{"id":44252,"date":"2023-09-27T17:04:45","date_gmt":"2023-09-27T16:04:45","guid":{"rendered":"https:\/\/gogohanguk.com\/?page_id=44252"},"modified":"2023-09-27T17:05:18","modified_gmt":"2023-09-27T16:05:18","slug":"health-and-medical-background-information-form","status":"publish","type":"page","link":"https:\/\/gogohanguk.com\/en\/health-and-medical-background-information-form\/","title":{"rendered":"Health and Medical Background Information Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"44252\" class=\"elementor elementor-44252\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1836585f e-flex e-con-boxed e-con e-parent\" data-id=\"1836585f\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8efac9c elementor-widget elementor-widget-image\" data-id=\"8efac9c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"745\" height=\"179\" src=\"https:\/\/gogohanguk.com\/wp-content\/uploads\/2023\/04\/GGH-logo-3-1.png\" class=\"attachment-large size-large wp-image-42612\" alt=\"\" srcset=\"https:\/\/gogohanguk.com\/wp-content\/uploads\/2023\/04\/GGH-logo-3-1.png 745w, https:\/\/gogohanguk.com\/wp-content\/uploads\/2023\/04\/GGH-logo-3-1-300x72.png 300w\" sizes=\"(max-width: 745px) 100vw, 745px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-646c175 e-flex e-con-boxed e-con e-child\" data-id=\"646c175\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-9cb44fe gravityform-lp elementor-widget elementor-widget-text-editor\" data-id=\"9cb44fe\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><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 InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_171' style='display:none'><div id='gf_171' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_171' id='gform_171'  action='\/en\/wp-json\/wp\/v2\/pages\/44252#gf_171' data-formid='171' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_171' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_171_2\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">[Health and Medical Background Information]<\/h3><div class='gsection_description' id='gfield_description_171_2'>Please let us know as much information as possible. The information provided on this form does not necessarily confirm or deny your admission.<\/div><\/div><fieldset id=\"field_171_20\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Q1. Name (as it appears in your passport)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><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_171_20'>\n                            \n                            <span id='input_171_20_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_20.3' id='input_171_20_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_171_20_3' class='gform-field-label gform-field-label--type-sub '>Given Name(s)<\/label>\n                                                <\/span>\n                            \n                            <span id='input_171_20_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_20.6' id='input_171_20_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_171_20_6' class='gform-field-label gform-field-label--type-sub '>Surname\/Family name<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_171_26\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_171_26'>Q2. Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_26' id='input_171_26' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_171_27\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Q3. Do you currently have any learning or educational special needs?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_171_27'>\n\t\t\t<div class='gchoice gchoice_171_27_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Yes'  id='choice_171_27_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_171_27\"   \/>\n\t\t\t\t\t<label for='choice_171_27_0' id='label_171_27_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_171_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='No'  id='choice_171_27_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_171_27_1' id='label_171_27_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_171_27'>Examples: Dyslexia, speech impediment, hearing impaired, visually impaired, etc.<\/div><\/fieldset><div id=\"field_171_28\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_171_28'>What are your special needs and what assistance do you require?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_171_28' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_171_29\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Q4. Are you currently diagnosed with any mental health conditions?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_171_29'>\n\t\t\t<div class='gchoice gchoice_171_29_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='Yes'  id='choice_171_29_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_171_29\"   \/>\n\t\t\t\t\t<label for='choice_171_29_0' id='label_171_29_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_171_29_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_29' type='radio' value='No'  id='choice_171_29_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_171_29_1' id='label_171_29_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_171_29'>Examples: Anxiety, depression, bipolar disorder, schizophrenia, etc. We understand you may have a diagnosis but currently do not need treatment.<\/div><\/fieldset><div id=\"field_171_35\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_171_35'>Please list your diagnosed mental health conditions.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_171_35' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_171_33\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Q5. Are you currently undergoing treatment or taking any prescribed medication for any physical, mental, or emotional health issues?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_171_33'>\n\t\t\t<div class='gchoice gchoice_171_33_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='Yes'  id='choice_171_33_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_171_33\"   \/>\n\t\t\t\t\t<label for='choice_171_33_0' id='label_171_33_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_171_33_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='No'  id='choice_171_33_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_171_33_1' id='label_171_33_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_171_33'>Examples: Counseling, psychotherapy, physical therapy, rehabilitation, etc.<\/div><\/fieldset><div id=\"field_171_36\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_171_36'>Please give the details of the treatment(s) or medication(s) you are receiving.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_171_36' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_171_31\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Will the above treatment(s) be required when you study in Korea?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_171_31'>\n\t\t\t<div class='gchoice gchoice_171_31_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Yes'  id='choice_171_31_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_171_31\"   \/>\n\t\t\t\t\t<label for='choice_171_31_0' id='label_171_31_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_171_31_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='No'  id='choice_171_31_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_171_31_1' id='label_171_31_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_171_31_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Some'  id='choice_171_31_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_171_31_2' id='label_171_31_2' class='gform-field-label gform-field-label--type-inline'>Some<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_171_31'>Note: It is your responsibility to check that your treatment(s) will be available while you study. Please consult with the proper medical professionals regarding treatment while in Korea. <\/div><\/fieldset><div id=\"field_171_32\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_171_32'>Which treatment(s) will be required when you study in Korea?