{"id":195,"date":"2018-11-05T11:48:06","date_gmt":"2018-11-05T15:48:06","guid":{"rendered":"http:\/\/brightislandoutreach.org\/?page_id=195"},"modified":"2019-10-07T14:04:33","modified_gmt":"2019-10-07T18:04:33","slug":"sign-up-form","status":"publish","type":"page","link":"https:\/\/brightislandoutreach.org\/sign-up-form\/","title":{"rendered":"Sign Up Form"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; fullwidth=&#8221;on&#8221; _builder_version=&#8221;3.16.1&#8243;][et_pb_fullwidth_header title=&#8221;VOLUNTEER&#8221; text_orientation=&#8221;center&#8221; _builder_version=&#8221;3.16.1&#8243; title_font_size=&#8221;54px&#8221; background_image=&#8221;https:\/\/brightislandoutreach.org\/wp-content\/uploads\/2018\/10\/5622938.jpg&#8221;][\/et_pb_fullwidth_header][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;3.0.47&#8243;][et_pb_row _builder_version=&#8221;3.0.48&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;3.0.47&#8243; parallax=&#8221;off&#8221; parallax_method=&#8221;on&#8221;][et_pb_text _builder_version=&#8221;3.16.1&#8243; text_orientation=&#8221;center&#8221;]<\/p>\n<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 gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_2' ><div id='gf_2' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_2' id='gform_2'  action='\/wp-json\/wp\/v2\/pages\/195#gf_2' data-formid='2' novalidate><div id='gf_page_steps_2' class='gf_page_steps'><div id='gf_step_2_1' class='gf_step gf_step_active gf_step_first'><span class='gf_step_number'>1<\/span><span class='gf_step_label'><\/span><\/div><div id='gf_step_2_2' class='gf_step gf_step_next gf_step_pending'><span class='gf_step_number'>2<\/span><span class='gf_step_label'><\/span><\/div><div id='gf_step_2_3' class='gf_step gf_step_pending'><span class='gf_step_number'>3<\/span><span class='gf_step_label'><\/span><\/div><div id='gf_step_2_4' class='gf_step gf_step_pending'><span class='gf_step_number'>4<\/span><span class='gf_step_label'><\/span><\/div><div id='gf_step_2_5' class='gf_step gf_step_pending'><span class='gf_step_number'>5<\/span><span class='gf_step_label'><\/span><\/div><div id='gf_step_2_6' class='gf_step gf_step_last gf_step_pending'><span class='gf_step_number'>6<\/span><span class='gf_step_label'><\/span><\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_2_1' class='gform_page ' data-js='page-field-id-1' >\n                                    <div class='gform_page_fields'><ul id='gform_fields_2' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_2_1\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_1\" ><label class='gfield_label gform-field-label' for='input_2_1'>Choose your trip...<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_1'>Please select your trip dates and fill out the following form to register to Volunteer with BIO! \n*Payment instructions to secure your spot and trip details will be emailed to you after registration (Paypal is available for those that wish to use it).  *Please note - Airfare is not included. | Seleccione las fechas de su viaje y complete el siguiente formulario para registrarse como voluntario en BIO!\n*Las instrucciones de pago para asegurar su lugar y los detalles del viaje se le enviar\u00e1n por correo electr\u00f3nico despu\u00e9s del registro (Paypal est\u00e1 disponible para aquellos que deseen usarlo). * Nota: la tarifa a\u00e9rea no est\u00e1 incluida.<\/div><div class='ginput_container ginput_container_select'><select name='input_1' id='input_2_1' class='medium gfield_select'  aria-describedby=\"gfield_description_2_1\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='April 18 - 21 | Boca Chica Dbacks' >April 18 - 21 | Boca Chica Dbacks<\/option><option value='June 1st- June 5th 2024 | Doctor' >June 1st- June 5th 2024 | Las Terrenas | Doctor<\/option><option value='June 1st- June 5th 2024 | Las Terrenas | RDH, RDA, Non-Dental' >June 1st- June 5th 2024 | Las Terrenas | RDH, RDA, Non-Dental<\/option><option value='June 1st- June 5th 2024 | Las Terrenas | Student' >June 1st- June 5th 2024 | Las Terrenas | Student<\/option><option value='June 5th - June 9th 2024 | Las Terrenas | Doctor' >June 5th - June 9th 2024 | Las Terrenas | Doctor<\/option><option value='June 5th - June 9th 2024 | Las Terrenas | RDH, RDA, Non-Dental' >June 5th - June 9th 2024 | Las Terrenas | RDH, RDA, Non-Dental<\/option><option value='June 5th - June 9th 2024 | Las Terrenas | Student' >June 5th - June 9th 2024 | Las Terrenas | Student<\/option><option value='Sept 21st - 29th 2024 | Juan Dolio | Doctor' >Sept 21st - 29th 2024 | Juan Dolio | Doctor<\/option><option value='Sept 21st - 29th 2024 | Juan Dolio | RDH, RDA, Non-Dental' >Sept 21st - 29th 2024 | Juan Dolio | RDH, RDA, Non-Dental<\/option><option value='Sept 21st - 29th 2024 | Juan Dolios | Student' >Sept 21st - 29th 2024 | Juan Dolio | Student<\/option><option value='Revive Mission | Dental Yogis | Registration Only' >Revive Mission | Dental Yogis | Registration Only<\/option><\/select><\/div><\/li><li id=\"field_2_3\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_3\" ><label class='gfield_label gform-field-label' for='input_2_3'>Last Name | Apellido<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_2_3' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_4\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_4\" ><label class='gfield_label gform-field-label' for='input_2_4'>First Name | Primer Nombre<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_2_4' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_5\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_5\" ><label class='gfield_label gform-field-label' for='input_2_5'>Middle Initial |  Inicial del Segundo Nombre<\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_2_5' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_6\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_6\" ><label class='gfield_label gform-field-label' for='input_2_6'>Date of Birth | Fecha de Nacimiento<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_2_6' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_55\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_55\" ><label class='gfield_label gform-field-label' >Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_55'>\n\t\t\t<li class='gchoice gchoice_2_55_0'>\n\t\t\t\t<input name='input_55' type='radio' value='Female'  id='choice_2_55_0'    \/>\n\t\t\t\t<label for='choice_2_55_0' id='label_2_55_0' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_55_1'>\n\t\t\t\t<input name='input_55' type='radio' value='Male'  id='choice_2_55_1'    \/>\n\t\t\t\t<label for='choice_2_55_1' id='label_2_55_1' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_55_2'>\n\t\t\t\t<input name='input_55' type='radio' value='Other'  id='choice_2_55_2'    \/>\n\t\t\t\t<label for='choice_2_55_2' id='label_2_55_2' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_56\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_56\" ><label class='gfield_label gform-field-label' for='input_2_56'>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_56' id='input_2_56' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_2_8\" 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_2_8\" ><label class='gfield_label gform-field-label' >T-Shirt Size |  Talla de Camiseta<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_8'>\n\t\t\t<li class='gchoice gchoice_2_8_0'>\n\t\t\t\t<input name='input_8' type='radio' value='XS' checked='checked' id='choice_2_8_0'    \/>\n\t\t\t\t<label for='choice_2_8_0' id='label_2_8_0' class='gform-field-label gform-field-label--type-inline'>XS<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_8_1'>\n\t\t\t\t<input name='input_8' type='radio' value='S'  id='choice_2_8_1'    \/>\n\t\t\t\t<label for='choice_2_8_1' id='label_2_8_1' class='gform-field-label gform-field-label--type-inline'>S<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_8_2'>\n\t\t\t\t<input name='input_8' type='radio' value='M'  id='choice_2_8_2'    \/>\n\t\t\t\t<label for='choice_2_8_2' id='label_2_8_2' class='gform-field-label gform-field-label--type-inline'>M<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_8_3'>\n\t\t\t\t<input name='input_8' type='radio' value='L'  id='choice_2_8_3'    \/>\n\t\t\t\t<label for='choice_2_8_3' id='label_2_8_3' class='gform-field-label gform-field-label--type-inline'>L<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_8_4'>\n\t\t\t\t<input name='input_8' type='radio' value='XL'  id='choice_2_8_4'    \/>\n\t\t\t\t<label for='choice_2_8_4' id='label_2_8_4' class='gform-field-label gform-field-label--type-inline'>XL<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_8_5'>\n\t\t\t\t<input name='input_8' type='radio' value='gf_other_choice'  id='choice_2_8_5'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_2_8_other' name='input_8_other' type='text' value='Other' aria-label='Other' onfocus='jQuery(this).prev(\"input\")[0].click(); if(jQuery(this).val() == \"Other\") { jQuery(this).val(\"\"); }' onblur='if(jQuery(this).val().replace(\" \", \"\") == \"\") { jQuery(this).val(\"Other\"); }'   \/>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_2_10' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_2' class='gform_page' data-js='page-field-id-10' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_2_2' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_2_11\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_11\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Address |  Direcci\u00f3n<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \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_2_11' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_2_11_1_container' >\n                                        <input type='text' name='input_11.1' id='input_2_11_1' value=''    aria-required='true'    \/>\n                                        <label for='input_2_11_1' id='input_2_11_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_2_11_2_container' >\n                                        <input type='text' name='input_11.2' id='input_2_11_2' value=''     aria-required='false'   \/>\n                                        <label for='input_2_11_2' id='input_2_11_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_2_11_3_container' >\n                                    <input type='text' name='input_11.3' id='input_2_11_3' value=''    aria-required='true'    \/>\n                                    <label for='input_2_11_3' id='input_2_11_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_2_11_4_container' >\n                                        <input type='text' name='input_11.4' id='input_2_11_4' value=''      aria-required='true'    \/>\n                                        <label for='input_2_11_4' id='input_2_11_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_2_11_5_container' >\n                                    <input type='text' name='input_11.5' id='input_2_11_5' value=''    aria-required='true'    \/>\n                                    <label for='input_2_11_5' id='input_2_11_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_2_11_6_container' >\n                                        <select name='input_11.6' id='input_2_11_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >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' selected='selected'>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_2_11_6' id='input_2_11_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><\/li><li id=\"field_2_12\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_12\" ><label class='gfield_label gform-field-label' for='input_2_12'>Passport #<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_2_12' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_13\" class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_13\" ><label class='gfield_label gform-field-label' for='input_2_13'>Mobile Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_13' id='input_2_13' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_14\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_14\" ><label class='gfield_label gform-field-label' for='input_2_14'>Home Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_14' id='input_2_14' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_15\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_15\" ><label class='gfield_label gform-field-label' for='input_2_15'>Emergency Contact Name | Nombre del Contacto de Emergencia<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_2_15' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_16\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_16\" ><label class='gfield_label gform-field-label' for='input_2_16'>Relationship | Relaci\u00f3n<\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_2_16' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_17\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_17\" ><label class='gfield_label gform-field-label' for='input_2_17'>Emergency Contact Phone | N\u00famero de Tel\u00e9fono de Contacto de Emergencia<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_2_17' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_18' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"1\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"1\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_2_18' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_3' class='gform_page' data-js='page-field-id-18' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_2_3' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_2_19\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_19\" ><label class='gfield_label gform-field-label' >Occupation | Ocupaci\u00f3n<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_19'>\n\t\t\t<li class='gchoice gchoice_2_19_0'>\n\t\t\t\t<input name='input_19' type='radio' value='Student | Estudiante'  id='choice_2_19_0'    \/>\n\t\t\t\t<label for='choice_2_19_0' id='label_2_19_0' class='gform-field-label gform-field-label--type-inline'>Student | Estudiante<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_19_1'>\n\t\t\t\t<input name='input_19' type='radio' value='Employed | Empleado'  id='choice_2_19_1'    \/>\n\t\t\t\t<label for='choice_2_19_1' id='label_2_19_1' class='gform-field-label gform-field-label--type-inline'>Employed | Empleado<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_19_2'>\n\t\t\t\t<input name='input_19' type='radio' value='Other | Otro'  id='choice_2_19_2'    \/>\n\t\t\t\t<label for='choice_2_19_2' id='label_2_19_2' class='gform-field-label gform-field-label--type-inline'>Other | Otro<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_19_3'>\n\t\t\t\t<input name='input_19' type='radio' value='gf_other_choice'  id='choice_2_19_3'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_2_19_other' name='input_19_other' type='text' value='Other' aria-label='Other' onfocus='jQuery(this).prev(\"input\")[0].click(); if(jQuery(this).val() == \"Other\") { jQuery(this).val(\"\"); }' onblur='if(jQuery(this).val().replace(\" \", \"\") == \"\") { jQuery(this).val(\"Other\"); }'   \/>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_20\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_20\" ><label class='gfield_label gform-field-label' for='input_2_20'>Employed by | Empleado por<\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_2_20' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_22\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_22\" ><label class='gfield_label gform-field-label' >Will this be your first trip with BIO? | Ser\u00e1 este su primer viaje con BIO?