{"id":28140,"date":"2026-02-16T14:55:08","date_gmt":"2026-02-16T20:55:08","guid":{"rendered":"https:\/\/uwm.edu\/engineering\/students\/future\/k-12-students\/enquest\/enquest-overnight-camp-registration\/enquest-overnight-program-participant-form\/"},"modified":"2026-03-09T06:40:53","modified_gmt":"2026-03-09T11:40:53","slug":"enquest-overnight-program-participant-form","status":"publish","type":"page","link":"https:\/\/uwm.edu\/engineering\/students\/future\/k-12-students\/enquest\/enquest-overnight-camp-registration\/enquest-overnight-program-participant-form\/","title":{"rendered":"EnQuest 2026 Overnight Program Participant Form"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\" id=\"h-this-form-must-be-completed-by-a-parent-or-guardian-before-a-registered-student-can-participate-in-the-camp\"><strong>This form must be completed by a parent or guardian before a registered student can participate in the camp.<\/strong><br><\/h2>\n\n\n\n<p>The overnight camp is held in the following 51ÁÔÆæ locations:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>51ÁÔÆæ EMS Building, 3200 N. Cramer Street, Milwaukee, WI 53211<\/li>\n\n\n\n<li>51ÁÔÆæ Sandburg Residence Hall, 3400 N. Maryland Avenue, Milwaukee, WI 53211<\/li>\n<\/ul>\n\n\n\n<p>Field trips to other buildings on the 51ÁÔÆæ campus may occur during the course of this camp.<\/p>\n\n\n<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_unknown gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_62' ><form method='post' enctype='multipart\/form-data'  id='gform_62'  action='\/engineering\/wp-json\/wp\/v2\/pages\/28140' data-formid='62' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6Let4LkmAAAAAMDytJZITec55NB97k2BiShMXqPE' data-tabindex='0'><input id=\"input_8be689ca91bd438fe3d545f8455c952f\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_8be689ca91bd438fe3d545f8455c952f\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_62' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_62_83\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_83'>Name<\/label><div class='gfield_description' id='gfield_description_62_83'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_83' id='input_62_83' type='text' value='' autocomplete='new-password'\/><\/div><\/div><div id=\"field_62_27\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">CAMPER INFORMATION<\/h3><\/div><div id=\"field_62_81\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_81'>Participant First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_81' id='input_62_81' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_82\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_82'>Participant Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_82' id='input_62_82' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_8\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_8'>Participant DOB<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_8' id='input_62_8' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_62_8_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_62_8_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_62_8' class='gform_hidden' value='https:\/\/uwm.edu\/engineering\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_62_9\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_9'>Age on July 26<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_62_9' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_4\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_4'>Participant Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_62_4' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_3\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_3'>Participant Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_3' id='input_62_3' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_62_10\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_10'>Participant Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_62_10' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_62_5\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Participant Home Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_62_5' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_62_5_1_container' >\n                                        <label for='input_62_5_1' id='input_62_5_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_5.1' id='input_62_5_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_62_5_2_container' >\n                                        <label for='input_62_5_2' id='input_62_5_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_5.2' id='input_62_5_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_62_5_3_container' >\n                                    <label for='input_62_5_3' id='input_62_5_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_5.3' id='input_62_5_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_62_5_4_container' >\n                                        <label for='input_62_5_4' id='input_62_5_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                        <input type='text' name='input_5.4' id='input_62_5_4' value=''      aria-required='true'    \/>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_62_5_5_container' >\n                                    <label for='input_62_5_5' id='input_62_5_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                    <input type='text' name='input_5.5' id='input_62_5_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_5.6' id='input_62_5_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_62_60\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">CUSTODIAL PARENT\/GUARDIAN INFORMATION<\/h3><\/div><div id=\"field_62_61\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_61'>Parent\/Guardian Name(s)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_61' id='input_62_61' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_62\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_62'>Parent\/Guardian Cell Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_62' id='input_62_62' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_63\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_63'>Parent\/Guardian Home or Work Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_63' id='input_62_63' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_78\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">EMERGENCY CONTACT<\/h3><\/div><div id=\"field_62_65\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_65'>Emergency