_62_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_62_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_62_2\" name=\"wpforms[fields][62]\" value=\"Female\" aria-errormessage=\"wpforms-11411-field_62_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_62_2\">Female<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_139-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"139\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Ethnicity <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_139\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_139_1\" name=\"wpforms[fields][139]\" value=\"African American\" aria-errormessage=\"wpforms-11411-field_139_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_139_1\">African American<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_139_2\" name=\"wpforms[fields][139]\" value=\"Hispanic\/Latino\" aria-errormessage=\"wpforms-11411-field_139_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_139_2\">Hispanic\/Latino<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_139_3\" name=\"wpforms[fields][139]\" value=\"Asian\" aria-errormessage=\"wpforms-11411-field_139_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_139_3\">Asian<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_139_4\" name=\"wpforms[fields][139]\" value=\"White\" aria-errormessage=\"wpforms-11411-field_139_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_139_4\">White<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_139_5\" name=\"wpforms[fields][139]\" value=\"Other\" aria-errormessage=\"wpforms-11411-field_139_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_139_5\">Other<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_152-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"152\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Your Relationship to this Child <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_152\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-11411-field_152_1\" name=\"wpforms[fields][152]\" value=\"Parent\" aria-errormessage=\"wpforms-11411-field_152_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_152_1\">Parent<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_152_2\" name=\"wpforms[fields][152]\" value=\"Grandparent\" aria-errormessage=\"wpforms-11411-field_152_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_152_2\">Grandparent<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_152_3\" name=\"wpforms[fields][152]\" value=\"Aunt or Uncle\" aria-errormessage=\"wpforms-11411-field_152_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_152_3\">Aunt or Uncle<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_152_4\" name=\"wpforms[fields][152]\" value=\"Caregiver\" aria-errormessage=\"wpforms-11411-field_152_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_152_4\">Caregiver<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><\/div><\/div><\/div><\/div><div id=\"wpforms-11411-field_65-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"65\" style=\"display:none;\"><h3 id=\"wpforms-11411-field_65\" aria-errormessage=\"wpforms-11411-field_65-error\">Child 6<\/h3><\/div><div id=\"wpforms-11411-field_66-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"66\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_67-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"67\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Child 6 Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-11411-field_67\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][67][first]\" aria-errormessage=\"wpforms-11411-field_67-error\" required><label for=\"wpforms-11411-field_67\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-11411-field_67-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][67][last]\" aria-errormessage=\"wpforms-11411-field_67-last-error\" required><label for=\"wpforms-11411-field_67-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_69-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"69\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Date of Birth <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][69][date][m]\" id=\"wpforms-11411-field_69-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\" aria-label=\"Month\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][69][date][d]\" id=\"wpforms-11411-field_69-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\" aria-label=\"Day\"  required><option value=\"\" class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][69][date][y]\" id=\"wpforms-11411-field_69-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\" aria-label=\"Year\"  required><option value=\"\" class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_68-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"68\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Gender <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_68\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_68_1\" name=\"wpforms[fields][68]\" value=\"Male\" aria-errormessage=\"wpforms-11411-field_68_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_68_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_68_2\" name=\"wpforms[fields][68]\" value=\"Female\" aria-errormessage=\"wpforms-11411-field_68_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_68_2\">Female<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_140-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"140\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Ethnicity <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_140\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_140_1\" name=\"wpforms[fields][140]\" value=\"African American\" aria-errormessage=\"wpforms-11411-field_140_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_140_1\">African American<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_140_2\" name=\"wpforms[fields][140]\" value=\"Hispanic\/Latino\" aria-errormessage=\"wpforms-11411-field_140_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_140_2\">Hispanic\/Latino<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_140_3\" name=\"wpforms[fields][140]\" value=\"Asian\" aria-errormessage=\"wpforms-11411-field_140_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_140_3\">Asian<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_140_4\" name=\"wpforms[fields][140]\" value=\"White\" aria-errormessage=\"wpforms-11411-field_140_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_140_4\">White<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_140_5\" name=\"wpforms[fields][140]\" value=\"Other\" aria-errormessage=\"wpforms-11411-field_140_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_140_5\">Other<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_153-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"153\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Your Relationship to this Child <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_153\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-11411-field_153_1\" name=\"wpforms[fields][153]\" value=\"Parent\" aria-errormessage=\"wpforms-11411-field_153_1-error\" required  checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_153_1\">Parent<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_153_3\" name=\"wpforms[fields][153]\" value=\"Grandparent\" aria-errormessage=\"wpforms-11411-field_153_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_153_3\">Grandparent<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_153_4\" name=\"wpforms[fields][153]\" value=\"Aunt or Uncle\" aria-errormessage=\"wpforms-11411-field_153_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_153_4\">Aunt or Uncle<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_153_5\" name=\"wpforms[fields][153]\" value=\"Caregiver\" aria-errormessage=\"wpforms-11411-field_153_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_153_5\">Caregiver<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><\/div><\/div><\/div><\/div><div id=\"wpforms-11411-field_76-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"76\" style=\"display:none;\"><h3 id=\"wpforms-11411-field_76\" aria-errormessage=\"wpforms-11411-field_76-error\">Child 7<\/h3><\/div><div id=\"wpforms-11411-field_71-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"71\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_72-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"72\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Child 7 Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-11411-field_72\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][72][first]\" aria-errormessage=\"wpforms-11411-field_72-error\" required><label for=\"wpforms-11411-field_72\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-11411-field_72-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][72][last]\" aria-errormessage=\"wpforms-11411-field_72-last-error\" required><label for=\"wpforms-11411-field_72-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_74-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"74\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Date of Birth <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][74][date][m]\" id=\"wpforms-11411-field_74-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\" aria-label=\"Month\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][74][date][d]\" id=\"wpforms-11411-field_74-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\" aria-label=\"Day\"  required><option value=\"\" class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][74][date][y]\" id=\"wpforms-11411-field_74-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\" aria-label=\"Year\"  required><option value=\"\" class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_73-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"73\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Gender <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_73\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_73_1\" name=\"wpforms[fields][73]\" value=\"Male\" aria-errormessage=\"wpforms-11411-field_73_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_73_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_73_2\" name=\"wpforms[fields][73]\" value=\"Female\" aria-errormessage=\"wpforms-11411-field_73_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_73_2\">Female<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_141-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"141\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Ethnicity <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_141\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_141_1\" name=\"wpforms[fields][141]\" value=\"African American\" aria-errormessage=\"wpforms-11411-field_141_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_141_1\">African American<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_141_2\" name=\"wpforms[fields][141]\" value=\"Hispanic\/Latino\" aria-errormessage=\"wpforms-11411-field_141_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_141_2\">Hispanic\/Latino<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_141_3\" name=\"wpforms[fields][141]\" value=\"Asian\" aria-errormessage=\"wpforms-11411-field_141_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_141_3\">Asian<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_141_4\" name=\"wpforms[fields][141]\" value=\"White\" aria-errormessage=\"wpforms-11411-field_141_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_141_4\">White<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_141_5\" name=\"wpforms[fields][141]\" value=\"Other\" aria-errormessage=\"wpforms-11411-field_141_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_141_5\">Other<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-50\"><div id=\"wpforms-11411-field_154-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"154\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Your Relationship to this Child <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_154\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_154_1\" name=\"wpforms[fields][154]\" value=\"Parent\" aria-errormessage=\"wpforms-11411-field_154_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_154_1\">Parent<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_154_2\" name=\"wpforms[fields][154]\" value=\"Grandparent\" aria-errormessage=\"wpforms-11411-field_154_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_154_2\">Grandparent<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_154_3\" name=\"wpforms[fields][154]\" value=\"Aunt or Uncle\" aria-errormessage=\"wpforms-11411-field_154_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_154_3\">Aunt or Uncle<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_154_4\" name=\"wpforms[fields][154]\" value=\"Caregiver\" aria-errormessage=\"wpforms-11411-field_154_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_154_4\">Caregiver<\/label><\/li><\/ul><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\"><\/div><\/div><\/div><\/div><div id=\"wpforms-11411-field_82-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"82\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"5\" data-formid=\"11411\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Back<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"5\" data-formid=\"11411\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-6  \" data-page=\"6\" style=\"display:none;\"><div id=\"wpforms-11411-field_78-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"78\"><fieldset><legend class=\"wpforms-field-label\">T1. Please mark ALL the benefits you are currently receiving <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_78\" class=\"wpforms-field-required\"><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-11411-field_78_2\" name=\"wpforms[fields][78][]\" value=\"SNAP\" aria-errormessage=\"wpforms-11411-field_78_2-error\" aria-describedby=\"wpforms-11411-field_78-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_78_2\">SNAP<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-11411-field_78_4\" name=\"wpforms[fields][78][]\" value=\"WIC\" aria-errormessage=\"wpforms-11411-field_78_4-error\" aria-describedby=\"wpforms-11411-field_78-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_78_4\">WIC<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-11411-field_78_5\" name=\"wpforms[fields][78][]\" value=\"Medicaid\" aria-errormessage=\"wpforms-11411-field_78_5-error\" aria-describedby=\"wpforms-11411-field_78-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_78_5\">Medicaid<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-11411-field_78_6\" name=\"wpforms[fields][78][]\" value=\"National School Lunch Program\" aria-errormessage=\"wpforms-11411-field_78_6-error\" aria-describedby=\"wpforms-11411-field_78-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_78_6\">National School Lunch Program<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-11411-field_78_1\" name=\"wpforms[fields][78][]\" value=\"TANF\" aria-errormessage=\"wpforms-11411-field_78_1-error\" aria-describedby=\"wpforms-11411-field_78-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_78_1\">TANF<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-11411-field_78_3\" name=\"wpforms[fields][78][]\" value=\"SSI\" aria-errormessage=\"wpforms-11411-field_78_3-error\" aria-describedby=\"wpforms-11411-field_78-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_78_3\">SSI<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-11411-field_78_8\" name=\"wpforms[fields][78][]\" value=\"None\" aria-errormessage=\"wpforms-11411-field_78_8-error\" aria-describedby=\"wpforms-11411-field_78-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_78_8\">None<\/label><\/li><\/ul><div id=\"wpforms-11411-field_78-description\" class=\"wpforms-field-description\">Receiving Kids' Meals lunches will NOT impact any benefits you currently receive.