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_22'>\n\t\t\t<li class='gchoice gchoice_2_22_0'>\n\t\t\t\t<input name='input_22' type='radio' value='Yes'  id='choice_2_22_0'    \/>\n\t\t\t\t<label for='choice_2_22_0' id='label_2_22_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_22_1'>\n\t\t\t\t<input name='input_22' type='radio' value='No'  id='choice_2_22_1'    \/>\n\t\t\t\t<label for='choice_2_22_1' id='label_2_22_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_23\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_23\" ><label class='gfield_label gform-field-label' for='input_2_23'>Who is your primary contact with BIO? | Qui\u00e9n es su contacto principal con BIO?<\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_2_23' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_24\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_24\" ><label class='gfield_label gform-field-label' for='input_2_24'>Name of your group\/organization (if applicable)? | Nombre de su grupo\/organizaci\u00f3n (si corresponde)?<\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_2_24' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_25\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_25\" ><label class='gfield_label gform-field-label' for='input_2_25'>List any family members traveling with you | Enumere a los miembros de la familia que viajan con usted<\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_2_25' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_27\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_27\" ><label class='gfield_label gform-field-label' >Please rate your proficiency in Spanish | Por favor califique su dominio del espa\u00f1ol<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_27'>\n\t\t\t<li class='gchoice gchoice_2_27_0'>\n\t\t\t\t<input name='input_27' type='radio' value='Fluent'  id='choice_2_27_0'    \/>\n\t\t\t\t<label for='choice_2_27_0' id='label_2_27_0' class='gform-field-label gform-field-label--type-inline'>Fluent<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_27_1'>\n\t\t\t\t<input name='input_27' type='radio' value='Workplace-Proficient'  id='choice_2_27_1'    \/>\n\t\t\t\t<label for='choice_2_27_1' id='label_2_27_1' class='gform-field-label gform-field-label--type-inline'>Workplace-Proficient<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_27_2'>\n\t\t\t\t<input name='input_27' type='radio' value='Conversational'  id='choice_2_27_2'    \/>\n\t\t\t\t<label for='choice_2_27_2' id='label_2_27_2' class='gform-field-label gform-field-label--type-inline'>Conversational<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_27_3'>\n\t\t\t\t<input name='input_27' type='radio' value='Beginner'  id='choice_2_27_3'    \/>\n\t\t\t\t<label for='choice_2_27_3' id='label_2_27_3' class='gform-field-label gform-field-label--type-inline'>Beginner<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_27_4'>\n\t\t\t\t<input name='input_27' type='radio' value='None'  id='choice_2_27_4'    \/>\n\t\t\t\t<label for='choice_2_27_4' id='label_2_27_4' class='gform-field-label gform-field-label--type-inline'>None<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_27_5'>\n\t\t\t\t<input name='input_27' type='radio' value='gf_other_choice'  id='choice_2_27_5'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_2_27_other' name='input_27_other' type='text' value='Other' aria-label='Other' onfocus='jQuery(this).prev(\"input\")[0].click(); if(jQuery(this).val() == \"Other\") { jQuery(this).val(\"\"); }' onblur='if(jQuery(this).val().replace(\" \", \"\") == \"\") { jQuery(this).val(\"Other\"); }'   \/>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_28\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_28\" ><label class='gfield_label gform-field-label' for='input_2_28'>Please provide some information about yourself (background, interests, hobbies, etc.) |  Proporcione cierta informaci\u00f3n sobre usted (antecedentes, intereses, pasatiempos, etc.)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_28' id='input_2_28' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_2_29\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_29\" ><label class='gfield_label gform-field-label' for='input_2_29'>Please list any health issues that we should know about | Enumere cualquier problema de salud que debamos saber<\/label><div class='gfield_description' id='gfield_description_2_29'>Our expeditions, at times, require a high level of physical demand and the weather can be hot and humid. Any information that would be useful for our team to know about will help us to better accommodate your needs (Allergies, physical limitations, asthma, pace maker, etc.) | Nuestras expediciones, a veces, requieren un alto nivel de demanda f\u00edsica y el clima puede ser c\u00e1lido y h\u00famedo. Cualquier informaci\u00f3n que sea \u00fatil para que nuestro equipo conozca nos ayudar\u00e1 a satisfacer mejor sus necesidades (alergias, limitaciones f\u00edsicas, asma, marcapasos, etc.)<\/div><div class='ginput_container ginput_container_text'><input name='input_29' id='input_2_29' type='text' value='' class='medium'  aria-describedby=\"gfield_description_2_29\"    aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_59\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_59\" ><label class='gfield_label gform-field-label' for='input_2_59'>Please indicate if you have any special dietary requirements and describe |  Indique si tiene alg\u00fan requerimiento diet\u00e9tico especial y descr\u00edbalo.<\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_2_59' type='text' value='' class='medium'  aria-describedby=\"gfield_description_2_59\"    aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_2_59'>If you have a dietary restriction please let us know well in advance so we can prepare | Si tiene una restricci\u00f3n diet\u00e9tica, inf\u00f3rmenos con anticipaci\u00f3n para que podamos prepararnos<\/div><\/li><li id=\"field_2_30\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_30\" ><label class='gfield_label gform-field-label' for='input_2_30'>Briefly describe your own objectives and expectations for this vision\/mission trip | Describa brevemente sus propios objetivos y expectativas para este viaje de visi\u00f3n \/ misi\u00f3n<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_30' id='input_2_30' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_31' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_2_31' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"4\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"4\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_4' class='gform_page' data-js='page-field-id-31' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_2_4' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_2_32\" 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_2_32\" ><h2><strong>WAIVER OF LIABILITY<\/strong><\/h2><br><p><strong> (please read carefully)<\/strong><br \/>\n<p>I certify that my answers are true and complete to the best of my knowledge. I understand that any falsified\nstatements on this Application, or omissions of fact, either on this Application or during the pre-departure process,\nwill result in my application being rejected.\nI acknowledge that my purpose in participating in this expedition is to learn more for the ultimate purpose of\nsupporting the people of the Dominican Republic, and more specifically the beneficiaries of the programs.\nIn respect for my hosts and the beneficiaries, I will make effort to communicate any changes to my travel plans or\nschedule with the greatest advanced notice possible.<\/p><\/li><li id=\"field_2_61\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_61\" ><label class='gfield_label gform-field-label' for='input_2_61'>PRECAUTIONARY CORONAVIRUS DISEASE (COVID-19) PANDEMIC WAIVER AND RELEASE OF LIABILITY (type initials below) | (escriba las iniciales a continuaci\u00f3n)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_61'>Due to the coronavirus disease (COVID-19) pandemic, that is beyond our control, Bright Island Outreach is taking extra precautionary measures with the intake of each participant based on practices recommended by public health officials and related organizations. With that in mind, please read this carefully before accepting.\nTHIS IS A RELEASE OF LIABILITY AND A WAIVER OF CERTAIN LEGAL RIGHTS. BY SIGNING BELOW, YOU ARE ACKNOWLEDGING AND ACCEPTING THE FOLLOWING:\n\nI consent to having my temperatures taken by a\nrepresentative of Bright island Outreach upon entering any area of operation and to any other precautionary measures taken by Bright Island Outreach in striving to reduce potential exposure to COVID-19.\nI acknowledge and understand that Bright Island Outreach and it's representatives cannot guarantee that any precautionary measures taken by Bright Island Outreach\nwill fully protect anyone from being exposed to and\/or contracting COVID-19 or any other contagion.\nI understand the symptoms of COVID-19 include, but are not limited to:\n\u2022 Fever\n\u2022 Fatigue\n\u2022 Cough\n\u2022 Shortness of breath\nI affirm that I, each Participant, and all of our household members do not currently have any of the above symptoms and have not experienced any of the above symptoms within the last fourteen (14) days. In the event that I, any Participant, or any of our household members experiences any of the above symptoms after I sign this release, I agree that none of us will enter any Bright Island Outreach location until fourteen (14) days have elapsed since such person has experienced such symptom(s).\nI affirm that I, each Participant, and all of our household members have not been diagnosed with COVID-19 within the last thirty (30) days and have not been knowingly exposed to anyone diagnosed with COVID-19 within the last thirty (30) days. In the event that I, any Participant, or any of our household members is diagnosed with COVID-19 or is knowingly exposed to anyone diagnosed with COVID-19 after I sign this release, I agree that none of us will enter any Bright Island Outreach location until thirty (30) days have elapsed since such diagnosis or exposure.\nI affirm that I, any Participant, and all of our household members have not traveled to any location outside of my city of residence that is or has been considered a \u201chot spot\u201d for COVID-19 infections within the last fourteen (14) days. In the event that I, any Participant, or any of our household members travels to any such location after I sign this release, I agree that none of us will enter any Bright Island Outreach location until fourteen (14) days have elapsed since such person(s) traveled to such location. Accordingly, I, individually and on behalf of each Participant, agree to each statement above and I also hereby waive, release, indemnify, and forever hold harmless Bright Island Outreach and affiliates, and\ntheir respective owner(s), directors, officers, agents, employees, representatives, successors and\nassigns, administrators, and executors, as well as any location at which any Bright Island Outreach Program\nis conducted and each of their respective owner(s), directors, officers, agents, employees, representatives, successors and assigns, administrators, and executors (collectively, the \u201cReleased Parties\u201d) from all liabilities and claims for any injuries, losses, death, damages, or costs (including reasonable attorneys\u2019 and experts\u2019 fees) to myself, any Participant, my spouse, child, guests,\nunborn child(ren), or relatives which arise out of or are incident to any Participant\u2019s participation in any activities relating to the Bright Island Outreach Programs provided by any Bright Island Outreach location or my attendance at any activities relating to the program provided by any Bright Island Outreach program location including those caused by any negligent act or omission by any of the Released Parties, by anyone at or using any facility at which any Bright Island Outreach program is conducted, or as a result of a defective product. This provision will apply to ordinary acts of negligence but will not apply to gross acts\/omissions of negligence, willful, or wanton acts\/omissions, or those of an intentional\/criminal nature. <\/div><div class='ginput_container ginput_container_text'><input name='input_61' id='input_2_61' type='text' value='' class='small'  aria-describedby=\"gfield_description_2_61\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_63\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_63\" ><label class='gfield_label gform-field-label screen-reader-text' for='input_2_63'>In the event travel to the Dominican Republic is restricted, the organizers reserve the right to postpone and reschedule the mission.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_63'>In the event travel to the Dominican Republic is restricted, the organizers reserve the right to postpone and reschedule the mission.