Contact Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_65' id='input_62_65' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_64\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_64'>Relationship to camper<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_64' id='input_62_64' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_66\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_66'>Emergency Contact Primary Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_66' id='input_62_66' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_67\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_67'>Emergency Contact Alternate Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_67' id='input_62_67' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_26\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">PERMISSIONS<\/h3><div class='gsection_description' id='gfield_description_62_26'>PLEASE READ THE FOLLOWING PARAGRAPHS CAREFULLY. IF YOU HAVE ANY QUESTIONS REGARDING THIS AGREEMENT OR WOULD LIKE TO NEGOTIATE ITS TERMS, CONTACT Chris Beimborn at (414)251-9140.<\/div><\/div><fieldset id=\"field_62_6\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Terms and Conditions<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_62_6' tabindex='0'>The EnQuest Overnight Camp will involve the use of engineering and laboratory tools which may include soldering irons and materials that are handled using protective equipment such as gloves and ventilation hoods. Participants will create sand molds in the UW-Milwaukee Foundry &amp; Materials Processing lab and observe metal casting in this facility. Participants may take advantage of special opportunities to take field trips to nearby sites, including visits to UW-Milwaukee facilities or tours of professional workplaces; dates and locations will be provided to parents\/guardians. Students will learn about research in biomedical engineering and use lab equipment and meet researchers. Participation in the camp requires these activities.<br \/>\n<br \/>\nI, the undersigned parent or guardian, give permission for my child\/ward named above to participate in the University of Wisconsin-Milwaukee (51ÁÔÆæ) sponsored activity identified above, and in doing so, voluntarily agree to assume all of the risk and responsibilities involved in my child\/ward\u2019s participation in this activity.<br \/>\n<br \/>\nASSUMPTION OF RISKS<br \/>\nYou are being asked to sign this form because you would like to participate in the above-listed event (the \u201cProgram\u201d) sponsored by the University of Wisconsin-Milwaukee (\u201c51ÁÔÆæ\u201d). Before you can participate, 51ÁÔÆæ asks that you read this document carefully. If you want to ask questions about this document or request changes to it, you can do so by contacting the party listed above.<br \/>\n<br \/>\nI understand that the UW-Milwaukee EnQuest Overnight Camp, by its very nature, carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries and\/or illness. I am aware of the risks of participation, which include, but are not limited to minor injury such as bruises, contusions, broken bones, concussion, and catastrophic injuries, such as paralysis and even death. 51ÁÔÆæ recommends you minimize your risks by talking to a doctor before participating in the Program. I know, understand, and appreciate the risks that are inherent in the above-listed activity. I hereby assert that participation is voluntary and that I knowingly assume all such risks.<\/div><div class='ginput_container ginput_container_consent'><input name='input_6.1' id='input_62_6_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_62_6\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_62_6_1' >I confirm that I have read and understood the terms outlined above.<\/label><input type='hidden' name='input_6.2' value='I confirm that I have read and understood the terms outlined above.' class='gform_hidden' \/><input type='hidden' name='input_6.3' value='5' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_62_79\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_79'>Camper Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_79' id='input_62_79' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_69\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_69'>Parent\/Guardian Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_62_69'>Retype name to sign<\/div><div class='ginput_container ginput_container_text'><input name='input_69' id='input_62_69' type='text' value='' class='large'  aria-describedby=\"gfield_description_62_69\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_62_13\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datefield gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div id='input_62_13' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_62_13_1_container'>\n                                            <input type='number' maxlength='2' name='input_13[]' id='input_62_13_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_62_13_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_62_13_2_container'>\n                                            <input type='number' maxlength='2' name='input_13[]' id='input_62_13_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_62_13_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_62_13_3_container'>\n                                            <input type='number' maxlength='4' name='input_13[]' id='input_62_13_3' value=''   aria-required='true'   placeholder='YYYY' min='1920' max='2027' step='1'\/>\n                                            <label for='input_62_13_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                       <\/div>\n                                   <\/div><\/fieldset><fieldset id=\"field_62_14\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >HOLD HARMLESS, INDEMNITY AND RELEASE<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_62_14' tabindex='0'>In consideration of my child\/ward\u2019s participation in these activities, I , for myself, spouse, heirs, personal representatives, estate or assigns, agree to defend, hold harmless, indemnify and release the Releasees and their officers, employees, agents, and volunteers from and against any and all claims, demands, actions, or causes of action of any sort on account of damage to personal property, personal injury, or death which may result from participation in the above-listed activity. This release includes claims based on the negligence of the Releasees, and their officers, employees, agents, and volunteers, but expressly does not include claims based on their intentional misconduct or recklessness. I understand that by agreeing to this clause, I am releasing claims and giving up substantial rights, including my right to sue.