{"id":893,"date":"2019-07-29T04:14:08","date_gmt":"2019-07-29T04:14:08","guid":{"rendered":"https:\/\/teamimpaact.com.au\/?page_id=893"},"modified":"2023-09-28T10:51:21","modified_gmt":"2023-09-28T10:51:21","slug":"health-waiver-and-tcs","status":"publish","type":"page","link":"https:\/\/teamimpaact.com.au\/health-waiver-and-tcs\/","title":{"rendered":"Health Waiver and T&#038;C&#8217;s"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; disabled_on=&#8221;off|off|off&#8221; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_code module_class=&#8221;waiver-form&#8221; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;]<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>\n                <div class='gf_browser_safari gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_3' ><div id='gf_3' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_3' id='gform_3'  action='\/wp-json\/wp\/v2\/pages\/893#gf_3' data-formid='3' >\n                        <div class='gform-body gform_body'><div id='gform_fields_3' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_3_51\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_51\"><h2>Client Details<\/h2><\/div><fieldset id=\"field_3_8\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label gfield_visibility_visible\"  data-js-reload=\"field_3_8\"><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex'  ><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/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_3_8'>\n                            \n                            <span id='input_3_8_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_8.3' id='input_3_8_3' value='' tabindex='50'  aria-required='true'     \/>\n                                                    <label for='input_3_8_3' class='gform-field-label gform-field-label--type-sub '>Name *<\/label>\n                                                <\/span>\n                            \n                            <span id='input_3_8_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_8.6' id='input_3_8_6' value='' tabindex='52'  aria-required='true'     \/>\n                                                    <label for='input_3_8_6' class='gform-field-label gform-field-label--type-sub '>Nick Name *<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_3_12\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_12\"><label class='gfield_label gform-field-label' for='input_3_12' >Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_12' id='input_3_12' type='text' value='' class='datepicker gform-datepicker ymd_slash datepicker_with_icon gdatepicker_with_icon' tabindex='54'  placeholder='yyyy\/mm\/dd' aria-describedby=\"input_3_12_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_3_12_date_format' class='screen-reader-text'>YYYY slash MM slash DD<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_3_12' class='gform_hidden' value='https:\/\/teamimpaact.com.au\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_3_46\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_46\"><legend class='gfield_label gform-field-label'  >Sex<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_46'>\n\t\t\t<div class='gchoice gchoice_3_46_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_46' type='radio' value='Male'  id='choice_3_46_0' onchange='gformToggleRadioOther( this )'  tabindex='55'  \/>\n\t\t\t\t\t<label for='choice_3_46_0' id='label_3_46_0' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_46_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_46' type='radio' value='Female'  id='choice_3_46_1' onchange='gformToggleRadioOther( this )'  tabindex='56'  \/>\n\t\t\t\t\t<label for='choice_3_46_1' id='label_3_46_1' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_15\"  class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_15\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_3_15' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_3_15_1_container' >\n                                        <input type='text' name='input_15.1' id='input_3_15_1' value='' tabindex='57'   aria-required='true'    \/>\n                                        <label for='input_3_15_1' id='input_3_15_1_label' class='gform-field-label gform-field-label--type-sub '>Address Line<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_3_15_2_container' >\n                                        <input type='text' name='input_15.2' id='input_3_15_2' value='' tabindex='58'    aria-required='false'   \/>\n                                        <label for='input_3_15_2' id='input_3_15_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_3_15_3_container' >\n                                    <input type='text' name='input_15.3' id='input_3_15_3' value='' tabindex='59'   aria-required='true'    \/>\n                                    <label for='input_3_15_3' id='input_3_15_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_3_15_4_container' >\n                                        <input type='text' name='input_15.4' id='input_3_15_4' value='' tabindex='61'     aria-required='true'    \/>\n                                        <label for='input_3_15_4' id='input_3_15_4_label' class='gform-field-label gform-field-label--type-sub '>State\/Province\/Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_3_15_5_container' >\n                                    <input type='text' name='input_15.5' id='input_3_15_5' value='' tabindex='62'   aria-required='true'    \/>\n                                    <label for='input_3_15_5' id='input_3_15_5_label' class='gform-field-label gform-field-label--type-sub '>Zip\/Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_3_15_6_container' >\n                                        <select name='input_15.6' id='input_3_15_6' tabindex='63'  aria-required='true'    ><option value='' selected='selected'><\/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' >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>\n                                        <label for='input_3_15_6' id='input_3_15_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_3_13\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_13\"><label class='gfield_label gform-field-label' for='input_3_13' >Occupation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_3_13' type='text' value='' class='medium'   tabindex='64'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_3_16\"  class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_16\"><label class='gfield_label gform-field-label' for='input_3_16' >Email<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_16' id='input_3_16' type='text' value='' class='medium' tabindex='65'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_3_10\"  class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_10\"><label class='gfield_label gform-field-label' for='input_3_10' >Mobile<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_10' id='input_3_10' type='text' value='' class='medium' tabindex='66'  aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_3_10\"  \/><\/div><div class='gfield_description' id='gfield_description_3_10'>Phone Number *<\/div><\/div><div id=\"field_3_32\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_32\"><label class='gfield_label gform-field-label' for='input_3_32' >Emergency Contact<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_3_32' type='text' value='' class='medium'  aria-describedby=\"gfield_description_3_32\" tabindex='67'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_3_32'>Emergency Contact Name<\/div><\/div><div id=\"field_3_48\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_48\"><label class='gfield_label gform-field-label' for='input_3_48' >Emergency Mobile<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_48' id='input_3_48' type='text' value='' class='medium'  aria-describedby=\"gfield_description_3_48\" tabindex='68'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_3_48'>Emergency Contact Name<\/div><\/div><fieldset id=\"field_3_21\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_21\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >How did you hear about Team Impaact?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_3_21'><div class='gchoice gchoice_3_21_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.1' type='checkbox'  value='Friend Family'  id='choice_3_21_1' tabindex='69'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_21_1' id='label_3_21_1' class='gform-field-label gform-field-label--type-inline'>Friend Family<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_21_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.2' type='checkbox'  value='Facebook'  id='choice_3_21_2' tabindex='70'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_21_2' id='label_3_21_2' class='gform-field-label gform-field-label--type-inline'>Facebook<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_21_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.3' type='checkbox'  value='Instagram'  id='choice_3_21_3' tabindex='71'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_21_3' id='label_3_21_3' class='gform-field-label gform-field-label--type-inline'>Instagram<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_21_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.4' type='checkbox'  value='Internet'  id='choice_3_21_4' tabindex='72'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_21_4' id='label_3_21_4' class='gform-field-label gform-field-label--type-inline'>Internet<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_21_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.5' type='checkbox'  value='Flyer'  id='choice_3_21_5' tabindex='73'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_21_5' id='label_3_21_5' class='gform-field-label gform-field-label--type-inline'>Flyer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_21_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.6' type='checkbox'  value='Sign'  id='choice_3_21_6' tabindex='74'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_21_6' id='label_3_21_6' class='gform-field-label gform-field-label--type-inline'>Sign<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_108\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_108\"><label class='gfield_label gform-field-label' for='input_3_108' >Do you have any friends or family that would like to experience what we have to offer here at T.I. with you? If so, what are their names?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_108' id='input_3_108' class='textarea medium' tabindex='75'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_109\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_109\"><label class='gfield_label gform-field-label' for='input_3_109' >What are you hobbies?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_109' id='input_3_109' class='textarea medium' tabindex='76'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_110\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_110\"><label class='gfield_label gform-field-label' for='input_3_110' >Do you have any children? If so, what are their names and ages?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_110' id='input_3_110' class='textarea medium' tabindex='77'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_111\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_111\"><label class='gfield_label gform-field-label' for='input_3_111' >Do you have any pets? If so, what are they and what are their names?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_111' id='input_3_111' class='textarea medium' tabindex='78'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_58\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_58\"><h2>Training History<\/h2><\/div><fieldset id=\"field_3_103\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_103\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >I am<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_3_103'><div class='gchoice gchoice_3_103_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_103.1' type='checkbox'  value='New To Exercise'  id='choice_3_103_1' tabindex='79'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_103_1' id='label_3_103_1' class='gform-field-label gform-field-label--type-inline'>New To Exercise<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_103_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_103.2' type='checkbox'  value='Somewhere In The Middle'  id='choice_3_103_2' tabindex='80'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_103_2' id='label_3_103_2' class='gform-field-label gform-field-label--type-inline'>Somewhere In The Middle<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_103_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_103.3' type='checkbox'  value='Experience'  id='choice_3_103_3' tabindex='81'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_103_3' id='label_3_103_3' class='gform-field-label gform-field-label--type-inline'>Experience<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_52\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_52\"><legend class='gfield_label gform-field-label'  >Currently Exercising?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_52'>\n\t\t\t<div class='gchoice gchoice_3_52_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='Yes'  id='choice_3_52_0' onchange='gformToggleRadioOther( this )'  tabindex='82'  \/>\n\t\t\t\t\t<label for='choice_3_52_0' id='label_3_52_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_3_52_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='No'  id='choice_3_52_1' onchange='gformToggleRadioOther( this )'  tabindex='83'  \/>\n\t\t\t\t\t<label for='choice_3_52_1' id='label_3_52_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_53\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_53\"><legend class='gfield_label gform-field-label'  >Times Per Week?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_53'>\n\t\t\t<div class='gchoice gchoice_3_53_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='1'  id='choice_3_53_0' onchange='gformToggleRadioOther( this )'  tabindex='84'  \/>\n\t\t\t\t\t<label for='choice_3_53_0' id='label_3_53_0' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_53_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='2'  id='choice_3_53_1' onchange='gformToggleRadioOther( this )'  tabindex='85'  \/>\n\t\t\t\t\t<label for='choice_3_53_1' id='label_3_53_1' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_53_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='3'  id='choice_3_53_2' onchange='gformToggleRadioOther( this )'  tabindex='86'  \/>\n\t\t\t\t\t<label for='choice_3_53_2' id='label_3_53_2' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_53_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='4'  id='choice_3_53_3' onchange='gformToggleRadioOther( this )'  tabindex='87'  \/>\n\t\t\t\t\t<label for='choice_3_53_3' id='label_3_53_3' class='gform-field-label gform-field-label--type-inline'>4<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_53_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='5'  id='choice_3_53_4' onchange='gformToggleRadioOther( this )'  tabindex='88'  \/>\n\t\t\t\t\t<label for='choice_3_53_4' id='label_3_53_4' class='gform-field-label gform-field-label--type-inline'>5<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_53_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='6'  id='choice_3_53_5' onchange='gformToggleRadioOther( this )'  tabindex='89'  \/>\n\t\t\t\t\t<label for='choice_3_53_5' id='label_3_53_5' class='gform-field-label gform-field-label--type-inline'>6<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_53_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='7'  id='choice_3_53_6' onchange='gformToggleRadioOther( this )'  tabindex='90'  \/>\n\t\t\t\t\t<label for='choice_3_53_6' id='label_3_53_6' class='gform-field-label gform-field-label--type-inline'>7<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_54\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_54\"><legend class='gfield_label gform-field-label'  >Consistent?