{"id":997,"date":"2026-05-20T14:17:07","date_gmt":"2026-05-20T14:17:07","guid":{"rendered":"https:\/\/chipolahealthystart.org\/CHSC\/?page_id=997"},"modified":"2026-05-20T15:24:42","modified_gmt":"2026-05-20T15:24:42","slug":"tentative-registration-questions","status":"publish","type":"page","link":"https:\/\/chipolahealthystart.org\/index.php\/tentative-registration-questions\/","title":{"rendered":"Agency Registration"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"997\" class=\"elementor elementor-997\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d6d7473 e-flex e-con-boxed e-con e-parent\" data-id=\"d6d7473\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-36e7b79 elementor-widget elementor-widget-text-editor\" data-id=\"36e7b79\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Dear Community Partners,<\/p><p>We are excited to invite you to <span style=\"color: #00ccff;\">REGISTER<\/span> for our upcoming <span style=\"color: #ff9900;\">Community-Wide Baby Shower<\/span>, hosted by the <span style=\"color: #00ccff;\">Chipola Healthy Start Coalition<\/span> in partnership with the <span style=\"color: #ffcc00;\">Jackson County Health Department<\/span> and<span style=\"color: #ff9900;\"> WIC<\/span>.<\/p><p>This year, our theme is:<br \/><span style=\"color: #ff9900;\">RISE for Breastfeeding!<\/span> \ud83c\udf1e<br \/><span style=\"color: #ff9900;\">Resilience<\/span>, <span style=\"color: #00ccff;\">Interdependence<\/span>, <span style=\"color: #ffcc00;\">Self-Determination<\/span>, and <span style=\"color: #ff9900;\">Empowerment<\/span><\/p><p>Our goal is to ensure that all new and expecting parents leave feeling celebrated and informed!<\/p><p>Location: Jackson County Health Department<br \/>Date: Tuesday, August 4, 2026<\/p><p>Time: 10am \u2013 2pm CST<\/p><p>Last Day To Register: Monday, July 6, 2026<\/p><p>The baby shower will bring together community agencies and partners to support and celebrate mothers and families in our community. The baby shower will consist of:<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8a7f4ac elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"8a7f4ac\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-coffee\" viewBox=\"0 0 640 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M192 384h192c53 0 96-43 96-96h32c70.6 0 128-57.4 128-128S582.6 32 512 32H120c-13.3 0-24 10.7-24 24v232c0 53 43 96 96 96zM512 96c35.3 0 64 28.7 64 64s-28.7 64-64 64h-32V96h32zm47.7 384H48.3c-47.6 0-61-64-36-64h583.3c25 0 11.8 64-35.9 64z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Light Refreshments<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-book-reader\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M352 96c0-53.02-42.98-96-96-96s-96 42.98-96 96 42.98 96 96 96 96-42.98 96-96zM233.59 241.1c-59.33-36.32-155.43-46.3-203.79-49.05C13.55 191.13 0 203.51 0 219.14v222.8c0 14.33 11.59 26.28 26.49 27.05 43.66 2.29 131.99 10.68 193.04 41.43 9.37 4.72 20.48-1.71 20.48-11.87V252.56c-.01-4.67-2.32-8.95-6.42-11.46zm248.61-49.05c-48.35 2.74-144.46 12.73-203.78 49.05-4.1 2.51-6.41 6.96-6.41 11.63v245.79c0 10.19 11.14 16.63 20.54 11.9 61.04-30.72 149.32-39.11 192.97-41.4 14.9-.78 26.49-12.73 26.49-27.06V219.14c-.01-15.63-13.56-28.01-29.81-27.09z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Parent Resources<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-baby\" viewBox=\"0 0 384 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M192 160c44.2 0 80-35.8 80-80S236.2 0 192 0s-80 35.8-80 80 35.8 80 80 80zm-53.4 248.8l25.6-32-61.5-51.2L56.8 383c-11.4 14.2-11.7 34.4-.8 49l48 64c7.9 10.5 19.9 16 32 16 8.3 0 16.8-2.6 24-8 17.7-13.2 21.2-38.3 8-56l-29.4-39.2zm142.7-83.2l-61.5 51.2 25.6 32L216 448c-13.2 17.7-9.7 42.8 8 56 7.2 5.4 15.6 8 24 8 12.2 0 24.2-5.5 32-16l48-64c10.9-14.6 10.6-34.8-.8-49l-45.9-57.4zM376.7 145c-12.7-18.1-37.6-22.4-55.7-9.8l-40.6 28.5c-52.7 37-124.2 37-176.8 0L63 135.3C44.9 122.6 20 127 7.3 145-5.4 163.1-1 188 17 200.7l40.6 28.5c17 11.9 35.4 20.9 54.4 27.9V288h160v-30.8c19-7 37.4-16 54.4-27.9l40.6-28.5c18.1-12.8 22.4-37.7 9.7-55.8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Breastfeeding education<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-box-open\" viewBox=\"0 0 640 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M425.7 256c-16.9 0-32.8-9-41.4-23.4L320 126l-64.2 106.6c-8.7 14.5-24.6 23.5-41.5 23.5-4.5 0-9-.6-13.3-1.9L64 215v178c0 14.7 10 27.5 24.2 31l216.2 54.1c10.2 2.5 20.9 2.5 31 0L551.8 424c14.2-3.6 24.2-16.4 24.2-31V215l-137 39.1c-4.3 1.3-8.8 1.9-13.3 1.9zm212.6-112.2L586.8 41c-3.1-6.2-9.8-9.8-16.7-8.9L320 64l91.7 152.1c3.8 6.3 11.4 9.3 18.5 7.3l197.9-56.5c9.9-2.9 14.7-13.9 10.2-23.1zM53.2 41L1.7 143.8c-4.6 9.2.3 20.2 10.1 23l197.9 56.5c7.1 2 14.7-1 18.5-7.3L320 64 69.8 32.1c-6.9-.8-13.5 2.7-16.6 8.9z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Giveaways