{"id":141,"date":"2020-08-11T01:17:09","date_gmt":"2020-08-11T01:17:09","guid":{"rendered":"http:\/\/onewiththewater.org\/survey\/?page_id=141"},"modified":"2020-08-17T22:11:41","modified_gmt":"2020-08-17T22:11:41","slug":"health-survey","status":"publish","type":"page","link":"https:\/\/onewiththewater.org\/survey\/health-survey\/","title":{"rendered":"Health Survey"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.0.4&#8243; background_color=&#8221;#161b2f&#8221;][et_pb_row _builder_version=&#8221;4.0.4&#8243; background_color=&#8221;#ffffff&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;30px|40px|30px|40px|false|false&#8221; border_radii=&#8221;on|10px|10px|10px|10px&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.0.4&#8243;][et_pb_text admin_label=&#8221;Healthy Swimming Checklist&#8221; _builder_version=&#8221;4.0.4&#8243; text_font_size=&#8221;16px&#8221; custom_margin=&#8221;0px||0px||false|false&#8221; custom_padding=&#8221;0px||0px||false|false&#8221; hover_enabled=&#8221;0&#8243;]<\/p>\n<h1 style=\"text-align: center;\">Healthy Swimming Checklist<\/h1>\n<p>Please complete this for the adult and the swimmer intending to attend the lessons.<\/p>\n<hr \/>\n<p>[\/et_pb_text][et_pb_text admin_label=&#8221;Formidable Form&#8221; _builder_version=&#8221;4.0.4&#8243; hover_enabled=&#8221;0&#8243;]<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_3_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_js_validate \" id=\"form_health-survey\"  >\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Health Survey<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"3\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_3\" id=\"frm_hide_fields_3\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"health-survey\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_3\" name=\"frm_submit_entry_3\" value=\"60ef010c81\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/survey\/wp-json\/wp\/v2\/pages\/141\" \/><div id=\"frm_field_20_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_full vertical_radio\">\r\n    <div  id=\"field_ku7ns_label\" class=\"frm_primary_label\">1.\tWithin the last 10 days, have you been diagnosed with COVID-19 or had a test confirming you have the virus?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_ku7ns_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_20-0\"><label for=\"field_ku7ns-0\">\t\t<input type=\"radio\" name=\"item_meta[20]\" id=\"field_ku7ns-0\" value=\"YES\"\n\t\t   data-reqmsg=\"Please answer Yes or No\" aria-required=\"true\" data-invmsg=\"1.\tWithin the last 10 days, have you been diagnosed with COVID-19 or had a test confirming you have the virus? is invalid\" aria-invalid=\"false\"  \/> YES<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_20-1\"><label for=\"field_ku7ns-1\">\t\t<input type=\"radio\" name=\"item_meta[20]\" id=\"field_ku7ns-1\" value=\"NO\"\n\t\t   data-reqmsg=\"Please answer Yes or No\" aria-required=\"true\" data-invmsg=\"1.\tWithin the last 10 days, have you been diagnosed with COVID-19 or had a test confirming you have the virus? is invalid\" aria-invalid=\"false\"  \/> NO<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_158_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_full vertical_radio\">\r\n    <div  id=\"field_hgn4w_label\" class=\"frm_primary_label\">2.\tWithin the last 10 days, have you been in contact with someone who has Covid-19?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_hgn4w_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_158-0\"><label for=\"field_hgn4w-0\">\t\t<input type=\"radio\" name=\"item_meta[158]\" id=\"field_hgn4w-0\" value=\"YES\"\n\t\t   data-reqmsg=\"Please answer Yes or No\" aria-required=\"true\" data-invmsg=\"2.\tWithin the last 10 days, have you been in contact with someone who has Covid-19? is invalid\" aria-invalid=\"false\"  \/> YES<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_158-1\"><label for=\"field_hgn4w-1\">\t\t<input type=\"radio\" name=\"item_meta[158]\" id=\"field_hgn4w-1\" value=\"NO\"\n\t\t   data-reqmsg=\"Please answer Yes or No\" aria-required=\"true\" data-invmsg=\"2.\tWithin the last 10 days, have you been in contact with someone who has Covid-19? is invalid\" aria-invalid=\"false\"  \/> NO<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_21_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_full vertical_radio\">\r\n    <div  id=\"field_svmtj_label\" class=\"frm_primary_label\">3.\tHave you had any one or more of these symptoms today or within the past 24 hours, which is new or not explained by another reason? \r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_svmtj_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_21-0\"><label for=\"field_svmtj-0\">\t\t<input type=\"radio\" name=\"item_meta[21]\" id=\"field_svmtj-0\" value=\"YES\"\n\t\t   data-reqmsg=\"Please answer Yes or No\" aria-required=\"true\" data-invmsg=\"3.\tHave you had any one or more of these symptoms today or within the past 24 hours, which is new or not explained by another reason?  is invalid\" aria-invalid=\"false\"  \/> YES<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_21-1\"><label for=\"field_svmtj-1\">\t\t<input type=\"radio\" name=\"item_meta[21]\" id=\"field_svmtj-1\" value=\"NO\"\n\t\t   data-reqmsg=\"Please answer Yes or No\" aria-required=\"true\" data-invmsg=\"3.\tHave you had any one or more of these symptoms today or within the past 24 hours, which is new or not explained by another reason?  is invalid\" aria-invalid=\"false\"  \/> NO<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_22_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_full vertical_radio\">\r\n    <div  id=\"field_3vqra_label\" class=\"frm_primary_label\">4.