{"id":27873,"date":"2017-12-14T10:24:07","date_gmt":"2017-12-14T15:24:07","guid":{"rendered":"https:\/\/montreal.dodgebow.ca\/?page_id=27873"},"modified":"2018-02-12T14:20:14","modified_gmt":"2018-02-12T19:20:14","slug":"waiver-station","status":"publish","type":"page","link":"https:\/\/montreal.dodgebow.ca\/en\/waiver-station\/","title":{"rendered":"Waiver Station"},"content":{"rendered":"<div class=\"row row-large align-top\"  id=\"row-1682087700\">  \t<div id=\"col-1169045664\" class=\"col large-12\"  > \t\t\t\t<div class=\"col-inner\"  > \t\t\t \t\t\t <script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>                 <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_1' style='display:none'><div id='gf_1' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_1' id='gform_1'  action='\/en\/wp-json\/wp\/v2\/pages\/27873#gf_1' data-formid='1' ><div id='gf_page_steps_1' class='gf_page_steps'><div id='gf_step_1_1' class='gf_step gf_step_active gf_step_first'><span class='gf_step_number'>1<\/span><span class='gf_step_label'>Welcome<\/span><\/div><div id='gf_step_1_2' class='gf_step gf_step_next gf_step_pending'><span class='gf_step_number'>2<\/span><span class='gf_step_label'>Info<\/span><\/div><div id='gf_step_1_3' class='gf_step gf_step_pending'><span class='gf_step_number'>3<\/span><span class='gf_step_label'>Waiver<\/span><\/div><div id='gf_step_1_4' class='gf_step gf_step_last gf_step_pending'><span class='gf_step_number'>4<\/span><span class='gf_step_label'>Signature<\/span><\/div><\/div>                         <div class='gform-body gform_body'><div id='gform_page_1_1' class='gform_page' data-js='page-field-id-1' >                                     <div class='gform_page_fields'><ul id='gform_fields_1' class='gform_fields top_label form_sublabel_above description_above'><li id=\"field_1_25\"  class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_above gfield_visibility_hidden\"  data-js-reload=\"field_1_25\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_25' >IP<\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_1_25' type='text' value='216.73.217.116' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_29\"  class=\"gfield gfield--type-simple gf_right_half field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_29\"><label class='gfield_label gform-field-label' for='input_1_29' >When will your session take place? (required)<\/label><div class='gfield_description' id='gfield_description_1_29'>Date and time (YYYY-MM-DD HH:mm) of your booking<\/div><div class='ginput_container ginput_container_simple'><input name='input_29' id='date' type='text' value='' class='medium'     aria-invalid=\"false\" \/><\/div><\/li><li id=\"field_1_28\"  class=\"gfield gfield--type-text gf_left_half field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_28\"><label class='gfield_label gform-field-label' for='input_1_28' >What is your Order number? (required)<\/label><div class='gfield_description' id='gfield_description_1_28'>Order # shown on top your email receipt<\/div><div class='ginput_container ginput_container_text'><input name='input_28' id='input_1_28' type='text' value='' class='medium'  aria-describedby=\"gfield_description_1_28\"    aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_31\"  class=\"gfield gfield--type-username field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_31\"><label class='gfield_label gform-field-label' for='input_1_31' >Username<\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_1_31' type='text' value='' class='medium'  aria-describedby=\"input_1_31_desc\"    aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_18\"  class=\"gfield gfield--type-radio gfield--type-choice gf_list_3col gf_activity_choice gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_18\"><label class='gfield_label gform-field-label'  >What Activity will you be participating in?