{"id":8,"date":"2025-12-03T16:12:13","date_gmt":"2025-12-03T16:12:13","guid":{"rendered":"https:\/\/proserv1.quarterdev.ca\/?page_id=8"},"modified":"2025-12-03T16:28:00","modified_gmt":"2025-12-03T16:28:00","slug":"intake-form","status":"publish","type":"page","link":"https:\/\/proserv1.quarterdev.ca\/?page_id=8","title":{"rendered":"Intake Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"8\" class=\"elementor elementor-8\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8ea78da e-flex e-con-boxed e-con e-parent\" data-id=\"8ea78da\" data-element_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-ade2e43 elementor-widget__width-initial elementor-widget elementor-widget-image\" data-id=\"ade2e43\" data-element_type=\"widget\" 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<\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F8#gf_1' data-formid='1' novalidate>\n        <div id='gf_progressbar_wrapper_1' class='gf_progressbar_wrapper'>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>7<\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_14' style='width:14%;'><span>14%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_1_1' class='gform_page ' data-js='page-field-id-1' >\n                                    <div class='gform_page_fields'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_above description_above'><fieldset id=\"field_1_1\"  class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_1\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><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_1_1'>\n                            \n                            <span id='input_1_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_1_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_1.3' id='input_1_1_3' value=''   aria-required='true'    autocomplete=\"given-name\" \/>\n                                                <\/span>\n                            \n                            <span id='input_1_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_1_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_1.6' id='input_1_1_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_1_10\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_10\"><label class='gfield_label gform-field-label' for='input_1_10' >Preferred Parental Title<\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_1_10' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_1_2\"  class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_2\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_1_2_container'>\n                                <span id='input_1_2_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_1_2' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                    <input class='' type='email' name='input_2' id='input_1_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                                <\/span>\n                                <span id='input_1_2_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_1_2_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                    <input class='' type='email' name='input_2_2' id='input_1_2_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_1_9\"  class=\"gfield gfield--type-text gfield--width-third field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_9\"><label class='gfield_label gform-field-label' for='input_1_9' >Referred By<\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_1_9' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_7\"  class=\"gfield gfield--type-text gfield--width-third field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_7\"><label class='gfield_label gform-field-label' for='input_1_7' >Status of File<\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_1_7' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_8\"  class=\"gfield gfield--type-text gfield--width-third field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_8\"><label class='gfield_label gform-field-label' for='input_1_8' >Court File Number<\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_1_8' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_1_29' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <button type='button'  id='gform_save_1_2_link' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  onclick='if(window[\"gf_submitting_1\"]){return false;}  if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;} jQuery(\"#gform_save_1\").val(1); jQuery(\"#gform_1\").trigger(\"submit\",[true]);' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_1\"]){return false;} if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;} jQuery(\"#gform_save_1\").val(1); jQuery(\"#gform_1\").trigger(\"submit\",[true]); }'><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> Save and Continue Later<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_2' class='gform_page' data-js='page-field-id-29' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_2' class='gform_fields top_label form_sublabel_above description_above'><fieldset id=\"field_1_11\"  class=\"gfield gfield--type-address gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_11\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Address<\/legend>    \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_1_11' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_11_1_container' >\n                                        <label for='input_1_11_1' id='input_1_11_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_11.1' id='input_1_11_1' value=''    aria-required='false'   autocomplete=\"address-line1\" \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_1_11_2_container' >\n                                        <label for='input_1_11_2' id='input_1_11_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_11.2' id='input_1_11_2' value=''    autocomplete=\"address-line2\" aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_11_3_container' >\n                                    <label for='input_1_11_3' id='input_1_11_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_11.3' id='input_1_11_3' value=''    aria-required='false'   autocomplete=\"address-level2\" \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_1_11_4_container' >\n                                        <label for='input_1_11_4' id='input_1_11_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                        <input type='text' name='input_11.4' id='input_1_11_4' value=''      aria-required='false'   autocomplete=\"address-level1\" \/>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_1_11_5_container' >\n                                    <label for='input_1_11_5' id='input_1_11_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                    <input type='text' name='input_11.5' id='input_1_11_5' value=''    aria-required='false'   autocomplete=\"postal-code\" \/>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_1_11_6_container' >\n                                        <label for='input_1_11_6' id='input_1_11_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                        <select name='input_11.6' id='input_1_11_6'   aria-required='false'   autocomplete=\"country-name\" ><option value='' selected='selected'><\/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' >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                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_1_12\"  class=\"gfield gfield--type-phone gfield--width-third field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_12\"><label class='gfield_label gform-field-label' for='input_1_12' >Primary