<form-template> <fields> <field type="paragraph" subtype="p" label="EARTH DAY CRAFT EVENT" class="paragraph"></field> <field type="paragraph" subtype="p" label="Wednesday, April 22nd 2026" class="paragraph"></field> <field type="paragraph" subtype="p" label="Miniota Elementary School | 3:40 - 5:15 PM " class="paragraph"></field> <field type="text" subtype="text" required="true" label="Child Name" class="form-control text-input" name="text-1681830953843"></field> <field type="text" subtype="text" label="Child Age" class="form-control text-input" name="text-1681830969953"></field> <field type="date" label="Child Date of Birth" class="form-control calendar" name="date-1681830982985"></field> <field type="text" subtype="text" label="Child Grade" class="form-control text-input" name="text-1681830994641"></field> <field type="text" subtype="text" required="true" label="Parent / Guardian 1" class="form-control text-input" name="text-1681831006129"></field> <field type="text" subtype="text" label="Parent / Guardian 2" class="form-control text-input" name="text-1681831017122"></field> <field type="text" subtype="text" required="true" label="Phone (Home)" class="form-control text-input" name="text-1681831027498"></field> <field type="text" subtype="text" label="Phone (Work)" class="form-control text-input" name="text-1681831041385"></field> <field type="text" subtype="text" label="Phone (Cell)" class="form-control text-input" name="text-1681831049569"></field> <field type="text" subtype="text" label="Email Address" class="form-control text-input" name="text-1681831059097"></field> <field type="text" subtype="text" label="Mailing Address" class="form-control text-input" name="text-1681831071817"></field> <field type="text" subtype="text" label="Emergency Contact" class="form-control text-input" name="text-1681831079954"></field> <field type="text" subtype="text" label="Emergency Phone" class="form-control text-input" name="text-1681831084505"></field> <field type="textarea" label="Additional Information" class="form-control text-area" name="textarea-1681831108106"></field> <field type="checkbox" required="true" label="I certify that my child is in good health and is able to participate in vigorous activities involved with Valley Recreation District programs, and I authorize the director/instructors to seek emergency medical treatment if it is deemed necessary. This also assures that I release the instructors, Valley Recreation District, Prairie View Municipality and the program facilities from any and all liability from any injury or illness incurred going to the program from home, while at the program or returning home from the program. As well all liability for losses and damages of all and every description." class="checkbox" name="checkbox-1681831125529"></field> <field type="radio-group" class="radio-group" name="radio-group-1681831145409"> <option value="I give authorization to allow pictures to be taken and used for promotion (Facebook page, posters etc.)">I give authorization to allow pictures to be taken and used for promotion (Facebook page, posters etc.)</option> <option value="I DO NOT give authorization to allow pictures to be taken and used for promotion." selected="true">I DO NOT give authorization to allow pictures to be taken and used for promotion.</option> </field> </fields> </form-template> Submit Submitting...