<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_1_18'> \t\t\t<li class='gchoice gchoice_1_18_0'> \t\t\t\t<input name='input_18' type='radio' value='DodgeBow'  id='choice_1_18_0'    \/> \t\t\t\t<label for='choice_1_18_0' id='label_1_18_0' class='gform-field-label gform-field-label--type-inline'><img decoding=\"async\" src=\"https:\/\/montreal.dodgebow.ca\/wp-content\/uploads\/sites\/2\/2017\/12\/Dodgebow-Square-Color-600x600-Archery-180x180.png\"><\/label> \t\t\t<\/li> \t\t\t<li class='gchoice gchoice_1_18_1'> \t\t\t\t<input name='input_18' type='radio' value='ForceAcademy'  id='choice_1_18_1'    \/> \t\t\t\t<label for='choice_1_18_1' id='label_1_18_1' class='gform-field-label gform-field-label--type-inline'><img decoding=\"async\" src=\"https:\/\/montreal.dodgebow.ca\/wp-content\/uploads\/sites\/2\/2017\/12\/Logo-Face-Academy-Square-Colours-180x180.png\"><\/label> \t\t\t<\/li> \t\t\t<li class='gchoice gchoice_1_18_2'> \t\t\t\t<input name='input_18' type='radio' value='NERFHero'  id='choice_1_18_2'    \/> \t\t\t\t<label for='choice_1_18_2' id='label_1_18_2' class='gform-field-label gform-field-label--type-inline'><img decoding=\"async\" src=\"https:\/\/montreal.dodgebow.ca\/wp-content\/uploads\/sites\/2\/2017\/12\/NERF-Hero-Montreal-Logo-600x600-180x180.png\"><\/label> \t\t\t<\/li><\/ul><\/div><\/li><\/ul>                     <\/div>                     <div class='gform_page_footer top_label'>                          <input type='button' id='gform_next_button_1_32' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/>                      <\/div>                 <\/div>                 <div id='gform_page_1_2' class='gform_page' data-js='page-field-id-32' style='display:none;'>                     <div class='gform_page_fields'>                         <ul id='gform_fields_1_2' class='gform_fields top_label form_sublabel_above description_above'><li id=\"field_1_1\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_1\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Player&#039;s Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name has_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_1_1'>                             <span id='input_1_1_2_container' class='name_prefix name_prefix_select gform-grid-col gform-grid-col--size-auto' >                                                     <label for='input_1_1_2' class='gform-field-label gform-field-label--type-sub'>Prefix<\/label>                                                     <select name='input_1.2' id='input_1_1_2'    aria-required='false'   >                           <option value=''><\/option><option value='Mr.' selected='selected'>Mr.<\/option><option value='Ms.' >Ms.<\/option>                       <\/select>                                                   <\/span>                             <span id='input_1_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >                                                     <label for='input_1_1_3' class='gform-field-label gform-field-label--type-sub'>First<\/label>                                                     <input type='text' name='input_1.3' id='input_1_1_3' value=''   aria-required='true'     \/>                                                 <\/span>                                                          <span id='input_1_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >                                                             <label for='input_1_1_6' class='gform-field-label gform-field-label--type-sub'>Last<\/label>                                                             <input type='text' name='input_1.6' id='input_1_1_6' value=''   aria-required='true'     \/>                                                         <\/span>                                                      <\/div><\/li><li id=\"field_1_20\"  class=\"gfield gfield--type-address gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_20\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Postal Code &amp; Country<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>                         <div class='ginput_complex ginput_container has_zip has_country ginput_container_address gform-grid-row' id='input_1_20' >                         <input type='hidden' class='gform_hidden' name='input_20.4' id='input_1_20_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_1_20_5_container' >                                     <label for='input_1_20_5' id='input_1_20_5_label' class='gform-field-label gform-field-label--type-sub'>Postal Code \/ Zip<\/label>                                     <input type='text' name='input_20.5' id='input_1_20_5' value=''    aria-required='true'    \/>                                 <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_1_20_6_container' >                                         <label for='input_1_20_6' id='input_1_20_6_label' class='gform-field-label gform-field-label--type-sub'>Country<\/label>                                         <select name='input_20.6' id='input_1_20_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' selected='selected'>Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option> <\/select>                                     <\/span>                     <div class='gf_clear gf_clear_complex'><\/div>                 <\/div><\/li><li id=\"field_1_4\"  class=\"gfield gfield--type-email gf_left_third gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_4\"><label class='gfield_label gform-field-label' for='input_1_4' >Player&#039;s Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>                             <input name='input_4' id='input_1_4' type='text' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>                         <\/div><\/li><li id=\"field_1_2\"  class=\"gfield gfield--type-date gfield--input-type-datefield gf_middle_third gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_2\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Player&#039;s Birthdate<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_1_2' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\">                                             <div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_1_2_3_container'>                                                 <input type='text' maxlength='4' name='input_2[]' id='input_1_2_3' value=''   aria-required='true'   placeholder='YYYY'   \/>                                                 <label for='input_1_2_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>                                             <\/div><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_1_2_1_container'>                                                 <input type='text' maxlength='2' name='input_2[]' id='input_1_2_1' value=''   aria-required='true'   placeholder='MM' \/>                                                 <label for='input_1_2_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>                                             <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_1_2_2_container'>                                                 <input type='text' maxlength='2' name='input_2[]' id='input_1_2_2' value=''   aria-required='true'   placeholder='DD' \/>                                                 <label for='input_1_2_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>                                            <\/div>                                         <\/div><\/div><\/li><li id=\"field_1_3\"  class=\"gfield gfield--type-phone gf_right_third field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_3\"><label class='gfield_label gform-field-label' for='input_1_3' >Emergency contact phone number<\/label><div class='ginput_container ginput_container_phone'><input name='input_3' id='input_1_3' type='text' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_23\"  class=\"gfield gfield--type-hidden gform_hidden field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_23\"><div class='ginput_container ginput_container_text'><input name='input_23' id='input_1_23' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='en' \/><\/div><\/li><\/ul>                     <\/div>                     <div class='gform_page_footer top_label'>                         <input type='button' id='gform_previous_button_1_12' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Prev.'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"1\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"1\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_12' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/>                      <\/div>                 <\/div>                 <div id='gform_page_1_3' class='gform_page' data-js='page-field-id-12' style='display:none;'>                     <div class='gform_page_fields'>                         <ul id='gform_fields_1_3' class='gform_fields top_label form_sublabel_above description_above'><li id=\"field_1_19\"  class=\"gfield gfield--type-section gsection gf_scroll_text field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_19\"><h2 class=\"gsection_title\">Waiver<\/h2><div class='gsection_description' id='gfield_description_1_19'><p><strong>ACKNOWLEDGEMENT &amp; ASSUMPTION OF RISK &amp; RESPONSIBILITY<\/strong><\/p> <p>Warning: There are significant elements of risk in any sport or activity associated with archery and the use of any associated equipment (referred to herein as \u2018activity\u2019). Although we have taken responsible steps to provide you with appropriate safety equipment, instructions, and knowledgeable supervisors so you can enjoy an activity for which you may not be skilled, we wish to remind you this activity is not without risk. The elements that contribute to the unique character of the activity can be cause of loss or damage to equipment, or serious accidental injury. It is important for you to know in advance what to expect and be informed of the inherent risks.