Telephone Number<\/label><div class='ginput_container ginput_container_phone'><input name='input_12' id='input_1_12' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_13\"  class=\"gfield gfield--type-phone gfield--width-third field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_13\"><label class='gfield_label gform-field-label' for='input_1_13' >Mobile Number<\/label><div class='ginput_container ginput_container_phone'><input name='input_13' id='input_1_13' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_14\"  class=\"gfield gfield--type-text gfield--width-third field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_14\"><label class='gfield_label gform-field-label' for='input_1_14' >Age<\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_1_14' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_1_15\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_15\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Consent<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_1_15'><div class='gchoice gchoice_1_15_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.1' type='checkbox'  value='May we email you at the above address?'  id='choice_1_15_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_15_1' id='label_1_15_1' class='gform-field-label gform-field-label--type-inline'>May we email you at the above address?<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_15_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.2' type='checkbox'  value='May we share this email with the other party?'  id='choice_1_15_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_15_2' id='label_1_15_2' class='gform-field-label gform-field-label--type-inline'>May we share this email with the other party?<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_6' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"1\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"1\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_6' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <button type='button'  id='gform_save_1_3_link' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  onclick='if(window[\"gf_submitting_1\"]){return false;}  if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;} jQuery(\"#gform_save_1\").val(1); jQuery(\"#gform_1\").trigger(\"submit\",[true]);' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_1\"]){return false;} if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;} jQuery(\"#gform_save_1\").val(1); jQuery(\"#gform_1\").trigger(\"submit\",[true]); }'><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> Save and Continue Later<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_3' class='gform_page' data-js='page-field-id-6' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_3' class='gform_fields top_label form_sublabel_above description_above'><div id=\"field_1_16\"  class=\"gfield gfield--type-text gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_16\"><label class='gfield_label gform-field-label' for='input_1_16' >Your Employer<\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_1_16' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_17\"  class=\"gfield gfield--type-text gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_17\"><label class='gfield_label gform-field-label' for='input_1_17' >Your Annual Income<\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_1_17' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_18\"  class=\"gfield gfield--type-phone gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_18\"><label class='gfield_label gform-field-label' for='input_1_18' >Work Telephone Number<\/label><div class='ginput_container ginput_container_phone'><input name='input_18' id='input_1_18' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_19\"  class=\"gfield gfield--type-text gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_19\"><label class='gfield_label gform-field-label' for='input_1_19' >Preferred Language of Communication<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_1_19' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_1_20\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_20\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Consent<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_1_20'><div class='gchoice gchoice_1_20_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.1' type='checkbox'  value='May We Call You At Work?'  id='choice_1_20_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_20_1' id='label_1_20_1' class='gform-field-label gform-field-label--type-inline'>May We Call You At Work?<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_22\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_22\"><label class='gfield_label gform-field-label' for='input_1_22' >Date of Marriage\/Cohabitation<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_22' id='input_1_22' type='text' value='' class='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_1_22_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_1_22_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_1_22' class='gform_hidden' value='https:\/\/proserv1.quarterdev.ca\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_1_21\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_21\"><label class='gfield_label gform-field-label' for='input_1_21' >Date of Separation<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_21' id='input_1_21' type='text' value='' class='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_1_21_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_1_21_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_1_21' class='gform_hidden' value='https:\/\/proserv1.quarterdev.ca\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_1_23\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_23\"><label class='gfield_label gform-field-label' for='input_1_23' >Name of Lawyer<\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_1_23' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_30' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"2\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_30' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <button type='button'  id='gform_save_1_4_link' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  onclick='if(window[\"gf_submitting_1\"]){return false;}  if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;} jQuery(\"#gform_save_1\").val(1); jQuery(\"#gform_1\").trigger(\"submit\",[true]);' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_1\"]){return false;} if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;} jQuery(\"#gform_save_1\").val(1); jQuery(\"#gform_1\").trigger(\"submit\",[true]); }'><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> Save and Continue Later<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_4' class='gform_page' data-js='page-field-id-30' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_4' class='gform_fields top_label form_sublabel_above description_above'><div id=\"field_1_25\"  class=\"gfield gfield--type-text gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_25\"><label class='gfield_label gform-field-label' for='input_1_25' >Name of Other Party<\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_1_25' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_26\"  class=\"gfield gfield--type-text gfield--width-half field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_26\"><label class='gfield_label gform-field-label' for='input_1_26' >Party 2 - Annual Income<\/label><div class='ginput_container ginput_container_text'><input name='input_26' id='input_1_26' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_1_27\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_27\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Reconciliation<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_1_27'><div class='gchoice gchoice_1_27_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.1' type='checkbox'  value='Are you interested in reconciliation'  id='choice_1_27_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_27_1' id='label_1_27_1' class='gform-field-label gform-field-label--type-inline'>Are you interested in reconciliation<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_31\"  class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_31\"><label class='gfield_label gform-field-label' for='input_1_31' >Are you currently involved in a court proceeding for these issues?