for families in our local community<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-photo-video\" viewBox=\"0 0 640 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M608 0H160a32 32 0 0 0-32 32v96h160V64h192v320h128a32 32 0 0 0 32-32V32a32 32 0 0 0-32-32zM232 103a9 9 0 0 1-9 9h-30a9 9 0 0 1-9-9V73a9 9 0 0 1 9-9h30a9 9 0 0 1 9 9zm352 208a9 9 0 0 1-9 9h-30a9 9 0 0 1-9-9v-30a9 9 0 0 1 9-9h30a9 9 0 0 1 9 9zm0-104a9 9 0 0 1-9 9h-30a9 9 0 0 1-9-9v-30a9 9 0 0 1 9-9h30a9 9 0 0 1 9 9zm0-104a9 9 0 0 1-9 9h-30a9 9 0 0 1-9-9V73a9 9 0 0 1 9-9h30a9 9 0 0 1 9 9zm-168 57H32a32 32 0 0 0-32 32v288a32 32 0 0 0 32 32h384a32 32 0 0 0 32-32V192a32 32 0 0 0-32-32zM96 224a32 32 0 1 1-32 32 32 32 0 0 1 32-32zm288 224H64v-32l64-64 32 32 128-128 96 96z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Photo opportunities<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-baa3b5c elementor-widget elementor-widget-text-editor\" data-id=\"baa3b5c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Partner &amp; Registration Details:<\/p><p>Participation is open to all community agencies. A $50 donation to Chipola Healthy Start Coalition or a donated item for raffle equivalent or more than $50. As a registered partner for this event, you will receive: Access to one 5-foot rectangular table and 2 chairs. Opportunity to showcase your agency and provide the resources needed. Time to share information about your organization with attendees.<\/p><p>Keep In Mind:<\/p><p>By registering for this event, we ask that you commit to attending and having someone available at your table throughout the entire event. If something comes up and you can no longer attend or stay for the full day, please contact Chipola Healthy Start as soon as possible. Please bring handouts or other helpful materials for attendees visiting your table. There will also be time for agencies to briefly introduce themselves and share information with the group, so come prepared to highlight your organization.<\/p><p>To register please complete the provided registration link and\/or contact:<\/p><p>Valery Lawton, Community Liaison &#8211; <span style=\"color: #00ccff;\">vlawton@chipolahealthystart.org<\/span><\/p><p>Tierra Franklin, Program Manager \u2013 <span style=\"color: #00ccff;\">tfranklin@chipolahealthystart.org<\/span>.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bb17299 fluent-form-widget-step-header-yes fluent-form-widget-step-progressbar-yes fluentform-widget-submit-button-custom elementor-widget elementor-widget-fluent-form-widget\" data-id=\"bb17299\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"fluent-form-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\n            <div class=\"fluentform-widget-wrapper fluentform-widget-align-default\">\n\n            \n            <div class='fluentform ff-default fluentform_wrapper_5 ffs_default_wrap'><form data-form_id=\"5\" id=\"fluentform_5\" class=\"frm-fluent-form fluent_form_5 ff-el-form-top ff_form_instance_5_1 ff-form-loading ffs_default\" data-form_instance=\"ff_form_instance_5_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Tentative Registration<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='997' \/><input type=\"hidden\" id=\"_fluentform_5_fluentformnonce\" name=\"_fluentform_5_fluentformnonce\" value=\"079ea9fc36\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/997\" \/><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-5_1\" ><h3 class='ff-el-section-title'>Agency Information<\/h3><div class='ff-section_break_desk'><p>Agency and point of contact information<\/p><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_5_input_text' id='label_ff_5_input_text' aria-label=\"Agency Name\">Agency Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" data-name=\"input_text\" id=\"ff_5_input_text\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div data-type=\"name-element\" data-name=\"names\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_5_names_first_name_' id='label_ff_5_names_first_name_' >First Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" id=\"ff_5_names_first_name_\" class=\"ff-el-form-control\" placeholder=\"Enter Your First Name\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_5_names_last_name_' id='label_ff_5_names_last_name_' >Last Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[last_name]\" id=\"ff_5_names_last_name_\" class=\"ff-el-form-control\" placeholder=\"Enter Your Last Name\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_5_input_text_1' id='label_ff_5_input_text_1' aria-label=\"Job Title\">Job Title<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_1\" class=\"ff-el-form-control\" data-name=\"input_text_1\" id=\"ff_5_input_text_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_5_email' id='label_ff_5_email' aria-label=\"Email\">Email<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_5_email\" class=\"ff-el-form-control\" placeholder=\"Email