{"id":619,"date":"2023-08-21T10:09:26","date_gmt":"2023-08-21T14:09:26","guid":{"rendered":"https:\/\/request.cooperhealth.org\/apps\/?page_id=619"},"modified":"2023-08-21T10:20:41","modified_gmt":"2023-08-21T14:20:41","slug":"participate-in-a-community-event","status":"publish","type":"page","link":"https:\/\/request.cooperhealth.org\/apps\/participate-in-a-community-event\/","title":{"rendered":"Community Event Participation Request"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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data-form-theme='legacy' data-form-index='0' id='gform_wrapper_7' style='display:none'><form method='post' enctype='multipart\/form-data'  id='gform_7'  action='\/apps\/wp-json\/wp\/v2\/pages\/619' data-formid='7' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_7' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><li id=\"field_7_1\" class=\"gfield gfield--type-name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_7_1' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Contact Name<\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_7_1'>\n                            \n            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'>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_7_2\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_7_2' class='gfield_label gform-field-label' for='input_7_2'><span class='gform-field-label__text'>Organization Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_7_2' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_7_3\" class=\"gfield gfield--type-phone gfield--phone-format-standard gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_7_3' class='gfield_label gform-field-label' for='input_7_3'><span class='gform-field-label__text'>Phone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_3' id='input_7_3' type='tel' value='' class='medium'  placeholder='(999) 999-9999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/li><li id=\"field_7_4\" class=\"gfield gfield--type-email gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_7_4' class='gfield_label gform-field-label' for='input_7_4'><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_4' id='input_7_4' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_7_5\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"><label id='gfield_label_7_5' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>What type of outreach are you requesting?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_7_5'><li class='gchoice gchoice_7_5_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.1' type='checkbox'  value='A single health education event'  id='choice_7_5_1'    aria-labelledby=\"label_7_5_1 gfield_label_7_5\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_7_5_1' id='label_7_5_1' class='gform-field-label gform-field-label--type-inline'>A single health education event<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_7_5_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.2' type='checkbox'  value='A series of health education events (more than one day)'  id='choice_7_5_2'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_5_2' id='label_7_5_2' class='gform-field-label gform-field-label--type-inline'>A series of health education events (more than one day)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_7_5_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.3' type='checkbox'  value='Clinical screening'  id='choice_7_5_3'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_5_3' id='label_7_5_3' class='gform-field-label gform-field-label--type-inline'>Clinical screening<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_7_5_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.4' type='checkbox'  value='Other'  id='choice_7_5_4'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_7_5_4' id='label_7_5_4' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_7_6\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_7_6' class='gfield_label gform-field-label' for='input_7_6'><span class='gform-field-label__text'>Please specify the type of outreach you&#039;re requesting<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_6' id='input_7_6' class='textarea medium'     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field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_7_8' class='gfield_label gform-field-label' for='input_7_8'><span class='gform-field-label__text'>Date for Request<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_7_8'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_8'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_7_8' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_7_8' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_7_8' aria-label='Date for Request: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/li><li id=\"field_7_9\" class=\"gfield gfield--type-radio gfield--type-choice gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"><label id='gfield_label_7_9' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Is your requested date flexible?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_7_9'>\n\t\t\t<li class='gchoice gchoice_7_9_0'>\n\t\t\t\t<input name='input_9' type='radio' value='Yes'  id='choice_7_9_0'    \/>\n\t\t\t\t<label for='choice_7_9_0' id='label_7_9_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_7_9_1'>\n\t\t\t\t<input name='input_9' type='radio' value='No'  id='choice_7_9_1'    \/>\n\t\t\t\t<label for='choice_7_9_1' id='label_7_9_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_7_10\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_7_10' class='gfield_label gform-field-label' for='input_7_10'><span class='gform-field-label__text'>How many people do you expect to 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