<\/div><div class='ginput_container ginput_container_text'><input name='input_63' id='input_2_63' type='text' value='' class='medium'  aria-describedby=\"gfield_description_2_63\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_33\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_33\" ><label class='gfield_label gform-field-label' for='input_2_33'>ASSUMPTION OF RISKS (type initials below) | ASUNCI\u00d3N DE RIESGOS (escriba las iniciales a continuaci\u00f3n)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_33'>I acknowledge that travel to, from and within any foreign country contains risks and potential losses and I assume all responsibility for myself and accompanying family members during my trip. Therefore, I release Dr. Eric Harris, and other expedition coordinators from any liability or damages. | Reconozco que viajar hacia, desde y dentro de cualquier pa\u00eds extranjero contiene riesgos y p\u00e9rdidas potenciales, y asumo toda la responsabilidad por m\u00ed y por los miembros de mi familia durante mi viaje. Por lo tanto, libero al Dr. Eric Harris y a otros coordinadores de expedici\u00f3n de cualquier responsabilidad o da\u00f1os.<\/div><div class='ginput_container ginput_container_text'><input name='input_33' id='input_2_33' type='text' value='' class='small'  aria-describedby=\"gfield_description_2_33\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_34\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_34\" ><label class='gfield_label gform-field-label' for='input_2_34'>PHOTOGRAPHY\/ VIDEO \/UPDATES CONSENT  (type initials below)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_34'>I grant permission to Dr. Eric Harris and other participants or representatives to take photographs and video of me and to use, edit, publish and reproduce all images and videos of me for promotional and marketing purposes, fundraising, and other publications or presentations sponsored by Dr. Eric Harris or his affiliates, without restriction and without compensation to me. I release Dr. Harris from all claims and liability with respect to any photographs or videos of me that they take, use, edit, publish, or reproduce.<\/div><div class='ginput_container ginput_container_text'><input name='input_34' id='input_2_34' type='text' value='' class='small'  aria-describedby=\"gfield_description_2_34\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_35\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_35\" ><label class='gfield_label gform-field-label' for='input_2_35'>ACKNOWLEDGEMENT OF UNDERSTANDING (type initials below) | RECONOCIMIENTO DE ENTENDIMIENTO (escriba las iniciales a continuaci\u00f3n)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_35'>I have read this agreement, fully understand its terms, and I understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing this agreement freely and voluntarily, and intend this agreement by my signature to be a complete and unconditional release of all liability of BRIGHT ISLAND OUTREACH. | He le\u00eddo este acuerdo, entiendo completamente sus t\u00e9rminos y entiendo que estoy renunciando a derechos sustanciales, incluido mi derecho a demandar. Reconozco que estoy firmando este acuerdo de forma libre y voluntaria, y pretendo que este acuerdo con mi firma sea una liberaci\u00f3n completa e incondicional de toda responsabilidad de BRIGHT ISLAND OUTREACH.<\/div><div class='ginput_container ginput_container_text'><input name='input_35' id='input_2_35' type='text' value='' class='small'  aria-describedby=\"gfield_description_2_35\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_36\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_36\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Please type full name | Por favor escriba el nombre completo<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_2_36'>\n                            \n                            <span id='input_2_36_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_36.3' id='input_2_36_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_2_36_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_2_36_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_36.6' id='input_2_36_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_2_36_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_2_37\" class=\"gfield gfield--type-signature gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_37\" ><label class='gfield_label gform-field-label' for='input_2_37'>Signature (full name) | Firma (nombre completo)<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_2_37_Container' class='gfield_signature_container ginput_container' style='height:180px; width:500px; ' ><input type='hidden' class='gform_hidden' name='input_2_37_valid' id='input_2_37_valid' \/><canvas id='input_2_37' width='500' height='180'><\/canvas><\/div><\/div><\/li><li id=\"field_2_38\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_38\" ><label class='gfield_label gform-field-label' for='input_2_38'>Date | Fecha<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_38' id='input_2_38' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_2_38_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_2_38_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_38' class='gform_hidden' value='https:\/\/brightislandoutreach.org\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_39' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_2_39' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"5\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"5\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_5' class='gform_page' data-js='page-field-id-39' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_2_5' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_2_40\" 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_2_40\" ><h2><strong>Liability Waiver and Assumption of Risk<\/strong><\/h2>\n<p>As you travel abroad, you are representing your family, your school, your community, and your country. The key to a successful trip is your open-mindedness and willingness to accept new cultures and the occasional inconveniences of international travel. If you keep your eyes and your mind open, you will bring home something of lasting value.<br>\nThe purpose of Bright Island Outreach is to attend to the needs of global communities that have little or no access to oral health care while providing health care professional school candidates with opportunities to experience and contribute to communities in need. It is in this spirit that we make this assumption of risk agreement for this trip.<br>\n\nEvent Description: Humanitarian Trip in Dominican Republic<\/p><\/li><li id=\"field_2_41\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_41\" ><label class='gfield_label gform-field-label' for='input_2_41'>Personal Responsibility (type initials below) | Responsabilidad personal (escriba las iniciales a continuaci\u00f3n)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_41'>I (undersigned name) understand that my participation in the 2024 Dominican Republic Humanitarian Expedition is subject to all of the following conditions, promises, agreements, and understandings. By signing this Release and Assumption of Risk Agreement, I understand that I am (1) agreeing to all of the following conditions and agreements; (2) making the stated promises; and (3) have the following understandings.\nI am solely responsible and liable for (1) obtaining all personal documentation appropriate for this trip including but not limited to, international passports and other forms of government issued identification; (2) paying all costs and expenses related to my participation in the program; (3) I am responsible for my punctuality, personal conduct, and personal belongings while traveling and (4) that the program is not responsible for the products or services provided by the host organization or the proper performance or presentation of their duties, obligations, products or services. | \n(Nombre abajo firmante) entiendo que mi participaci\u00f3n en la Expedici\u00f3n Humanitaria de Rep\u00fablica Dominicana 2024 est\u00e1 sujeta a todas las siguientes condiciones, promesas, acuerdos y entendimientos. Al firmar este Acuerdo de exenci\u00f3n y asunci\u00f3n de riesgos, entiendo que (1) estoy de acuerdo con todas las siguientes condiciones y acuerdos; (2) hacer las promesas establecidas; y (3) tienen los siguientes entendimientos.\nSoy el \u00fanico responsable de (1) obtener toda la documentaci\u00f3n personal apropiada para este viaje, incluidos, entre otros, pasaportes internacionales y otras formas de identificaci\u00f3n emitidas por el gobierno; (2) pagar todos los costos y gastos relacionados con mi participaci\u00f3n en el programa; (3) Soy responsable de mi puntualidad, conducta personal y pertenencias personales mientras viajo y (4) que el programa no es responsable de los productos o servicios proporcionados por la organizaci\u00f3n anfitriona o del desempe\u00f1o o presentaci\u00f3n adecuada de sus deberes, obligaciones, Productos o servicios.<\/div><div class='ginput_container ginput_container_text'><input name='input_41' id='input_2_41' type='text' value='' class='small'  aria-describedby=\"gfield_description_2_41\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_42\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_42\" ><label class='gfield_label gform-field-label' for='input_2_42'>Student Conduct Code (type initials below) | C\u00f3digo de conducta del estudiante (escriba las iniciales a continuaci\u00f3n)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_42'>I acknowledge that I have been advised regarding the Student Conduct Code associated with my affiliated educational institution and agree to abide by that code while participating in the program\/trip. Further, I agree and pledge that I will comply with all regulations and directions given me by staff members while participating in the program, including University officials, volunteers and employees of the host organizations, and all other officials acting within their official capacities. I agree that I will comply with all applicable laws of the jurisdictions in which I travel and will not engage in any conduct or behavior that causes potential harm to myself or others, or is disruptive to the trip, the sponsoring organization, the educational institution, or the organization hosting our stay. | Reconozco que me han informado sobre el C\u00f3digo de Conducta del Estudiante asociado con mi instituci\u00f3n educativa afiliada y acepto cumplir ese c\u00f3digo mientras participo en el programa \/ viaje. Adem\u00e1s, estoy de acuerdo y prometo que cumplir\u00e9 con todas las regulaciones e instrucciones que me dieron los miembros del personal mientras participo en el programa, incluidos los funcionarios de la Universidad, los voluntarios y los empleados de las organizaciones anfitrionas, y todos los dem\u00e1s funcionarios que act\u00faan dentro de sus capacidades oficiales. Acepto cumplir con todas las leyes aplicables de las jurisdicciones en las que viajo y no participar\u00e9 en ninguna conducta o comportamiento que pueda causarme da\u00f1o a m\u00ed mismo o a otros, o que sea perjudicial para el viaje, la organizaci\u00f3n patrocinadora, la instituci\u00f3n educativa, o la organizaci\u00f3n que aloja nuestra estad\u00eda.<\/div><div class='ginput_container ginput_container_text'><input name='input_42' id='input_2_42' type='text' value='' class='small'  aria-describedby=\"gfield_description_2_42\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_43\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_43\" ><label class='gfield_label gform-field-label' for='input_2_43'>Damages Waiver (type initials below) |  Exenci\u00f3n de da\u00f1os (escriba las iniciales a continuaci\u00f3n)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_43'>In consideration of approval for my personal attendance at the above-mentioned activity, I, for myself, my heirs, executors, administrators, and assigns, do waive, release, and discharge any and all rights, demands, or claims for damage and cause of suit or action known or unknown, that I may have against the State of Arizona, the affiliated educational institution, the sponsoring organization or their employees or agents for any or all injuries in any manner resulting from the above referenced class. I hereby authorize the event manager or their designee to request medical assistance as they find necessary and further attest and verify that I have full knowledge of all risks involved in this activity and that I will assume and pay my own medical and emergency expenses in the event of accident or illness regardless of whether I\u2019ve authorized such payments.| En consideraci\u00f3n a la aprobaci\u00f3n de mi asistencia personal a la actividad mencionada anteriormente, yo mismo, mis herederos, ejecutores, administradores y cesionarios, renuncio, libero y descargo todos y cada uno de los derechos, demandas o reclamos por da\u00f1os y causas. de demanda o acci\u00f3n conocida o desconocida, que pueda tener contra el Estado de Arizona, la instituci\u00f3n educativa afiliada, la organizaci\u00f3n patrocinadora o sus empleados o agentes por cualquiera o todas las lesiones de cualquier manera que resulten de la clase mencionada anteriormente. Por la presente, autorizo \u200b\u200bal administrador del evento o su designado a solicitar asistencia m\u00e9dica cuando lo consideren necesario y atestig\u00fce y verifique que tengo pleno conocimiento de todos los riesgos involucrados en esta actividad y que asumir\u00e9 y pagar\u00e9 mis propios gastos m\u00e9dicos y de emergencia en el evento de accidente o enfermedad, independientemente de si he autorizado dichos pagos.