<\/div><div class='ginput_container ginput_container_consent'><input name='input_14.1' id='input_62_14_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_62_14\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_62_14_1' >I confirm that I have read and understood the terms outlined above.<\/label><input type='hidden' name='input_14.2' value='I confirm that I have read and understood the terms outlined above.' class='gform_hidden' \/><input type='hidden' name='input_14.3' value='5' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_62_80\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_80'>Camper Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_80' id='input_62_80' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_68\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_68'>Parent\/Guardian Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_62_68'>Retype name to sign<\/div><div class='ginput_container ginput_container_text'><input name='input_68' id='input_62_68' type='text' value='' class='large'  aria-describedby=\"gfield_description_62_68\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_62_17\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datefield gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div id='input_62_17' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_62_17_1_container'>\n                                            <input type='number' maxlength='2' name='input_17[]' id='input_62_17_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_62_17_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_62_17_2_container'>\n                                            <input type='number' maxlength='2' name='input_17[]' id='input_62_17_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_62_17_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_62_17_3_container'>\n                                            <input type='number' maxlength='4' name='input_17[]' id='input_62_17_3' value=''   aria-required='true'   placeholder='YYYY' min='1920' max='2027' step='1'\/>\n                                            <label for='input_62_17_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                       <\/div>\n                                   <\/div><\/fieldset><fieldset id=\"field_62_18\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >RELEASE FOR USE OF PHOTOS AND LIKENESS BY 51ÁÔÆæ (OPTIONAL)<\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_62_18' tabindex='0'>I understand that the University of Wisconsin-Milwaukee (\u201c51ÁÔÆæ\u201d) and partners of the 51ÁÔÆæ EnQuest Overnight Camp may take photographs, video, audiotape and other image and sound-based media of the campus, (including inside its buildings and including through the use of drones), and its employees, students, and visitors (collectively, the \u201cImages\u201d). 51ÁÔÆæ may wish to use such Images for educational, promotional, advertising, and other purposes, including, but not limited to printed publications and on its website. Therefore, I hereby freely and voluntarily consent to the use and publication of my name, participation, picture, and\/or likeness by 51ÁÔÆæ and\/or its employees and\/or agents for any and all purposes including, but not limited to, educational, promotional, advertising, and trade, through any medium or format as technology may now or in the future allow, including, but not limited to, videotape, audiotape, webcasting, podcasting, film, photograph, television, radio, digital, internet, theater, or exhibition, at any time from this date forward. I further waive any claims against 51ÁÔÆæ and\/or its employees and\/or agents based upon or related to its use or publication of my likeness, voice, participation, and\/or picture.<br \/>\n<br \/>\nI understand that this form is optional, and I am not required to sign it. I freely give this authorization without expectation of compensation.<\/div><div class='ginput_container ginput_container_consent'><input name='input_18.1' id='input_62_18_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_62_18\"  aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_62_18_1' >I confirm that I have read and understood the terms outlined above.<\/label><input type='hidden' name='input_18.2' value='I confirm that I have read and understood the terms outlined above.' class='gform_hidden' \/><input type='hidden' name='input_18.3' value='5' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_62_19\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_19'>Camper Name<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_62_19' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_57\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_57'>Parent\/Guardian Signature<\/label><div class='gfield_description' id='gfield_description_62_57'>Retype name to sign<\/div><div class='ginput_container ginput_container_text'><input name='input_57' id='input_62_57' type='text' value='' class='large'  aria-describedby=\"gfield_description_62_57\"    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_62_24\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datefield gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Date<\/legend><div id='input_62_24' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_62_24_1_container'>\n                                            <input type='number' maxlength='2' name='input_24[]' id='input_62_24_1' value=''   aria-required='false'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_62_24_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_62_24_2_container'>\n                                            <input type='number' maxlength='2' name='input_24[]' id='input_62_24_2' value=''   aria-required='false'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_62_24_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_62_24_3_container'>\n                                            <input type='number' maxlength='4' name='input_24[]' id='input_62_24_3' value=''   aria-required='false'   placeholder='YYYY' min='1920' max='2027' step='1'\/>\n                                            <label for='input_62_24_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                       <\/div>\n                                   <\/div><\/fieldset><fieldset id=\"field_62_25\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Parent\/Guardian Home Address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_62_25' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_62_25_1_container' >\n                                        <label for='input_62_25_1' id='input_62_25_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_25.1' id='input_62_25_1' value=''    aria-required='false'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_62_25_2_container' >\n                                        <label for='input_62_25_2' id='input_62_25_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_25.2' id='input_62_25_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_62_25_3_container' >\n                                    <label for='input_62_25_3' id='input_62_25_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_25.3' id='input_62_25_3' value=''    aria-required='false'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_62_25_4_container' >\n                                        <label for='input_62_25_4' id='input_62_25_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                        <input type='text' name='input_25.4' id='input_62_25_4' value=''      aria-required='false'    \/>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_62_25_5_container' >\n                                    <label for='input_62_25_5' id='input_62_25_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                    <input type='text' name='input_25.5' id='input_62_25_5' value=''    aria-required='false'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_25.6' id='input_62_25_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_62_28\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">CAMPER HEALTH INFORMATION<\/h3><\/div><fieldset id=\"field_62_30\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Check all that apply:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_62_30'>(Depression, Anxiety, ADHD, ADD, etc&#8230;)<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_62_30'><div class='gchoice gchoice_62_30_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.1' type='checkbox'  value='Asthma'  id='choice_62_30_1'   aria-describedby=\"gfield_description_62_30\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_62_30_1' id='label_62_30_1' class='gform-field-label gform-field-label--type-inline'>Asthma<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_62_30_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.2' type='checkbox'  value='Diabetes'  id='choice_62_30_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_62_30_2' id='label_62_30_2' class='gform-field-label gform-field-label--type-inline'>Diabetes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_62_30_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.3' type='checkbox'  value='Epilepsy\/Seizures'  id='choice_62_30_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_62_30_3' id='label_62_30_3' class='gform-field-label gform-field-label--type-inline'>Epilepsy\/Seizures<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_62_30_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.4' type='checkbox'  value='Headaches'  id='choice_62_30_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_62_30_4' id='label_62_30_4' class='gform-field-label gform-field-label--type-inline'>Headaches<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_62_30_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.5' type='checkbox'  value='Mental Health Conditions'  id='choice_62_30_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_62_30_5' id='label_62_30_5' class='gform-field-label gform-field-label--type-inline'>Mental Health Conditions<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_62_30_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.6' type='checkbox'  value='Cognitive\/Developmental Concerns'  id='choice_62_30_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_62_30_6' id='label_62_30_6' class='gform-field-label gform-field-label--type-inline'>Cognitive\/Developmental Concerns<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_62_30_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.7' type='checkbox'  value='Dizziness, light-headedness, or fainting associated with exercise in the past year'  id='choice_62_30_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_62_30_7' id='label_62_30_7' class='gform-field-label gform-field-label--type-inline'>Dizziness, light-headedness, or fainting associated with exercise in the past year<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_62_30_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.8' type='checkbox'  value='Unexplained, rapid or irregular heartbeat within the last year'  id='choice_62_30_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_62_30_8' id='label_62_30_8' class='gform-field-label gform-field-label--type-inline'>Unexplained, rapid or irregular heartbeat within the last year<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_62_30_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.9' type='checkbox'  value='A physician has denied or restricted participation in sports due to a heart problem'  id='choice_62_30_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_62_30_9' id='label_62_30_9' class='gform-field-label gform-field-label--type-inline'>A physician has denied or restricted participation in sports due to a heart problem<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_62_30_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_30.11' type='checkbox'  value='None of the above'  id='choice_62_30_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_62_30_11' id='label_62_30_11' class='gform-field-label gform-field-label--type-inline'>None of the above<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_62_76\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Please indicate camper allergies here:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_62_76'>Check all that apply.