{"id":868,"date":"2023-03-20T10:04:00","date_gmt":"2023-03-20T14:04:00","guid":{"rendered":"https:\/\/impactacademyschool.org\/?page_id=868"},"modified":"2026-03-03T10:35:22","modified_gmt":"2026-03-03T14:35:22","slug":"summer-camp-registration","status":"publish","type":"page","link":"https:\/\/impactacademyschool.org\/index.php\/summer-camp-registration\/","title":{"rendered":"Summer Camp Registration"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-b22eb2ed-ce62-4abb-8242-8f90bf8b9301\" id=\"wpforms-863\"><form id=\"wpforms-form-863\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"863\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/868?wpforms_form_id=863\" data-token=\"c59fe56049530f808bcd9888696718a9\" data-token-time=\"1776345135\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-863-field_44-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"44\"><label class=\"wpforms-field-label\">Checkboxes (copy) <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-863-field_44\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-863-field_44_1\" name=\"wpforms[fields][44][]\" value=\"Session 1 - June 1, 2026 through June 12, 2026\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_44_1\">Session 1 &#8211; June 1, 2026 through June 12, 2026<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-863-field_44_2\" name=\"wpforms[fields][44][]\" value=\"Session 2 - June 15, 2026 through June 26, 2026\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_44_2\">Session 2 &#8211; June 15, 2026 through June 26, 2026<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-863-field_44_3\" name=\"wpforms[fields][44][]\" value=\"Session 3 - June 29, 2026 through July 10, 2026\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_44_3\">Session 3 &#8211; June 29, 2026 through July 10, 2026<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-863-field_44_4\" name=\"wpforms[fields][44][]\" value=\"Session 4 - July 13, 2026 through July 24, 2026\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_44_4\">Session 4 &#8211; July 13, 2026 through July 24, 2026<\/label><\/li><\/ul><div class=\"wpforms-field-description\">Non-refundable registration fee of $150 is due at the time of registration. Camp cost is $750 per child per two week session.  Campers must attend full sessions only. All summer camp fees MUST be paid two week prior to the beginning of the session(s) to be attended. Session 1 payment is due May 18, 2026. Session 2 payment is due June 1, 2026. Session 3 payment is due June 15, 2026. Session 4 payment is due June 29, 2026. All summer camp fees are non-refundable. Further information will be provided as it becomes available. <\/div><\/div><div id=\"wpforms-863-field_6-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-863-field_6\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-863-field_6\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][6]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-863-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><label class=\"wpforms-field-label\">Camper Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-863-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" required><label for=\"wpforms-863-field_1\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-863-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" required><label for=\"wpforms-863-field_1-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-863-field_43-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"43\"><label class=\"wpforms-field-label\">Has the camper previously attended Impact Academy&#039;s Summer Camp? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-863-field_43\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-863-field_43_1\" name=\"wpforms[fields][43]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_43_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-863-field_43_2\" name=\"wpforms[fields][43]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_43_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-863-field_26-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-863-field_26\">Parent Name(s) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-863-field_26\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][26]\" required><\/div><div id=\"wpforms-863-field_39-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"39\"><label class=\"wpforms-field-label\" for=\"wpforms-863-field_39\">Parent Occupation(s) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-863-field_39\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][39]\" required><\/div><div id=\"wpforms-863-field_2-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"2\"><label class=\"wpforms-field-label\">Address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-863-field_2\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][2][address1]\" required><label for=\"wpforms-863-field_2\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-863-field_2-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][2][address2]\" ><label for=\"wpforms-863-field_2-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-863-field_2-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][2][city]\" required><label for=\"wpforms-863-field_2-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-863-field_2-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][2][state]\" required><option class=\"placeholder\" value=\"\" selected disabled>&#8212; Select state &#8212;<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-863-field_2-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-863-field_2-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][2][postal]\" required><label for=\"wpforms-863-field_2-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><\/div><div id=\"wpforms-863-field_4-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"4\"><label class=\"wpforms-field-label\">DOB <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][4][date][m]\" id=\"wpforms-863-field_4-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][4][date][d]\" id=\"wpforms-863-field_4-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][4][date][y]\" id=\"wpforms-863-field_4-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/div><div id=\"wpforms-863-field_5-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-863-field_5\">Diagnosis(es) <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-863-field_5\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][5]\" required><\/textarea><\/div><div id=\"wpforms-863-field_7-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-863-field_7\">Primary Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-863-field_7\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][7]\" aria-label=\"Primary Phone\" required><\/div><div id=\"wpforms-863-field_8-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-863-field_8\">Secondary Phone<\/label><input type=\"tel\" id=\"wpforms-863-field_8\" class=\"wpforms-field-medium wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][8]\" aria-label=\"Secondary Phone\" ><\/div><div id=\"wpforms-863-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-863-field_9\">Current School <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-863-field_9\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][9]\" required><\/div><div id=\"wpforms-863-field_12-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"12\"><label class=\"wpforms-field-label\">Does student have: (Please check all that apply)<\/label><ul id=\"wpforms-863-field_12\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-863-field_12_1\" name=\"wpforms[fields][12][]\" value=\"IEP\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_12_1\">IEP<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-863-field_12_2\" name=\"wpforms[fields][12][]\" value=\"504 Plan\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_12_2\">504 Plan<\/label><\/li><\/ul><\/div><div id=\"wpforms-863-field_17-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-863-field_17\">Please upload IEP\/Behavior Plan<\/label><div\n\t\tclass=\"wpforms-uploader \"\n\t\tdata-field-id=\"17\"\n\t\tdata-form-id=\"863\"\n\t\tdata-input-name=\"wpforms_863_17\"\n\t\tdata-extensions=\"jpg,jpeg,jpe,gif,png,bmp,tiff,tif,webp,avif,ico,heic,heif,heics,heifs,asf,asx,wmv,wmx,wm,avi,divx,mov,qt,mpeg,mpg,mpe,mp4,m4v,ogv,webm,mkv,3gp,3gpp,3g2,3gp2,txt,asc,c,cc,h,srt,csv,tsv,ics,rtx,css,vtt,mp3,m4a,m4b,aac,ra,ram,wav,x-wav,ogg,oga,flac,mid,midi,wma,wax,mka,rtf,pdf,class,tar,zip,gz,gzip,rar,7z,psd,xcf,doc,pot,pps,ppt,wri,xla,xls,xlt,xlw,mpp,docx,docm,dotx,dotm,xlsx,xlsm,xlsb,xltx,xltm,xlam,pptx,pptm,ppsx,ppsm,potx,potm,ppam,sldx,sldm,onetoc,onetoc2,onepkg,oxps,xps,odt,odp,ods,odg,odc,odb,odf,wp,wpd,key,numbers,pages\"\n\t\tdata-max-size=\"2097152\"\n\t\tdata-max-file-number=\"2\"\n\t\tdata-post-max-size=\"2097152\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg  viewBox=\"0 0 640 640\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M352 173.3L352 384C352 401.7 337.7 416 320 416C302.3 416 288 401.7 288 384L288 173.3L246.6 214.7C234.1 227.2 213.8 227.2 201.3 214.7C188.8 202.2 188.8 181.9 201.3 169.4L297.3 73.4C309.8 60.9 330.1 60.9 342.6 73.4L438.6 169.4C451.1 181.9 451.1 202.2 438.6 214.7C426.1 227.2 405.8 227.2 393.3 214.7L352 173.3zM320 464C364.2 464 400 428.2 400 384L480 384C515.3 384 544 412.7 544 448L544 480C544 515.3 515.3 544 480 544L160 544C124.7 544 96 515.3 96 480L96 448C96 412.7 124.7 384 160 384L240 384C240 428.2 275.8 464 320 464zM464 488C477.3 488 488 477.3 488 464C488 450.7 477.3 440 464 440C450.7 440 440 450.7 440 464C440 477.3 450.7 488 464 488z\"\/>\n\t\t<\/svg>\n\n\t\t<span class=\"modern-title\">\n\t\t\t\t\t\t\tDrag &amp; Drop Files, \t\t\t\t<span>Choose Files to Upload<\/span>\n\t\t\t\t\t<\/span>\n\n\t\t\t\t\t<span class=\"modern-hint\">You can upload up to 2 files.<\/span>\n\t\t\t<\/div>\n<\/div>\n\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-863-field_17\"\n\t\tname=\"wpforms_863_17\" \t\tvalue=\"\">\n<\/div><div id=\"wpforms-863-field_18-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-863-field_18\">Medical Insurance Company <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-863-field_18\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][18]\" required><\/div><div id=\"wpforms-863-field_19-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-863-field_19\">Policy Number<\/label><input type=\"text\" id=\"wpforms-863-field_19\" class=\"wpforms-field-medium\" name=\"wpforms[fields][19]\" ><\/div><div id=\"wpforms-863-field_22-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-863-field_22\">ABA Therapy Company <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-863-field_22\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][22]\" required><\/div><div id=\"wpforms-863-field_21-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"21\"><label class=\"wpforms-field-label\">Previously required 1\/1? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-863-field_21\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-863-field_21_1\" name=\"wpforms[fields][21]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_21_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-863-field_21_2\" name=\"wpforms[fields][21]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_21_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-863-field_32-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"32\"><label class=\"wpforms-field-label\">Is your child potty-trained? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-863-field_32\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-863-field_32_1\" name=\"wpforms[fields][32]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_32_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-863-field_32_2\" name=\"wpforms[fields][32]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_32_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-863-field_33-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"33\"><label class=\"wpforms-field-label\">Does your child have a history of seizures? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-863-field_33\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-863-field_33_1\" name=\"wpforms[fields][33]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_33_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-863-field_33_2\" name=\"wpforms[fields][33]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_33_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-863-field_24-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-863-field_24\">Date of last seizure, if applicable.<\/label><input type=\"text\" id=\"wpforms-863-field_24\" class=\"wpforms-field-medium\" name=\"wpforms[fields][24]\" ><\/div><div id=\"wpforms-863-field_34-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"34\"><label class=\"wpforms-field-label\">Does your child have pica? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-863-field_34\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-863-field_34_1\" name=\"wpforms[fields][34]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_34_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-863-field_34_2\" name=\"wpforms[fields][34]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_34_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-863-field_35-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"35\"><label class=\"wpforms-field-label\">Is your child an elopement risk? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-863-field_35\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-863-field_35_1\" name=\"wpforms[fields][35]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_35_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-863-field_35_2\" name=\"wpforms[fields][35]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_35_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-863-field_36-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"36\"><label class=\"wpforms-field-label\">Does your child have allergies? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-863-field_36\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-863-field_36_1\" name=\"wpforms[fields][36]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_36_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-863-field_36_2\" name=\"wpforms[fields][36]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_36_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-863-field_25-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-863-field_25\">Allergies:<\/label><textarea id=\"wpforms-863-field_25\" class=\"wpforms-field-medium\" name=\"wpforms[fields][25]\" ><\/textarea><\/div><div id=\"wpforms-863-field_37-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"37\"><label class=\"wpforms-field-label\">Does your child exhibit disruptive behavior? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-863-field_37\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-863-field_37_1\" name=\"wpforms[fields][37]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_37_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-863-field_37_2\" name=\"wpforms[fields][37]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_37_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-863-field_38-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"38\"><label class=\"wpforms-field-label\">Does your child take medicine during school hours? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-863-field_38\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-863-field_38_1\" name=\"wpforms[fields][38]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_38_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-863-field_38_2\" name=\"wpforms[fields][38]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-863-field_38_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-863-field_23-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-863-field_23\">List of current medications, if any.<\/label><input type=\"text\" id=\"wpforms-863-field_23\" class=\"wpforms-field-medium\" name=\"wpforms[fields][23]\" ><\/div><div id=\"wpforms-863-field_29-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-863-field_29\">Dietary Restrictions?<\/label><textarea id=\"wpforms-863-field_29\" class=\"wpforms-field-medium\" name=\"wpforms[fields][29]\" ><\/textarea><\/div><div id=\"wpforms-863-field_30-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-863-field_30\">Additional Information?<\/label><textarea id=\"wpforms-863-field_30\" class=\"wpforms-field-medium\" name=\"wpforms[fields][30]\" ><\/textarea><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-recaptcha wpforms-is-recaptcha-type-v3\" ><input type=\"hidden\" name=\"wpforms[recaptcha]\" value=\"\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"863\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/impactacademyschool.org\/index.php\/wp-json\/wp\/v2\/pages\/868\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-863\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/impactacademyschool.org\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"class_list":["post-868","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/impactacademyschool.org\/index.php\/wp-json\/wp\/v2\/pages\/868","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/impactacademyschool.org\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/impactacademyschool.org\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/impactacademyschool.org\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/impactacademyschool.org\/index.php\/wp-json\/wp\/v2\/comments?post=868"}],"version-history":[{"count":16,"href":"https:\/\/impactacademyschool.org\/index.php\/wp-json\/wp\/v2\/pages\/868\/revisions"}],"predecessor-version":[{"id":1066,"href":"https:\/\/impactacademyschool.org\/index.php\/wp-json\/wp\/v2\/pages\/868\/revisions\/1066"}],"wp:attachment":[{"href":"https:\/\/impactacademyschool.org\/index.php\/wp-json\/wp\/v2\/media?parent=868"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}