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_31' id='input_1_31' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_1_33\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_33\"><label class='gfield_label gform-field-label' for='input_1_33' >Is there an existing separation agreement or court Order?<\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_1_33' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_34\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_34\"><label class='gfield_label gform-field-label' for='input_1_34' >Are there any legal reason(s) preventing you from communicating directly or indirectly (restraining order\/peace bond)?<\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_1_34' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_35\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_35\"><label class='gfield_label gform-field-label' for='input_1_35' >Who made the decision to end the relationship?<\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_1_35' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_32\"  class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_32\"><label class='gfield_label gform-field-label' for='input_1_32' >Please tell us one positive thing about the other party.<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_32' id='input_1_32' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_1_36\"  class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_36\"><label class='gfield_label gform-field-label' for='input_1_36' >Please provide a brief history of your marriage\/relationship.<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_36' id='input_1_36' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_41' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"3\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_41' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"5\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <button type='button'  id='gform_save_1_5_link' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  onclick='if(window[\"gf_submitting_1\"]){return false;}  if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;} jQuery(\"#gform_save_1\").val(1); jQuery(\"#gform_1\").trigger(\"submit\",[true]);' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_1\"]){return false;} if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;} jQuery(\"#gform_save_1\").val(1); jQuery(\"#gform_1\").trigger(\"submit\",[true]); }'><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> Save and Continue Later<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_5' class='gform_page' data-js='page-field-id-41' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_5' class='gform_fields top_label form_sublabel_above description_above'><fieldset id=\"field_1_38\"  class=\"gfield gfield--type-list gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_38\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Are there children from this marriage?<\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Childs Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Date of Birth<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Age<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Child is living with?<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_38_cell1 gform-grid-col' data-label='Childs Name'><input aria-invalid='false'   aria-label='Childs Name, Row 1' data-aria-label-template='Childs Name, Row {0}' type='text' name='input_38[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_38_cell2 gform-grid-col' data-label='Date of Birth'><input aria-invalid='false'   aria-label='Date of Birth, Row 1' data-aria-label-template='Date of Birth, Row {0}' type='text' name='input_38[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_38_cell3 gform-grid-col' data-label='Age'><input aria-invalid='false'   aria-label='Age, Row 1' data-aria-label-template='Age, Row {0}' type='text' name='input_38[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_38_cell4 gform-grid-col' data-label='Child is living with?'><input aria-invalid='false'   aria-label='Child is living with?, Row 1' data-aria-label-template='Child is living with?, Row {0}' type='text' name='input_38[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type=\"button\"  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type=\"button\"  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_39\"  class=\"gfield gfield--type-list gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_39\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Do you have children from any other relationship(s)?<\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Childs Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Date of Birth<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Age<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Child is living with?<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_39_cell1 gform-grid-col' data-label='Childs Name'><input aria-invalid='false'   aria-label='Childs Name, Row 1' data-aria-label-template='Childs Name, Row {0}' type='text' name='input_39[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_39_cell2 gform-grid-col' data-label='Date of Birth'><input aria-invalid='false'   aria-label='Date of Birth, Row 1' data-aria-label-template='Date of Birth, Row {0}' type='text' name='input_39[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_39_cell3 gform-grid-col' data-label='Age'><input aria-invalid='false'   aria-label='Age, Row 1' data-aria-label-template='Age, Row {0}' type='text' name='input_39[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_39_cell4 gform-grid-col' data-label='Child is living with?'><input aria-invalid='false'   aria-label='Child is living with?, Row 1' data-aria-label-template='Child is living with?, Row {0}' type='text' name='input_39[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type=\"button\"  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type=\"button\"  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_40\"  class=\"gfield gfield--type-list gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_40\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >What are the issues you wish to discuss in mediation?<\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Issue<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Why is this important to you?<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_40_cell1 gform-grid-col' data-label='Issue'><input aria-invalid='false'   aria-label='Issue, Row 1' data-aria-label-template='Issue, Row {0}' type='text' name='input_40[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_40_cell2 gform-grid-col' data-label='Why is this important to you?'