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_54'>\n\t\t\t<div class='gchoice gchoice_3_54_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Yes'  id='choice_3_54_0' onchange='gformToggleRadioOther( this )'  tabindex='91'  \/>\n\t\t\t\t\t<label for='choice_3_54_0' id='label_3_54_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_3_54_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='No'  id='choice_3_54_1' onchange='gformToggleRadioOther( this )'  tabindex='92'  \/>\n\t\t\t\t\t<label for='choice_3_54_1' id='label_3_54_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_55\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_55\"><legend class='gfield_label gform-field-label'  >Achieving Results<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_55'>\n\t\t\t<div class='gchoice gchoice_3_55_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='Yes'  id='choice_3_55_0' onchange='gformToggleRadioOther( this )'  tabindex='93'  \/>\n\t\t\t\t\t<label for='choice_3_55_0' id='label_3_55_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_3_55_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='No'  id='choice_3_55_1' onchange='gformToggleRadioOther( this )'  tabindex='94'  \/>\n\t\t\t\t\t<label for='choice_3_55_1' id='label_3_55_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_56\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_56\"><legend class='gfield_label gform-field-label'  >Do You Like To Train In The Morning Or Afternoon?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_56'>\n\t\t\t<div class='gchoice gchoice_3_56_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='Am'  id='choice_3_56_0' onchange='gformToggleRadioOther( this )'  tabindex='95'  \/>\n\t\t\t\t\t<label for='choice_3_56_0' id='label_3_56_0' class='gform-field-label gform-field-label--type-inline'>Am<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_56_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='Pm'  id='choice_3_56_1' onchange='gformToggleRadioOther( this )'  tabindex='96'  \/>\n\t\t\t\t\t<label for='choice_3_56_1' id='label_3_56_1' class='gform-field-label gform-field-label--type-inline'>Pm<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_57\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_57\"><label class='gfield_label gform-field-label' for='input_3_57' >On A Scale Of 1-10 1 = Poor, 10 = Excellent, How would You Rate Your Current Fitness?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_57' id='input_3_57' type='text' value='' class='medium'   tabindex='97'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_3_22\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_22\"><label class='gfield_label gform-field-label' for='input_3_22' >How long ago were you in your best condition?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_22' id='input_3_22' class='textarea medium' tabindex='98'   placeholder='If you have TICKED the YES box to the above question, or have any other condition please give details:' aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_59\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_59\"><label class='gfield_label gform-field-label' for='input_3_59' >What were you doing differently back then?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_59' id='input_3_59' class='textarea medium' tabindex='99'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_60\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_60\"><h2>CURRENT LIFESTYLE <\/h2><\/div><fieldset id=\"field_3_23\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_23\"><legend class='gfield_label gform-field-label'  >Do you have a stressful job?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_23'>\n\t\t\t<div class='gchoice gchoice_3_23_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='Yes'  id='choice_3_23_0' onchange='gformToggleRadioOther( this )'  tabindex='100'  \/>\n\t\t\t\t\t<label for='choice_3_23_0' id='label_3_23_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_3_23_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='No'  id='choice_3_23_1' onchange='gformToggleRadioOther( this )'  tabindex='101'  \/>\n\t\t\t\t\t<label for='choice_3_23_1' id='label_3_23_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_25\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_25\"><label class='gfield_label gform-field-label' for='input_3_25' >What is your current work \/ study schedule?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_25' id='input_3_25' class='textarea medium' tabindex='102'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_3_24\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_24\"><legend class='gfield_label gform-field-label'  >Do you drink alcohol?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_24'>\n\t\t\t<div class='gchoice gchoice_3_24_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Yes'  id='choice_3_24_0' onchange='gformToggleRadioOther( this )'  tabindex='103'  \/>\n\t\t\t\t\t<label for='choice_3_24_0' id='label_3_24_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_3_24_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='No'  id='choice_3_24_1' onchange='gformToggleRadioOther( this )'  tabindex='104'  \/>\n\t\t\t\t\t<label for='choice_3_24_1' id='label_3_24_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_61\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_61\"><legend class='gfield_label gform-field-label'  >Do you smoke?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_61'>\n\t\t\t<div class='gchoice gchoice_3_61_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Yes'  id='choice_3_61_0' onchange='gformToggleRadioOther( this )'  tabindex='105'  \/>\n\t\t\t\t\t<label for='choice_3_61_0' id='label_3_61_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_3_61_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='No'  id='choice_3_61_1' onchange='gformToggleRadioOther( this )'  tabindex='106'  \/>\n\t\t\t\t\t<label for='choice_3_61_1' id='label_3_61_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_105\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_105\"><legend class='gfield_label gform-field-label'  >Do you drink coffee?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_105'>\n\t\t\t<div class='gchoice gchoice_3_105_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_105' type='radio' value='Yes'  id='choice_3_105_0' onchange='gformToggleRadioOther( this )'  tabindex='107'  \/>\n\t\t\t\t\t<label for='choice_3_105_0' id='label_3_105_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_3_105_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_105' type='radio' value='No'  id='choice_3_105_1' onchange='gformToggleRadioOther( this )'  tabindex='108'  \/>\n\t\t\t\t\t<label for='choice_3_105_1' id='label_3_105_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_62\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_62\"><legend class='gfield_label gform-field-label'  >Food Intolerance?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_62'>\n\t\t\t<div class='gchoice gchoice_3_62_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='Yes'  id='choice_3_62_0' onchange='gformToggleRadioOther( this )'  tabindex='109'  \/>\n\t\t\t\t\t<label for='choice_3_62_0' id='label_3_62_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_3_62_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='No'  id='choice_3_62_1' onchange='gformToggleRadioOther( this )'  tabindex='110'  \/>\n\t\t\t\t\t<label for='choice_3_62_1' id='label_3_62_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_26\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_26\"><label class='gfield_label gform-field-label' for='input_3_26' >How would you rate your nutrition on a scale of 1-10?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_26' id='input_3_26' class='textarea medium' tabindex='111'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_117\"  class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_117\"><label class='gfield_label gform-field-label' for='input_3_117' >How would you rate your sleep  on a scale of 1-10?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_117' id='input_3_117' class='textarea medium' tabindex='112' aria-describedby=\"gfield_description_3_117\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_3_117'>1 = poor, 10= good<\/div><\/div><div id=\"field_3_27\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_27\"><label class='gfield_label gform-field-label' for='input_3_27' >How many nights per week do you eat out, and what types of food?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_27' id='input_3_27' class='textarea medium' tabindex='113'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_63\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_63\"><h2>MEDICAL CONDITIONS <\/h2><\/div><fieldset id=\"field_3_64\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_64\"><legend class='gfield_label gform-field-label'  >High blood pressure?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_64'>\n\t\t\t<div class='gchoice gchoice_3_64_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Yes'  id='choice_3_64_0' onchange='gformToggleRadioOther( this )'  tabindex='114'  \/>\n\t\t\t\t\t<label for='choice_3_64_0' id='label_3_64_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_3_64_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='No'  id='choice_3_64_1' onchange='gformToggleRadioOther( this )'  tabindex='115'  \/>\n\t\t\t\t\t<label for='choice_3_64_1' id='label_3_64_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_65\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_65\"><legend class='gfield_label gform-field-label'  >Chest Pain<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_65'>\n\t\t\t<div class='gchoice gchoice_3_65_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Yes'  id='choice_3_65_0' onchange='gformToggleRadioOther( this )'  tabindex='116'  \/>\n\t\t\t\t\t<label for='choice_3_65_0' id='label_3_65_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_3_65_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='No'  id='choice_3_65_1' onchange='gformToggleRadioOther( this )'  tabindex='117'  \/>\n\t\t\t\t\t<label for='choice_3_65_1' id='label_3_65_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_66\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_66\"><legend class='gfield_label gform-field-label'  >Back Pain<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_66'>\n\t\t\t<div class='gchoice gchoice_3_66_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='Yes'  id='choice_3_66_0' onchange='gformToggleRadioOther( this )'  tabindex='118'  \/>\n\t\t\t\t\t<label for='choice_3_66_0' id='label_3_66_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_3_66_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='No'  id='choice_3_66_1' onchange='gformToggleRadioOther( this )'  tabindex='119'  \/>\n\t\t\t\t\t<label for='choice_3_66_1' id='label_3_66_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_67\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_67\"><legend class='gfield_label gform-field-label'  >Heart trouble\/history<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_67'>\n\t\t\t<div class='gchoice gchoice_3_67_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='Yes'  id='choice_3_67_0' onchange='gformToggleRadioOther( this )'  tabindex='120'  \/>\n\t\t\t\t\t<label for='choice_3_67_0' id='label_3_67_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_3_67_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='No'  id='choice_3_67_1' onchange='gformToggleRadioOther( this )'  tabindex='121'  \/>\n\t\t\t\t\t<label for='choice_3_67_1' id='label_3_67_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_68\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_68\"><legend class='gfield_label gform-field-label'  >Epilepsy<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_68'>\n\t\t\t<div class='gchoice gchoice_3_68_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='Yes'  id='choice_3_68_0' onchange='gformToggleRadioOther( this )'  tabindex='122'  \/>\n\t\t\t\t\t<label for='choice_3_68_0' id='label_3_68_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_3_68_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='No'  id='choice_3_68_1' onchange='gformToggleRadioOther( this )'  tabindex='123'  \/>\n\t\t\t\t\t<label for='choice_3_68_1' id='label_3_68_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_69\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_69\"><legend class='gfield_label gform-field-label'  >Asthma<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_69'>\n\t\t\t<div class='gchoice gchoice_3_69_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='Yes'  id='choice_3_69_0' onchange='gformToggleRadioOther( this )'  tabindex='124'  \/>\n\t\t\t\t\t<label for='choice_3_69_0' id='label_3_69_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_3_69_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='No'  id='choice_3_69_1' onchange='gformToggleRadioOther( this )'  tabindex='125'  \/>\n\t\t\t\t\t<label for='choice_3_69_1' id='label_3_69_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_70\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_70\"><legend class='gfield_label gform-field-label'  >Faint or dizzy spells<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_70'>\n\t\t\t<div class='gchoice gchoice_3_70_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='Yes'  id='choice_3_70_0' onchange='gformToggleRadioOther( this )'  tabindex='126'  \/>\n\t\t\t\t\t<label for='choice_3_70_0' id='label_3_70_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_3_70_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='No'  id='choice_3_70_1' onchange='gformToggleRadioOther( this )'  tabindex='127'  \/>\n\t\t\t\t\t<label for='choice_3_70_1' id='label_3_70_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_72\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_72\"><legend class='gfield_label gform-field-label'  >Arthritis<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_72'>\n\t\t\t<div class='gchoice gchoice_3_72_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='Yes'  id='choice_3_72_0' onchange='gformToggleRadioOther( this )'  tabindex='128'  \/>\n\t\t\t\t\t<label for='choice_3_72_0' id='label_3_72_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_3_72_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='No'  id='choice_3_72_1' onchange='gformToggleRadioOther( this )'  tabindex='129'  \/>\n\t\t\t\t\t<label for='choice_3_72_1' id='label_3_72_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_73\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_73\"><legend class='gfield_label gform-field-label'  >Sports injury<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_73'>\n\t\t\t<div class='gchoice gchoice_3_73_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Yes'  id='choice_3_73_0' onchange='gformToggleRadioOther( this )'  tabindex='130'  \/>\n\t\t\t\t\t<label for='choice_3_73_0' id='label_3_73_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_3_73_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='No'  id='choice_3_73_1' onchange='gformToggleRadioOther( this )'  tabindex='131'  \/>\n\t\t\t\t\t<label for='choice_3_73_1' id='label_3_73_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_74\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_74\"><legend class='gfield_label gform-field-label'  >Bone or joint problem<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_74'>\n\t\t\t<div class='gchoice gchoice_3_74_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Yes'  id='choice_3_74_0' onchange='gformToggleRadioOther( this )'  tabindex='132'  \/>\n\t\t\t\t\t<label for='choice_3_74_0' id='label_3_74_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_3_74_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='No'  id='choice_3_74_1' onchange='gformToggleRadioOther( this )'  tabindex='133'  \/>\n\t\t\t\t\t<label for='choice_3_74_1' id='label_3_74_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_75\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_75\"><legend class='gfield_label gform-field-label'  >Diabetes<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_75'>\n\t\t\t<div class='gchoice gchoice_3_75_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='Yes'  id='choice_3_75_0' onchange='gformToggleRadioOther( this )'  tabindex='134'  \/>\n\t\t\t\t\t<label for='choice_3_75_0' id='label_3_75_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_3_75_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='No'  id='choice_3_75_1' onchange='gformToggleRadioOther( this )'  tabindex='135'  \/>\n\t\t\t\t\t<label for='choice_3_75_1' id='label_3_75_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_76\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_76\"><legend class='gfield_label gform-field-label'  >Other<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_76'>\n\t\t\t<div class='gchoice gchoice_3_76_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='Yes'  id='choice_3_76_0' onchange='gformToggleRadioOther( this )'  tabindex='136'  \/>\n\t\t\t\t\t<label for='choice_3_76_0' id='label_3_76_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_3_76_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='No'  id='choice_3_76_1' onchange='gformToggleRadioOther( this )'  tabindex='137'  \/>\n\t\t\t\t\t<label for='choice_3_76_1' id='label_3_76_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_77\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_77\"><h2>HEALTH & FITNESS PRIORITIES<\/h2><\/div><fieldset id=\"field_3_78\"  class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_78\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Weight Loss<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_3_78'><div class='gchoice gchoice_3_78_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.1' type='checkbox'  value='Loss Weight'  id='choice_3_78_1' tabindex='138'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_78_1' id='label_3_78_1' class='gform-field-label gform-field-label--type-inline'>Loss Weight<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_78_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.2' type='checkbox'  value='Shape and Tone'  id='choice_3_78_2' tabindex='139'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_78_2' id='label_3_78_2' class='gform-field-label gform-field-label--type-inline'>Shape and Tone<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_78_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.3' type='checkbox'  value='Reduce body Fat'  id='choice_3_78_3' tabindex='140'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_78_3' id='label_3_78_3' class='gform-field-label gform-field-label--type-inline'>Reduce body Fat<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_78_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.4' type='checkbox'  value='Decrease Clothing Size'  id='choice_3_78_4' tabindex='141'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_78_4' id='label_3_78_4' class='gform-field-label gform-field-label--type-inline'>Decrease Clothing Size<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_79\"  class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_3_79\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Would you like to achieve these?