<\/div><div class='ginput_container ginput_container_text'><input name='input_43' id='input_2_43' type='text' value='' class='small'  aria-describedby=\"gfield_description_2_43\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_44\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_44\" ><label class='gfield_label gform-field-label' for='input_2_44'>Participation Termination (type initials below) | Terminaci\u00f3n de la participaci\u00f3n (escriba las iniciales a continuaci\u00f3n)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_44'>I understand and agree that the sponsoring organization and its affiliates shall have the right to enforce appropriate standards of conduct, and that they may at any time terminate my participation in the program\/trip for failure to maintain these standards OR for any actions or conduct which the sponsoring organization considers to be incompatible with the interests, harmony, comfort, and\/or welfare of the program and other participants. If my participation is terminated, I understand that I will be sent back at my own expense and with NO refund of any fees or costs. | \nEntiendo y acepto que la organizaci\u00f3n patrocinadora y sus afiliados tendr\u00e1n el derecho de hacer cumplir los est\u00e1ndares de conducta apropiados, y que en cualquier momento pueden terminar mi participaci\u00f3n en el programa \/ viaje por no mantener estos est\u00e1ndares O por cualquier acci\u00f3n o conducta que la organizaci\u00f3n patrocinadora considera que es incompatible con los intereses, la armon\u00eda, la comodidad y \/ o el bienestar del programa y otros participantes. Si se termina mi participaci\u00f3n, entiendo que se me enviar\u00e1 de vuelta a mi propio costo y SIN reembolso de ninguna tarifa o costo.<\/div><div class='ginput_container ginput_container_text'><input name='input_44' id='input_2_44' type='text' value='' class='small'  aria-describedby=\"gfield_description_2_44\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_45\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_45\" ><label class='gfield_label gform-field-label' for='input_2_45'>Medical Treatment (type initials AND select below) | Tratamiento m\u00e9dico (escriba iniciales Y seleccione a continuaci\u00f3n)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_45'>I AGREE, REPRESENT, and CONSENT that in the event of any medical emergency I do \/ do not (select one below) authorize and consent to any x-ray examination, anesthetic, medical, dental, or surgical diagnosis, treatment or hospital care that Bright Island Outreach and\/or its affiliates (including the organization advisor, program director, participating officials, or agents) deem necessary for my safety, health, or protection, and I FULLY RELEASE each of them from any liability for such decisions or actions taken in this regard. This consent includes, without limitation, an authorization to place me in a hospital for medical services or treatment or in the care of a local medical doctor. I certify that to my knowledge I have no medical conditions that would adversely affect my participation in the program. | ACEPTO, REPRESENTO y CONSENTIMIENTO que, en caso de cualquier emergencia m\u00e9dica, autorizo \u200b\u200b\/ no (seleccione uno a continuaci\u00f3n) autorizo \u200b\u200by consiento cualquier examen de rayos X, anestesia, diagn\u00f3stico m\u00e9dico, dental o quir\u00fargico, tratamiento o atenci\u00f3n hospitalaria que Bright Island Outreach y \/ o sus afiliados (incluido el asesor de la organizaci\u00f3n, el director del programa, los funcionarios participantes o los agentes) consideran necesarios para mi seguridad, salud o protecci\u00f3n, y LIBERO TOTALMENTE a cada uno de ellos de cualquier responsabilidad por tales decisiones o acciones tomadas a este respecto. Este consentimiento incluye, sin limitaci\u00f3n, una autorizaci\u00f3n para colocarme en un hospital para servicios o tratamiento m\u00e9dico o al cuidado de un m\u00e9dico local. Certifico que, a mi entender, no tengo afecciones m\u00e9dicas que afecten negativamente mi participaci\u00f3n en el programa.<\/div><div class='ginput_container ginput_container_text'><input name='input_45' id='input_2_45' type='text' value='' class='small'  aria-describedby=\"gfield_description_2_45\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_46\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_46\" ><label class='gfield_label gform-field-label' >Medical Treatment (please select one) | Tratamiento m\u00e9dico (seleccione uno)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_46'>\n\t\t\t<li class='gchoice gchoice_2_46_0'>\n\t\t\t\t<input name='input_46' type='radio' value='I DO consent | Doy mi consentimiento'  id='choice_2_46_0'    \/>\n\t\t\t\t<label for='choice_2_46_0' id='label_2_46_0' class='gform-field-label gform-field-label--type-inline'>I DO consent | Doy mi consentimiento<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_46_1'>\n\t\t\t\t<input name='input_46' type='radio' value='I DO NOT consent |  NO doy mi consentimiento'  id='choice_2_46_1'    \/>\n\t\t\t\t<label for='choice_2_46_1' id='label_2_46_1' class='gform-field-label gform-field-label--type-inline'>I DO NOT consent |  NO doy mi consentimiento<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_47\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_47\" ><label class='gfield_label gform-field-label' for='input_2_47'>Program Itinerary (type initials below) | Itinerario del Programa (escriba las iniciales a continuaci\u00f3n)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_47'>Bright Island Outreach reserves the right to modify and\/or change the Program Itinerary without notice. Every reasonable effort will be employed to operate the Program as planned; however, should unforeseen events and conditions require the itinerary to be altered or cancelled, BIO reserves the right to do so for the safety and best interest of the group. If these issues occur and BIO is forced to cancel a Program, BIO will attempt to rebook the Participant to an alternate program, subject to conditions and availability, and Force Majeure Terms and Conditions will apply. | Bright Island Outreach se reserva el derecho de modificar y\/o cambiar el itinerario del programa sin previo aviso. Se emplear\u00e1n todos los esfuerzos razonables para operar el Programa seg\u00fan lo planeado; Sin embargo, si eventos y condiciones imprevistos requieren que se modifique o cancele el itinerario, BIO se reserva el derecho de hacerlo por la seguridad y el mejor inter\u00e9s del grupo. Si ocurren estos problemas y BIO se ve obligado a cancelar un Programa, BIO intentar\u00e1 volver a reservar al Participante en un programa alternativo, sujeto a condiciones y disponibilidad, y se aplicar\u00e1n los T\u00e9rminos y Condiciones de Fuerza Mayor.<\/div><div class='ginput_container ginput_container_text'><input name='input_47' id='input_2_47' type='text' value='' class='small'  aria-describedby=\"gfield_description_2_47\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_64\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_64\" ><label class='gfield_label gform-field-label' for='input_2_64'>Refunds (type initials below) | Reembolsos (escriba las iniciales a continuaci\u00f3n)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_64'>I understand that the sponsoring organization reserves the right to make changes in cases of emergency or changed conditions or in the interest of the group. Any refunds necessarily prompted by any such actions will be determined in each individual case at the sole discretion of the sponsoring organization. | \nEntiendo que la organizaci\u00f3n patrocinadora se reserva el derecho de hacer cambios en casos de emergencia o condiciones cambiadas o en inter\u00e9s del grupo. Cualquier reembolso provocado necesariamente por tales acciones se determinar\u00e1 en cada caso individual a la sola discreci\u00f3n de la organizaci\u00f3n patrocinadora.<\/div><div class='ginput_container ginput_container_text'><input name='input_64' id='input_2_64' type='text' value='' class='small'  aria-describedby=\"gfield_description_2_64\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_48\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_48\" ><p><strong>I have read this Release and Assumption of Risks Agreement respecting the Humanitarian Trip in the Dominican Republic and understand and appreciate the risks I am assuming\nand voluntarily sign this Agreement to evidence my agreement to its terms and conditions.<\/strong><\/p><\/li><li id=\"field_2_49\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_49\" ><label class='gfield_label gform-field-label' for='input_2_49'>Printed Full Name |  Nombre completo<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_49' id='input_2_49' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_50\" class=\"gfield gfield--type-signature gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_50\" ><label class='gfield_label gform-field-label' for='input_2_50'>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_2_50_Container' class='gfield_signature_container ginput_container' style='height:180px; width:500px; ' ><input type='hidden' class='gform_hidden' name='input_2_50_valid' id='input_2_50_valid' \/><canvas id='input_2_50' width='500' height='180'><\/canvas><\/div><\/div><\/li><li id=\"field_2_51\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_51\" ><label class='gfield_label gform-field-label' for='input_2_51'>Date<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_51' id='input_2_51' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_2_51_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_2_51_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_51' class='gform_hidden' value='https:\/\/brightislandoutreach.org\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_52' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"4\"); 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Our preferred method of payment is through electronic check, or by mailing in a physical check. Please be advised there will be an additional fee of 3.9% for all credit card and PayPal processing. *Please note - Airfare is not included. <\/div><div class='ginput_container ginput_container_select'><select name='input_53' id='input_2_53' class='medium gfield_select'  aria-describedby=\"gfield_description_2_53\"   aria-invalid=\"false\" ><option value='PayPal April 18 - 21 | Boca Chica | Single Room Volunteer $2,597.50|2597.5' >PayPal April 18 - 21 | Boca Chica | Single Room Volunteer $2,597.50<\/option><option value='PayPal April 18 - 21 | Boca Chica | 2 Volunteer Shared Room $4,156.00|4156' >PayPal April 18 - 21 | Boca Chica | 2 Volunteer Shared Room $4,156.00<\/option><option value='PayPal June 1st - June 5th 2024 | Las Terrenas | Doctor $3,117|3117' >PayPal June 1st - June 5th 2024 | Las Terrenas | Doctor $3,117<\/option><option value='PayPal June 1st - June 5th 2024 | Las Terrenas | RDH, RDA, Non-Medical Volunteer $2,597.50|2597.5' >PayPal June 1st - June 5th 2024 | Las Terrenas | RDH, RDA, Non-Medical Volunteer $2,597.50<\/option><option value='PayPal June 1st - June 5th 2024 | Las Terrenas | Student $2,078|2078' >PayPal June 1st - June 5th 2024 | Las Terrenas | Student $2,078<\/option><option value='PayPal June 5th - June 9th 2024 | Las Terrenas | Doctor $3,117|3117' >PayPal June 5th - June 9th 2024 | Las Terrenas | Doctor $3,117<\/option><option value='PayPal June 5th - June 9th 2024 | Las Terrenas | RDH, RDA, Non-Medical Volunteer $2,597.50|2597.5' >PayPal June 5th - June 9th 2024 | Las Terrenas | RDH, RDA, Non-Medical Volunteer $2,597.50<\/option><option value='PayPal June 5th - June 9th 2024 | Las Terrenas | Student $2,078|2078' >PayPal June 5th - June 9th 2024 | Las Terrenas | Student $2,078<\/option><option value='PayPal Sept 21st - Sept 29th 2024 | Juan Dolio | Doctor $3,117|3117' >PayPal Sept 21st - Sept 29th 2024 | Juan Dolio | Doctor $3,117<\/option><option value='PayPal Sept 21st - Sept 29th 2024 | Juan Dolio | RDH, RDA, Non-Medical Volunteer $2,597.50|2597.5' >PayPal Sept 21st - Sept 29th 2024 | Juan Dolio | RDH, RDA, Non-Medical Volunteer $2,597.50<\/option><option value='PayPal Sept 21st - Sept 29th 2024 | Juan Dolio | Student $2,078|2078' >PayPal Sept 21st - Sept 29th 2024 | Juan Dolio | Student $2,078<\/option><option value='Registration Waiver Only|0' >Registration Waiver Only<\/option><\/select><\/div><\/li><li id=\"field_2_65\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_65\" ><label class='gfield_label gform-field-label' for='input_2_65'>Email<\/label><div class='ginput_container'><input name='input_65' id='input_2_65' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_2_65'>This field is for validation purposes and should be left unchanged.<\/div><\/li><\/ul><\/div>\n        <div 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!jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;}  jQuery(\"#gform_2\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=2&amp;title=&amp;description=&amp;tabindex=0&amp;theme=legacy' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_2' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='2' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_2' value='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' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_2' id='gform_target_page_number_2' value='2' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_2' id='gform_source_page_number_2' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/div><\/div>\n                        <\/form>\n                        <\/div>\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_2' id='gform_ajax_frame_2' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n\t\t                <script type=\"text\/javascript\">\ngform.initializeOnLoaded( function() {gformInitSpinner( 2, 'https:\/\/brightislandoutreach.org\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_2').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_2');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_2').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_2').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_2').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_2').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_2').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_2').val();gformInitSpinner( 2, 'https:\/\/brightislandoutreach.org\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [2, current_page]);window['gf_submitting_2'] = 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_2').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_2').