<\/div><\/fieldset><\/div><div id=\"wpforms-11411-field_84-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"84\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"6\" data-formid=\"11411\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Back<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"6\" data-formid=\"11411\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-7 last \" data-page=\"7\" style=\"display:none;\"><div id=\"wpforms-11411-field_81-container\" class=\"wpforms-field wpforms-field-content wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"81\"><div id=\"wpforms-11411-field_81\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-11411-field_81-error\"><h4>Authorization and Release<\/h4>\n<p>From time to time, Kids\u2019 Meals uses its meal recipients\u2019 or their family members\u2019 names, voice recordings, photographic or video images, or other likenesses for advertising, fundraising, or various other business or commercial purposes, including without limitation, in print publications,<br \/>\nadvertising materials, articles, flyers, billboards, and on Kids\u2019 Meals website.<\/p>\n<p>By signing this enrollment form, you, on behalf of yourself, your children and any other children in your family served by Kids\u2019 Meals, and your family (the \u201cReleasing Parties\u201d), consent and give Kids\u2019 Meals license to use any such person\u2019s name, voice recordings, photographic or video images, or other likenesses for Kids\u2019 Meals\u2019 advertising, fundraising, or other business or commercial purposes and understand that you will not be compensated for this use. You also understand and agree, on behalf of the Releasing Parties, that Kids\u2019 Meals will be the owner of any advertising, fundraising, or other business or commercial materials that make use of any the Releasing Parties\u2019 name, voice recordings, photographic or video images, or other likenesses.<\/p>\n<p>Finally, you, on behalf of the Releasing Parties, waive the right to inspect or approve the finished product that uses any of the Releasing Parties\u2019 name, voice recordings, photographic or video images, or other likenesses and release Kids\u2019 Meals and its employees, representatives, and board members from any and all claims and\/or liability related to the use of any such name, voice recordings, photographic or video images, or other likenesses, including without limitation, any claims and\/or liability based in whole or in part on any rights of publicity, invasions of privacy, portrayals in a false light, defamation, mental distress, and any other liability.<\/p>\n<p>By signing this Enrollment Form, Authorization, and Release, you agree that the information provided by you herein is correct and accurate and further that you and the Releasing Parties will be bound by the authorization and release contained herein.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-11411-field_129-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-hide wpforms-conditional-trigger\" data-field-id=\"129\"><fieldset><legend class=\"wpforms-field-label\">Response <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-11411-field_129\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_129_1\" name=\"wpforms[fields][129]\" value=\"Yes, I agree\" aria-errormessage=\"wpforms-11411-field_129_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_129_1\">Yes, I agree<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-11411-field_129_2\" name=\"wpforms[fields][129]\" value=\"No, I do not agree\" aria-errormessage=\"wpforms-11411-field_129_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-11411-field_129_2\">No, I do not agree<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-11411-field_83-container\" class=\"wpforms-field wpforms-field-signature wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"83\"><label class=\"wpforms-field-label\" for=\"wpforms-11411-field_83\">Signature for Authorization and Release <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-11411-field_83\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][83]\" autocomplete=\"off\" inputmode=\"none\" aria-errormessage=\"wpforms-11411-field_83-error\" required><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-11411-field_83-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Clear Signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Clear Signature<\/div>\n\t\t\t<\/div><\/div><\/div><div id=\"wpforms-11411-field_147-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"147\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-11411-field_147\">Today&#039;s Date <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-11411-field_147\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][147][date]\" aria-errormessage=\"wpforms-11411-field_147-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-11411-field_9-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"9\"><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" style=\"display:none;\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"11411\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/kidsmealsinc.org\/es\/wp-json\/wp\/v2\/pages\/9\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-11411\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" src=\"https:\/\/kidsmealsinc.org\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/form><\/div>  <!