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_3_79'><div class='gchoice gchoice_3_79_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.1' type='checkbox'  value='Lose Weight'  id='choice_3_79_1' tabindex='142'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_79_1' id='label_3_79_1' class='gform-field-label gform-field-label--type-inline'>Lose Weight<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_79_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.2' type='checkbox'  value='Shape and Tone'  id='choice_3_79_2' tabindex='143'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_79_2' id='label_3_79_2' class='gform-field-label gform-field-label--type-inline'>Shape and Tone<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_79_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.3' type='checkbox'  value='Reduce body Fat'  id='choice_3_79_3' tabindex='144'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_79_3' id='label_3_79_3' class='gform-field-label gform-field-label--type-inline'>Reduce body Fat<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_79_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.4' type='checkbox'  value='Decrease Clothing Size'  id='choice_3_79_4' tabindex='145'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_79_4' id='label_3_79_4' class='gform-field-label gform-field-label--type-inline'>Decrease Clothing Size<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_80\"  class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_80\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Fitness<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_3_80'><div class='gchoice gchoice_3_80_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_80.1' type='checkbox'  value='Increase Endurance'  id='choice_3_80_1' tabindex='146'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_80_1' id='label_3_80_1' class='gform-field-label gform-field-label--type-inline'>Increase Endurance<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_80_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_80.2' type='checkbox'  value='Sporting Performance'  id='choice_3_80_2' tabindex='147'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_80_2' id='label_3_80_2' class='gform-field-label gform-field-label--type-inline'>Sporting Performance<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_100\"  class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_100\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Wellness<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_3_100'><div class='gchoice gchoice_3_100_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_100.1' type='checkbox'  value='Stress Management'  id='choice_3_100_1' tabindex='148'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_100_1' id='label_3_100_1' class='gform-field-label gform-field-label--type-inline'>Stress Management<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_100_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_100.2' type='checkbox'  value='Increase Flexibility'  id='choice_3_100_2' tabindex='149'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_100_2' id='label_3_100_2' class='gform-field-label gform-field-label--type-inline'>Increase Flexibility<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_100_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_100.3' type='checkbox'  value='Rehabilitation'  id='choice_3_100_3' tabindex='150'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_100_3' id='label_3_100_3' class='gform-field-label gform-field-label--type-inline'>Rehabilitation<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_81\"  class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_81\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Strength<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_3_81'><div class='gchoice gchoice_3_81_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.1' type='checkbox'  value='Increase Strength'  id='choice_3_81_1' tabindex='151'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_81_1' id='label_3_81_1' class='gform-field-label gform-field-label--type-inline'>Increase Strength<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_81_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.2' type='checkbox'  value='Increase Muscle mass'  id='choice_3_81_2' tabindex='152'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_81_2' id='label_3_81_2' class='gform-field-label gform-field-label--type-inline'>Increase Muscle mass<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_81_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.3' type='checkbox'  value='Increase Stamina'  id='choice_3_81_3' tabindex='153'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_81_3' id='label_3_81_3' class='gform-field-label gform-field-label--type-inline'>Increase Stamina<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_112\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_112\"><h3 class=\"months-style\">What are your 3\/6\/12 month goals?<\/h3><\/div><div id=\"field_3_113\"  class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_113\"><label class='gfield_label gform-field-label' for='input_3_113' >3 Months<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_113' id='input_3_113' type='text' value='' class='large'   tabindex='154'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_3_114\"  class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_114\"><label class='gfield_label gform-field-label' for='input_3_114' >6 Months<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_114' id='input_3_114' type='text' value='' class='large'   tabindex='155'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_3_115\"  class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_115\"><label class='gfield_label gform-field-label' for='input_3_115' >12 Months<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_115' id='input_3_115' type='text' value='' class='large'   tabindex='156'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_3_28\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_28\"><label class='gfield_label gform-field-label' for='input_3_28' >Why do you want to achieve these results?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_28' id='input_3_28' class='textarea medium' tabindex='157'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_71\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_71\"><label class='gfield_label gform-field-label' for='input_3_71' >When do you want to achieve these by?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_71' id='input_3_71' class='textarea medium' tabindex='158'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_118\"  class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_118\"><label class='gfield_label gform-field-label' for='input_3_118' >How long do you think it will take you to achieve your goals?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_118' id='input_3_118' class='textarea medium' tabindex='159'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_104\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_104\"><label class='gfield_label gform-field-label' for='input_3_104' >Which part of the body would you like to achieve these results In?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_104' id='input_3_104' class='textarea medium' tabindex='160'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_82\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_82\"><label class='gfield_label gform-field-label' for='input_3_82' >How long have you been thinking about achieving your results?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_82' id='input_3_82' class='textarea medium' tabindex='161'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_3_119\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_119\"><legend class='gfield_label gform-field-label'  >Are you willing to commit to the process for the next 6 months?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_119'>\n\t\t\t<div class='gchoice gchoice_3_119_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_119' type='radio' value='Yes'  id='choice_3_119_0' onchange='gformToggleRadioOther( this )'  tabindex='162'  \/>\n\t\t\t\t\t<label for='choice_3_119_0' id='label_3_119_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_3_119_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_119' type='radio' value='No'  id='choice_3_119_1' onchange='gformToggleRadioOther( this )'  tabindex='163'  \/>\n\t\t\t\t\t<label for='choice_3_119_1' id='label_3_119_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_34\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_34\"><legend class='gfield_label gform-field-label'  >Are you 100% committed to achieving your why?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_34'>\n\t\t\t<div class='gchoice gchoice_3_34_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Yes'  id='choice_3_34_0' onchange='gformToggleRadioOther( this )'  tabindex='164'  \/>\n\t\t\t\t\t<label for='choice_3_34_0' id='label_3_34_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_3_34_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='No'  id='choice_3_34_1' onchange='gformToggleRadioOther( this )'  tabindex='165'  \/>\n\t\t\t\t\t<label for='choice_3_34_1' id='label_3_34_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_35\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_35\"><legend class='gfield_label gform-field-label'  >Are you willing to make sacrifices in order to achieve your why?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_35'>\n\t\t\t<div class='gchoice gchoice_3_35_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='Yes'  id='choice_3_35_0' onchange='gformToggleRadioOther( this )'  tabindex='166'  \/>\n\t\t\t\t\t<label for='choice_3_35_0' id='label_3_35_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_3_35_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='No'  id='choice_3_35_1' onchange='gformToggleRadioOther( this )'  tabindex='167'  \/>\n\t\t\t\t\t<label for='choice_3_35_1' id='label_3_35_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_107\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_107\"><label class='gfield_label gform-field-label' for='input_3_107' >What is your budget and what are you willing to invest into your health and fitness?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_107' id='input_3_107' class='textarea medium' tabindex='168'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_3_106\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_106\"><legend class='gfield_label gform-field-label'  >Personal Barrier Please Check<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_106'>\n\t\t\t<div class='gchoice gchoice_3_106_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='Time'  id='choice_3_106_0' onchange='gformToggleRadioOther( this )'  tabindex='169'  \/>\n\t\t\t\t\t<label for='choice_3_106_0' id='label_3_106_0' class='gform-field-label gform-field-label--type-inline'>Time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_106_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='Money'  id='choice_3_106_1' onchange='gformToggleRadioOther( this )'  tabindex='170'  \/>\n\t\t\t\t\t<label for='choice_3_106_1' id='label_3_106_1' class='gform-field-label gform-field-label--type-inline'>Money<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_106_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='Procrastination'  id='choice_3_106_2' onchange='gformToggleRadioOther( this )'  tabindex='171'  \/>\n\t\t\t\t\t<label for='choice_3_106_2' id='label_3_106_2' class='gform-field-label gform-field-label--type-inline'>Procrastination<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_106_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='Motivation'  id='choice_3_106_3' onchange='gformToggleRadioOther( this )'  tabindex='172'  \/>\n\t\t\t\t\t<label for='choice_3_106_3' id='label_3_106_3' class='gform-field-label gform-field-label--type-inline'>Motivation<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_106_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='Injury'  id='choice_3_106_4' onchange='gformToggleRadioOther( this )'  tabindex='173'  \/>\n\t\t\t\t\t<label for='choice_3_106_4' id='label_3_106_4' class='gform-field-label gform-field-label--type-inline'>Injury<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_106_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='None'  id='choice_3_106_5' onchange='gformToggleRadioOther( this )'  tabindex='174'  \/>\n\t\t\t\t\t<label for='choice_3_106_5' id='label_3_106_5' class='gform-field-label gform-field-label--type-inline'>None<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_36\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_36\"><legend class='gfield_label gform-field-label'  >Is this still a problem?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_36'>\n\t\t\t<div class='gchoice gchoice_3_36_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Yes'  id='choice_3_36_0' onchange='gformToggleRadioOther( this )'  tabindex='175'  \/>\n\t\t\t\t\t<label for='choice_3_36_0' id='label_3_36_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_3_36_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='No'  id='choice_3_36_1' onchange='gformToggleRadioOther( this )'  tabindex='176'  \/>\n\t\t\t\t\t<label for='choice_3_36_1' id='label_3_36_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_37\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_37\"><legend class='gfield_label gform-field-label'  >Do you have support from your friends and family?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_37'>\n\t\t\t<div class='gchoice gchoice_3_37_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='Yes'  id='choice_3_37_0' onchange='gformToggleRadioOther( this )'  tabindex='177'  \/>\n\t\t\t\t\t<label for='choice_3_37_0' id='label_3_37_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_3_37_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='No'  id='choice_3_37_1' onchange='gformToggleRadioOther( this )'  tabindex='178'  \/>\n\t\t\t\t\t<label for='choice_3_37_1' id='label_3_37_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_85\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_85\"><label class='gfield_label gform-field-label' for='input_3_85' >Life values &amp; what are you grateful for?