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [2]);window['gf_submitting_2'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_2').text());}, 50);}else{jQuery('#gform_2').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"2\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);                if (event.defaultPrevented) {                return;         }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_2\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_2\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_2\" );        let postRenderFired = false;                function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            jQuery( document ).trigger( 'gform_post_render', [2, current_page] );            gform.utils.trigger( { event: 'gform\/postRender', native: false, data: { formId: 2, currentPage: current_page } } );            if ( visibilityTestDiv ) {                visibilityTestDiv.parentNode.removeChild( visibilityTestDiv );            }        }        function debounce( func, wait, immediate ) {            var timeout;            return function() {                var context = this, args = arguments;                var later = function() {                    timeout = null;                    if ( !immediate ) func.apply( context, args );                };                var callNow = immediate && !timeout;                clearTimeout( timeout );                timeout = setTimeout( later, wait );                if ( callNow ) func.apply( context, args );            };        }        const debouncedTriggerPostRender = debounce( function() {            triggerPostRender();        }, 200 );        if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) {            const observer = new MutationObserver( ( mutations ) => {                mutations.forEach( ( mutation ) => {                    if ( mutation.type === 'attributes' && visibilityTestDiv.offsetParent !== null ) {                        debouncedTriggerPostRender();                        observer.disconnect();                    }                });            });            observer.observe( document.body, {                attributes: true,                childList: false,                subtree: true,                attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} );\n<\/script>\n\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"\n                <div class='gf_browser_safari gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='1' id='gform_wrapper_2' ><div id='gf_2' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_2' id='gform_2'  action='\/wp-json\/wp\/v2\/pages\/195#gf_2' data-formid='2' novalidate><div id='gf_page_steps_2' class='gf_page_steps'><div id='gf_step_2_1' class='gf_step gf_step_active gf_step_first'><span class='gf_step_number'>1<\/span><span class='gf_step_label'><\/span><\/div><div id='gf_step_2_2' class='gf_step gf_step_next gf_step_pending'><span class='gf_step_number'>2<\/span><span class='gf_step_label'><\/span><\/div><div id='gf_step_2_3' class='gf_step gf_step_pending'><span class='gf_step_number'>3<\/span><span class='gf_step_label'><\/span><\/div><div id='gf_step_2_4' class='gf_step gf_step_pending'><span class='gf_step_number'>4<\/span><span class='gf_step_label'><\/span><\/div><div id='gf_step_2_5' class='gf_step gf_step_pending'><span class='gf_step_number'>5<\/span><span class='gf_step_label'><\/span><\/div><div id='gf_step_2_6' class='gf_step gf_step_last gf_step_pending'><span class='gf_step_number'>6<\/span><span class='gf_step_label'><\/span><\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_2_1' class='gform_page ' data-js='page-field-id-1' >\n                                    <div class='gform_page_fields'><ul id='gform_fields_2' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_2_1\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_1\" ><label class='gfield_label gform-field-label' for='input_2_1'>Choose your trip...<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_1'>Please select your trip dates and fill out the following form to register to Volunteer with BIO! \n*Payment instructions to secure your spot and trip details will be emailed to you after registration (Paypal is available for those that wish to use it).  *Please note - Airfare is not included. | Seleccione las fechas de su viaje y complete el siguiente formulario para registrarse como voluntario en BIO!\n*Las instrucciones de pago para asegurar su lugar y los detalles del viaje se le enviar\u00e1n por correo electr\u00f3nico despu\u00e9s del registro (Paypal est\u00e1 disponible para aquellos que deseen usarlo). * Nota: la tarifa a\u00e9rea no est\u00e1 incluida.<\/div><div class='ginput_container ginput_container_select'><select name='input_1' id='input_2_1' class='medium gfield_select'  aria-describedby=\"gfield_description_2_1\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='April 18 - 21 | Boca Chica Dbacks' >April 18 - 21 | Boca Chica Dbacks<\/option><option value='June 1st- June 5th 2024 | Doctor' >June 1st- June 5th 2024 | Las Terrenas | Doctor<\/option><option value='June 1st- June 5th 2024 | Las Terrenas | RDH, RDA, Non-Dental' >June 1st- June 5th 2024 | Las Terrenas | RDH, RDA, Non-Dental<\/option><option value='June 1st- June 5th 2024 | Las Terrenas | Student' >June 1st- June 5th 2024 | Las Terrenas | Student<\/option><option value='June 5th - June 9th 2024 | Las Terrenas | Doctor' >June 5th - June 9th 2024 | Las Terrenas | Doctor<\/option><option value='June 5th - June 9th 2024 | Las Terrenas | RDH, RDA, Non-Dental' >June 5th - June 9th 2024 | Las Terrenas | RDH, RDA, Non-Dental<\/option><option value='June 5th - June 9th 2024 | Las Terrenas | Student' >June 5th - June 9th 2024 | Las Terrenas | Student<\/option><option value='Sept 21st - 29th 2024 | Juan Dolio | Doctor' >Sept 21st - 29th 2024 | Juan Dolio | Doctor<\/option><option value='Sept 21st - 29th 2024 | Juan Dolio | RDH, RDA, Non-Dental' >Sept 21st - 29th 2024 | Juan Dolio | RDH, RDA, Non-Dental<\/option><option value='Sept 21st - 29th 2024 | Juan Dolios | Student' >Sept 21st - 29th 2024 | Juan Dolio | Student<\/option><option value='Revive Mission | Dental Yogis | Registration Only' >Revive Mission | Dental Yogis | Registration Only<\/option><\/select><\/div><\/li><li id=\"field_2_3\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_3\" ><label class='gfield_label gform-field-label' for='input_2_3'>Last Name | Apellido<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_2_3' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_4\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_4\" ><label class='gfield_label gform-field-label' for='input_2_4'>First Name | Primer Nombre<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_2_4' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_5\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_5\" ><label class='gfield_label gform-field-label' for='input_2_5'>Middle Initial |  Inicial del Segundo Nombre<\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_2_5' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_6\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_6\" ><label class='gfield_label gform-field-label' for='input_2_6'>Date of Birth | Fecha de Nacimiento<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_2_6' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_55\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_55\" ><label class='gfield_label gform-field-label' >Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_55'>\n\t\t\t<li class='gchoice gchoice_2_55_0'>\n\t\t\t\t<input name='input_55' type='radio' value='Female'  id='choice_2_55_0'    \/>\n\t\t\t\t<label for='choice_2_55_0' id='label_2_55_0' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_55_1'>\n\t\t\t\t<input name='input_55' type='radio' value='Male'  id='choice_2_55_1'    \/>\n\t\t\t\t<label for='choice_2_55_1' id='label_2_55_1' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_55_2'>\n\t\t\t\t<input name='input_55' type='radio' value='Other'  id='choice_2_55_2'    \/>\n\t\t\t\t<label for='choice_2_55_2' id='label_2_55_2' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_56\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_56\" ><label class='gfield_label gform-field-label' for='input_2_56'>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_56' id='input_2_56' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_2_8\" 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_2_8\" ><label class='gfield_label gform-field-label' >T-Shirt Size |  Talla de Camiseta<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_8'>\n\t\t\t<li class='gchoice gchoice_2_8_0'>\n\t\t\t\t<input name='input_8' type='radio' value='XS' checked='checked' id='choice_2_8_0'    \/>\n\t\t\t\t<label for='choice_2_8_0' id='label_2_8_0' class='gform-field-label gform-field-label--type-inline'>XS<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_8_1'>\n\t\t\t\t<input name='input_8' type='radio' value='S'  id='choice_2_8_1'    \/>\n\t\t\t\t<label for='choice_2_8_1' id='label_2_8_1' class='gform-field-label gform-field-label--type-inline'>S<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_8_2'>\n\t\t\t\t<input name='input_8' type='radio' value='M'  id='choice_2_8_2'    \/>\n\t\t\t\t<label for='choice_2_8_2' id='label_2_8_2' class='gform-field-label gform-field-label--type-inline'>M<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_8_3'>\n\t\t\t\t<input name='input_8' type='radio' value='L'  id='choice_2_8_3'    \/>\n\t\t\t\t<label for='choice_2_8_3' id='label_2_8_3' class='gform-field-label gform-field-label--type-inline'>L<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_8_4'>\n\t\t\t\t<input name='input_8' type='radio' value='XL'  id='choice_2_8_4'    \/>\n\t\t\t\t<label for='choice_2_8_4' id='label_2_8_4' class='gform-field-label gform-field-label--type-inline'>XL<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_8_5'>\n\t\t\t\t<input name='input_8' type='radio' value='gf_other_choice'  id='choice_2_8_5'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_2_8_other' name='input_8_other' type='text' value='Other' aria-label='Other' onfocus='jQuery(this).prev(\"input\")[0].click(); if(jQuery(this).val() == \"Other\") { jQuery(this).val(\"\"); }' onblur='if(jQuery(this).val().replace(\" \", \"\") == \"\") { jQuery(this).val(\"Other\"); }'   \/>\n\t\t\t<\/li><\/ul><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_2_10' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_2' class='gform_page' data-js='page-field-id-10' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_2_2' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_2_11\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_11\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Address |  Direcci\u00f3n<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \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_2_11' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_2_11_1_container' >\n                                        <input type='text' name='input_11.1' id='input_2_11_1' value=''    aria-required='true'    \/>\n                                        <label for='input_2_11_1' id='input_2_11_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_2_11_2_container' >\n                                        <input type='text' name='input_11.2' id='input_2_11_2' value=''     aria-required='false'   \/>\n                                        <label for='input_2_11_2' id='input_2_11_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_2_11_3_container' >\n                                    <input type='text' name='input_11.3' id='input_2_11_3' value=''    aria-required='true'    \/>\n                                    <label for='input_2_11_3' id='input_2_11_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_2_11_4_container' >\n                                        <input type='text' name='input_11.4' id='input_2_11_4' value=''      aria-required='true'    \/>\n                                        <label for='input_2_11_4' id='input_2_11_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_2_11_5_container' >\n                                    <input type='text' name='input_11.5' id='input_2_11_5' value=''    aria-required='true'    \/>\n                                    <label for='input_2_11_5' id='input_2_11_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_2_11_6_container' >\n                                        <select name='input_11.6' id='input_2_11_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >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' selected='selected'>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_2_11_6' id='input_2_11_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><\/li><li id=\"field_2_12\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_12\" ><label class='gfield_label gform-field-label' for='input_2_12'>Passport #<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_2_12' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_13\" class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_13\" ><label class='gfield_label gform-field-label' for='input_2_13'>Mobile Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_13' id='input_2_13' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_14\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_14\" ><label class='gfield_label gform-field-label' for='input_2_14'>Home Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_14' id='input_2_14' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_15\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_15\" ><label class='gfield_label gform-field-label' for='input_2_15'>Emergency Contact Name | Nombre del Contacto de Emergencia<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_2_15' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_16\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_16\" ><label class='gfield_label gform-field-label' for='input_2_16'>Relationship | Relaci\u00f3n<\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_2_16' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_17\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_17\" ><label class='gfield_label gform-field-label' for='input_2_17'>Emergency Contact Phone | N\u00famero de Tel\u00e9fono