<\/p> <p>ACKNOWLEDGMENT OF RISKS: I ACKNOWLEDGE THAT THE FOLLOWING DESCRIBES SOME, BUT NOT ALL THE RISKS OF DODGEBOW:<\/p> <ul> <li>Slips, trips, falls while using the facilities or equipment;<\/li> <li>Misuse of equipment or facilities, or failure of equipment;<\/li> <li>The risk that my health and physical strength, coordination, sense of balance may not be sufficient to practice safely the sport of DodgeBow;<\/li> <li>Fatigue, chill and\/or dizziness, which may diminish my reaction time and increase the risk of accident;<\/li> <li>Bruising of the arms from improperly firing the bow. Abrasion from sliding on the floor;<\/li> <li>The presence and actions of other participants.<\/li> <\/ul> <p>I understand the description of these risks is not complete and that other unknown or unanticipated risks may result in serious injury.<\/p> <p>&nbsp;<\/p> <p>HEALTH AND PHYSICAL CONDITION<\/p> <p>I confirm that I am in proper physical condition and I suffer from no personal health issues that prevent me from participating in the activities of SPORTS DODGEBOW INC..  I understand the nature of this activity and that I am qualified to participate in such activity.<\/p> <p>&nbsp;<\/p> <p>ASSUMPTION OF RISK<\/p> <p>I assume the risk(s) of personal injury, accidents and\/or illness, including but not limited to: sprains, torn muscles and\/or ligaments; fractured or broken bones; eye damage; cuts, wounds, scrapes, abrasions, and\/or contusions; dehydration, oxygen shortage (anoxia); head, neck, and\/or spinal injuries; shock, paralysis, and\/or death.  I further understand that bodily injury may be caused by my own actions, or inactions, those of others participating in the event.  I fully accept and assume all such risks and all responsibility for losses, costs, and damages I incur as a result of my own participation in the activity.  I acknowledge that if I believe event conditions are unsafe, I will immediately discontinue participation in the activity.<\/p> <p>&nbsp;<\/p> <p><strong>RELEASE AND DISCHARGE<\/strong><\/p> <p>I hereby Release, Discharge, Covenant not to sue (collectively, \u201cRelease\u201d) SPORTS DODGEBOW INC., and agree to indemnify, save, and hold harmless its respective administrators, agents, officers, employees, volunteers, other participants, any sponsors, advertisers, and when applicable, owners and lessors or premises on which the activity takes place (separately, the \u201cReleases\u201d), from any and all claims, demands, liability, losses, or damages on my account, caused or alleged to be caused in whole or in part by the negligence of the Releases or otherwise.  I further agree that if I, or anyone on my behalf, makes a claim against any of the Releases, I will indemnify and hold harmless each the Releases from any loss, liability, damage, or cost which may incur as the result of such claim.<\/p> <p>AGREEMENT TO ABIDE BY THE RULES AND REGULATIONS<\/p> <p>I agree to abide by the rules and regulations of SPORTS DODGEBOW INC., which are posted on the website. A written copy of the rules and regulations will be made available on request. I acknowledge that I requested that this acknowledgement be provided to me in English.<\/p> <p>\u201cI have read and understood the foregoing acknowledgment of risks and assumption of risk and responsibility and that I will abide by the rules and regulations of SPORTS DODGEBOW INC.\u201d<\/p> <p>The client understands that the products and services offered in this activity are not associated, affiliated, endorsed, or sponsored by the Star Wars Franchise, Lucasfilm Entertainment Company Ltd., nor any of its affiliates, nor have they been reviewed tested or certified by same.<\/p> <p>&nbsp;<\/p> <p><strong>MEDIA RELEASE AGREEMENT<\/strong><\/p> <p>Whereas I, the undersigned, have been informed, understand, and agree that SPORTS DODGEBOW INC. (the \u201cProducer\u201d) will be taking photographs and producing a video program and whereas, I understand that my voice, name, and image may be recorded by various mechanical and electrical means of all descriptions (such recordings, photographs, any piece thereof, the contents therein and all reproductions thereof, along with the utilization of my name, shall be collectively referred to herein as the &#8220;Released Subject Matter&#8221;),<\/p> <p>I hereby freely and without restraint consent to give unto the Producer and its agents or assigns or anyone authorized by the Producer, (collectively referred to herein as the &#8220;Releases&#8221;) the unrestrained right in perpetuity to fully own, utilize, or alter the Released Subject Matter, in any manner the Releases may see fit and for any purpose whatsoever, all of the foregoing to be without limitation of any kind.  