-- .wpforms-container -->\n<div class=\"wpforms-save-resume-confirmation\" id=\"wpforms-save-resume-confirmation-11411\" style=\"display: none\">\n\n\t\n\t<div class=\"message\">\n\t\t<p>Your application has been saved and a unique link has been created which you can access to continue filling out this form.<\/p>\n<p>Enter your email address to receive the link via email. Alternatively, you can copy and save the link below.<\/p>\n<p>Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted.<\/p>\n\t<\/div>\n\n\t<div class=\"wpforms-save-resume-actions\">\n\t\t\t\t\t<div class=\"wpforms-field\">\n\t\t\t\t<label class=\"wpforms-field-label wpforms-save-resume-label\">\n\t\t\t\t\tCopy Link\t\t\t\t<\/label>\n\t\t\t\t<div class=\"wpforms-save-resume-shortcode-container\">\n\t\t\t\t\t<input type=\"text\" class=\"wpforms-save-resume-shortcode\" value=\"\" disabled \/>\n\t\t\t\t\t<span class=\"wpforms-save-resume-shortcode-copy\" title=\"Copy resume link to clipboard\">\n\t\t\t\t\t\t\t<span class=\"copy-icon\"><\/span>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\n\t\t\t\t\t<form class=\"wpforms-validate wpforms-form wpforms-save-resume-email-notification\" method=\"post\" action=\"\/es\/wp-json\/wp\/v2\/pages\/9\" data-token=\"8b23db28924706d4138ab1d9480a9824\">\n\t\t\t\t<div class=\"wpforms-field wpforms-field-email\">\n\t\t\t\t\t<label class=\"wpforms-field-label wpforms-save-resume-label\">\n\t\t\t\t\t\tEmail\t\t\t\t\t\t<span class=\"wpforms-required-label\">*<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t\t\t<input type=\"email\" name=\"wpforms[save_resume_email]\" required>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"wpforms-submit-container\">\n\t\t\t\t\t<input type=\"hidden\" id=\"_wpnonce\" name=\"_wpnonce\" value=\"9c1d9abdcc\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/es\/wp-json\/wp\/v2\/pages\/9\" \/>\t\t\t\t\t<input type=\"hidden\" name=\"wpforms[form_id]\" value=\"11411\">\n\t\t\t\t\t<input type=\"hidden\" name=\"wpforms[entry_id]\" class=\"wpforms-save-resume-entry-id\" value=\"\">\n\t\t\t\t\t<button type=\"submit\" name=\"wpforms[save-resume]\" class=\"wpforms-submit\" value=\"wpforms-submit\" disabled>\n\t\t\t\t\t\tSend Link\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/form>\n\t\t\t<\/div>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-c2b68c9 e-con-full e-flex e-con e-child\" data-id=\"c2b68c9\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-10e14d9 elementor-widget elementor-widget-text-editor\" data-id=\"10e14d9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h4>Download and Email Application<\/h4><p>If you do not want to apply online, please click the button to download and fill out the application instead. Then email the completed form to <a href=\"mailto:clients@kidsmealsinc.org\">clients@kidsmealsinc.org<\/a><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e7a1fd2 elementor-widget elementor-widget-button\" data-id=\"e7a1fd2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/kidsmealsinc.org\/wp-content\/uploads\/Application-2025-2026.pdf\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Download Application<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-f1c9fca e-grid pad e-con-boxed e-con e-parent\" data-id=\"f1c9fca\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e377a42 balance elementor-widget elementor-widget-heading\" data-id=\"e377a42\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\"> Other Resources for Help\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-66ac650 elementor-widget elementor-widget-text-editor\" data-id=\"66ac650\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>CALL 211<\/strong>\u2013 United Way Help Line-Whether you need help finding child care, food stamps, care for an aging parent or a haven from domestic violence, 211 is the number to call when you don\u2019t know who to call.\u00a0Basic needs, like food, utilities and health care, topped the list of requests last year, followed by rent assistance and help finding shelter.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7c961c8 elementor-widget elementor-widget-text-editor\" data-id=\"7c961c8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<ul><li><a href=\"https:\/\/www.whamministries.org\/care-ministry\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">West Houston Area Ministries<\/a><\/li><li><a href=\"http:\/\/www.houstontx.gov\/parks\/pdfs\/HPARDCurbsideMealProgramSite.pdf\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">HPARD Food Distribution<\/a><\/li><li><a href=\"https:\/\/www.houstonfoodbank.org\/find-help\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Houston Food Bank<\/a><\/li><li><a href=\"https:\/\/himfoodpantry.org\/receive-food\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Heights Interfaith Ministries Food Pantry<\/a><\/li><li><a href=\"https:\/\/houstonrecovers.org\/covid19\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Houston