de Contacto de Emergencia<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_2_17' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_18' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"1\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"1\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_2_18' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_3' class='gform_page' data-js='page-field-id-18' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_2_3' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_2_19\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_19\" ><label class='gfield_label gform-field-label' >Occupation | Ocupaci\u00f3n<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_19'>\n\t\t\t<li class='gchoice gchoice_2_19_0'>\n\t\t\t\t<input name='input_19' type='radio' value='Student | Estudiante'  id='choice_2_19_0'    \/>\n\t\t\t\t<label for='choice_2_19_0' id='label_2_19_0' class='gform-field-label gform-field-label--type-inline'>Student | Estudiante<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_19_1'>\n\t\t\t\t<input name='input_19' type='radio' value='Employed | Empleado'  id='choice_2_19_1'    \/>\n\t\t\t\t<label for='choice_2_19_1' id='label_2_19_1' class='gform-field-label gform-field-label--type-inline'>Employed | Empleado<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_19_2'>\n\t\t\t\t<input name='input_19' type='radio' value='Other | Otro'  id='choice_2_19_2'    \/>\n\t\t\t\t<label for='choice_2_19_2' id='label_2_19_2' class='gform-field-label gform-field-label--type-inline'>Other | Otro<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_19_3'>\n\t\t\t\t<input name='input_19' type='radio' value='gf_other_choice'  id='choice_2_19_3'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_2_19_other' name='input_19_other' type='text' value='Other' aria-label='Other' onfocus='jQuery(this).prev(\"input\")[0].click(); if(jQuery(this).val() == \"Other\") { jQuery(this).val(\"\"); }' onblur='if(jQuery(this).val().replace(\" \", \"\") == \"\") { jQuery(this).val(\"Other\"); }'   \/>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_20\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_20\" ><label class='gfield_label gform-field-label' for='input_2_20'>Employed by | Empleado por<\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_2_20' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_22\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_22\" ><label class='gfield_label gform-field-label' >Will this be your first trip with BIO? | Ser\u00e1 este su primer viaje con BIO?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_22'>\n\t\t\t<li class='gchoice gchoice_2_22_0'>\n\t\t\t\t<input name='input_22' type='radio' value='Yes'  id='choice_2_22_0'    \/>\n\t\t\t\t<label for='choice_2_22_0' id='label_2_22_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_22_1'>\n\t\t\t\t<input name='input_22' type='radio' value='No'  id='choice_2_22_1'    \/>\n\t\t\t\t<label for='choice_2_22_1' id='label_2_22_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_23\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_23\" ><label class='gfield_label gform-field-label' for='input_2_23'>Who is your primary contact with BIO? | Qui\u00e9n es su contacto principal con BIO?<\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_2_23' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_24\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_24\" ><label class='gfield_label gform-field-label' for='input_2_24'>Name of your group\/organization (if applicable)? | Nombre de su grupo\/organizaci\u00f3n (si corresponde)?<\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_2_24' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_25\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_25\" ><label class='gfield_label gform-field-label' for='input_2_25'>List any family members traveling with you | Enumere a los miembros de la familia que viajan con usted<\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_2_25' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_27\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_27\" ><label class='gfield_label gform-field-label' >Please rate your proficiency in Spanish | Por favor califique su dominio del espa\u00f1ol<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_27'>\n\t\t\t<li class='gchoice gchoice_2_27_0'>\n\t\t\t\t<input name='input_27' type='radio' value='Fluent'  id='choice_2_27_0'    \/>\n\t\t\t\t<label for='choice_2_27_0' id='label_2_27_0' class='gform-field-label gform-field-label--type-inline'>Fluent<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_27_1'>\n\t\t\t\t<input name='input_27' type='radio' value='Workplace-Proficient'  id='choice_2_27_1'    \/>\n\t\t\t\t<label for='choice_2_27_1' id='label_2_27_1' class='gform-field-label gform-field-label--type-inline'>Workplace-Proficient<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_27_2'>\n\t\t\t\t<input name='input_27' type='radio' value='Conversational'  id='choice_2_27_2'    \/>\n\t\t\t\t<label for='choice_2_27_2' id='label_2_27_2' class='gform-field-label gform-field-label--type-inline'>Conversational<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_27_3'>\n\t\t\t\t<input name='input_27' type='radio' value='Beginner'  id='choice_2_27_3'    \/>\n\t\t\t\t<label for='choice_2_27_3' id='label_2_27_3' class='gform-field-label gform-field-label--type-inline'>Beginner<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_27_4'>\n\t\t\t\t<input name='input_27' type='radio' value='None'  id='choice_2_27_4'    \/>\n\t\t\t\t<label for='choice_2_27_4' id='label_2_27_4' class='gform-field-label gform-field-label--type-inline'>None<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_27_5'>\n\t\t\t\t<input name='input_27' type='radio' value='gf_other_choice'  id='choice_2_27_5'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_2_27_other' name='input_27_other' type='text' value='Other' aria-label='Other' onfocus='jQuery(this).prev(\"input\")[0].click(); if(jQuery(this).val() == \"Other\") { jQuery(this).val(\"\"); }' onblur='if(jQuery(this).val().replace(\" \", \"\") == \"\") { jQuery(this).val(\"Other\"); }'   \/>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_28\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_28\" ><label class='gfield_label gform-field-label' for='input_2_28'>Please provide some information about yourself (background, interests, hobbies, etc.) |  Proporcione cierta informaci\u00f3n sobre usted (antecedentes, intereses, pasatiempos, etc.)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_28' id='input_2_28' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_2_29\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_29\" ><label class='gfield_label gform-field-label' for='input_2_29'>Please list any health issues that we should know about | Enumere cualquier problema de salud que debamos saber<\/label><div class='gfield_description' id='gfield_description_2_29'>Our expeditions, at times, require a high level of physical demand and the weather can be hot and humid. Any information that would be useful for our team to know about will help us to better accommodate your needs (Allergies, physical limitations, asthma, pace maker, etc.) | Nuestras expediciones, a veces, requieren un alto nivel de demanda f\u00edsica y el clima puede ser c\u00e1lido y h\u00famedo. Cualquier informaci\u00f3n que sea \u00fatil para que nuestro equipo conozca nos ayudar\u00e1 a satisfacer mejor sus necesidades (alergias, limitaciones f\u00edsicas, asma, marcapasos, etc.)<\/div><div class='ginput_container ginput_container_text'><input name='input_29' id='input_2_29' type='text' value='' class='medium'  aria-describedby=\"gfield_description_2_29\"    aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_59\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_59\" ><label class='gfield_label gform-field-label' for='input_2_59'>Please indicate if you have any special dietary requirements and describe |  Indique si tiene alg\u00fan requerimiento diet\u00e9tico especial y descr\u00edbalo.<\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_2_59' type='text' value='' class='medium'  aria-describedby=\"gfield_description_2_59\"    aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_2_59'>If you have a dietary restriction please let us know well in advance so we can prepare | Si tiene una restricci\u00f3n diet\u00e9tica, inf\u00f3rmenos con anticipaci\u00f3n para que podamos prepararnos<\/div><\/li><li id=\"field_2_30\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_30\" ><label class='gfield_label gform-field-label' for='input_2_30'>Briefly describe your own objectives and expectations for this vision\/mission trip | Describa brevemente sus propios objetivos y expectativas para este viaje de visi\u00f3n \/ misi\u00f3n<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_30' id='input_2_30' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_31' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"2\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_2_31' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"4\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"4\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_4' class='gform_page' data-js='page-field-id-31' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_2_4' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_2_32\" 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_2_32\" ><h2><strong>WAIVER OF LIABILITY<\/strong><\/h2><br><p><strong> (please read carefully)<\/strong><br \/>\n<p>I certify that my answers are true and complete to the best of my knowledge. I understand that any falsified\nstatements on this Application, or omissions of fact, either on this Application or during the pre-departure process,\nwill result in my application being rejected.\nI acknowledge that my purpose in participating in this expedition is to learn more for the ultimate purpose of\nsupporting the people of the Dominican Republic, and more specifically the beneficiaries of the programs.\nIn respect for my hosts and the beneficiaries, I will make effort to communicate any changes to my travel plans or\nschedule with the greatest advanced notice possible.<\/p><\/li><li id=\"field_2_61\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_61\" ><label class='gfield_label gform-field-label' for='input_2_61'>PRECAUTIONARY CORONAVIRUS DISEASE (COVID-19) PANDEMIC WAIVER AND RELEASE OF LIABILITY (type initials below) | (escriba las iniciales a continuaci\u00f3n)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_61'>Due to the coronavirus disease (COVID-19) pandemic, that is beyond our control, Bright Island Outreach is taking extra precautionary measures with the intake of each participant based on practices recommended by public health officials and related organizations. With that in mind, please read this carefully before accepting.\nTHIS IS A RELEASE OF LIABILITY AND A WAIVER OF CERTAIN LEGAL RIGHTS. BY SIGNING BELOW, YOU ARE ACKNOWLEDGING AND ACCEPTING THE FOLLOWING:\n\nI consent to having my temperatures taken by a\nrepresentative of Bright island Outreach upon entering any area of operation and to any other precautionary measures taken by Bright Island Outreach in striving to reduce potential exposure to COVID-19.\nI acknowledge and understand that Bright Island Outreach and it's representatives cannot guarantee that any precautionary measures taken by Bright Island Outreach\nwill fully protect anyone from being exposed to and\/or contracting COVID-19 or any other contagion.\nI understand the symptoms of COVID-19 include, but are not limited to:\n\u2022 Fever\n\u2022 Fatigue\n\u2022 Cough\n\u2022 Shortness of breath\nI affirm that I, each Participant, and all of our household members do not currently have any of the above symptoms and have not experienced any of the above symptoms within the last fourteen (14) days. In the event that I, any Participant, or any of our household members experiences any of the above symptoms after I sign this release, I agree that none of us will enter any Bright Island Outreach location until fourteen (14) days have elapsed since such person has experienced such symptom(s).\nI affirm that I, each Participant, and all of our household members have not been diagnosed with COVID-19 within the last thirty (30) days and have not been knowingly exposed to anyone diagnosed with COVID-19 within the last thirty (30) days. In the event that I, any Participant, or any of our household members is diagnosed with COVID-19 or is knowingly exposed to anyone diagnosed with COVID-19 after I sign this release, I agree that none of us will enter any Bright Island Outreach location until thirty (30) days have elapsed since such diagnosis or exposure.\nI affirm that I, any Participant, and all of our household members have not traveled to any location outside of my city of residence that is or has been considered a \u201chot spot\u201d for COVID-19 infections within the last fourteen (14) days. In the event that I, any Participant, or any of our household members travels to any such location after I sign this release, I agree that none of us will enter any Bright Island Outreach location until fourteen (14) days have elapsed since such person(s) traveled to such location. Accordingly, I, individually and on behalf of each Participant, agree to each statement above and I also hereby waive, release, indemnify, and forever hold harmless Bright Island Outreach and affiliates, and\ntheir respective owner(s), directors, officers, agents, employees, representatives, successors and\nassigns, administrators, and executors, as well as any location at which any Bright Island Outreach Program\nis conducted and each of their respective owner(s), directors, officers, agents, employees, representatives, successors and assigns, administrators, and executors (collectively, the \u201cReleased Parties\u201d) from all liabilities and claims for any injuries, losses, death, damages, or costs (including reasonable attorneys\u2019 and experts\u2019 fees) to myself, any Participant, my spouse, child, guests,\nunborn child(ren), or relatives which arise out of or are incident to any Participant\u2019s participation in any activities relating to the Bright Island Outreach Programs provided by any Bright Island Outreach location or my attendance at any activities relating to the program provided by any Bright Island Outreach program location including those caused by any negligent act or omission by any of the Released Parties, by anyone at or using any facility at which any Bright Island Outreach program is conducted, or as a result of a defective product. This provision will apply to ordinary acts of negligence but will not apply to gross acts\/omissions of negligence, willful, or wanton acts\/omissions, or those of an intentional\/criminal nature. <\/div><div class='ginput_container ginput_container_text'><input name='input_61' id='input_2_61' type='text' value='' class='small'  aria-describedby=\"gfield_description_2_61\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_63\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_63\" ><label class='gfield_label gform-field-label screen-reader-text' for='input_2_63'>In the event travel to the Dominican Republic is restricted, the organizers reserve the right to postpone and reschedule the mission.