The Producer and its agents or assigns shall have complete ownership of the Released Subject Matter in which I appear, including copyright interests.  Without limiting the generality of the foregoing, I hereby authorize the Releases and grant unto them the unrestrained rights to utilize the Released Subject Matter in connection with advertising, publicity, distribution, public displays, and exhibitions.  I hereby stipulate that the Released Subject Matter is the property of the Producer to do with as it will.<\/p> <p>I hereby waive to the fullest extent that I may lawfully do so, any causes of action in law or equity I may have or may hereafter acquire against the Releases or any of them for libel, slander, invasion of privacy, copyright or trademark violation, right of publicity, or false light arising out of or in connection with the utilization by the Releases or another of the Released Subject Matter.<\/p> <p>It is my intention that I freely consent to grant the aforementioned unrestrained rights without any compensation for any and all usages of the Released Subject Matter and that the Producer has no financial commitment or obligations to me as a result of this Agreement.  I expressly stipulate that the Releases may utilize the Released Subject Matter or not as they choose in their sole discretion without affecting the validity of this Release.  This Release shall be governed by Quebec Law.<\/p><\/div><\/li><li id=\"field_1_16\"  class=\"gfield gfield--type-hidden gform_hidden field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_16\"><div class='ginput_container ginput_container_text'><input name='input_16' id='input_1_16' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='&lt;p&gt;&lt;strong&gt;ACKNOWLEDGEMENT &amp; ASSUMPTION OF RISK &amp; RESPONSIBILITY&lt;\/strong&gt;&lt;\/p&gt; &lt;p&gt;Warning: There are significant elements of risk in any sport or activity associated with archery and the use of any associated equipment (referred to herein as \u2018activity\u2019). Although we have taken responsible steps to provide you with appropriate safety equipment, instructions, and knowledgeable supervisors so you can enjoy an activity for which you may not be skilled, we wish to remind you this activity is not without risk. The elements that contribute to the unique character of the activity can be cause of loss or damage to equipment, or serious accidental injury. It is important for you to know in advance what to expect and be informed of the inherent risks.&lt;\/p&gt; &lt;p&gt;ACKNOWLEDGMENT OF RISKS: I ACKNOWLEDGE THAT THE FOLLOWING DESCRIBES SOME, BUT NOT ALL THE RISKS OF DODGEBOW:&lt;\/p&gt; &lt;ul&gt; &lt;li&gt;Slips, trips, falls while using the facilities or equipment;&lt;\/li&gt; &lt;li&gt;Misuse of equipment or facilities, or failure of equipment;&lt;\/li&gt; &lt;li&gt;The risk that my health and physical strength, coordination, sense of balance may not be sufficient to practice safely the sport of DodgeBow;&lt;\/li&gt; &lt;li&gt;Fatigue, chill and\/or dizziness, which may diminish my reaction time and increase the risk of accident;&lt;\/li&gt; &lt;li&gt;Bruising of the arms from improperly firing the bow. Abrasion from sliding on the floor;&lt;\/li&gt; &lt;li&gt;The presence and actions of other participants.&lt;\/li&gt; &lt;\/ul&gt; &lt;p&gt;I understand the description of these risks is not complete and that other unknown or unanticipated risks may result in serious injury.&lt;\/p&gt; &lt;p&gt;&nbsp;&lt;\/p&gt; &lt;p&gt;HEALTH AND PHYSICAL CONDITION&lt;\/p&gt; &lt;p&gt;I confirm that I am in proper physical condition and I suffer from no personal health issues that prevent me from participating in the activities of SPORTS DODGEBOW INC..  I understand the nature of this activity and that I am qualified to participate in such activity.&lt;\/p&gt; &lt;p&gt;&nbsp;&lt;\/p&gt; &lt;p&gt;ASSUMPTION OF RISK&lt;\/p&gt; &lt;p&gt;I assume the risk(s) of personal injury, accidents and\/or illness, including but not limited to: sprains, torn muscles and\/or ligaments; fractured or broken bones; eye damage; cuts, wounds, scrapes, abrasions, and\/or contusions; dehydration, oxygen shortage (anoxia); head, neck, and\/or spinal injuries; shock, paralysis, and\/or death.  