Recovers<\/a><\/li><li><a href=\"https:\/\/texaswic.org\/apply\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">WIC<\/a><\/li><li><a href=\"https:\/\/hhs.texas.gov\/services\/food\/snap-food-benefits\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">SNAP<\/a><\/li><li><a href=\"https:\/\/www.fns.usda.gov\/cn\/applying-free-and-reduced-price-school-meals\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">National School Lunch Program (NSLP)<\/a><\/li><li><a href=\"http:\/\/www.findhelp.org\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">FindHelp<\/a><\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-bfa7f2f e-grid e-con-boxed e-con e-parent\" data-id=\"bfa7f2f\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-df44470 e-con-full e-flex e-con e-child\" data-id=\"df44470\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-3b6c4ca e-con-full e-flex e-con e-child\" data-id=\"3b6c4ca\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-060a25d elementor-view-default elementor-widget elementor-widget-icon\" data-id=\"060a25d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<div class=\"elementor-icon\">\n\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-shopping-basket\" viewBox=\"0 0 576 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M576 216v16c0 13.255-10.745 24-24 24h-8l-26.113 182.788C514.509 462.435 494.257 480 470.37 480H105.63c-23.887 0-44.139-17.565-47.518-41.212L32 256h-8c-13.255 0-24-10.745-24-24v-16c0-13.255 10.745-24 24-24h67.341l106.78-146.821c10.395-14.292 30.407-17.453 44.701-7.058 14.293 10.395 17.453 30.408 7.058 44.701L170.477 192h235.046L326.12 82.821c-10.395-14.292-7.234-34.306 7.059-44.701 14.291-10.395 34.306-7.235 44.701 7.058L484.659 192H552c13.255 0 24 10.745 24 24zM312 392V280c0-13.255-10.745-24-24-24s-24 10.745-24 24v112c0 13.255 10.745 24 24 24s24-10.745 24-24zm112 0V280c0-13.255-10.745-24-24-24s-24 10.745-24 24v112c0 13.255 10.745 24 24 24s24-10.745 24-24zm-224 0V280c0-13.255-10.745-24-24-24s-24 10.745-24 24v112c0 13.255 10.745 24 24 24s24-10.745 24-24z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bb4ffe6 elementor-widget elementor-widget-heading\" data-id=\"bb4ffe6\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Food and Groceries<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f14222a elementor-align-center elementor-widget elementor-widget-button\" data-id=\"f14222a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/kidsmealsinc.org\/wp-content\/uploads\/Food-and-Groceries-Resources.pdf\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">See Resources<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-201d89a e-con-full e-flex e-con e-child\" data-id=\"201d89a\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-eb2c296 elementor-view-default elementor-widget elementor-widget-icon\" data-id=\"eb2c296\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<div class=\"elementor-icon\">\n\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-lightbulb\" viewBox=\"0 0 352 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M96.06 454.35c.01 6.29 1.87 12.45 5.36 17.69l17.09 25.69a31.99 31.99 0 0 0 26.64 14.28h61.71a31.99 31.99 0 0 0 26.64-14.28l17.09-25.69a31.989 31.989 0 0 0 5.36-17.69l.04-38.35H96.01l.05 38.35zM0 176c0 44.37 16.45 84.85 43.56 115.78 16.52 18.85 42.36 58.23 52.21 91.45.04.26.07.52.11.78h160.24c.04-.26.07-.51.11-.78 9.85-33.22 35.69-72.6 52.21-91.45C335.55 260.85 352 220.37 352 176 352 78.61 272.91-.3 175.45 0 73.44.31 0 82.97 0 176zm176-80c-44.11 0-80 35.89-80 80 0 8.84-7.16 16-16 16s-16-7.16-16-16c0-61.76 50.24-112 112-112 8.84 0 16 7.16 16 16s-7.16 16-16 16z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a4af38d elementor-widget elementor-widget-heading\" data-id=\"a4af38d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Rent and Utilities<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8e0ec18 elementor-align-center elementor-widget elementor-widget-button\" data-id=\"8e0ec18\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/kidsmealsinc.org\/wp-content\/uploads\/Rent-and-Utilities-Resources.pdf\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">See Resources<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-258b707 e-con-full e-flex e-con e-child\" data-id=\"258b707\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-becd8ab elementor-view-default elementor-widget elementor-widget-icon\" data-id=\"becd8ab\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<div class=\"elementor-icon\">\n\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-baby-carriage\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M144.8 17c-11.3-17.8-37.2-22.8-54-9.4C35.3 51.9 0 118 0 192h256L144.8 17zM496 96h-48c-35.3 0-64 28.7-64 64v64H0c0 50.6 23 96.4 60.3 130.7C25.7 363.6 0 394.7 0 432c0 44.2 35.8 80 80 80s80-35.8 80-80c0-8.9-1.8-17.2-4.4-25.2 21.6 5.9 44.6 9.2 68.4 9.2s46.9-3.3 68.4-9.2c-2.7 8-4.4 16.3-4.4 25.2 0 44.2 35.8 80 80 80s80-35.8 80-80c0-37.3-25.7-68.4-60.3-77.3C425 320.4 448 274.6 448 224v-64h48c8.8 0 16-7.2 16-16v-32c0-8.8-7.2-16-16-16zM80 464c-17.6 0-32-14.4-32-32s14.4-32 32-32 32 14.4 32 32-14.4 32-32 32zm320-32c0 17.6-14.4 32-32 32s-32-14.4-32-32 14.4-32 32-32 32 14.4 32 