><input aria-invalid='false'   aria-label='Why is this important to you?, Row 1' data-aria-label-template='Why is this important to you?, Row {0}' type='text' name='input_40[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type=\"button\"  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type=\"button\"  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_42' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"4\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_1_42' class='gform_next_button gform-theme-button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_1\").val(\"6\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_1\").val(\"6\");  jQuery(\"#gform_1\").trigger(\"submit\",[true]); } ' \/> <button type='button'  id='gform_save_1_6_link' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  onclick='if(window[\"gf_submitting_1\"]){return false;}  if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;} jQuery(\"#gform_save_1\").val(1); jQuery(\"#gform_1\").trigger(\"submit\",[true]);' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_1\"]){return false;} if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;} jQuery(\"#gform_save_1\").val(1); jQuery(\"#gform_1\").trigger(\"submit\",[true]); }'><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> Save and Continue Later<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_6' class='gform_page' data-js='page-field-id-42' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_6' class='gform_fields top_label form_sublabel_above description_above'><div id=\"field_1_43\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_43\"><label class='gfield_label gform-field-label' for='input_1_43' >What is communication like with your partner?<\/label><div class='ginput_container ginput_container_text'><input name='input_43' id='input_1_43' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_44\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_44\"><label class='gfield_label gform-field-label' for='input_1_44' >Do you have any concerns about being in the same room with your former partner?<\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_1_44' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_45\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_45\"><label class='gfield_label gform-field-label' for='input_1_45' >What would you consider to be the greatest obstacle in reaching an agreement in mediation?<\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_1_45' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_1_47\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_47\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Indicate the factors that best explain your reasons for separating.<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_1_47'><div class='gchoice gchoice_1_47_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.1' type='checkbox'  value='Physical abuse \/ violence'  id='choice_1_47_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_47_1' id='label_1_47_1' class='gform-field-label gform-field-label--type-inline'>Physical abuse \/ violence<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_47_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.2' type='checkbox'  value='Emotional abuse'  id='choice_1_47_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_47_2' id='label_1_47_2' class='gform-field-label gform-field-label--type-inline'>Emotional abuse<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_47_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.3' type='checkbox'  value='Drug \/ alcohol abuse'  id='choice_1_47_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_47_3' id='label_1_47_3' class='gform-field-label gform-field-label--type-inline'>Drug \/ alcohol abuse<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_47_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.4' type='checkbox'  value='Mental illness'  id='choice_1_47_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_47_4' id='label_1_47_4' class='gform-field-label gform-field-label--type-inline'>Mental illness<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_47_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.5' type='checkbox'  value='Infidelity'  id='choice_1_47_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_47_5' id='label_1_47_5' class='gform-field-label gform-field-label--type-inline'>Infidelity<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_47_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.6' type='checkbox'  value='Poor communication'  id='choice_1_47_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_47_6' id='label_1_47_6' class='gform-field-label gform-field-label--type-inline'>Poor communication<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_47_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.7' type='checkbox'  value='Threats'  id='choice_1_47_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_47_7' id='label_1_47_7' class='gform-field-label gform-field-label--type-inline'>Threats<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_47_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_47.8' type='checkbox'  value='Incompatibility'  id='choice_1_47_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_47_8' id='label_1_47_8' class='gform-field-label gform-field-label--type-inline'>Incompatibility<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice 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for='input_1_48' >Other factors that best explain your reasons for separating:<\/label><div class='ginput_container ginput_container_text'><input name='input_48' id='input_1_48' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_1_49\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_49\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Is there any<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_1_49'><div class='gchoice gchoice_1_49_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.1' type='checkbox'  value='CAS file'  id='choice_1_49_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_49_1' id='label_1_49_1' class='gform-field-label gform-field-label--type-inline'>CAS 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data-js-reload=\"field_1_50\"><label class='gfield_label gform-field-label' for='input_1_50' >Do you have any disabilities you would like to inform us about?<\/label><div class='ginput_container ginput_container_text'><input name='input_50' id='input_1_50' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_51\"  class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_51\"><label class='gfield_label gform-field-label' for='input_1_51' >Is there anything else you would like us to know?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_51' id='input_1_51' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_1_52\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_52\"><label class='gfield_label gform-field-label' for='input_1_52' >How did you hear about Purdon Family Law Mediation<\/label><div class='ginput_container ginput_container_text'><input name='input_52' id='input_1_52' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_1_37\"  class=\"gfield gfield--type-captcha gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_1_37\"><label class='gfield_label gform-field-label' for='input_1_37' >CAPTCHA<\/label><div id='input_1_37' class='ginput_container ginput_recaptcha' data-sitekey=''  data-theme='light' data-tabindex='0'  data-badge=''><\/div><\/div><div id=\"field_1_54\"  class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  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