I further understand that bodily injury may be caused by my own actions, or inactions, those of others participating in the event.  I fully accept and assume all such risks and all responsibility for losses, costs, and damages I incur as a result of my own participation in the activity.  I acknowledge that if I believe event conditions are unsafe, I will immediately discontinue participation in the activity.&lt;\/p&gt; &lt;p&gt;&nbsp;&lt;\/p&gt; &lt;p&gt;&lt;strong&gt;RELEASE AND DISCHARGE&lt;\/strong&gt;&lt;\/p&gt; &lt;p&gt;I hereby Release, Discharge, Covenant not to sue (collectively, \u201cRelease\u201d) SPORTS DODGEBOW INC., and agree to indemnify, save, and hold harmless its respective administrators, agents, officers, employees, volunteers, other participants, any sponsors, advertisers, and when applicable, owners and lessors or premises on which the activity takes place (separately, the \u201cReleases\u201d), from any and all claims, demands, liability, losses, or damages on my account, caused or alleged to be caused in whole or in part by the negligence of the Releases or otherwise.  I further agree that if I, or anyone on my behalf, makes a claim against any of the Releases, I will indemnify and hold harmless each the Releases from any loss, liability, damage, or cost which may incur as the result of such claim.&lt;\/p&gt; &lt;p&gt;AGREEMENT TO ABIDE BY THE RULES AND REGULATIONS&lt;\/p&gt; &lt;p&gt;I agree to abide by the rules and regulations of SPORTS DODGEBOW INC., which are posted on the website. A written copy of the rules and regulations will be made available on request. I acknowledge that I requested that this acknowledgement be provided to me in English.&lt;\/p&gt; &lt;p&gt;\u201cI have read and understood the foregoing acknowledgment of risks and assumption of risk and responsibility and that I will abide by the rules and regulations of SPORTS DODGEBOW INC.\u201d&lt;\/p&gt; &lt;p&gt;The client understands that the products and services offered in this activity are not associated, affiliated, endorsed, or sponsored by the Star Wars Franchise, Lucasfilm Entertainment Company Ltd., nor any of its affiliates, nor have they been reviewed tested or certified by same.&lt;\/p&gt; &lt;p&gt;&nbsp;&lt;\/p&gt; &lt;p&gt;&lt;strong&gt;MEDIA RELEASE AGREEMENT&lt;\/strong&gt;&lt;\/p&gt; &lt;p&gt;Whereas I, the undersigned, have been informed, understand, and agree that SPORTS DODGEBOW INC. (the \u201cProducer\u201d) will be taking photographs and producing a video program and whereas, I understand that my voice, name, and image may be recorded by various mechanical and electrical means of all descriptions (such recordings, photographs, any piece thereof, the contents therein and all reproductions thereof, along with the utilization of my name, shall be collectively referred to herein as the &#8220;Released Subject Matter&#8221;),&lt;\/p&gt; &lt;p&gt;I hereby freely and without restraint consent to give unto the Producer and its agents or assigns or anyone authorized by the Producer, (collectively referred to herein as the &#8220;Releases&#8221;) the unrestrained right in perpetuity to fully own, utilize, or alter the Released Subject Matter, in any manner the Releases may see fit and for any purpose whatsoever, all of the foregoing to be without limitation of any kind.  The Producer and its agents or assigns shall have complete ownership of the Released Subject Matter in which I appear, including copyright interests.  Without limiting the generality of the foregoing, I hereby authorize the Releases and grant unto them the unrestrained rights to utilize the Released Subject Matter in connection with advertising, publicity, distribution, public displays, and exhibitions.  I hereby stipulate that the Released Subject Matter is the property of the Producer to do with as it will.&lt;\/p&gt; &lt;p&gt;I hereby waive to the fullest extent that I may lawfully do so, any causes of action in law or equity I may have or may hereafter acquire against the Releases or any of them for libel, slander, invasion of privacy, copyright or trademark violation, right of publicity, or false light arising out of or in connection with the utilization by the Releases or another of the Released Subject Matter.&lt;\/p&gt; &lt;p&gt;It is my intention that I freely consent to grant the aforementioned unrestrained rights without any compensation for any and all usages of the Released Subject Matter and that the Producer has no financial commitment or obligations to me as a result of this Agreement.  