32z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6ef3c3e elementor-widget elementor-widget-heading\" data-id=\"6ef3c3e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Baby Basic Needs<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b8ff4cd elementor-align-center elementor-widget elementor-widget-button\" data-id=\"b8ff4cd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/kidsmealsinc.org\/wp-content\/uploads\/Baby-Basic-Needs-Resources.pdf\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">See Resources<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-fdb1bc0 e-con-full e-flex e-con e-child\" data-id=\"fdb1bc0\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-41aa6fb elementor-view-default elementor-widget elementor-widget-icon\" data-id=\"41aa6fb\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<div class=\"elementor-icon\">\n\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-home\" viewBox=\"0 0 576 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M280.37 148.26L96 300.11V464a16 16 0 0 0 16 16l112.06-.29a16 16 0 0 0 15.92-16V368a16 16 0 0 1 16-16h64a16 16 0 0 1 16 16v95.64a16 16 0 0 0 16 16.05L464 480a16 16 0 0 0 16-16V300L295.67 148.26a12.19 12.19 0 0 0-15.3 0zM571.6 251.47L488 182.56V44.05a12 12 0 0 0-12-12h-56a12 12 0 0 0-12 12v72.61L318.47 43a48 48 0 0 0-61 0L4.34 251.47a12 12 0 0 0-1.6 16.9l25.5 31A12 12 0 0 0 45.15 301l235.22-193.74a12.19 12.19 0 0 1 15.3 0L530.9 301a12 12 0 0 0 16.9-1.6l25.5-31a12 12 0 0 0-1.7-16.93z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6bf6e3a elementor-widget elementor-widget-heading\" data-id=\"6bf6e3a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Housing Resources<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8b8e674 elementor-align-center elementor-widget elementor-widget-button\" data-id=\"8b8e674\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/kidsmealsinc.org\/wp-content\/uploads\/Housing-Resources.pdf\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">See Resources<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-56e5734 pad tight read e-flex e-con-boxed e-con e-parent\" data-id=\"56e5734\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7657262 balance elementor-widget elementor-widget-heading\" data-id=\"7657262\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Comment or Concern?<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-64a26da elementor-button-align-start elementor-widget elementor-widget-form\" data-id=\"64a26da\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Need Help\" aria-label=\"Need Help\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"9\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"64a26da\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Need Help? - Kids&#039; Meals Inc.\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"9\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFirst Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_a9ebfee elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a9ebfee\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLast Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_a9ebfee]\" id=\"form-field-field_a9ebfee\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEmail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_a950d25 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label 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class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h3>Apply to receive lunches from Kids\u2019 Meals<\/h3><p>Kids\u2019 Meals delivers free, healthy lunches to the homes of preschool-aged children (ages 0-5 years old) in need of food in 56 zip codes in Harris and Montgomery Counties.<\/p><p>Deliveries are Monday through Friday year-round with the exception of certain holidays.<\/p><p>To start receiving lunches, you must qualify and this application must be COMPLETELY filled out. If you have any questions please contact Kids\u2019 Meals at 713-695-5437 or email Clients@kidsmealsinc.org<\/p><p>To receive lunches from Kids\u2019 Meals, you must meet 3 criteria:<br \/>At least one child five years old or younger must live in your home<br \/>You must live in one of 56 zip codes that Kids\u2019 Meals delivers to<br \/>Your monthly income must meet the eligibility guidelines below:<br \/>Eligibility guidelines are on a monthly basis according to the Texas Department of Agriculture, Emergency Food Assistance Program, Effective: July 1, 2024 \u2013 June 30, 2025<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>We are ready to help you! \u00a1Ahora puedes ver nuestro sitio web en espa\u00f1ol! En computadora: Haz clic en la bandera de Estados Unidos en la esquina superior derecha y selecciona la bandera de M\u00e9xico para la versi\u00f3n en espa\u00f1ol. En m\u00f3vil: Toca las 3 l\u00edneas (men\u00fa), luego haz clic en la bandera de Estados [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"_acf_changed":false,"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-9","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Need Help? - Kids&#039; Meals Inc.<\/title>\n<meta name=\"description\" content=\"Free Daily meals delivered to your home for your child under age 6. 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