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_62_76'><div class='gchoice gchoice_62_76_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.1' type='checkbox'  value='Medications'  id='choice_62_76_1'   aria-describedby=\"gfield_description_62_76\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_62_76_1' id='label_62_76_1' class='gform-field-label gform-field-label--type-inline'>Medications<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_62_76_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.2' type='checkbox'  value='Seasonal allergies'  id='choice_62_76_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_62_76_2' id='label_62_76_2' class='gform-field-label gform-field-label--type-inline'>Seasonal allergies<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_62_76_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.3' type='checkbox'  value='Insect stings'  id='choice_62_76_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_62_76_3' id='label_62_76_3' class='gform-field-label gform-field-label--type-inline'>Insect stings<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_62_76_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.4' type='checkbox'  value='Foods'  id='choice_62_76_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_62_76_4' id='label_62_76_4' class='gform-field-label gform-field-label--type-inline'>Foods<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_62_76_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.5' type='checkbox'  value='Other'  id='choice_62_76_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_62_76_5' id='label_62_76_5' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_62_76_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.6' type='checkbox'  value='Do allergies require EPI PEN injection?'  id='choice_62_76_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_62_76_6' id='label_62_76_6' class='gform-field-label gform-field-label--type-inline'>Do allergies require EPI PEN injection?<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_62_76_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.7' type='checkbox'  value='No known allergies'  id='choice_62_76_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_62_76_7' id='label_62_76_7' class='gform-field-label gform-field-label--type-inline'>No known allergies<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_62_77\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_77'>Please name specified allergens here.<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_77' id='input_62_77' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_62_75\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Does the camper use an inhaler?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_62_75'>\n\t\t\t<div class='gchoice gchoice_62_75_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='Yes'  id='choice_62_75_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_62_75_0' id='label_62_75_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_62_75_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='No'  id='choice_62_75_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_62_75_1' id='label_62_75_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_62_31\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_31'>Date of last Tetanus booster (Td or Dtap or DTP):<\/label><div class='gfield_description' id='gfield_description_62_31'>Note: a tetanus shot is not required for camp attendance. However, it is important for medical professionals to know if you have or have not had a current tetanus booster in case of emergency.<\/div><div class='ginput_container ginput_container_date'>\n                            <input name='input_31' id='input_62_31' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_62_31_date_format gfield_description_62_31\" aria-invalid=\"false\" \/>\n                            <span id='input_62_31_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_62_31' class='gform_hidden' value='https:\/\/uwm.edu\/engineering\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_62_32\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_32'>Describe any limitations or restrictions of program activities:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_32' id='input_62_32' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_62_33\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_33'>Describe any special accommodations regarding physical or emotional conditions we need to be aware of regarding your participation in this program:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_33' id='input_62_33' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_62_29\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">MEDICAL INFORMATION<\/h3><div class='gsection_description' id='gfield_description_62_29'>All medications brought to 51ÁÔÆæ programs must be in the original medicine packaging. Prescription medication must be labeled with the participant\u2019s name, doctor\u2019s name and phone number, medication name, dosage, prescription number, date prescribed, and instructions. Only the amount of medication necessary during the course of the program should be brought to 51ÁÔÆæ.\nOver\u2010the\u2010counter medications, dermal creams, and medication necessary for life\u2010threatening conditions (inhalers, insulin syringes, EpiPens, etc.) may be carried and self\u2010administered by all program participants.\nProgram participants under the age of 18 who require prescription medications (other than those described above) must provide such medications to 51ÁÔÆæ staff at the outset of the program (or as soon as such medications become available). 51ÁÔÆæ staff will distribute (but not administer) such medications to the participant as directed during the program.<\/div><\/div><div id=\"field_62_36\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_36'>Name of primary care provider:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_62_36' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_37\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_37'>Phone Number:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_62_37' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_62_35\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Please choose one of the following:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_62_35'>\n\t\t\t<div class='gchoice gchoice_62_35_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='No prescription medication will be brought to this event.'  id='choice_62_35_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_62_35_0' id='label_62_35_0' class='gform-field-label gform-field-label--type-inline'>No prescription medication will be brought to this event.