Address\" data-name=\"email\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_5_phone' id='label_ff_5_phone' aria-label=\"Phone\/Mobile\">Phone\/Mobile<\/label><\/div><div class='ff-el-input--content'><input name=\"phone\" class=\"ff-el-form-control ff-el-phone\" type=\"tel\" placeholder=\"Mobile Number\" data-name=\"phone\" id=\"ff_5_phone\" inputmode=\"tel\"  aria-invalid='false' aria-required=true><\/div><\/div><div class='ff-el-group  ff-dropzone'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_image-upload_1' id='label_ff_5_image-upload_1' aria-label=\"Logo upload for promotional materials\">Logo upload for promotional materials<\/label><\/div><div class='ff-el-input--content'><label for='ff_5_image-upload_1' class='ff_file_upload_holder'><span class='ff_upload_btn ff-btn' tabindex='0'>Choose File (JPG or PNG)<\/span> <input type=\"file\" name=\"image-upload\" id=\"ff_5_image-upload_1\" class=\"ff-el-form-control  ff-screen-reader-element\" accept=\"image\/*\" data-name=\"image-upload\" multiple=\"1\"  aria-invalid='false' aria-required=false><\/label><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-5_2\" ><h3 class='ff-el-section-title'>Participation Details<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Will your agency participate in the Community-Wide Baby Shower?\">Will your agency participate in the Community-Wide Baby Shower?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_11d874302bab402b922ceb41bd19a4ff'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"yes\"  id='input_radio_11d874302bab402b922ceb41bd19a4ff' aria-label='Yes' aria-invalid='false' aria-required=true> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_8cadaeae20f216769ae0f0abadabea2a'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"no\"  id='input_radio_8cadaeae20f216769ae0f0abadabea2a' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Will someone be present at your table for the entirety of the event?\">Will someone be present at your table for the entirety of the event?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_39e6030ca8b0e3212c4b5f2868b78772'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"yes\"  id='input_radio_1_39e6030ca8b0e3212c4b5f2868b78772' aria-label='Yes' aria-invalid='false' aria-required=true> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_8b779b07c7c4c5b595e4fffc77fbeb2a'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"no\"  id='input_radio_1_8b779b07c7c4c5b595e4fffc77fbeb2a' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_5_numeric_field' id='label_ff_5_numeric_field' aria-label=\"How many representatives from your agency will attend?\">How many representatives from your agency will attend?<\/label><\/div><div class='ff-el-input--content'><input type=\"number\" name=\"numeric_field\" id=\"ff_5_numeric_field\" class=\"ff-el-form-control\" data-name=\"numeric_field\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_5_description' id='label_ff_5_description' aria-label=\"Please list the names of representatives attending.\">Please list the names of representatives attending.<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"true\" aria-labelledby=\"label_ff_5_description\" name=\"description\" id=\"ff_5_description\" class=\"ff-el-form-control\" rows=\"3\" cols=\"2\" data-name=\"description\" ><\/textarea><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-5_3\" ><h3 class='ff-el-section-title'>Table &amp; Resource Information<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_5_description_1' id='label_ff_5_description_1' aria-label=\"What resources or services will your agency provide to attendees?\">What resources or services will your agency provide to attendees?<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"true\" aria-labelledby=\"label_ff_5_description_1\" name=\"description_1\" id=\"ff_5_description_1\" class=\"ff-el-form-control\" rows=\"3\" cols=\"2\" data-name=\"description_1\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_description_2' id='label_ff_5_description_2' aria-label=\"Will your agency provide giveaways, raffle items, or promotional materials? (If any)\">Will your agency provide giveaways, raffle items, or promotional materials? (If any)<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_5_description_2\" name=\"description_2\" id=\"ff_5_description_2\" class=\"ff-el-form-control\" rows=\"3\" cols=\"2\" data-name=\"description_2\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Will your agency need access to electricity?\">Will your agency need access to electricity?