\tHave you had any one or more of these symptoms today or within the past 24 hours, which is new or not explained by another reason? <br \/><ul> <li>Fever, Chills, or Repeated Shaking\/Shivering <\/li> <li>Cough <\/li> <li>Sore Throat <\/li> <li>Shortness of Breath, Difficulty Breathing <\/li> <li>Feeling Unusually Weak or Fatigued <\/li> <li>Loss of Taste or Smell <\/li> <li>Muscle pain<\/li> <li>Headache <\/li> <li>Runny or congested nose <\/li> <li>Diarrhea <\/li> <\/ul>\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_3vqra_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_22-0\"><label for=\"field_3vqra-0\">\t\t<input type=\"radio\" name=\"item_meta[22]\" id=\"field_3vqra-0\" value=\"YES\"\n\t\t   data-reqmsg=\"Please answer Yes or No\" aria-required=\"true\" data-invmsg=\"4.\tHave you had any one or more of these symptoms today or within the past 24 hours, which is new or not explained by another reason? &lt;br \/&gt;&lt;ul&gt; &lt;li&gt;Fever, Chills, or Repeated Shaking\/Shivering &lt;\/li&gt; &lt;li&gt;Cough &lt;\/li&gt; &lt;li&gt;Sore Throat &lt;\/li&gt; &lt;li&gt;Shortness of Breath, Difficulty Breathing &lt;\/li&gt; &lt;li&gt;Feeling Unusually Weak or Fatigued &lt;\/li&gt; &lt;li&gt;Loss of Taste or Smell &lt;\/li&gt; &lt;li&gt;Muscle pain&lt;\/li&gt; &lt;li&gt;Headache &lt;\/li&gt; &lt;li&gt;Runny or congested nose &lt;\/li&gt; &lt;li&gt;Diarrhea &lt;\/li&gt; &lt;\/ul&gt; is invalid\" aria-invalid=\"false\"  \/> YES<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_22-1\"><label for=\"field_3vqra-1\">\t\t<input type=\"radio\" name=\"item_meta[22]\" id=\"field_3vqra-1\" value=\"NO\"\n\t\t   data-reqmsg=\"Please answer Yes or No\" aria-required=\"true\" data-invmsg=\"4.\tHave you had any one or more of these symptoms today or within the past 24 hours, which is new or not explained by another reason? &lt;br \/&gt;&lt;ul&gt; &lt;li&gt;Fever, Chills, or Repeated Shaking\/Shivering &lt;\/li&gt; &lt;li&gt;Cough &lt;\/li&gt; &lt;li&gt;Sore Throat &lt;\/li&gt; &lt;li&gt;Shortness of Breath, Difficulty Breathing &lt;\/li&gt; &lt;li&gt;Feeling Unusually Weak or Fatigued &lt;\/li&gt; &lt;li&gt;Loss of Taste or Smell &lt;\/li&gt; &lt;li&gt;Muscle pain&lt;\/li&gt; &lt;li&gt;Headache &lt;\/li&gt; &lt;li&gt;Runny or congested nose &lt;\/li&gt; &lt;li&gt;Diarrhea &lt;\/li&gt; &lt;\/ul&gt; is invalid\" aria-invalid=\"false\"  \/> NO<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_14_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_qh4icy2\" id=\"field_qh4icy2_label\" class=\"frm_primary_label\">Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qh4icy2\" name=\"item_meta[14]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Name is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_qh4icy2\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_qh4icy2\">First<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_15_container\" class=\"frm_form_field form-field  frm_required_field frm_hidden_container frm_half\">\r\n    <label for=\"field_ocfup12\" id=\"field_ocfup12_label\" class=\"frm_primary_label\">Last Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ocfup12\" name=\"item_meta[15]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Last is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_ocfup12\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_ocfup12\">Last<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_23_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_full\">\r\n    <label for=\"field_p8vki\" id=\"field_p8vki_label\" class=\"frm_primary_label\">Phone\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_p8vki\" name=\"item_meta[23]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Phone is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_16_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_full\">\r\n    <label for=\"field_29yf4d2\" id=\"field_29yf4d2_label\" class=\"frm_primary_label\">Email\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_29yf4d2\" name=\"item_meta[16]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Please enter a valid email address\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_17_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_half\">\r\n    <label for=\"field_e6lis62\" id=\"field_e6lis62_label\" class=\"frm_primary_label\">Lesson Location:\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_e6lis62\" name=\"item_meta[17]\" value=\"\"  data-invmsg=\"Subject is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_e6lis62\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_e6lis62\">Pool Location<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_24_container\" class=\"frm_form_field form-field  frm_top_container frm_half\">\r\n    <label for=\"field_flfyf\" id=\"field_flfyf_label\" class=\"frm_primary_label\">Time:\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_flfyf\" name=\"item_meta[24]\" value=\"\"  data-invmsg=\"Subject is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_flfyf\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_flfyf\">Lesson Time<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_28_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p style=\"font-size: 115%;\">If you answer \u201cyes\u201d to any of the questions above we recommend you consult your family physician to get tested and please contact us again when you are ready to start your lessons. <\/p>\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit\" type=\"submit\"  >Submit<\/button>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n<\/form>\n<\/div>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.0.4&#8243; background_color=&#8221;#161b2f&#8221;][et_pb_row _builder_version=&#8221;4.0.4&#8243; background_color=&#8221;#ffffff&#8221; custom_margin=&#8221;0px||||false|false&#8221; custom_padding=&#8221;30px|40px|30px|40px|false|false&#8221; border_radii=&#8221;on|10px|10px|10px|10px&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.0.4&#8243;][et_pb_text 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