{"id":1499,"date":"2024-06-25T13:21:31","date_gmt":"2024-06-25T17:21:31","guid":{"rendered":"https:\/\/research.ohioguidestone.org\/study\/?page_id=1499"},"modified":"2024-06-25T13:21:31","modified_gmt":"2024-06-25T17:21:31","slug":"caresource-special-enrollment-form","status":"publish","type":"page","link":"https:\/\/research.ohioguidestone.org\/study\/caresource-special-enrollment-form\/","title":{"rendered":"Caresource Special Enrollment Form"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full wpforms-container-save-resume\" id=\"wpforms-1485\"><form id=\"wpforms-form-1485\" class=\"wpforms-validate wpforms-form\" data-formid=\"1485\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/study\/wp-json\/wp\/v2\/pages\/1499\" data-token=\"1d93fc069721528546c916a6e49c6bff\" data-token-time=\"1776658318\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-1485-field_127-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"127\"><label class=\"wpforms-field-label\">Electronic Agreement <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1485-field_127\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1485-field_127_1\" name=\"wpforms[fields][127][]\" value=\"By checking this box, I agree to use electronic records and electronic signatures.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_127_1\">By checking this box, I agree to use electronic records and electronic signatures.<\/label><\/li><\/ul><\/div><div id=\"wpforms-1485-field_2-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half wpforms-first\" data-field-id=\"2\"><label class=\"wpforms-field-label\">Staff name<\/label><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-1485-field_2\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][2][first]\" ><label for=\"wpforms-1485-field_2\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1485-field_2-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][2][last]\" ><label for=\"wpforms-1485-field_2-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><div class=\"wpforms-field-description\">For staff use only<\/div><\/div><div id=\"wpforms-1485-field_5-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-half\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-1485-field_5\">Date <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1485-field_5\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-large\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][5][date]\" 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 class=\"wpforms-field-description\">Date of form completion. <\/div><\/div><div id=\"wpforms-1485-field_6-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"6\"><h3 id=\"wpforms-1485-field_6\">Enrollment Information<\/h3><\/div><div id=\"wpforms-1485-field_7-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half wpforms-first\" data-field-id=\"7\"><label class=\"wpforms-field-label\">Participant name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-1485-field_7\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][7][first]\" required><label for=\"wpforms-1485-field_7\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1485-field_7-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][7][last]\" required><label for=\"wpforms-1485-field_7-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><div class=\"wpforms-field-description\">Father's First & Last Name<\/div><\/div><div id=\"wpforms-1485-field_8-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-half\" data-field-id=\"8\"><label class=\"wpforms-field-label\">Participant&#039;s date of birth <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-large\"><select name=\"wpforms[fields][8][date][m]\" id=\"wpforms-1485-field_8-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\"  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][8][date][d]\" id=\"wpforms-1485-field_8-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\"  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][8][date][y]\" id=\"wpforms-1485-field_8-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\"  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 class=\"wpforms-field-description\">Father's Date of Birth<\/div><\/div><div id=\"wpforms-1485-field_14-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-half\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-1485-field_14\">Phone number <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1485-field_14\" class=\"wpforms-field-large wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][14]\" aria-label=\"Phone number\" required><div class=\"wpforms-field-description\">Father's cell phone number. <\/div><\/div><div id=\"wpforms-1485-field_12-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"12\"><label class=\"wpforms-field-label\">Father&#039;s Mailing Address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-large\"><div ><input type=\"text\" id=\"wpforms-1485-field_12\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][12][address1]\" required><label for=\"wpforms-1485-field_12\" 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-1485-field_12-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][12][address2]\" ><label for=\"wpforms-1485-field_12-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-1485-field_12-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][12][city]\" required><label for=\"wpforms-1485-field_12-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-1485-field_12-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][12][state]\" required><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/option><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\" >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-1485-field_12-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-1485-field_12-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][12][postal]\" required><label for=\"wpforms-1485-field_12-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/div><div id=\"wpforms-1485-field_13-container\" class=\"wpforms-field wpforms-field-email wpforms-one-half wpforms-first\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-1485-field_13\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1485-field_13\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][13]\" spellcheck=\"false\" required><div class=\"wpforms-field-description\">Father's email address. <\/div><\/div><div id=\"wpforms-1485-field_9-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-third wpforms-first wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"9\"><label class=\"wpforms-field-label\">Is your baby born yet? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1485-field_9\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1485-field_9_1\" name=\"wpforms[fields][9]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_9_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1485-field_9_2\" name=\"wpforms[fields][9]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_9_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-1485-field_130-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"130\"><label class=\"wpforms-field-label\">Baby&#039;s delivery status (check all that apply)<\/label><ul id=\"wpforms-1485-field_130\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1485-field_130_1\" name=\"wpforms[fields][130][]\" value=\"Baby was born full term 37-42 weeks\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_130_1\">Baby was born full term 37-42 weeks<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1485-field_130_2\" name=\"wpforms[fields][130][]\" value=\"Baby was born early under 36 weeks\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_130_2\">Baby was born early under 36 weeks<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-1485-field_130_3\" name=\"wpforms[fields][130][]\" value=\"Baby was admitted or spent time in the Neonatal Intensive Care Unit (NICU)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_130_3\">Baby was admitted or spent time in the Neonatal Intensive Care Unit (NICU)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-1485-field_130_4\" name=\"wpforms[fields][130][]\" value=\"Baby had health issues\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_130_4\">Baby had health issues<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-1485-field_130_5\" name=\"wpforms[fields][130][]\" value=\"Baby was delivered by C-section\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_130_5\">Baby was delivered by C-section<\/label><\/li><\/ul><div class=\"wpforms-field-description\">These questions are about your baby. If you baby has not been born yet, please go to the next question.<\/div><\/div><div id=\"wpforms-1485-field_10-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-third wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"10\" style=\"display:none;\"><label class=\"wpforms-field-label\">Baby&#039;s date of birth <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-large\"><select name=\"wpforms[fields][10][date][m]\" id=\"wpforms-1485-field_10-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\"  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-1485-field_10-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\"  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-1485-field_10-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\"  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 class=\"wpforms-field-description\">If baby has not been born will enter their estimated due date. <\/div><\/div><div id=\"wpforms-1485-field_11-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-third wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"11\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1485-field_11\">Baby&#039;s estimated due date <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1485-field_11\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-large\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"1\" data-disable-todays-date=\"0\" data-input=\"true\" name=\"wpforms[fields][11][date]\" 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 class=\"wpforms-field-description\">Day that baby is (or was) supposed to be born.<\/div><\/div><div id=\"wpforms-1485-field_128-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-one-half wpforms-first wpforms-list-inline\" data-field-id=\"128\"><label class=\"wpforms-field-label\">I give permission for study staff to text me regarding study appointments at the above phone number <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1485-field_128\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1485-field_128_1\" name=\"wpforms[fields][128][]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_128_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1485-field_128_2\" name=\"wpforms[fields][128][]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_128_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-1485-field_129-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-one-half wpforms-list-inline\" data-field-id=\"129\"><label class=\"wpforms-field-label\">I give permission for study staff to leave me voicemails regarding study appointments at the above phone number <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1485-field_129\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1485-field_129_1\" name=\"wpforms[fields][129][]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_129_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1485-field_129_2\" name=\"wpforms[fields][129][]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_129_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-1485-field_15-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half wpforms-first\" data-field-id=\"15\"><label class=\"wpforms-field-label\">Emergency contact<\/label><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-1485-field_15\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][15][first]\" ><label for=\"wpforms-1485-field_15\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1485-field_15-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][15][last]\" ><label for=\"wpforms-1485-field_15-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-1485-field_16-container\" class=\"wpforms-field wpforms-field-phone wpforms-one-half\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-1485-field_16\">Emergency contact number<\/label><input type=\"tel\" id=\"wpforms-1485-field_16\" class=\"wpforms-field-large wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][16]\" aria-label=\"Emergency contact number\" ><\/div><div id=\"wpforms-1485-field_19-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"19\"><h3 id=\"wpforms-1485-field_19\">Demographic Information<\/h3><\/div><div id=\"wpforms-1485-field_20-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-1485-field_20\">Primary language spoken at home <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1485-field_20\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][20]\" required><\/div><div id=\"wpforms-1485-field_21-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-half wpforms-list-inline\" data-field-id=\"21\"><label class=\"wpforms-field-label\">Are you of Hispanic\/Latinx heritage? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1485-field_21\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1485-field_21_1\" name=\"wpforms[fields][21]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_21_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1485-field_21_2\" name=\"wpforms[fields][21]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_21_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-1485-field_22-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-two-thirds wpforms-first wpforms-list-2-columns wpforms-conditional-trigger\" data-field-id=\"22\"><label class=\"wpforms-field-label\">Race (please choose all that apply) <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1485-field_22\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1485-field_22_1\" name=\"wpforms[fields][22][]\" value=\"Native American\/Alaskan Native\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_22_1\">Native American\/Alaskan Native<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1485-field_22_2\" name=\"wpforms[fields][22][]\" value=\"Asian\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_22_2\">Asian<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-1485-field_22_3\" name=\"wpforms[fields][22][]\" value=\"African American\/Black\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_22_3\">African American\/Black<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-1485-field_22_4\" name=\"wpforms[fields][22][]\" value=\"Caucasian\/White\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_22_4\">Caucasian\/White<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-1485-field_22_5\" name=\"wpforms[fields][22][]\" value=\"Native Hawaiian\/Pacific Islander\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_22_5\">Native Hawaiian\/Pacific Islander<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-1485-field_22_6\" name=\"wpforms[fields][22][]\" value=\"Other\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_22_6\">Other<\/label><\/li><\/ul><\/div><div id=\"wpforms-1485-field_23-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"23\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1485-field_23\">If other, please explain <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1485-field_23\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][23]\" required><\/div><div id=\"wpforms-1485-field_24-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-half wpforms-first wpforms-list-3-columns\" data-field-id=\"24\"><label class=\"wpforms-field-label\">Relationship status <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1485-field_24\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1485-field_24_1\" name=\"wpforms[fields][24]\" value=\"Married\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_24_1\">Married<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1485-field_24_2\" name=\"wpforms[fields][24]\" value=\"Partnered\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_24_2\">Partnered<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1485-field_24_3\" name=\"wpforms[fields][24]\" value=\"Single\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_24_3\">Single<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1485-field_24_4\" name=\"wpforms[fields][24]\" value=\"Divorced\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_24_4\">Divorced<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-1485-field_24_5\" name=\"wpforms[fields][24]\" value=\"Widowed\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_24_5\">Widowed<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-1485-field_24_6\" name=\"wpforms[fields][24]\" value=\"Separated\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_24_6\">Separated<\/label><\/li><\/ul><\/div><div id=\"wpforms-1485-field_38-container\" class=\"wpforms-field wpforms-field-number wpforms-one-third wpforms-first\" data-field-id=\"38\"><label class=\"wpforms-field-label\" for=\"wpforms-1485-field_38\">Household family size (includes you, other adults, and children) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-1485-field_38\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][38]\" step=\"any\" required><\/div><div id=\"wpforms-1485-field_39-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-third wpforms-list-inline\" data-field-id=\"39\"><label class=\"wpforms-field-label\">Is the mother of your baby included in your household? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1485-field_39\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1485-field_39_1\" name=\"wpforms[fields][39]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_39_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1485-field_39_2\" name=\"wpforms[fields][39]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_39_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-1485-field_42-container\" class=\"wpforms-field wpforms-field-radio wpforms-one-half wpforms-first wpforms-list-2-columns wpforms-conditional-trigger\" data-field-id=\"42\"><label class=\"wpforms-field-label\">Who do you co-parent with? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1485-field_42\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1485-field_42_1\" name=\"wpforms[fields][42]\" value=\"No one\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_42_1\">No one<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1485-field_42_2\" name=\"wpforms[fields][42]\" value=\"Husband\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_42_2\">Husband<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1485-field_42_3\" name=\"wpforms[fields][42]\" value=\"Wife\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_42_3\">Wife<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"radio\" id=\"wpforms-1485-field_42_8\" name=\"wpforms[fields][42]\" value=\"Partner\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_42_8\">Partner<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1485-field_42_4\" name=\"wpforms[fields][42]\" value=\"Sister\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_42_4\">Sister<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-1485-field_42_5\" name=\"wpforms[fields][42]\" value=\"Brother\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_42_5\">Brother<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-1485-field_42_6\" name=\"wpforms[fields][42]\" value=\"Other\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1485-field_42_6\">Other<\/label><\/li><\/ul><\/div><div id=\"wpforms-1485-field_43-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"43\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1485-field_43\">If other, please explain <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1485-field_43\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][43]\" required><\/div><div id=\"wpforms-1485-field_44-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"44\"><label class=\"wpforms-field-label\" for=\"wpforms-1485-field_44\">My co-parent&#039;s relationship to my child(ren) is <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1485-field_44\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][44]\" placeholder=\"Mother\" required><div class=\"wpforms-field-description\">Examples: Mother, Father, Stepmother, Dad's girlfriend, Mom's partner, Grandmother, Aunt, Foster mother, etc.<\/div><\/div><div id=\"wpforms-1485-field_131-container\" class=\"wpforms-field wpforms-field-number-slider\" data-field-id=\"131\"><label class=\"wpforms-field-label\" for=\"wpforms-1485-field_131\">How many children do you have. <\/label>\n<input\n\ttype=\"range\"\n\tid=\"wpforms-1485-field_131\" class=\"wpforms-field-medium\" name=\"wpforms[fields][131]\" value=\"0\"\t\tmin=\"0\"\n\tmax=\"15\"\n\tstep=\"1\">\n\n<div class=\"wpforms-field-number-slider-hint\"\n\tdata-hint=\"Selected Value: {value}\">\n\tSelected Value: <b>0<\/b><\/div>\n<\/div><div id=\"wpforms-1485-field_134-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"134\"><label class=\"wpforms-field-label\" for=\"wpforms-1485-field_134\">How did you find out about this study? <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1485-field_134\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][134]\" required><\/div><div id=\"wpforms-1485-field_137-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-id=\"137\"><label class=\"wpforms-field-label\" for=\"wpforms-1485-field_137\">If you are eligible to participate, and complete project sessions, you will be offered a thank you gift. Would you prefer a gift card -or- diapers? <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-1485-field_137\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][137]\" required=\"required\"><option value=\"Amazon Gift Card\"  class=\"choice-1 depth-1\"  >Amazon Gift Card<\/option><option value=\"Target Gift Card\"  class=\"choice-2 depth-1\"  >Target Gift Card<\/option><option value=\"Diapers\"  class=\"choice-3 depth-1\"  >Diapers<\/option><\/select><\/div><div id=\"wpforms-1485-field_138-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-id=\"138\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1485-field_138\">What size diapers do you need? *<\/label><select id=\"wpforms-1485-field_138\" class=\"wpforms-field-medium\" name=\"wpforms[fields][138]\"><option value=\"Newborn: Up to 10 lbs\"  class=\"choice-4 depth-1\"  >Newborn: Up to 10 lbs<\/option><option value=\"Size 1: 8\u201314 lbs\"  class=\"choice-5 depth-1\"  >Size 1: 8\u201314 lbs<\/option><option value=\"Size 2: 12\u201318 lbs\"  class=\"choice-6 depth-1\"  >Size 2: 12\u201318 lbs<\/option><option value=\"Size 3: 16\u201321 lbs\"  class=\"choice-7 depth-1\"  >Size 3: 16\u201321 lbs<\/option><option value=\"Size 4: 20\u201332 lbs\"  class=\"choice-8 depth-1\"  >Size 4: 20\u201332 lbs<\/option><option value=\"Size 5: 27\u201335 lbs\"  class=\"choice-9 depth-1\"  >Size 5: 27\u201335 lbs<\/option><option value=\"Size 6: Over 35 lbs\"  class=\"choice-10 depth-1\"  >Size 6: Over 35 lbs<\/option><option value=\"Size 7: 41 lbs and over\"  class=\"choice-11 depth-1\"  >Size 7: 41 lbs and over<\/option><\/select><\/div><div id=\"wpforms-1485-field_140-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-id=\"140\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1485-field_140\">Diaper Brand *<\/label><select id=\"wpforms-1485-field_140\" class=\"wpforms-field-medium\" name=\"wpforms[fields][140]\"><option value=\"Huggies\"  class=\"choice-4 depth-1\"  >Huggies<\/option><option value=\"Pampers\"  class=\"choice-5 depth-1\"  >Pampers<\/option><option value=\"Luvs\"  class=\"choice-6 depth-1\"  >Luvs<\/option><option value=\"Honest\"  class=\"choice-7 depth-1\"  >Honest<\/option><option value=\"Pura\"  class=\"choice-8 depth-1\"  >Pura<\/option><option value=\"Other (details below)\"  class=\"choice-9 depth-1\"  >Other (details below)<\/option><\/select><\/div><div id=\"wpforms-1485-field_142-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"142\"><label class=\"wpforms-field-label\" for=\"wpforms-1485-field_142\">Please share the brand diapers if yours was not listed. And please feel free to give any other details.<\/label><input type=\"text\" id=\"wpforms-1485-field_142\" class=\"wpforms-field-medium\" name=\"wpforms[fields][142]\" ><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"1485\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/pages\/1499\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1485\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><\/div><\/form><\/div>  <!-- .wpforms-container -->\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"neve_meta_sidebar":"full-width","neve_meta_container":"","neve_meta_enable_content_width":"on","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"class_list":["post-1499","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/pages\/1499","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/comments?post=1499"}],"version-history":[{"count":1,"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/pages\/1499\/revisions"}],"predecessor-version":[{"id":1500,"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/pages\/1499\/revisions\/1500"}],"wp:attachment":[{"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/media?parent=1499"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}