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_85' id='input_3_85' class='textarea medium' tabindex='179'   placeholder='Eg. You value family, friends, health Etc.' aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_86\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_86\"><label class='gfield_label gform-field-label' for='input_3_86' >Fears<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_86' id='input_3_86' class='textarea medium' tabindex='180'   placeholder='Eg. Snakes, spiders, financially insecure, death, etc.' aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_87\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_87\"><h2>Terms & Conditions<\/h2>\n<h3>1st Session Comfort Guarantee<\/h3>\n<p>If you change your mind, you can terminate this agreement within 48hrs after your first paid Group and PT session with Team Impaact. Email info@teamimpaact.com.au and we will cancel all future payments and refund to you within 14 days any monies paid via banking transfer into your nominated account. <\/p>\n<h3>Suspension and Cancellation Policy - Within Minimum Term<\/h3>\n<p>All membership options give you the ability to suspend your membership at no extra charge for a minimum of 2 weeks and up to a maximum of 1 month during your minimum term. We require 14 business days before your next payment date to suspend your membership. <\/p>\n<p>If you cancel your membership within the minimum term there is an upfront 100% cancellation fee of your remaining payments. We also require 14 business days before your payment date to cancel your membership.<\/p>\n<p>You can terminate the agreement due to sickness or physical incapacity at no extra charge, however, you must supply a medical certificate. <\/p>\n<h3>5 Hour Cancellation Policy<\/h3>\n<p>Should I cancel a personal training session with less than 5 business hours notice, I acknowledge that the session is forfeited and full - training fees applies. For Monday morning sessions I will leave a message on Sunday. When I give 5 hours notice I acknowledge that rescheduling my appointment to a more convenient time at no charge, will be pending on availability of training times. <\/p>\n<h3>After Your Minimum Term<\/h3>\n<p>Your membership is ongoing after your minimum term (26 weeks) so no changes will be made unless you notify us via email. After your minimum term, you can suspend or cancel your membership with no cancellation fee by providing 14 business days notice prior to your next payment date via email. You have a maximum of 6 weeks per year to have your membership placed on hold. If you would like to downgrade your membership level, we will also need 14 business days  notice prior to your next payment date to amend your payments.<\/p>\n<ol>\n<li>Understand that I am entering into an agreement for a minimum term of 26 weeks during which i will be debited on a fortnightly basis for the selected service, as per the ezidebit agreement. <\/li>\n<li>I have read, understand Team Impaacts terms and conditions. <\/li>\n<\/ol><\/div><fieldset id=\"field_3_91\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_91\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/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_3_91'>\n                            \n                            <span id='input_3_91_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_91.3' id='input_3_91_3' value='' tabindex='182'  aria-required='true'     \/>\n                                                    <label for='input_3_91_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_3_91_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_91.6' id='input_3_91_6' value='' tabindex='184'  aria-required='true'     \/>\n                                                    <label for='input_3_91_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_3_97\"  class=\"gfield gfield--type-signature gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_97\"><label class='gfield_label gform-field-label' for='input_3_97' >Participant&#039;s Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_3_97_Container' class='gfield_signature_container ginput_container' style='height:180px; width:700px; ' ><input type='hidden' class='gform_hidden' name='input_3_97_valid' id='input_3_97_valid' \/><canvas id='input_3_97' width='700' height='180'><\/canvas><div class='gfield_signature_reset_container'><svg id=\"input_3_97_resetIcon\" class=\"gfield_signature_reset_icon\" version=\"1.1\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"26\" height=\"26\" viewBox=\"0 0 26 26\">\n\t\t\t\t\t<title>Reset signature<\/title>\n\t\t\t\t\t<path fill=\"#fff\" d=\"M13 6.906v1.939c0 0.487 0.585 0.726 0.921 0.379l3.022-3.023c0.217-0.217 0.217-0.553 0-0.769l-3.022-3.022c-0.336-0.336-0.921-0.098-0.921 0.39v1.939c-4.788 0-8.667 3.878-8.667 8.667 0 1.127 0.217 2.21 0.617 3.196 0.293 0.726 1.224 0.921 1.777 0.368 0.292-0.292 0.412-0.737 0.249-1.127-0.314-0.748-0.477-1.582-0.477-2.438 0-3.586 2.914-6.5 6.5-6.5zM19.273 9.842c-0.293 0.293-0.412 0.748-0.249 1.127 0.303 0.758 0.477 1.582 0.477 2.438 0 3.586-2.914 6.5-6.5 6.5v-1.939c0-0.488-0.585-0.726-0.921-0.379l-3.023 3.023c-0.217 0.217-0.217 0.552 0 0.769l3.023 3.023c0.336 0.336 0.921 0.098 0.921-0.379v-1.95c4.788 0 8.667-3.878 8.667-8.667 0-1.127-0.217-2.21-0.618-3.196-0.292-0.726-1.224-0.921-1.777-0.368z\"><\/path>\n\t\t\t\t<\/svg><svg id=\"input_3_97_lockedReset\" class=\"gform_signature_locked_reset\" version=\"1.1\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"18\" height=\"18\" viewBox=\"0 0 26 26\">\n\t\t\t\t\t<title>Signature locked. Reset to sign again<\/title>\n\t\t\t\t\t<path fill=\"#fff\" d=\"M19.5 8.667h-1.083v-2.167c0-2.99-2.427-5.417-5.417-5.417s-5.417 2.427-5.417 5.417v2.167h-1.083c-1.192 0-2.167 0.975-2.167 2.167v10.833c0 1.192 0.975 2.167 2.167 2.167h13c1.192 0 2.167-0.975 2.167-2.167v-10.833c0-1.192-0.975-2.167-2.167-2.167zM13 18.417c-1.192 0-2.167-0.975-2.167-2.167s0.975-2.167 2.167-2.167c1.192 0 2.167 0.975 2.167 2.167s-0.975 2.167-2.167 2.167zM9.75 8.667v-2.167c0-1.798 1.452-3.25 3.25-3.25s3.25 1.452 3.25 3.25v2.167h-6.5z\"><\/path>\n\t\t\t\t\t<path fill=\"#fff\" d=\"M13 18.417c-1.192 0-2.167-0.975-2.167-2.167s0.975-2.167 2.167-2.167c1.192 0 2.167 0.975 2.167 2.167s-0.975 2.167-2.167 2.167z\"><\/path>\n\t\t\t\t<\/svg>\n\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_3_97'>Click To Sign<\/div><\/div><fieldset id=\"field_3_92\"  class=\"gfield gfield--type-date gfield--input-type-datedropdown gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_92\"><legend class='gfield_label gform-field-label'  >Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div id='input_3_92' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_3_92_2_container'><select name='input_92[]' id='input_3_92_2' tabindex='186'  aria-required='true'  ><option value=''>Day<\/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><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_3_92_1_container'><select name='input_92[]' id='input_3_92_1' tabindex='187'  aria-required='true'  ><option value=''>Month<\/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><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_3_92_3_container'><select name='input_92[]' id='input_3_92_3' tabindex='188'  aria-required='true'  ><option value=''>Year<\/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><\/fieldset><div id=\"field_3_93\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_93\"><h2>WAIVER<\/h2><\/div><fieldset id=\"field_3_31\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_31\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Acceptance of risk<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_3_31'><div class='gchoice gchoice_3_31_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.1' type='checkbox'  value='I am aware that all activities associated with receiving group fitness personal training instruction from the trainer including, but not limited t activities involving aerobic exercise, stretching, running and weight lifting, as well as additional strenuous exercise and or exertion of strength, and other sustained physical activities which place stress on the cardiovascular and muscular system collectively referred to as &quot;Training&quot;, are and can be hazardous activities that include certain risk and dangers, including but not limited to catastrophic injuries including paralysis, other serious injuries and death. I voluntarily accept full responsibility of all risks involved,  including risks from participating in any way in the training, use of equipment provided by the trainer of use of equipment I provide, whether the training occurs at the park, gym, home, or any other location and in any weather condition.'  id='choice_3_31_1' tabindex='189'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_31_1' id='label_3_31_1' class='gform-field-label gform-field-label--type-inline'>I am aware that all activities associated with receiving group fitness personal training instruction from the trainer including, but not limited t activities involving aerobic exercise, stretching, running and weight lifting, as well as additional strenuous exercise and or exertion of strength, and other sustained physical activities which place stress on the cardiovascular and muscular system collectively referred to as \"Training\", are and can be hazardous activities that include certain risk and dangers, including but not limited to catastrophic injuries including paralysis, other serious injuries and death. I voluntarily accept full responsibility of all risks involved,  including risks from participating in any way in the training, use of equipment provided by the trainer of use of equipment I provide, whether the training occurs at the park, gym, home, or any other location and in any weather condition.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_95\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_95\">I have read the acceptance of risk provision in this agreement and I understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am singing the agreement freely and voluntarily and intend, by my signature that this document is completed and an unconditional release of liability to the greatest extent allowed by law. \n<ol>\n<li>The information given by me in this safety questionnaire is true, complete and accurate and I understand the advice given above. <\/li>\n<li>I have obtained clearance from a medical professional where required or recommended. <\/li>\n<\/ol><\/div><fieldset id=\"field_3_96\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_96\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/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_3_96'>\n                            \n                            <span id='input_3_96_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_96.3' id='input_3_96_3' value='' tabindex='191'  aria-required='true'     \/>\n                                                    <label for='input_3_96_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_3_96_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_96.6' id='input_3_96_6' value='' tabindex='193'  aria-required='true'     \/>\n                                                    <label for='input_3_96_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_3_98\"  class=\"gfield gfield--type-signature gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_98\"><label class='gfield_label gform-field-label' for='input_3_98' >Participant&#039;s Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_3_98_Container' class='gfield_signature_container ginput_container' style='height:180px; width:700px; ' ><input type='hidden' class='gform_hidden' name='input_3_98_valid' id='input_3_98_valid' \/><canvas id='input_3_98' width='700' height='180'><\/canvas><div class='gfield_signature_reset_container'><svg id=\"input_3_98_resetIcon\" class=\"gfield_signature_reset_icon\" version=\"1.1\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"26\" height=\"26\" viewBox=\"0 0 26 26\">\n\t\t\t\t\t<title>Reset signature<\/title>\n\t\t\t\t\t<path fill=\"#fff\" d=\"M13 6.906v1.939c0 0.487 0.585 0.726 0.921 0.379l3.022-3.023c0.217-0.217 0.217-0.553 0-0.769l-3.022-3.022c-0.336-0.336-0.921-0.098-0.921 0.39v1.939c-4.788 0-8.667 3.878-8.667 8.667 0 1.127 0.217 2.21 0.617 3.196 0.293 0.726 1.224 0.921 1.777 0.368 0.292-0.292 0.412-0.737 0.249-1.127-0.314-0.748-0.477-1.582-0.477-2.438 0-3.586 2.914-6.5 6.5-6.5zM19.273 9.842c-0.293 0.293-0.412 0.748-0.249 1.127 0.303 0.758 0.477 1.582 0.477 2.438 0 3.586-2.914 6.5-6.5 6.5v-1.939c0-0.488-0.585-0.726-0.921-0.379l-3.023 3.023c-0.217 0.217-0.217 0.552 0 0.769l3.023 3.023c0.336 0.336 0.921 0.098 0.921-0.379v-1.95c4.788 0 8.667-3.878 8.667-8.667 0-1.127-0.217-2.21-0.618-3.196-0.292-0.726-1.224-0.921-1.777-0.368z\"><\/path>\n\t\t\t\t<\/svg><svg id=\"input_3_98_lockedReset\" class=\"gform_signature_locked_reset\" version=\"1.1\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"18\" height=\"18\" viewBox=\"0 0 26 26\">\n\t\t\t\t\t<title>Signature locked. Reset to sign again<\/title>\n\t\t\t\t\t<path fill=\"#fff\" d=\"M19.5 8.667h-1.083v-2.167c0-2.99-2.427-5.417-5.417-5.417s-5.417 2.427-5.417 5.417v2.167h-1.083c-1.192 0-2.167 0.975-2.167 2.167v10.833c0 1.192 0.975 2.167 2.167 2.167h13c1.192 0 2.167-0.975 2.167-2.167v-10.833c0-1.192-0.975-2.167-2.167-2.167zM13 18.417c-1.192 0-2.167-0.975-2.167-2.167s0.975-2.167 2.167-2.167c1.192 0 2.167 0.975 2.167 2.167s-0.975 2.167-2.167 2.167zM9.75 8.667v-2.167c0-1.798 1.452-3.25 3.25-3.25s3.25 1.452 3.25 3.25v2.167h-6.5z\"><\/path>\n\t\t\t\t\t<path fill=\"#fff\" d=\"M13 18.417c-1.192 0-2.167-0.975-2.167-2.167s0.975-2.167 2.167-2.167c1.192 0 2.167 0.975 2.167 2.167s-0.975 2.167-2.167 2.167z\"><\/path>\n\t\t\t\t<\/svg>\n\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_3_98'>Click To Sign<\/div><\/div><fieldset id=\"field_3_99\"  class=\"gfield gfield--type-date gfield--input-type-datedropdown gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_99\"><legend class='gfield_label gform-field-label'  >Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div id='input_3_99' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_3_99_2_container'><select name='input_99[]' id='input_3_99_2' tabindex='195'  aria-required='true'  ><option value=''>Day<\/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><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_3_99_1_container'><select name='input_99[]' id='input_3_99_1' tabindex='196'  aria-required='true'  ><option value=''>Month<\/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><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_3_99_3_container'><select name='input_99[]' id='input_3_99_3' tabindex='197'  aria-required='true'  ><option value=''>Year<\/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><\/fieldset><\/div><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_3' class='gform_button button' value='Agree To This Document' tabindex='198' onclick='if(window[\"gf_submitting_3\"]){return false;}  window[\"gf_submitting_3\"]=true;  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_3\"]){return false;} window[\"gf_submitting_3\"]=true;  jQuery(\"#gform_3\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=3&amp;title=&amp;description=&amp;tabindex=49' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_3' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='3' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_3' value='WyJbXSIsImVmMDA1Y2IwNWIyMDBkM2YyYTgwMjg4YWE3OWJmZDM5Il0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_3' id='gform_target_page_number_3' value='0' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_3' id='gform_source_page_number_3' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div>\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_3' id='gform_ajax_frame_3' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n\t\t                <script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 3, 'https:\/\/teamimpaact.com.au\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_3').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_3');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_3').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_3').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_3').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_3').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_3').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_3').val();gformInitSpinner( 3, 'https:\/\/teamimpaact.com.au\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [3, current_page]);window['gf_submitting_3'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_3').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_3').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [3]);window['gf_submitting_3'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_3').text());}, 50);}else{jQuery('#gform_3').