<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_62_35_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_35' type='radio' value='The prescription medication listed below will be brought to the event.'  id='choice_62_35_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_62_35_1' id='label_62_35_1' class='gform-field-label gform-field-label--type-inline'>The prescription medication listed below will be brought to the event.<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_62_44\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">FIRST MEDICATION<\/h3><div class='gsection_description' id='gfield_description_62_44'>If applicable<\/div><\/div><div id=\"field_62_38\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_38'>Name of medication<\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_62_38' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_39\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_39'>Dosage<\/label><div class='ginput_container ginput_container_text'><input name='input_39' id='input_62_39' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_40\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_40'>Side Effect Experiences<\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_62_40' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_42\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_42'>How is medication taken?<\/label><div class='gfield_description' id='gfield_description_62_42'>Orally, via injection, etc&#8230;<\/div><div class='ginput_container ginput_container_text'><input name='input_42' id='input_62_42' type='text' value='' class='large'  aria-describedby=\"gfield_description_62_42\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_43\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_43'>When is medication taken?<\/label><div class='gfield_description' id='gfield_description_62_43'>Days, time, etc&#8230;<\/div><div class='ginput_container ginput_container_text'><input name='input_43' id='input_62_43' type='text' value='' class='large'  aria-describedby=\"gfield_description_62_43\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_71\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_71'>Additional information related to this medication<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_71' id='input_62_71' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_62_58\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">SECOND MEDICATION<\/h3><div class='gsection_description' id='gfield_description_62_58'>If applicable<\/div><\/div><div id=\"field_62_45\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_45'>Name of medication<\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_62_45' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_46\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_46'>Dosage<\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_62_46' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_47\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_47'>Side Effect Experiences<\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_62_47' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_48\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_48'>How is medication taken?<\/label><div class='gfield_description' id='gfield_description_62_48'>Orally, via injection, etc&#8230;<\/div><div class='ginput_container ginput_container_text'><input name='input_48' id='input_62_48' type='text' value='' class='large'  aria-describedby=\"gfield_description_62_48\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_50\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_50'>When is medication taken?<\/label><div class='gfield_description' id='gfield_description_62_50'>Days, time, etc&#8230;<\/div><div class='ginput_container ginput_container_text'><input name='input_50' id='input_62_50' type='text' value='' class='large'  aria-describedby=\"gfield_description_62_50\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_70\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_70'>Additional information related to this medication<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_70' id='input_62_70' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_62_59\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">THIRD MEDICATION<\/h3><div class='gsection_description' id='gfield_description_62_59'>If applicable<\/div><\/div><div id=\"field_62_51\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_51'>Name of medication<\/label><div class='ginput_container ginput_container_text'><input name='input_51' id='input_62_51' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_52\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_52'>Dosage<\/label><div class='ginput_container ginput_container_text'><input name='input_52' id='input_62_52' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_53\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_53'>Side Effect Experiences<\/label><div class='ginput_container ginput_container_text'><input name='input_53' id='input_62_53' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_54\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_54'>How is medication taken?<\/label><div class='gfield_description' id='gfield_description_62_54'>Orally, via injection, etc&#8230;<\/div><div class='ginput_container ginput_container_text'><input name='input_54' id='input_62_54' type='text' value='' class='large'  aria-describedby=\"gfield_description_62_54\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_55\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_55'>When is medication taken?<\/label><div class='gfield_description' id='gfield_description_62_55'>Days, time, etc&#8230;<\/div><div class='ginput_container ginput_container_text'><input name='input_55' id='input_62_55' type='text' value='' class='large'  aria-describedby=\"gfield_description_62_55\"    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_62_72\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_62_72'>Additional information related to this medication<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_72' id='input_62_72' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_62_73\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">ADDITIONAL MEDICATIONS<\/h3><\/div><div id=\"field_62_74\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_above 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