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_83459920be2a2611221068e73ef32488'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"yes\"  id='input_radio_2_83459920be2a2611221068e73ef32488' aria-label='Yes' aria-invalid='false' aria-required=true> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_e914d9e592f0999c48f7e06e0ad2db63'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"no\"  id='input_radio_2_e914d9e592f0999c48f7e06e0ad2db63' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-5_4\" ><h3 class='ff-el-section-title'>Agency Spotlight<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_5_post_content' id='label_ff_5_post_content' aria-label=\"Please provide a brief description of your agency to be shared during introductions.\">Please provide a brief description of your agency to be shared during introductions.<\/label><\/div><div class='ff-el-input--content'><textarea name=\"post_content\" id=\"ff_5_post_content\" class=\"ff-el-form-control fluentform-post-content\" rows=\"3\" cols=\"2\" data-name=\"post_content\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Would your agency like an opportunity to speak briefly during the event?\">Would your agency like an opportunity to speak briefly during the event?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_60d6f664af8b283aaa41869b488e7d4d'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"yes\"  id='input_radio_3_60d6f664af8b283aaa41869b488e7d4d' aria-label='Yes' aria-invalid='false' aria-required=true> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_49b2b7fe780d030c6cfce70b60693e0a'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"no\"  id='input_radio_3_49b2b7fe780d030c6cfce70b60693e0a' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-5_5\" ><h3 class='ff-el-section-title'>Donation Information<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Will your agency provide:\">Will your agency provide:<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_4_64e380fbf7c4f53ffb82b90cc6beddc7'><input  type=\"radio\" name=\"input_radio_4\" data-name=\"input_radio_4\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"$50 Donation\"  id='input_radio_4_64e380fbf7c4f53ffb82b90cc6beddc7' aria-label='$50 Donation' aria-invalid='false' aria-required=true> <span>$50 Donation<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_4_b5c047e8e524ac6d953e547351742dc8'><input  type=\"radio\" name=\"input_radio_4\" data-name=\"input_radio_4\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Raffle Item Valued at $50\"  id='input_radio_4_b5c047e8e524ac6d953e547351742dc8' aria-label='Raffle Item Valued at $50' aria-invalid='false' aria-required=true> <span>Raffle Item Valued at $50<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_5_input_text_3' id='label_ff_5_input_text_3' aria-label=\"If donating a raffle item, please describe the item.\">If donating a raffle item, please describe the item.<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_3\" class=\"ff-el-form-control\" data-name=\"input_text_3\" id=\"ff_5_input_text_3\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-5_6\" ><h3 class='ff-el-section-title'>Final Acknowledgment<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-5_7\" ><p><span data-olk-copy-source=\"MessageBody\">By registering, I acknowledge that my agency is committed to attending the event and maintaining representation at our table throughout the duration of the event. If our agency can no longer attend, we agree to notify Chipola Healthy Start Coalition as soon as possible.<\/span><\/p><\/div><div class='ff-el-group    ff-el-input--content'><div class='ff-el-form-check ff-el-tc'><label aria-label='I have read and agree to the terms above.' class='ff-el-form-check-label ff_tc_label' for=terms-n-condition_4615426f8678ea4f0ffb8fc4b4390bad><span class='ff_tc_checkbox'><input type=\"checkbox\" name=\"terms-n-condition\" class=\"ff-el-form-check-input\" data-name=\"terms-n-condition\" id=\"terms-n-condition_4615426f8678ea4f0ffb8fc4b4390bad\"  value='on' aria-invalid='false' aria-required=true><\/span> <div class='ff_t_c'><p>I have read and agree to the terms above.<\/p><\/div><\/label><\/div><\/div><div class='ff-el-group ff-text-left ff_submit_btn_wrapper'><button type=\"submit\" class=\"ff-btn ff-btn-submit ff-btn-md ff_btn_style\"  aria-label=\"Submit Form\">Submit Form<\/button><\/div><\/fieldset><\/form><div id='fluentform_5_errors' class='ff-errors-in-stack ff_form_instance_5_1 ff-form-loading_errors ff_form_instance_5_1_errors'><\/div><\/div>            <script type=\"text\/javascript\">\n                window.fluent_form_ff_form_instance_5_1 = {\"id\":\"5\",\"ajaxUrl\":\"https:\\\/\\\/chipolahealthystart.org\\\/wp-admin\\\/admin-ajax.php\",\"settings\":{\"layout\":{\"labelPlacement\":\"top\",\"asteriskPlacement\":\"asterisk-right\",\"helpMessagePlacement\":\"with_label\",\"errorMessagePlacement\":\"inline\",\"cssClassName\":\"\"},\"restrictions\":{\"denyEmptySubmission\":{\"enabled\":false}}},\"form_instance\":\"ff_form_instance_5_1\",\"form_id_selector\":\"fluentform_5\",\"rules\":{\"input_text\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"names[first_name]\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"names[middle_name]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"names[last_name]\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"input_text_1\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"email\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true},\"email\":{\"value\":true,\"message\":\"This field must contain a valid email\",\"global_message\":\"This field must contain a valid email\",\"global\":true}},\"phone\":{\"required\":{\"value\":true,\"global\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\"},\"valid_phone_number\":{\"value\":false,\"global\":true,\"message\":\"Phone number is not valid\",\"global_message\":\"Phone number is not valid\"}},\"image-upload\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true},\"max_file_size\":{\"value\":1048576,\"_valueFrom\":\"MB\",\"message\":\"Validation fails for maximum file size\",\"global_message\":\"Validation fails for maximum file size\",\"global\":true},\"max_file_count\":{\"value\":1,\"message\":\"Validation fails for maximum file count\",\"global_message\":\"Validation fails for maximum file count\",\"global\":true},\"allowed_image_types\":{\"value\":[\"jpg|jpeg\",\"png\"],\"message\":\"Allowed image types does not match\",\"global_message\":\"Allowed image types does not match\",\"global\":true}},\"input_radio\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"input_radio_1\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"numeric_field\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true},\"numeric\":{\"value\":true,\"message\":\"This field must contain numeric value\",\"global_message\":\"This field must contain numeric value\",\"global\":true},\"min\":{\"value\":\"\",\"message\":\"Validation fails for minimum value\",\"global_message\":\"Validation fails for minimum value\",\"global\":true},\"max\":{\"value\":\"\",\"message\":\"Validation fails for maximum value\",\"global_message\":\"Validation fails for maximum value\",\"global\":true},\"digits\":{\"value\":\"\",\"message\":\"Validation fails for limited digits\",\"global_message\":\"Validation fails for limited digits\",\"global\":true}},\"description\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"description_1\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"description_2\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"input_radio_2\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"post_content\":{\"required\":{\"value\":true,\"global\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\"}},\"input_radio_3\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"input_radio_4\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"input_text_3\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}},\"terms-n-condition\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"This field is required\",\"global\":true}}},\"debounce_time\":300,\"file_upload_settings\":{\"image-upload\":{\"enabled\":false,\"mode\":\"ratio\",\"crop_ratio\":\"free\",\"enforce_size\":false,\"width\":0,\"height\":0,\"button_ui\":\"dropzone\"}}};\n                            <\/script>\n                        <\/div>\n\n            \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Dear Community Partners, We are excited to invite you to REGISTER for our upcoming Community-Wide Baby Shower, hosted by the Chipola Healthy Start Coalition in partnership with the Jackson County Health Department and WIC. This year, our theme is:RISE for Breastfeeding! \ud83c\udf1eResilience, Interdependence, Self-Determination, and Empowerment Our goal is to ensure that all new and [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_eb_attr":"","footnotes":""},"class_list":["post-997","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/chipolahealthystart.org\/index.php\/wp-json\/wp\/v2\/pages\/997","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/chipolahealthystart.org\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/chipolahealthystart.org\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/chipolahealthystart.org\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/chipolahealthystart.org\/index.php\/wp-json\/wp\/v2\/comments?post=997"}],"version-history":[{"count":16,"href":"https:\/\/chipolahealthystart.org\/index.php\/wp-json\/wp\/v2\/pages\/997\/revisions"}],"predecessor-version":[{"id":1031,"href":"https:\/\/chipolahealthystart.org\/index.php\/wp-json\/wp\/v2\/pages\/997\/revisions\/1031"}],"wp:attachment":[{"href":"https:\/\/chipolahealthystart.org\/index.php\/wp-json\/wp\/v2\/media?parent=997"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}