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_63'>In the event travel to the Dominican Republic is restricted, the organizers reserve the right to postpone and reschedule the mission.<\/div><div class='ginput_container ginput_container_text'><input name='input_63' id='input_2_63' type='text' value='' class='medium'  aria-describedby=\"gfield_description_2_63\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_33\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_33\" ><label class='gfield_label gform-field-label' for='input_2_33'>ASSUMPTION OF RISKS (type initials below) | ASUNCI\u00d3N DE RIESGOS (escriba las iniciales a continuaci\u00f3n)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_33'>I acknowledge that travel to, from and within any foreign country contains risks and potential losses and I assume all responsibility for myself and accompanying family members during my trip. Therefore, I release Dr. Eric Harris, and other expedition coordinators from any liability or damages. | Reconozco que viajar hacia, desde y dentro de cualquier pa\u00eds extranjero contiene riesgos y p\u00e9rdidas potenciales, y asumo toda la responsabilidad por m\u00ed y por los miembros de mi familia durante mi viaje. Por lo tanto, libero al Dr. Eric Harris y a otros coordinadores de expedici\u00f3n de cualquier responsabilidad o da\u00f1os.<\/div><div class='ginput_container ginput_container_text'><input name='input_33' id='input_2_33' type='text' value='' class='small'  aria-describedby=\"gfield_description_2_33\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_34\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_34\" ><label class='gfield_label gform-field-label' for='input_2_34'>PHOTOGRAPHY\/ VIDEO \/UPDATES CONSENT  (type initials below)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_34'>I grant permission to Dr. Eric Harris and other participants or representatives to take photographs and video of me and to use, edit, publish and reproduce all images and videos of me for promotional and marketing purposes, fundraising, and other publications or presentations sponsored by Dr. Eric Harris or his affiliates, without restriction and without compensation to me. I release Dr. Harris from all claims and liability with respect to any photographs or videos of me that they take, use, edit, publish, or reproduce.<\/div><div class='ginput_container ginput_container_text'><input name='input_34' id='input_2_34' type='text' value='' class='small'  aria-describedby=\"gfield_description_2_34\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_35\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_35\" ><label class='gfield_label gform-field-label' for='input_2_35'>ACKNOWLEDGEMENT OF UNDERSTANDING (type initials below) | RECONOCIMIENTO DE ENTENDIMIENTO (escriba las iniciales a continuaci\u00f3n)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_35'>I have read this agreement, fully understand its terms, and I understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing this agreement freely and voluntarily, and intend this agreement by my signature to be a complete and unconditional release of all liability of BRIGHT ISLAND OUTREACH. | He le\u00eddo este acuerdo, entiendo completamente sus t\u00e9rminos y entiendo que estoy renunciando a derechos sustanciales, incluido mi derecho a demandar. Reconozco que estoy firmando este acuerdo de forma libre y voluntaria, y pretendo que este acuerdo con mi firma sea una liberaci\u00f3n completa e incondicional de toda responsabilidad de BRIGHT ISLAND OUTREACH.<\/div><div class='ginput_container ginput_container_text'><input name='input_35' id='input_2_35' type='text' value='' class='small'  aria-describedby=\"gfield_description_2_35\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_36\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_36\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Please type full name | Por favor escriba el nombre completo<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_2_36'>\n                            \n                            <span id='input_2_36_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_36.3' id='input_2_36_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_2_36_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_2_36_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_36.6' id='input_2_36_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_2_36_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_2_37\" class=\"gfield gfield--type-signature gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_37\" ><label class='gfield_label gform-field-label' for='input_2_37'>Signature (full name) | Firma (nombre completo)<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_2_37_Container' class='gfield_signature_container ginput_container' style='height:180px; width:500px; ' ><input type='hidden' class='gform_hidden' name='input_2_37_valid' id='input_2_37_valid' \/><canvas id='input_2_37' width='500' height='180'><\/canvas><\/div><\/div><\/li><li id=\"field_2_38\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_38\" ><label class='gfield_label gform-field-label' for='input_2_38'>Date | Fecha<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_38' id='input_2_38' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_2_38_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_2_38_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_38' class='gform_hidden' value='https:\/\/brightislandoutreach.org\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_39' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"3\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_2_39' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"5\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_2\").val(\"5\");  jQuery(\"#gform_2\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_5' class='gform_page' data-js='page-field-id-39' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_2_5' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_2_40\" 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_2_40\" ><h2><strong>Liability Waiver and Assumption of Risk<\/strong><\/h2>\n<p>As you travel abroad, you are representing your family, your school, your community, and your country. The key to a successful trip is your open-mindedness and willingness to accept new cultures and the occasional inconveniences of international travel. If you keep your eyes and your mind open, you will bring home something of lasting value.<br>\nThe purpose of Bright Island Outreach is to attend to the needs of global communities that have little or no access to oral health care while providing health care professional school candidates with opportunities to experience and contribute to communities in need. It is in this spirit that we make this assumption of risk agreement for this trip.<br>\n\nEvent Description: Humanitarian Trip in Dominican Republic<\/p><\/li><li id=\"field_2_41\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_41\" ><label class='gfield_label gform-field-label' for='input_2_41'>Personal Responsibility (type initials below) | Responsabilidad personal (escriba las iniciales a continuaci\u00f3n)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_41'>I (undersigned name) understand that my participation in the 2024 Dominican Republic Humanitarian Expedition is subject to all of the following conditions, promises, agreements, and understandings. By signing this Release and Assumption of Risk Agreement, I understand that I am (1) agreeing to all of the following conditions and agreements; (2) making the stated promises; and (3) have the following understandings.\nI am solely responsible and liable for (1) obtaining all personal documentation appropriate for this trip including but not limited to, international passports and other forms of government issued identification; (2) paying all costs and expenses related to my participation in the program; (3) I am responsible for my punctuality, personal conduct, and personal belongings while traveling and (4) that the program is not responsible for the products or services provided by the host organization or the proper performance or presentation of their duties, obligations, products or services. | \n(Nombre abajo firmante) entiendo que mi participaci\u00f3n en la Expedici\u00f3n Humanitaria de Rep\u00fablica Dominicana 2024 est\u00e1 sujeta a todas las siguientes condiciones, promesas, acuerdos y entendimientos. Al firmar este Acuerdo de exenci\u00f3n y asunci\u00f3n de riesgos, entiendo que (1) estoy de acuerdo con todas las siguientes condiciones y acuerdos; (2) hacer las promesas establecidas; y (3) tienen los siguientes entendimientos.\nSoy el \u00fanico responsable de (1) obtener toda la documentaci\u00f3n personal apropiada para este viaje, incluidos, entre otros, pasaportes internacionales y otras formas de identificaci\u00f3n emitidas por el gobierno; (2) pagar todos los costos y gastos relacionados con mi participaci\u00f3n en el programa; (3) Soy responsable de mi puntualidad, conducta personal y pertenencias personales mientras viajo y (4) que el programa no es responsable de los productos o servicios proporcionados por la organizaci\u00f3n anfitriona o del desempe\u00f1o o presentaci\u00f3n adecuada de sus deberes, obligaciones, Productos o servicios.<\/div><div class='ginput_container ginput_container_text'><input name='input_41' id='input_2_41' type='text' value='' class='small'  aria-describedby=\"gfield_description_2_41\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_42\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_42\" ><label class='gfield_label gform-field-label' for='input_2_42'>Student Conduct Code (type initials below) | C\u00f3digo de conducta del estudiante (escriba las iniciales a continuaci\u00f3n)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_42'>I acknowledge that I have been advised regarding the Student Conduct Code associated with my affiliated educational institution and agree to abide by that code while participating in the program\/trip. Further, I agree and pledge that I will comply with all regulations and directions given me by staff members while participating in the program, including University officials, volunteers and employees of the host organizations, and all other officials acting within their official capacities. I agree that I will comply with all applicable laws of the jurisdictions in which I travel and will not engage in any conduct or behavior that causes potential harm to myself or others, or is disruptive to the trip, the sponsoring organization, the educational institution, or the organization hosting our stay. | Reconozco que me han informado sobre el C\u00f3digo de Conducta del Estudiante asociado con mi instituci\u00f3n educativa afiliada y acepto cumplir ese c\u00f3digo mientras participo en el programa \/ viaje. Adem\u00e1s, estoy de acuerdo y prometo que cumplir\u00e9 con todas las regulaciones e instrucciones que me dieron los miembros del personal mientras participo en el programa, incluidos los funcionarios de la Universidad, los voluntarios y los empleados de las organizaciones anfitrionas, y todos los dem\u00e1s funcionarios que act\u00faan dentro de sus capacidades oficiales. Acepto cumplir con todas las leyes aplicables de las jurisdicciones en las que viajo y no participar\u00e9 en ninguna conducta o comportamiento que pueda causarme da\u00f1o a m\u00ed mismo o a otros, o que sea perjudicial para el viaje, la organizaci\u00f3n patrocinadora, la instituci\u00f3n educativa, o la organizaci\u00f3n que aloja nuestra estad\u00eda.<\/div><div class='ginput_container ginput_container_text'><input name='input_42' id='input_2_42' type='text' value='' class='small'  aria-describedby=\"gfield_description_2_42\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_43\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_43\" ><label class='gfield_label gform-field-label' for='input_2_43'>Damages Waiver (type initials below) |  Exenci\u00f3n de da\u00f1os (escriba las iniciales a continuaci\u00f3n)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_43'>In consideration of approval for my personal attendance at the above-mentioned activity, I, for myself, my heirs, executors, administrators, and assigns, do waive, release, and discharge any and all rights, demands, or claims for damage and cause of suit or action known or unknown, that I may have against the State of Arizona, the affiliated educational institution, the sponsoring organization or their employees or agents for any or all injuries in any manner resulting from the above referenced class. I hereby authorize the event manager or their designee to request medical assistance as they find necessary and further attest and verify that I have full knowledge of all risks involved in this activity and that I will assume and pay my own medical and emergency expenses in the event of accident or illness regardless of whether I\u2019ve authorized such payments.