I expressly stipulate that the Releases may utilize the Released Subject Matter or not as they choose in their sole discretion without affecting the validity of this Release.  This Release shall be governed by Quebec Law.&lt;\/p&gt;' \/><\/div><\/li><li id=\"field_1_6\"  class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_6\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Email options<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_6'><li class='gchoice gchoice_1_6_1'> \t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.1' type='checkbox'  value='follow-up' checked='checked' id='choice_1_6_1'   \/> \t\t\t\t\t\t\t\t<label for='choice_1_6_1' id='label_1_6_1' class='gform-field-label gform-field-label--type-inline'>I\u2019d like to receive my photos\/videos and evaluation of today's activity<\/label> \t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_6_2'> \t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.2' type='checkbox'  value='mailing-list' checked='checked' id='choice_1_6_2'   \/> \t\t\t\t\t\t\t\t<label for='choice_1_6_2' id='label_1_6_2' class='gform-field-label gform-field-label--type-inline'>I\u2019d like to receive free tickets, rebates and news for future events<\/label> \t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><\/ul>                     <\/div>                     <div class='gform_page_footer top_label'>                         <input type='button' id='gform_previous_button_1_13' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Prev.'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_13' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/>                      <\/div>                 <\/div>                 <div id='gform_page_1_4' class='gform_page' data-js='page-field-id-13' style='display:none;'>                     <div class='gform_page_fields'>                         <ul id='gform_fields_1_4' class='gform_fields top_label form_sublabel_above description_above'><li id=\"field_1_14\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_14\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Acknowledgment<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_1_14'><li class='gchoice gchoice_1_14_1'> \t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.1' type='checkbox'  value='I hereby certify that I am over the age of eighteen (18), and that I have read, understood, and agreed with the waiver. I have read and understood the foregoing acknowledgment of risks and assumption of risk and responsibility and that I will abide by the rules and regulations of SPORTS DODGEBOW INC.' checked='checked' id='choice_1_14_1'   \/> \t\t\t\t\t\t\t\t<label for='choice_1_14_1' id='label_1_14_1' class='gform-field-label gform-field-label--type-inline'>I hereby certify that I am over the age of eighteen (18), and that I have read, understood, and agreed with the waiver. I have read and understood the foregoing acknowledgment of risks and assumption of risk and responsibility and that I will abide by the rules and regulations of SPORTS DODGEBOW INC.<\/label> \t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_15\"  class=\"gfield gfield--type-signature gf_signature gfield_contains_required field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_15\"><label class='gfield_label gform-field-label' for='input_1_15' >Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_15'>(use your finger to sign on the screen)<\/div><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_1_15_Container' class='gfield_signature_container ginput_container' style='height:180px; width:1034px; ' ><input type='hidden' class='gform_hidden' name='input_1_15_valid' id='input_1_15_valid' \/><canvas id='input_1_15' width='1034' height='180'><\/canvas><\/div><\/div><\/li><li id=\"field_1_30\"  class=\"gfield gfield--type-simple field_sublabel_above gfield--has-description field_description_above gfield_visibility_hidden\"  data-js-reload=\"field_1_30\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gform-field-label' for='input_1_30' >Signed the<\/label><div class='gfield_description' id='gfield_description_1_30'>The date and time when you're signing<\/div><div class='ginput_container ginput_container_simple'><input name='input_30' id='date' type='text' value='' class='medium'     aria-invalid=\"false\" \/><\/div><\/li><li id=\"field_1_22\"  class=\"gfield gfield--type-text gf_right_half gfield_contains_required field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  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