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_171_32' type='text' value='' class='large'  aria-describedby=\"gfield_description_171_32\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_171_32'>Note: ALL amphetamines are banned in Korea. ALL narcotics are considered controlled substances in Korea. If you need to take amphetamines or narcotics while studying in Korea, you MUST receive special permission to bring them with you. All prescription medication MUST be in appropriate pharmacy packaging with the prescription and doctor&#8217;s note regarding the medication. You are only permitted 90 days\u2019 worth of prescription medication for personal use. If you need to bring more, you MUST receive special permission or receive another prescription in Korea from a physician in Korea.\n\nFor non-prescription\/OTA (Over the counter) medication including supplements, vitamins, diet pills, and similar. You are permitted 90 days\u2019 worth of non-prescription medication for personal use. If you need to bring more, you MUST receive special permission.\n<\/div><\/div><fieldset id=\"field_171_21\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_171_21' tabindex='0'>I understand that in the event my health condition (physical, mental, emotional):<br \/>\n<br \/>\n* Prevents me from attending school for an extended period and\/or<br \/>\n* Causes the school to worry about my well-being and\/or<br \/>\n* Threatens the well-being of the faculty, staff, students, or teachers that,<br \/>\n<br \/>\nThe school may choose to end my enrollment and\/or cancel my student visa before the end of my studies in Korea.<br \/>\n<br \/>\nGo! Go! Hanguk will not assume responsibility for any medical expense nor will bear any responsibility for any sickness, injury, or bodily harm that occurs during your study period.<\/div><div class='ginput_container ginput_container_consent'><input name='input_21.1' id='input_171_21_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_171_21\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_171_21_1' >I agree to the above policy.<\/label><input type='hidden' name='input_21.2' value='I agree to the above policy.' class='gform_hidden' \/><input type='hidden' name='input_21.3' value='11' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_171_37\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">[Emergency Contact&#039;s Information]<\/h3><div class='gsection_description' id='gfield_description_171_37'>Please share your emergency contact&#8217;s information. Your emergency contact must be a parent, spouse, or family member:<\/div><\/div><fieldset id=\"field_171_41\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Q1. Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><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_171_41'>\n                            \n                            <span id='input_171_41_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_41.3' id='input_171_41_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_171_41_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_171_41_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_41.6' id='input_171_41_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_171_41_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_171_39\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_171_39'>Q2. Relationship<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_39' id='input_171_39' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_171_40\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_171_40'>Q3. Mobile Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_171_40' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_171_42\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_171_42'>Q4. Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_42' id='input_171_42' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_171_43\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_171_43'>Q5. Please select what language primary contact person speaks.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_43' id='input_171_43' class='large gfield_select'  aria-describedby=\"gfield_description_171_43\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='English' >English<\/option><option value='Spanish' >Spanish<\/option><option value='French' >French<\/option><option value='Italian' >Italian<\/option><option value='German' >German<\/option><option value='Swedish' >Swedish<\/option><option value='Japanese' >Japanese<\/option><option value='Korean' >Korean<\/option><option value='Others' >Others<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_171_43'>You can select only one.<\/div><\/div><div id=\"field_171_44\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Secondary contact in case the primary emergency contact person cannot speak English, Spanish, French, Italian, German, Swedish, Japanese or Korean.<\/h3><\/div><fieldset id=\"field_171_45\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Q1. Name<\/legend><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_171_45'>\n                            \n                            <span id='input_171_45_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_45.3' id='input_171_45_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_171_45_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_171_45_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_45.6' id='input_171_45_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_171_45_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_171_46\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_171_46'>Q2. Relationship<\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_171_46' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_171_47\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_171_47'>Q3. Mobile Phone Number<\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_171_47' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_171_48\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_171_48'>Q4. Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_48' id='input_171_48' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_171_49\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_171_49'>Q5. Please select what language secondary contact person speaks.<\/label><div class='ginput_container ginput_container_select'><select name='input_49' id='input_171_49' class='large gfield_select'  aria-describedby=\"gfield_description_171_49\"   aria-invalid=\"false\" ><option value='English' >English<\/option><option value='Spanish' >Spanish<\/option><option value='French' >French<\/option><option value='Italian' >Italian<\/option><option value='German' >German<\/option><option value='Swedish' >Swedish<\/option><option value='Japanese' >Japanese<\/option><option value='Korean' >Korean<\/option><option value='Others' >Others<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_171_49'>You can select only one.<\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_171' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' 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