| En consideraci\u00f3n a la aprobaci\u00f3n de mi asistencia personal a la actividad mencionada anteriormente, yo mismo, mis herederos, ejecutores, administradores y cesionarios, renuncio, libero y descargo todos y cada uno de los derechos, demandas o reclamos por da\u00f1os y causas. de demanda o acci\u00f3n conocida o desconocida, que pueda tener contra el Estado de Arizona, la instituci\u00f3n educativa afiliada, la organizaci\u00f3n patrocinadora o sus empleados o agentes por cualquiera o todas las lesiones de cualquier manera que resulten de la clase mencionada anteriormente. Por la presente, autorizo \u200b\u200bal administrador del evento o su designado a solicitar asistencia m\u00e9dica cuando lo consideren necesario y atestig\u00fce y verifique que tengo pleno conocimiento de todos los riesgos involucrados en esta actividad y que asumir\u00e9 y pagar\u00e9 mis propios gastos m\u00e9dicos y de emergencia en el evento de accidente o enfermedad, independientemente de si he autorizado dichos pagos.<\/div><div class='ginput_container ginput_container_text'><input name='input_43' id='input_2_43' type='text' value='' class='small'  aria-describedby=\"gfield_description_2_43\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_44\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_44\" ><label class='gfield_label gform-field-label' for='input_2_44'>Participation Termination (type initials below) | Terminaci\u00f3n de la participaci\u00f3n (escriba las iniciales a continuaci\u00f3n)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_44'>I understand and agree that the sponsoring organization and its affiliates shall have the right to enforce appropriate standards of conduct, and that they may at any time terminate my participation in the program\/trip for failure to maintain these standards OR for any actions or conduct which the sponsoring organization considers to be incompatible with the interests, harmony, comfort, and\/or welfare of the program and other participants. If my participation is terminated, I understand that I will be sent back at my own expense and with NO refund of any fees or costs. | \nEntiendo y acepto que la organizaci\u00f3n patrocinadora y sus afiliados tendr\u00e1n el derecho de hacer cumplir los est\u00e1ndares de conducta apropiados, y que en cualquier momento pueden terminar mi participaci\u00f3n en el programa \/ viaje por no mantener estos est\u00e1ndares O por cualquier acci\u00f3n o conducta que la organizaci\u00f3n patrocinadora considera que es incompatible con los intereses, la armon\u00eda, la comodidad y \/ o el bienestar del programa y otros participantes. Si se termina mi participaci\u00f3n, entiendo que se me enviar\u00e1 de vuelta a mi propio costo y SIN reembolso de ninguna tarifa o costo.<\/div><div class='ginput_container ginput_container_text'><input name='input_44' id='input_2_44' type='text' value='' class='small'  aria-describedby=\"gfield_description_2_44\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_45\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_45\" ><label class='gfield_label gform-field-label' for='input_2_45'>Medical Treatment (type initials AND select below) | Tratamiento m\u00e9dico (escriba iniciales Y seleccione a continuaci\u00f3n)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_45'>I AGREE, REPRESENT, and CONSENT that in the event of any medical emergency I do \/ do not (select one below) authorize and consent to any x-ray examination, anesthetic, medical, dental, or surgical diagnosis, treatment or hospital care that Bright Island Outreach and\/or its affiliates (including the organization advisor, program director, participating officials, or agents) deem necessary for my safety, health, or protection, and I FULLY RELEASE each of them from any liability for such decisions or actions taken in this regard. This consent includes, without limitation, an authorization to place me in a hospital for medical services or treatment or in the care of a local medical doctor. I certify that to my knowledge I have no medical conditions that would adversely affect my participation in the program. | ACEPTO, REPRESENTO y CONSENTIMIENTO que, en caso de cualquier emergencia m\u00e9dica, autorizo \u200b\u200b\/ no (seleccione uno a continuaci\u00f3n) autorizo \u200b\u200by consiento cualquier examen de rayos X, anestesia, diagn\u00f3stico m\u00e9dico, dental o quir\u00fargico, tratamiento o atenci\u00f3n hospitalaria que Bright Island Outreach y \/ o sus afiliados (incluido el asesor de la organizaci\u00f3n, el director del programa, los funcionarios participantes o los agentes) consideran necesarios para mi seguridad, salud o protecci\u00f3n, y LIBERO TOTALMENTE a cada uno de ellos de cualquier responsabilidad por tales decisiones o acciones tomadas a este respecto. Este consentimiento incluye, sin limitaci\u00f3n, una autorizaci\u00f3n para colocarme en un hospital para servicios o tratamiento m\u00e9dico o al cuidado de un m\u00e9dico local. Certifico que, a mi entender, no tengo afecciones m\u00e9dicas que afecten negativamente mi participaci\u00f3n en el programa.<\/div><div class='ginput_container ginput_container_text'><input name='input_45' id='input_2_45' type='text' value='' class='small'  aria-describedby=\"gfield_description_2_45\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_46\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_46\" ><label class='gfield_label gform-field-label' >Medical Treatment (please select one) | Tratamiento m\u00e9dico (seleccione uno)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_46'>\n\t\t\t<li class='gchoice gchoice_2_46_0'>\n\t\t\t\t<input name='input_46' type='radio' value='I DO consent | Doy mi consentimiento'  id='choice_2_46_0'    \/>\n\t\t\t\t<label for='choice_2_46_0' id='label_2_46_0' class='gform-field-label gform-field-label--type-inline'>I DO consent | Doy mi consentimiento<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_46_1'>\n\t\t\t\t<input name='input_46' type='radio' value='I DO NOT consent |  NO doy mi consentimiento'  id='choice_2_46_1'    \/>\n\t\t\t\t<label for='choice_2_46_1' id='label_2_46_1' class='gform-field-label gform-field-label--type-inline'>I DO NOT consent |  NO doy mi consentimiento<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_47\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_47\" ><label class='gfield_label gform-field-label' for='input_2_47'>Program Itinerary (type initials below) | Itinerario del Programa (escriba las iniciales a continuaci\u00f3n)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_47'>Bright Island Outreach reserves the right to modify and\/or change the Program Itinerary without notice. Every reasonable effort will be employed to operate the Program as planned; however, should unforeseen events and conditions require the itinerary to be altered or cancelled, BIO reserves the right to do so for the safety and best interest of the group. If these issues occur and BIO is forced to cancel a Program, BIO will attempt to rebook the Participant to an alternate program, subject to conditions and availability, and Force Majeure Terms and Conditions will apply. | Bright Island Outreach se reserva el derecho de modificar y\/o cambiar el itinerario del programa sin previo aviso. Se emplear\u00e1n todos los esfuerzos razonables para operar el Programa seg\u00fan lo planeado; Sin embargo, si eventos y condiciones imprevistos requieren que se modifique o cancele el itinerario, BIO se reserva el derecho de hacerlo por la seguridad y el mejor inter\u00e9s del grupo. Si ocurren estos problemas y BIO se ve obligado a cancelar un Programa, BIO intentar\u00e1 volver a reservar al Participante en un programa alternativo, sujeto a condiciones y disponibilidad, y se aplicar\u00e1n los T\u00e9rminos y Condiciones de Fuerza Mayor.<\/div><div class='ginput_container ginput_container_text'><input name='input_47' id='input_2_47' type='text' value='' class='small'  aria-describedby=\"gfield_description_2_47\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_64\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_64\" ><label class='gfield_label gform-field-label' for='input_2_64'>Refunds (type initials below) | Reembolsos (escriba las iniciales a continuaci\u00f3n)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_2_64'>I understand that the sponsoring organization reserves the right to make changes in cases of emergency or changed conditions or in the interest of the group. Any refunds necessarily prompted by any such actions will be determined in each individual case at the sole discretion of the sponsoring organization. | \nEntiendo que la organizaci\u00f3n patrocinadora se reserva el derecho de hacer cambios en casos de emergencia o condiciones cambiadas o en inter\u00e9s del grupo. Cualquier reembolso provocado necesariamente por tales acciones se determinar\u00e1 en cada caso individual a la sola discreci\u00f3n de la organizaci\u00f3n patrocinadora.<\/div><div class='ginput_container ginput_container_text'><input name='input_64' id='input_2_64' type='text' value='' class='small'  aria-describedby=\"gfield_description_2_64\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_48\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_48\" ><p><strong>I have read this Release and Assumption of Risks Agreement respecting the Humanitarian Trip in the Dominican Republic and understand and appreciate the risks I am assuming\nand voluntarily sign this Agreement to evidence my agreement to its terms and conditions.<\/strong><\/p><\/li><li id=\"field_2_49\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_49\" ><label class='gfield_label gform-field-label' for='input_2_49'>Printed Full Name |  Nombre completo<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_49' id='input_2_49' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_50\" class=\"gfield gfield--type-signature gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_50\" ><label class='gfield_label gform-field-label' for='input_2_50'>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_2_50_Container' class='gfield_signature_container ginput_container' style='height:180px; width:500px; ' ><input type='hidden' class='gform_hidden' name='input_2_50_valid' id='input_2_50_valid' \/><canvas id='input_2_50' width='500' height='180'><\/canvas><\/div><\/div><\/li><li id=\"field_2_51\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_2_51\" ><label class='gfield_label gform-field-label' for='input_2_51'>Date<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_51' id='input_2_51' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_2_51_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_2_51_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_51' class='gform_hidden' value='https:\/\/brightislandoutreach.org\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_52' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_2\").val(\"4\"); 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Our preferred method of payment is through electronic check, or by mailing in a physical check. Please be advised there will be an additional fee of 3.9% for all credit card and PayPal processing. *Please note - Airfare is not included. <\/div><div class='ginput_container ginput_container_select'><select name='input_53' id='input_2_53' class='medium gfield_select'  aria-describedby=\"gfield_description_2_53\"   aria-invalid=\"false\" ><option value='PayPal April 18 - 21 | Boca Chica | Single Room Volunteer $2,597.50|2597.5' >PayPal April 18 - 21 | Boca Chica | Single Room Volunteer $2,597.50<\/option><option value='PayPal April 18 - 21 | Boca Chica | 2 Volunteer Shared Room $4,156.00|4156' >PayPal April 18 - 21 | Boca Chica | 2 Volunteer Shared Room $4,156.00<\/option><option value='PayPal June 1st - June 5th 2024 | Las Terrenas | Doctor $3,117|3117' >PayPal June 1st - June 5th 2024 | Las Terrenas | Doctor $3,117<\/option><option value='PayPal June 1st - June 5th 2024 | Las Terrenas | RDH, RDA, Non-Medical Volunteer $2,597.50|2597.5' >PayPal June 1st - June 5th 2024 | Las Terrenas | RDH, RDA, Non-Medical Volunteer $2,597.50<\/option><option value='PayPal June 1st - June 5th 2024 | Las Terrenas | Student $2,078|2078' >PayPal June 1st - June 5th 2024 | Las Terrenas | Student $2,078<\/option><option value='PayPal June 5th - June 9th 2024 | Las Terrenas | Doctor $3,117|3117' >PayPal June 5th - June 9th 2024 | Las Terrenas | Doctor $3,117<\/option><option value='PayPal June 5th - June 9th 2024 | Las Terrenas | RDH, RDA, Non-Medical Volunteer $2,597.50|2597.5' >PayPal June 5th - June 9th 2024 | Las Terrenas | RDH, RDA, Non-Medical Volunteer $2,597.50<\/option><option value='PayPal June 5th - June 9th 2024 | Las Terrenas | Student $2,078|2078' >PayPal June 5th - June 9th 2024 | Las Terrenas | Student $2,078<\/option><option value='PayPal Sept 21st - Sept 29th 2024 | Juan Dolio | Doctor $3,117|3117' >PayPal Sept 21st - Sept 29th 2024 | Juan Dolio | Doctor $3,117<\/option><option value='PayPal Sept 21st - Sept 29th 2024 | Juan Dolio | RDH, RDA, Non-Medical Volunteer $2,597.50|2597.5' >PayPal Sept 21st - Sept 29th 2024 | Juan Dolio | RDH, RDA, Non-Medical Volunteer $2,597.50<\/option><option value='PayPal Sept 21st - Sept 29th 2024 | Juan Dolio | Student $2,078|2078' >PayPal Sept 21st - Sept 29th 2024 | Juan Dolio | Student $2,078<\/option><option value='Registration Waiver Only|0' >Registration Waiver Only<\/option><\/select><\/div><\/li><li id=\"field_2_65\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_2_65\" ><label class='gfield_label gform-field-label' for='input_2_65'>Email<\/label><div class='ginput_container'><input name='input_65' id='input_2_65' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_2_65'>This field is for validation purposes and should be left unchanged.<\/div><\/li><\/ul><\/div>\n        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_2' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='if(window[\"gf_submitting_2\"]){return false;}  if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_2\"]){return false;} if( !jQuery(\"#gform_2\")[0].checkValidity || jQuery(\"#gform_2\")[0].checkValidity()){window[\"gf_submitting_2\"]=true;}  jQuery(\"#gform_2\").trigger(\"submit\",[true]); 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