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gform_post_render', [3, current_page]);} );} ); \n\/* ]]> *\/\n<\/script>\n[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"\n                <div class='gf_browser_safari gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='1' id='gform_wrapper_3' ><div id='gf_3' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_3' id='gform_3'  action='\/wp-json\/wp\/v2\/pages\/893#gf_3' data-formid='3' >\n                        <div class='gform-body gform_body'><div id='gform_fields_3' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_3_51\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_51\"><h2>Client Details<\/h2><\/div><fieldset id=\"field_3_8\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label gfield_visibility_visible\"  data-js-reload=\"field_3_8\"><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex'  ><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/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_3_8'>\n                            \n                            <span id='input_3_8_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_8.3' id='input_3_8_3' value='' tabindex='50'  aria-required='true'     \/>\n                                                    <label for='input_3_8_3' class='gform-field-label gform-field-label--type-sub '>Name *<\/label>\n                                                <\/span>\n                            \n                            <span id='input_3_8_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_8.6' id='input_3_8_6' value='' tabindex='52'  aria-required='true'     \/>\n                                                    <label for='input_3_8_6' class='gform-field-label gform-field-label--type-sub '>Nick Name *<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_3_12\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_12\"><label class='gfield_label gform-field-label' for='input_3_12' >Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_12' id='input_3_12' type='text' value='' class='datepicker gform-datepicker ymd_slash datepicker_with_icon gdatepicker_with_icon' tabindex='54'  placeholder='yyyy\/mm\/dd' aria-describedby=\"input_3_12_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_3_12_date_format' class='screen-reader-text'>YYYY slash MM slash DD<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_3_12' class='gform_hidden' value='https:\/\/teamimpaact.com.au\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_3_46\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_46\"><legend class='gfield_label gform-field-label'  >Sex<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_46'>\n\t\t\t<div class='gchoice gchoice_3_46_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_46' type='radio' value='Male'  id='choice_3_46_0' onchange='gformToggleRadioOther( this )'  tabindex='55'  \/>\n\t\t\t\t\t<label for='choice_3_46_0' id='label_3_46_0' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_46_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_46' type='radio' value='Female'  id='choice_3_46_1' onchange='gformToggleRadioOther( this )'  tabindex='56'  \/>\n\t\t\t\t\t<label for='choice_3_46_1' id='label_3_46_1' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_15\"  class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_15\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_3_15' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_3_15_1_container' >\n                                        <input type='text' name='input_15.1' id='input_3_15_1' value='' tabindex='57'   aria-required='true'    \/>\n                                        <label for='input_3_15_1' id='input_3_15_1_label' class='gform-field-label gform-field-label--type-sub '>Address Line<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_3_15_2_container' >\n                                        <input type='text' name='input_15.2' id='input_3_15_2' value='' tabindex='58'    aria-required='false'   \/>\n                                        <label for='input_3_15_2' id='input_3_15_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_3_15_3_container' >\n                                    <input type='text' name='input_15.3' id='input_3_15_3' value='' tabindex='59'   aria-required='true'    \/>\n                                    <label for='input_3_15_3' id='input_3_15_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_3_15_4_container' >\n                                        <input type='text' name='input_15.4' id='input_3_15_4' value='' tabindex='61'     aria-required='true'    \/>\n                                        <label for='input_3_15_4' id='input_3_15_4_label' class='gform-field-label gform-field-label--type-sub '>State\/Province\/Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_3_15_5_container' >\n                                    <input type='text' name='input_15.5' id='input_3_15_5' value='' tabindex='62'   aria-required='true'    \/>\n                                    <label for='input_3_15_5' id='input_3_15_5_label' class='gform-field-label gform-field-label--type-sub '>Zip\/Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_3_15_6_container' >\n                                        <select name='input_15.6' id='input_3_15_6' tabindex='63'  aria-required='true'    ><option value='' selected='selected'><\/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' >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>\n                                        <label for='input_3_15_6' id='input_3_15_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_3_13\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_13\"><label class='gfield_label gform-field-label' for='input_3_13' >Occupation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_3_13' type='text' value='' class='medium'   tabindex='64'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_3_16\"  class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_16\"><label class='gfield_label gform-field-label' for='input_3_16' >Email<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_16' id='input_3_16' type='text' value='' class='medium' tabindex='65'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_3_10\"  class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_10\"><label class='gfield_label gform-field-label' for='input_3_10' >Mobile<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_10' id='input_3_10' type='text' value='' class='medium' tabindex='66'  aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_3_10\"  \/><\/div><div class='gfield_description' id='gfield_description_3_10'>Phone Number *<\/div><\/div><div id=\"field_3_32\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_32\"><label class='gfield_label gform-field-label' for='input_3_32' >Emergency Contact<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_3_32' type='text' value='' class='medium'  aria-describedby=\"gfield_description_3_32\" tabindex='67'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_3_32'>Emergency Contact Name<\/div><\/div><div id=\"field_3_48\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_48\"><label class='gfield_label gform-field-label' for='input_3_48' >Emergency Mobile<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_48' id='input_3_48' type='text' value='' class='medium'  aria-describedby=\"gfield_description_3_48\" tabindex='68'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_3_48'>Emergency Contact Name<\/div><\/div><fieldset id=\"field_3_21\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_21\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >How did you hear about Team Impaact?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_3_21'><div class='gchoice gchoice_3_21_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.1' type='checkbox'  value='Friend Family'  id='choice_3_21_1' tabindex='69'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_21_1' id='label_3_21_1' class='gform-field-label gform-field-label--type-inline'>Friend Family<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_21_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.2' type='checkbox'  value='Facebook'  id='choice_3_21_2' tabindex='70'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_21_2' id='label_3_21_2' class='gform-field-label gform-field-label--type-inline'>Facebook<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_21_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.3' type='checkbox'  value='Instagram'  id='choice_3_21_3' tabindex='71'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_21_3' id='label_3_21_3' class='gform-field-label gform-field-label--type-inline'>Instagram<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_21_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.4' type='checkbox'  value='Internet'  id='choice_3_21_4' tabindex='72'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_21_4' id='label_3_21_4' class='gform-field-label gform-field-label--type-inline'>Internet<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_21_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.5' type='checkbox'  value='Flyer'  id='choice_3_21_5' tabindex='73'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_21_5' id='label_3_21_5' class='gform-field-label gform-field-label--type-inline'>Flyer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_21_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.6' type='checkbox'  value='Sign'  id='choice_3_21_6' tabindex='74'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_21_6' id='label_3_21_6' class='gform-field-label gform-field-label--type-inline'>Sign<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_108\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_108\"><label class='gfield_label gform-field-label' for='input_3_108' >Do you have any friends or family that would like to experience what we have to offer here at T.I. with you? If so, what are their names?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_108' id='input_3_108' class='textarea medium' tabindex='75'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_109\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_109\"><label class='gfield_label gform-field-label' for='input_3_109' >What are you hobbies?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_109' id='input_3_109' class='textarea medium' tabindex='76'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_110\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_110\"><label class='gfield_label gform-field-label' for='input_3_110' >Do you have any children? If so, what are their names and ages?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_110' id='input_3_110' class='textarea medium' tabindex='77'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_111\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_111\"><label class='gfield_label gform-field-label' for='input_3_111' >Do you have any pets? If so, what are they and what are their names?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_111' id='input_3_111' class='textarea medium' tabindex='78'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_58\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_58\"><h2>Training History<\/h2><\/div><fieldset id=\"field_3_103\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_103\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >I am<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_3_103'><div class='gchoice gchoice_3_103_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_103.1' type='checkbox'  value='New To Exercise'  id='choice_3_103_1' tabindex='79'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_103_1' id='label_3_103_1' class='gform-field-label gform-field-label--type-inline'>New To Exercise<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_103_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_103.2' type='checkbox'  value='Somewhere In The Middle'  id='choice_3_103_2' tabindex='80'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_103_2' id='label_3_103_2' class='gform-field-label gform-field-label--type-inline'>Somewhere In The Middle<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_103_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_103.3' type='checkbox'  value='Experience'  id='choice_3_103_3' tabindex='81'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_103_3' id='label_3_103_3' class='gform-field-label gform-field-label--type-inline'>Experience<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_52\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_52\"><legend class='gfield_label gform-field-label'  >Currently Exercising?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_52'>\n\t\t\t<div class='gchoice gchoice_3_52_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='Yes'  id='choice_3_52_0' onchange='gformToggleRadioOther( this )'  tabindex='82'  \/>\n\t\t\t\t\t<label for='choice_3_52_0' id='label_3_52_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_3_52_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='No'  id='choice_3_52_1' onchange='gformToggleRadioOther( this )'  tabindex='83'  \/>\n\t\t\t\t\t<label for='choice_3_52_1' id='label_3_52_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_53\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_53\"><legend class='gfield_label gform-field-label'  >Times Per Week?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_53'>\n\t\t\t<div class='gchoice gchoice_3_53_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='1'  id='choice_3_53_0' onchange='gformToggleRadioOther( this )'  tabindex='84'  \/>\n\t\t\t\t\t<label for='choice_3_53_0' id='label_3_53_0' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_53_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='2'  id='choice_3_53_1' onchange='gformToggleRadioOther( this )'  tabindex='85'  \/>\n\t\t\t\t\t<label for='choice_3_53_1' id='label_3_53_1' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_53_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='3'  id='choice_3_53_2' onchange='gformToggleRadioOther( this )'  tabindex='86'  \/>\n\t\t\t\t\t<label for='choice_3_53_2' id='label_3_53_2' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_53_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='4'  id='choice_3_53_3' onchange='gformToggleRadioOther( this )'  tabindex='87'  \/>\n\t\t\t\t\t<label for='choice_3_53_3' id='label_3_53_3' class='gform-field-label gform-field-label--type-inline'>4<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_53_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='5'  id='choice_3_53_4' onchange='gformToggleRadioOther( this )'  tabindex='88'  \/>\n\t\t\t\t\t<label for='choice_3_53_4' id='label_3_53_4' class='gform-field-label gform-field-label--type-inline'>5<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_53_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='6'  id='choice_3_53_5' onchange='gformToggleRadioOther( this )'  tabindex='89'  \/>\n\t\t\t\t\t<label for='choice_3_53_5' id='label_3_53_5' class='gform-field-label gform-field-label--type-inline'>6<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_53_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_53' type='radio' value='7'  id='choice_3_53_6' onchange='gformToggleRadioOther( this )'  tabindex='90'  \/>\n\t\t\t\t\t<label for='choice_3_53_6' id='label_3_53_6' class='gform-field-label gform-field-label--type-inline'>7<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_54\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_54\"><legend class='gfield_label gform-field-label'  >Consistent?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_54'>\n\t\t\t<div class='gchoice gchoice_3_54_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Yes'  id='choice_3_54_0' onchange='gformToggleRadioOther( this )'  tabindex='91'  \/>\n\t\t\t\t\t<label for='choice_3_54_0' id='label_3_54_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_3_54_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='No'  id='choice_3_54_1' onchange='gformToggleRadioOther( this )'  tabindex='92'  \/>\n\t\t\t\t\t<label for='choice_3_54_1' id='label_3_54_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_55\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_55\"><legend class='gfield_label gform-field-label'  >Achieving Results<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_55'>\n\t\t\t<div class='gchoice gchoice_3_55_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='Yes'  id='choice_3_55_0' onchange='gformToggleRadioOther( this )'  tabindex='93'  \/>\n\t\t\t\t\t<label for='choice_3_55_0' id='label_3_55_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_3_55_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_55' type='radio' value='No'  id='choice_3_55_1' onchange='gformToggleRadioOther( this )'  tabindex='94'  \/>\n\t\t\t\t\t<label for='choice_3_55_1' id='label_3_55_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_56\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_56\"><legend class='gfield_label gform-field-label'  >Do You Like To Train In The Morning Or Afternoon?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_56'>\n\t\t\t<div class='gchoice gchoice_3_56_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='Am'  id='choice_3_56_0' onchange='gformToggleRadioOther( this )'  tabindex='95'  \/>\n\t\t\t\t\t<label for='choice_3_56_0' id='label_3_56_0' class='gform-field-label gform-field-label--type-inline'>Am<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_56_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_56' type='radio' value='Pm'  id='choice_3_56_1' onchange='gformToggleRadioOther( this )'  tabindex='96'  \/>\n\t\t\t\t\t<label for='choice_3_56_1' id='label_3_56_1' class='gform-field-label gform-field-label--type-inline'>Pm<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_57\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_57\"><label class='gfield_label gform-field-label' for='input_3_57' >On A Scale Of 1-10 1 = Poor, 10 = Excellent, How would You Rate Your Current Fitness?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_57' id='input_3_57' type='text' value='' class='medium'   tabindex='97'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_3_22\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_22\"><label class='gfield_label gform-field-label' for='input_3_22' >How long ago were you in your best condition?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_22' id='input_3_22' class='textarea medium' tabindex='98'   placeholder='If you have TICKED the YES box to the above question, or have any other condition please give details:' aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_59\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_59\"><label class='gfield_label gform-field-label' for='input_3_59' >What were you doing differently back then?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_59' id='input_3_59' class='textarea medium' tabindex='99'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_60\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_60\"><h2>CURRENT LIFESTYLE <\/h2><\/div><fieldset id=\"field_3_23\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_23\"><legend class='gfield_label gform-field-label'  >Do you have a stressful job?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_23'>\n\t\t\t<div class='gchoice gchoice_3_23_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='Yes'  id='choice_3_23_0' onchange='gformToggleRadioOther( this )'  tabindex='100'  \/>\n\t\t\t\t\t<label for='choice_3_23_0' id='label_3_23_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_3_23_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='No'  id='choice_3_23_1' onchange='gformToggleRadioOther( this )'  tabindex='101'  \/>\n\t\t\t\t\t<label for='choice_3_23_1' id='label_3_23_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_25\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_25\"><label class='gfield_label gform-field-label' for='input_3_25' >What is your current work \/ study schedule?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_25' id='input_3_25' class='textarea medium' tabindex='102'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_3_24\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_24\"><legend class='gfield_label gform-field-label'  >Do you drink alcohol?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_24'>\n\t\t\t<div class='gchoice gchoice_3_24_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Yes'  id='choice_3_24_0' onchange='gformToggleRadioOther( this )'  tabindex='103'  \/>\n\t\t\t\t\t<label for='choice_3_24_0' id='label_3_24_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_3_24_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='No'  id='choice_3_24_1' onchange='gformToggleRadioOther( this )'  tabindex='104'  \/>\n\t\t\t\t\t<label for='choice_3_24_1' id='label_3_24_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_61\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_61\"><legend class='gfield_label gform-field-label'  >Do you smoke?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_61'>\n\t\t\t<div class='gchoice gchoice_3_61_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='Yes'  id='choice_3_61_0' onchange='gformToggleRadioOther( this )'  tabindex='105'  \/>\n\t\t\t\t\t<label for='choice_3_61_0' id='label_3_61_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_3_61_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_61' type='radio' value='No'  id='choice_3_61_1' onchange='gformToggleRadioOther( this )'  tabindex='106'  \/>\n\t\t\t\t\t<label for='choice_3_61_1' id='label_3_61_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_105\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_105\"><legend class='gfield_label gform-field-label'  >Do you drink coffee?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_105'>\n\t\t\t<div class='gchoice gchoice_3_105_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_105' type='radio' value='Yes'  id='choice_3_105_0' onchange='gformToggleRadioOther( this )'  tabindex='107'  \/>\n\t\t\t\t\t<label for='choice_3_105_0' id='label_3_105_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_3_105_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_105' type='radio' value='No'  id='choice_3_105_1' onchange='gformToggleRadioOther( this )'  tabindex='108'  \/>\n\t\t\t\t\t<label for='choice_3_105_1' id='label_3_105_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_62\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_62\"><legend class='gfield_label gform-field-label'  >Food Intolerance?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_62'>\n\t\t\t<div class='gchoice gchoice_3_62_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='Yes'  id='choice_3_62_0' onchange='gformToggleRadioOther( this )'  tabindex='109'  \/>\n\t\t\t\t\t<label for='choice_3_62_0' id='label_3_62_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_3_62_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_62' type='radio' value='No'  id='choice_3_62_1' onchange='gformToggleRadioOther( this )'  tabindex='110'  \/>\n\t\t\t\t\t<label for='choice_3_62_1' id='label_3_62_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_26\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_26\"><label class='gfield_label gform-field-label' for='input_3_26' >How would you rate your nutrition on a scale of 1-10?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_26' id='input_3_26' class='textarea medium' tabindex='111'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_117\"  class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_117\"><label class='gfield_label gform-field-label' for='input_3_117' >How would you rate your sleep  on a scale of 1-10?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_117' id='input_3_117' class='textarea medium' tabindex='112' aria-describedby=\"gfield_description_3_117\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_3_117'>1 = poor, 10= good<\/div><\/div><div id=\"field_3_27\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_27\"><label class='gfield_label gform-field-label' for='input_3_27' >How many nights per week do you eat out, and what types of food?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_27' id='input_3_27' class='textarea medium' tabindex='113'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_63\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_63\"><h2>MEDICAL CONDITIONS <\/h2><\/div><fieldset id=\"field_3_64\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_64\"><legend class='gfield_label gform-field-label'  >High blood pressure?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_64'>\n\t\t\t<div class='gchoice gchoice_3_64_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Yes'  id='choice_3_64_0' onchange='gformToggleRadioOther( this )'  tabindex='114'  \/>\n\t\t\t\t\t<label for='choice_3_64_0' id='label_3_64_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_3_64_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='No'  id='choice_3_64_1' onchange='gformToggleRadioOther( this )'  tabindex='115'  \/>\n\t\t\t\t\t<label for='choice_3_64_1' id='label_3_64_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_65\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_65\"><legend class='gfield_label gform-field-label'  >Chest Pain<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_65'>\n\t\t\t<div class='gchoice gchoice_3_65_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Yes'  id='choice_3_65_0' onchange='gformToggleRadioOther( this )'  tabindex='116'  \/>\n\t\t\t\t\t<label for='choice_3_65_0' id='label_3_65_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_3_65_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='No'  id='choice_3_65_1' onchange='gformToggleRadioOther( this )'  tabindex='117'  \/>\n\t\t\t\t\t<label for='choice_3_65_1' id='label_3_65_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_66\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_66\"><legend class='gfield_label gform-field-label'  >Back Pain<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_66'>\n\t\t\t<div class='gchoice gchoice_3_66_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='Yes'  id='choice_3_66_0' onchange='gformToggleRadioOther( this )'  tabindex='118'  \/>\n\t\t\t\t\t<label for='choice_3_66_0' id='label_3_66_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_3_66_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='No'  id='choice_3_66_1' onchange='gformToggleRadioOther( this )'  tabindex='119'  \/>\n\t\t\t\t\t<label for='choice_3_66_1' id='label_3_66_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_67\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_67\"><legend class='gfield_label gform-field-label'  >Heart trouble\/history<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_67'>\n\t\t\t<div class='gchoice gchoice_3_67_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='Yes'  id='choice_3_67_0' onchange='gformToggleRadioOther( this )'  tabindex='120'  \/>\n\t\t\t\t\t<label for='choice_3_67_0' id='label_3_67_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_3_67_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='No'  id='choice_3_67_1' onchange='gformToggleRadioOther( this )'  tabindex='121'  \/>\n\t\t\t\t\t<label for='choice_3_67_1' id='label_3_67_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_68\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_68\"><legend class='gfield_label gform-field-label'  >Epilepsy<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_68'>\n\t\t\t<div class='gchoice gchoice_3_68_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='Yes'  id='choice_3_68_0' onchange='gformToggleRadioOther( this )'  tabindex='122'  \/>\n\t\t\t\t\t<label for='choice_3_68_0' id='label_3_68_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_3_68_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_68' type='radio' value='No'  id='choice_3_68_1' onchange='gformToggleRadioOther( this )'  tabindex='123'  \/>\n\t\t\t\t\t<label for='choice_3_68_1' id='label_3_68_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_69\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_69\"><legend class='gfield_label gform-field-label'  >Asthma<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_69'>\n\t\t\t<div class='gchoice gchoice_3_69_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='Yes'  id='choice_3_69_0' onchange='gformToggleRadioOther( this )'  tabindex='124'  \/>\n\t\t\t\t\t<label for='choice_3_69_0' id='label_3_69_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_3_69_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_69' type='radio' value='No'  id='choice_3_69_1' onchange='gformToggleRadioOther( this )'  tabindex='125'  \/>\n\t\t\t\t\t<label for='choice_3_69_1' id='label_3_69_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_70\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_70\"><legend class='gfield_label gform-field-label'  >Faint or dizzy spells<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_70'>\n\t\t\t<div class='gchoice gchoice_3_70_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='Yes'  id='choice_3_70_0' onchange='gformToggleRadioOther( this )'  tabindex='126'  \/>\n\t\t\t\t\t<label for='choice_3_70_0' id='label_3_70_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_3_70_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_70' type='radio' value='No'  id='choice_3_70_1' onchange='gformToggleRadioOther( this )'  tabindex='127'  \/>\n\t\t\t\t\t<label for='choice_3_70_1' id='label_3_70_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_72\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_72\"><legend class='gfield_label gform-field-label'  >Arthritis<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_72'>\n\t\t\t<div class='gchoice gchoice_3_72_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='Yes'  id='choice_3_72_0' onchange='gformToggleRadioOther( this )'  tabindex='128'  \/>\n\t\t\t\t\t<label for='choice_3_72_0' id='label_3_72_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_3_72_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='No'  id='choice_3_72_1' onchange='gformToggleRadioOther( this )'  tabindex='129'  \/>\n\t\t\t\t\t<label for='choice_3_72_1' id='label_3_72_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_73\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_73\"><legend class='gfield_label gform-field-label'  >Sports injury<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_73'>\n\t\t\t<div class='gchoice gchoice_3_73_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Yes'  id='choice_3_73_0' onchange='gformToggleRadioOther( this )'  tabindex='130'  \/>\n\t\t\t\t\t<label for='choice_3_73_0' id='label_3_73_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_3_73_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='No'  id='choice_3_73_1' onchange='gformToggleRadioOther( this )'  tabindex='131'  \/>\n\t\t\t\t\t<label for='choice_3_73_1' id='label_3_73_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_74\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_74\"><legend class='gfield_label gform-field-label'  >Bone or joint problem<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_74'>\n\t\t\t<div class='gchoice gchoice_3_74_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Yes'  id='choice_3_74_0' onchange='gformToggleRadioOther( this )'  tabindex='132'  \/>\n\t\t\t\t\t<label for='choice_3_74_0' id='label_3_74_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_3_74_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='No'  id='choice_3_74_1' onchange='gformToggleRadioOther( this )'  tabindex='133'  \/>\n\t\t\t\t\t<label for='choice_3_74_1' id='label_3_74_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_75\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_75\"><legend class='gfield_label gform-field-label'  >Diabetes<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_75'>\n\t\t\t<div class='gchoice gchoice_3_75_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='Yes'  id='choice_3_75_0' onchange='gformToggleRadioOther( this )'  tabindex='134'  \/>\n\t\t\t\t\t<label for='choice_3_75_0' id='label_3_75_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_3_75_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='No'  id='choice_3_75_1' onchange='gformToggleRadioOther( this )'  tabindex='135'  \/>\n\t\t\t\t\t<label for='choice_3_75_1' id='label_3_75_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_76\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_76\"><legend class='gfield_label gform-field-label'  >Other<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_76'>\n\t\t\t<div class='gchoice gchoice_3_76_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='Yes'  id='choice_3_76_0' onchange='gformToggleRadioOther( this )'  tabindex='136'  \/>\n\t\t\t\t\t<label for='choice_3_76_0' id='label_3_76_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_3_76_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_76' type='radio' value='No'  id='choice_3_76_1' onchange='gformToggleRadioOther( this )'  tabindex='137'  \/>\n\t\t\t\t\t<label for='choice_3_76_1' id='label_3_76_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_77\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_77\"><h2>HEALTH & FITNESS PRIORITIES<\/h2><\/div><fieldset id=\"field_3_78\"  class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_78\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Weight Loss<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_3_78'><div class='gchoice gchoice_3_78_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.1' type='checkbox'  value='Loss Weight'  id='choice_3_78_1' tabindex='138'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_78_1' id='label_3_78_1' class='gform-field-label gform-field-label--type-inline'>Loss Weight<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_78_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.2' type='checkbox'  value='Shape and Tone'  id='choice_3_78_2' tabindex='139'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_78_2' id='label_3_78_2' class='gform-field-label gform-field-label--type-inline'>Shape and Tone<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_78_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.3' type='checkbox'  value='Reduce body Fat'  id='choice_3_78_3' tabindex='140'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_78_3' id='label_3_78_3' class='gform-field-label gform-field-label--type-inline'>Reduce body Fat<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_78_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.4' type='checkbox'  value='Decrease Clothing Size'  id='choice_3_78_4' tabindex='141'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_78_4' id='label_3_78_4' class='gform-field-label gform-field-label--type-inline'>Decrease Clothing Size<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_79\"  class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_3_79\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Would you like to achieve these?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_3_79'><div class='gchoice gchoice_3_79_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.1' type='checkbox'  value='Lose Weight'  id='choice_3_79_1' tabindex='142'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_79_1' id='label_3_79_1' class='gform-field-label gform-field-label--type-inline'>Lose Weight<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_79_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.2' type='checkbox'  value='Shape and Tone'  id='choice_3_79_2' tabindex='143'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_79_2' id='label_3_79_2' class='gform-field-label gform-field-label--type-inline'>Shape and Tone<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_79_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.3' type='checkbox'  value='Reduce body Fat'  id='choice_3_79_3' tabindex='144'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_79_3' id='label_3_79_3' class='gform-field-label gform-field-label--type-inline'>Reduce body Fat<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_79_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.4' type='checkbox'  value='Decrease Clothing Size'  id='choice_3_79_4' tabindex='145'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_79_4' id='label_3_79_4' class='gform-field-label gform-field-label--type-inline'>Decrease Clothing Size<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_80\"  class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_80\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Fitness<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_3_80'><div class='gchoice gchoice_3_80_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_80.1' type='checkbox'  value='Increase Endurance'  id='choice_3_80_1' tabindex='146'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_80_1' id='label_3_80_1' class='gform-field-label gform-field-label--type-inline'>Increase Endurance<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_80_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_80.2' type='checkbox'  value='Sporting Performance'  id='choice_3_80_2' tabindex='147'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_80_2' id='label_3_80_2' class='gform-field-label gform-field-label--type-inline'>Sporting Performance<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_100\"  class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_100\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Wellness<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_3_100'><div class='gchoice gchoice_3_100_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_100.1' type='checkbox'  value='Stress Management'  id='choice_3_100_1' tabindex='148'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_100_1' id='label_3_100_1' class='gform-field-label gform-field-label--type-inline'>Stress Management<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_100_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_100.2' type='checkbox'  value='Increase Flexibility'  id='choice_3_100_2' tabindex='149'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_100_2' id='label_3_100_2' class='gform-field-label gform-field-label--type-inline'>Increase Flexibility<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_100_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_100.3' type='checkbox'  value='Rehabilitation'  id='choice_3_100_3' tabindex='150'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_100_3' id='label_3_100_3' class='gform-field-label gform-field-label--type-inline'>Rehabilitation<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_81\"  class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_81\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Strength<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_3_81'><div class='gchoice gchoice_3_81_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.1' type='checkbox'  value='Increase Strength'  id='choice_3_81_1' tabindex='151'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_81_1' id='label_3_81_1' class='gform-field-label gform-field-label--type-inline'>Increase Strength<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_81_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.2' type='checkbox'  value='Increase Muscle mass'  id='choice_3_81_2' tabindex='152'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_81_2' id='label_3_81_2' class='gform-field-label gform-field-label--type-inline'>Increase Muscle mass<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_81_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_81.3' type='checkbox'  value='Increase Stamina'  id='choice_3_81_3' tabindex='153'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_81_3' id='label_3_81_3' class='gform-field-label gform-field-label--type-inline'>Increase Stamina<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_112\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_112\"><h3 class=\"months-style\">What are your 3\/6\/12 month goals?<\/h3><\/div><div id=\"field_3_113\"  class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_113\"><label class='gfield_label gform-field-label' for='input_3_113' >3 Months<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_113' id='input_3_113' type='text' value='' class='large'   tabindex='154'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_3_114\"  class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_114\"><label class='gfield_label gform-field-label' for='input_3_114' >6 Months<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_114' id='input_3_114' type='text' value='' class='large'   tabindex='155'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_3_115\"  class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_115\"><label class='gfield_label gform-field-label' for='input_3_115' >12 Months<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_115' id='input_3_115' type='text' value='' class='large'   tabindex='156'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_3_28\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_28\"><label class='gfield_label gform-field-label' for='input_3_28' >Why do you want to achieve these results?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_28' id='input_3_28' class='textarea medium' tabindex='157'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_71\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_71\"><label class='gfield_label gform-field-label' for='input_3_71' >When do you want to achieve these by?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_71' id='input_3_71' class='textarea medium' tabindex='158'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_118\"  class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_118\"><label class='gfield_label gform-field-label' for='input_3_118' >How long do you think it will take you to achieve your goals?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_118' id='input_3_118' class='textarea medium' tabindex='159'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_104\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_104\"><label class='gfield_label gform-field-label' for='input_3_104' >Which part of the body would you like to achieve these results In?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_104' id='input_3_104' class='textarea medium' tabindex='160'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_82\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_82\"><label class='gfield_label gform-field-label' for='input_3_82' >How long have you been thinking about achieving your results?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_82' id='input_3_82' class='textarea medium' tabindex='161'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_3_119\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_119\"><legend class='gfield_label gform-field-label'  >Are you willing to commit to the process for the next 6 months?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_119'>\n\t\t\t<div class='gchoice gchoice_3_119_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_119' type='radio' value='Yes'  id='choice_3_119_0' onchange='gformToggleRadioOther( this )'  tabindex='162'  \/>\n\t\t\t\t\t<label for='choice_3_119_0' id='label_3_119_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_3_119_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_119' type='radio' value='No'  id='choice_3_119_1' onchange='gformToggleRadioOther( this )'  tabindex='163'  \/>\n\t\t\t\t\t<label for='choice_3_119_1' id='label_3_119_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_34\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_34\"><legend class='gfield_label gform-field-label'  >Are you 100% committed to achieving your why?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_34'>\n\t\t\t<div class='gchoice gchoice_3_34_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Yes'  id='choice_3_34_0' onchange='gformToggleRadioOther( this )'  tabindex='164'  \/>\n\t\t\t\t\t<label for='choice_3_34_0' id='label_3_34_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_3_34_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='No'  id='choice_3_34_1' onchange='gformToggleRadioOther( this )'  tabindex='165'  \/>\n\t\t\t\t\t<label for='choice_3_34_1' id='label_3_34_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_35\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_35\"><legend class='gfield_label gform-field-label'  >Are you willing to make sacrifices in order to achieve your why?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_35'>\n\t\t\t<div class='gchoice gchoice_3_35_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='Yes'  id='choice_3_35_0' onchange='gformToggleRadioOther( this )'  tabindex='166'  \/>\n\t\t\t\t\t<label for='choice_3_35_0' id='label_3_35_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_3_35_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='No'  id='choice_3_35_1' onchange='gformToggleRadioOther( this )'  tabindex='167'  \/>\n\t\t\t\t\t<label for='choice_3_35_1' id='label_3_35_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_107\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_107\"><label class='gfield_label gform-field-label' for='input_3_107' >What is your budget and what are you willing to invest into your health and fitness?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_107' id='input_3_107' class='textarea medium' tabindex='168'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_3_106\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_106\"><legend class='gfield_label gform-field-label'  >Personal Barrier Please Check<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_106'>\n\t\t\t<div class='gchoice gchoice_3_106_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='Time'  id='choice_3_106_0' onchange='gformToggleRadioOther( this )'  tabindex='169'  \/>\n\t\t\t\t\t<label for='choice_3_106_0' id='label_3_106_0' class='gform-field-label gform-field-label--type-inline'>Time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_106_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='Money'  id='choice_3_106_1' onchange='gformToggleRadioOther( this )'  tabindex='170'  \/>\n\t\t\t\t\t<label for='choice_3_106_1' id='label_3_106_1' class='gform-field-label gform-field-label--type-inline'>Money<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_106_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='Procrastination'  id='choice_3_106_2' onchange='gformToggleRadioOther( this )'  tabindex='171'  \/>\n\t\t\t\t\t<label for='choice_3_106_2' id='label_3_106_2' class='gform-field-label gform-field-label--type-inline'>Procrastination<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_106_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='Motivation'  id='choice_3_106_3' onchange='gformToggleRadioOther( this )'  tabindex='172'  \/>\n\t\t\t\t\t<label for='choice_3_106_3' id='label_3_106_3' class='gform-field-label gform-field-label--type-inline'>Motivation<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_106_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='Injury'  id='choice_3_106_4' onchange='gformToggleRadioOther( this )'  tabindex='173'  \/>\n\t\t\t\t\t<label for='choice_3_106_4' id='label_3_106_4' class='gform-field-label gform-field-label--type-inline'>Injury<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_106_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_106' type='radio' value='None'  id='choice_3_106_5' onchange='gformToggleRadioOther( this )'  tabindex='174'  \/>\n\t\t\t\t\t<label for='choice_3_106_5' id='label_3_106_5' class='gform-field-label gform-field-label--type-inline'>None<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_36\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_36\"><legend class='gfield_label gform-field-label'  >Is this still a problem?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_36'>\n\t\t\t<div class='gchoice gchoice_3_36_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='Yes'  id='choice_3_36_0' onchange='gformToggleRadioOther( this )'  tabindex='175'  \/>\n\t\t\t\t\t<label for='choice_3_36_0' id='label_3_36_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_3_36_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_36' type='radio' value='No'  id='choice_3_36_1' onchange='gformToggleRadioOther( this )'  tabindex='176'  \/>\n\t\t\t\t\t<label for='choice_3_36_1' id='label_3_36_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_37\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_37\"><legend class='gfield_label gform-field-label'  >Do you have support from your friends and family?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_37'>\n\t\t\t<div class='gchoice gchoice_3_37_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='Yes'  id='choice_3_37_0' onchange='gformToggleRadioOther( this )'  tabindex='177'  \/>\n\t\t\t\t\t<label for='choice_3_37_0' id='label_3_37_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_3_37_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='No'  id='choice_3_37_1' onchange='gformToggleRadioOther( this )'  tabindex='178'  \/>\n\t\t\t\t\t<label for='choice_3_37_1' id='label_3_37_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_85\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_85\"><label class='gfield_label gform-field-label' for='input_3_85' >Life values &amp; what are you grateful for?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_85' id='input_3_85' class='textarea medium' tabindex='179'   placeholder='Eg. You value family, friends, health Etc.' aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_86\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_86\"><label class='gfield_label gform-field-label' for='input_3_86' >Fears<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_86' id='input_3_86' class='textarea medium' tabindex='180'   placeholder='Eg. Snakes, spiders, financially insecure, death, etc.' aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_87\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_87\"><h2>Terms & Conditions<\/h2>\n<h3>1st Session Comfort Guarantee<\/h3>\n<p>If you change your mind, you can terminate this agreement within 48hrs after your first paid Group and PT session with Team Impaact. Email info@teamimpaact.com.au and we will cancel all future payments and refund to you within 14 days any monies paid via banking transfer into your nominated account. <\/p>\n<h3>Suspension and Cancellation Policy - Within Minimum Term<\/h3>\n<p>All membership options give you the ability to suspend your membership at no extra charge for a minimum of 2 weeks and up to a maximum of 1 month during your minimum term. We require 14 business days before your next payment date to suspend your membership. <\/p>\n<p>If you cancel your membership within the minimum term there is an upfront 100% cancellation fee of your remaining payments. We also require 14 business days before your payment date to cancel your membership.<\/p>\n<p>You can terminate the agreement due to sickness or physical incapacity at no extra charge, however, you must supply a medical certificate. <\/p>\n<h3>5 Hour Cancellation Policy<\/h3>\n<p>Should I cancel a personal training session with less than 5 business hours notice, I acknowledge that the session is forfeited and full - training fees applies. For Monday morning sessions I will leave a message on Sunday. When I give 5 hours notice I acknowledge that rescheduling my appointment to a more convenient time at no charge, will be pending on availability of training times. <\/p>\n<h3>After Your Minimum Term<\/h3>\n<p>Your membership is ongoing after your minimum term (26 weeks) so no changes will be made unless you notify us via email. After your minimum term, you can suspend or cancel your membership with no cancellation fee by providing 14 business days notice prior to your next payment date via email. You have a maximum of 6 weeks per year to have your membership placed on hold. If you would like to downgrade your membership level, we will also need 14 business days  notice prior to your next payment date to amend your payments.<\/p>\n<ol>\n<li>Understand that I am entering into an agreement for a minimum term of 26 weeks during which i will be debited on a fortnightly basis for the selected service, as per the ezidebit agreement. <\/li>\n<li>I have read, understand Team Impaacts terms and conditions. <\/li>\n<\/ol><\/div><fieldset id=\"field_3_91\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_91\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/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_3_91'>\n                            \n                            <span id='input_3_91_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_91.3' id='input_3_91_3' value='' tabindex='182'  aria-required='true'     \/>\n                                                    <label for='input_3_91_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_3_91_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_91.6' id='input_3_91_6' value='' tabindex='184'  aria-required='true'     \/>\n                                                    <label for='input_3_91_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_3_97\"  class=\"gfield gfield--type-signature gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_97\"><label class='gfield_label gform-field-label' for='input_3_97' >Participant&#039;s Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_3_97_Container' class='gfield_signature_container ginput_container' style='height:180px; width:700px; ' ><input type='hidden' class='gform_hidden' name='input_3_97_valid' id='input_3_97_valid' \/><canvas id='input_3_97' width='700' height='180'><\/canvas><div class='gfield_signature_reset_container'><svg id=\"input_3_97_resetIcon\" class=\"gfield_signature_reset_icon\" version=\"1.1\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"26\" height=\"26\" viewBox=\"0 0 26 26\">\n\t\t\t\t\t<title>Reset signature<\/title>\n\t\t\t\t\t<path fill=\"#fff\" d=\"M13 6.906v1.939c0 0.487 0.585 0.726 0.921 0.379l3.022-3.023c0.217-0.217 0.217-0.553 0-0.769l-3.022-3.022c-0.336-0.336-0.921-0.098-0.921 0.39v1.939c-4.788 0-8.667 3.878-8.667 8.667 0 1.127 0.217 2.21 0.617 3.196 0.293 0.726 1.224 0.921 1.777 0.368 0.292-0.292 0.412-0.737 0.249-1.127-0.314-0.748-0.477-1.582-0.477-2.438 0-3.586 2.914-6.5 6.5-6.5zM19.273 9.842c-0.293 0.293-0.412 0.748-0.249 1.127 0.303 0.758 0.477 1.582 0.477 2.438 0 3.586-2.914 6.5-6.5 6.5v-1.939c0-0.488-0.585-0.726-0.921-0.379l-3.023 3.023c-0.217 0.217-0.217 0.552 0 0.769l3.023 3.023c0.336 0.336 0.921 0.098 0.921-0.379v-1.95c4.788 0 8.667-3.878 8.667-8.667 0-1.127-0.217-2.21-0.618-3.196-0.292-0.726-1.224-0.921-1.777-0.368z\"><\/path>\n\t\t\t\t<\/svg><svg id=\"input_3_97_lockedReset\" class=\"gform_signature_locked_reset\" version=\"1.1\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"18\" height=\"18\" viewBox=\"0 0 26 26\">\n\t\t\t\t\t<title>Signature locked. Reset to sign again<\/title>\n\t\t\t\t\t<path fill=\"#fff\" d=\"M19.5 8.667h-1.083v-2.167c0-2.99-2.427-5.417-5.417-5.417s-5.417 2.427-5.417 5.417v2.167h-1.083c-1.192 0-2.167 0.975-2.167 2.167v10.833c0 1.192 0.975 2.167 2.167 2.167h13c1.192 0 2.167-0.975 2.167-2.167v-10.833c0-1.192-0.975-2.167-2.167-2.167zM13 18.417c-1.192 0-2.167-0.975-2.167-2.167s0.975-2.167 2.167-2.167c1.192 0 2.167 0.975 2.167 2.167s-0.975 2.167-2.167 2.167zM9.75 8.667v-2.167c0-1.798 1.452-3.25 3.25-3.25s3.25 1.452 3.25 3.25v2.167h-6.5z\"><\/path>\n\t\t\t\t\t<path fill=\"#fff\" d=\"M13 18.417c-1.192 0-2.167-0.975-2.167-2.167s0.975-2.167 2.167-2.167c1.192 0 2.167 0.975 2.167 2.167s-0.975 2.167-2.167 2.167z\"><\/path>\n\t\t\t\t<\/svg>\n\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_3_97'>Click To Sign<\/div><\/div><fieldset id=\"field_3_92\"  class=\"gfield gfield--type-date gfield--input-type-datedropdown gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_92\"><legend class='gfield_label gform-field-label'  >Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div id='input_3_92' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_3_92_2_container'><select name='input_92[]' id='input_3_92_2' tabindex='186'  aria-required='true'  ><option value=''>Day<\/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><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_3_92_1_container'><select name='input_92[]' id='input_3_92_1' tabindex='187'  aria-required='true'  ><option value=''>Month<\/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><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_3_92_3_container'><select name='input_92[]' id='input_3_92_3' tabindex='188'  aria-required='true'  ><option value=''>Year<\/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><\/fieldset><div id=\"field_3_93\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_93\"><h2>WAIVER<\/h2><\/div><fieldset id=\"field_3_31\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_31\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Acceptance of risk<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_3_31'><div class='gchoice gchoice_3_31_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_31.1' type='checkbox'  value='I am aware that all activities associated with receiving group fitness personal training instruction from the trainer including, but not limited t activities involving aerobic exercise, stretching, running and weight lifting, as well as additional strenuous exercise and or exertion of strength, and other sustained physical activities which place stress on the cardiovascular and muscular system collectively referred to as &quot;Training&quot;, are and can be hazardous activities that include certain risk and dangers, including but not limited to catastrophic injuries including paralysis, other serious injuries and death. I voluntarily accept full responsibility of all risks involved,  including risks from participating in any way in the training, use of equipment provided by the trainer of use of equipment I provide, whether the training occurs at the park, gym, home, or any other location and in any weather condition.'  id='choice_3_31_1' tabindex='189'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_31_1' id='label_3_31_1' class='gform-field-label gform-field-label--type-inline'>I am aware that all activities associated with receiving group fitness personal training instruction from the trainer including, but not limited t activities involving aerobic exercise, stretching, running and weight lifting, as well as additional strenuous exercise and or exertion of strength, and other sustained physical activities which place stress on the cardiovascular and muscular system collectively referred to as \"Training\", are and can be hazardous activities that include certain risk and dangers, including but not limited to catastrophic injuries including paralysis, other serious injuries and death. I voluntarily accept full responsibility of all risks involved,  including risks from participating in any way in the training, use of equipment provided by the trainer of use of equipment I provide, whether the training occurs at the park, gym, home, or any other location and in any weather condition.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_95\"  class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_95\">I have read the acceptance of risk provision in this agreement and I understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am singing the agreement freely and voluntarily and intend, by my signature that this document is completed and an unconditional release of liability to the greatest extent allowed by law. \n<ol>\n<li>The information given by me in this safety questionnaire is true, complete and accurate and I understand the advice given above. <\/li>\n<li>I have obtained clearance from a medical professional where required or recommended. <\/li>\n<\/ol><\/div><fieldset id=\"field_3_96\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_96\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/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_3_96'>\n                            \n                            <span id='input_3_96_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_96.3' id='input_3_96_3' value='' tabindex='191'  aria-required='true'     \/>\n                                                    <label for='input_3_96_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_3_96_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_96.6' id='input_3_96_6' value='' tabindex='193'  aria-required='true'     \/>\n                                                    <label for='input_3_96_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_3_98\"  class=\"gfield gfield--type-signature gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_98\"><label class='gfield_label gform-field-label' for='input_3_98' >Participant&#039;s Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_3_98_Container' class='gfield_signature_container ginput_container' style='height:180px; width:700px; ' ><input type='hidden' class='gform_hidden' name='input_3_98_valid' id='input_3_98_valid' \/><canvas id='input_3_98' width='700' height='180'><\/canvas><div class='gfield_signature_reset_container'><svg id=\"input_3_98_resetIcon\" class=\"gfield_signature_reset_icon\" version=\"1.1\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"26\" height=\"26\" viewBox=\"0 0 26 26\">\n\t\t\t\t\t<title>Reset signature<\/title>\n\t\t\t\t\t<path fill=\"#fff\" d=\"M13 6.906v1.939c0 0.487 0.585 0.726 0.921 0.379l3.022-3.023c0.217-0.217 0.217-0.553 0-0.769l-3.022-3.022c-0.336-0.336-0.921-0.098-0.921 0.39v1.939c-4.788 0-8.667 3.878-8.667 8.667 0 1.127 0.217 2.21 0.617 3.196 0.293 0.726 1.224 0.921 1.777 0.368 0.292-0.292 0.412-0.737 0.249-1.127-0.314-0.748-0.477-1.582-0.477-2.438 0-3.586 2.914-6.5 6.5-6.5zM19.273 9.842c-0.293 0.293-0.412 0.748-0.249 1.127 0.303 0.758 0.477 1.582 0.477 2.438 0 3.586-2.914 6.5-6.5 6.5v-1.939c0-0.488-0.585-0.726-0.921-0.379l-3.023 3.023c-0.217 0.217-0.217 0.552 0 0.769l3.023 3.023c0.336 0.336 0.921 0.098 0.921-0.379v-1.95c4.788 0 8.667-3.878 8.667-8.667 0-1.127-0.217-2.21-0.618-3.196-0.292-0.726-1.224-0.921-1.777-0.368z\"><\/path>\n\t\t\t\t<\/svg><svg id=\"input_3_98_lockedReset\" class=\"gform_signature_locked_reset\" version=\"1.1\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"18\" height=\"18\" viewBox=\"0 0 26 26\">\n\t\t\t\t\t<title>Signature locked. Reset to sign again<\/title>\n\t\t\t\t\t<path fill=\"#fff\" d=\"M19.5 8.667h-1.083v-2.167c0-2.99-2.427-5.417-5.417-5.417s-5.417 2.427-5.417 5.417v2.167h-1.083c-1.192 0-2.167 0.975-2.167 2.167v10.833c0 1.192 0.975 2.167 2.167 2.167h13c1.192 0 2.167-0.975 2.167-2.167v-10.833c0-1.192-0.975-2.167-2.167-2.167zM13 18.417c-1.192 0-2.167-0.975-2.167-2.167s0.975-2.167 2.167-2.167c1.192 0 2.167 0.975 2.167 2.167s-0.975 2.167-2.167 2.167zM9.75 8.667v-2.167c0-1.798 1.452-3.25 3.25-3.25s3.25 1.452 3.25 3.25v2.167h-6.5z\"><\/path>\n\t\t\t\t\t<path fill=\"#fff\" d=\"M13 18.417c-1.192 0-2.167-0.975-2.167-2.167s0.975-2.167 2.167-2.167c1.192 0 2.167 0.975 2.167 2.167s-0.975 2.167-2.167 2.167z\"><\/path>\n\t\t\t\t<\/svg>\n\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_3_98'>Click To Sign<\/div><\/div><fieldset id=\"field_3_99\"  class=\"gfield gfield--type-date gfield--input-type-datedropdown gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_99\"><legend class='gfield_label gform-field-label'  >Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div id='input_3_99' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_3_99_2_container'><select name='input_99[]' id='input_3_99_2' tabindex='195'  aria-required='true'  ><option value=''>Day<\/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><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_3_99_1_container'><select name='input_99[]' id='input_3_99_1' tabindex='196'  aria-required='true'  ><option value=''>Month<\/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><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_3_99_3_container'><select name='input_99[]' id='input_3_99_3' tabindex='197'  aria-required='true'  ><option value=''>Year<\/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><\/fieldset><\/div><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_3' class='gform_button button' value='Agree To This Document' tabindex='198' onclick='if(window[\"gf_submitting_3\"]){return false;}  window[\"gf_submitting_3\"]=true;  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_3\"]){return false;} window[\"gf_submitting_3\"]=true;  jQuery(\"#gform_3\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=3&amp;title=&amp;description=&amp;tabindex=49' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_3' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='3' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_3' value='WyJbXSIsImVmMDA1Y2IwNWIyMDBkM2YyYTgwMjg4YWE3OWJmZDM5Il0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_3' id='gform_target_page_number_3' value='0' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_3' id='gform_source_page_number_3' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div>\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_3' id='gform_ajax_frame_3' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n\t\t                <script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 3, 'https:\/\/teamimpaact.com.au\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_3').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_3');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_3').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_3').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_3').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_3').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_3').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_3').val();gformInitSpinner( 3, 'https:\/\/teamimpaact.com.au\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [3, current_page]);window['gf_submitting_3'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_3').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_3').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [3]);window['gf_submitting_3'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_3').text());}, 50);}else{jQuery('#gform_3').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gform_post_render', [3, current_page]);} );} ); \n\/* ]]> *\/\n<\/script>\n\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"_links":{"self":[{"href":"https:\/\/teamimpaact.com.au\/wp-json\/wp\/v2\/pages\/893"}],"collection":[{"href":"https:\/\/teamimpaact.com.au\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/teamimpaact.com.au\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/teamimpaact.com.au\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/teamimpaact.com.au\/wp-json\/wp\/v2\/comments?post=893"}],"version-history":[{"count":7,"href":"https:\/\/teamimpaact.com.au\/wp-json\/wp\/v2\/pages\/893\/revisions"}],"predecessor-version":[{"id":2861,"href":"https:\/\/teamimpaact.com.au\/wp-json\/wp\/v2\/pages\/893\/revisions\/2861"}],"wp:attachment":[{"href":"https:\/\/teamimpaact.com.au\/wp-json\/wp\/v2\/media?parent=893"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}