{"id":8191,"date":"2024-10-03T14:23:53","date_gmt":"2024-10-03T18:23:53","guid":{"rendered":"https:\/\/fadb.nu\/?page_id=8191"},"modified":"2024-10-03T14:24:33","modified_gmt":"2024-10-03T18:24:33","slug":"intake-form-eng","status":"publish","type":"page","link":"https:\/\/fadb.nu\/pap\/intake-form-eng\/","title":{"rendered":"Intake-Form ENG"},"content":{"rendered":"<div class=\"frm_forms  with_frm_style frm_style_sleek-smooth-style\" id=\"frm_form_5_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_ajax_submit  frm_pro_form  frm_slidein\" id=\"form_fzfp93\" action=\"\" >\n<div class=\"frm_form_fields  frm_page_num_1\">\n<fieldset>\n<legend class=\"frm_screen_reader\">Intake-form (ENG)<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<div class=\"frm_rootline_group\" role=\"group\" tabindex=\"0\" aria-label=\"Page 1 of 4\" ><ul class=\"frm_page_bar frm_rootline_4 frm_rootline frm_rootline_line  frm_show_lines frm_show_titles\"><li class=\"frm_rootline_single frm_current_page\"><input type=\"button\" value=\"1\" data-page=\"\" class=\"frm_page_1\" aria-disabled=\"true\" data-field=\"0\" aria-label=\"Contact Information\"  \/><span class=\"frm_rootline_title\">Contact Information<\/span><\/li><li class=\"frm_rootline_single\"><input type=\"button\" value=\"2\" data-page=\"35\" class=\"frm_page_skip frm_page_2\" data-field=\"140\" aria-label=\"Medical information\"  \/><span class=\"frm_rootline_title\">Medical information<\/span><\/li><li class=\"frm_rootline_single\"><input type=\"button\" value=\"3\" data-page=\"49\" class=\"frm_page_skip frm_page_3\" data-field=\"147\" aria-label=\"Wish Description\"  \/><span class=\"frm_rootline_title\">Wish Description<\/span><\/li>\t\t<li class=\"frm_rootline_single frm_rootline_show_hidden_steps_btn frm_hidden\">\n\t\t\t<input type=\"button\" class=\"frm_rootline_show_more_btn\" value=\"\u00b7\u00b7\u00b7\" \/>\n\t\t\t<ul class=\"frm_rootline_hidden_steps frm_hidden\"><\/ul>\n\t\t<\/li>\n\t\t<li class=\"frm_rootline_single\"><input type=\"button\" value=\"4\" data-page=\"65\" class=\"frm_page_skip frm_page_4\" data-field=\"156\" aria-label=\"Summary\"  \/><span class=\"frm_rootline_title\">Summary<\/span><\/li><\/ul><div class=\"frm_clearfix\"><\/div><\/div><input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"5\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_5\" id=\"frm_hide_fields_5\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"fzfp93\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_5\" name=\"frm_submit_entry_5\" value=\"777698ec38\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/pap\/wp-json\/wp\/v2\/pages\/8191\" \/><div id=\"frm_field_122_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div  id=\"field_4gvqp3_label\" class=\"frm_primary_label\">I am registering this wish for:\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_4gvqp3_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_122-0\">\t\t\t<label  for=\"field_4gvqp3-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[122]\" id=\"field_4gvqp3-0\" value=\"myself (patient)\"\n\t\t   data-reqmsg=\"I am registering this wish for: kan niet leeg zijn.\" data-invmsg=\"I am registering this wish for: is invalid\"  \/> myself (patient)<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_122-1\">\t\t\t<label  for=\"field_4gvqp3-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[122]\" id=\"field_4gvqp3-1\" value=\"someone else\"\n\t\t   data-reqmsg=\"I am registering this wish for: kan niet leeg zijn.\" data-invmsg=\"I am registering this wish for: is invalid\"  \/> someone else<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_123_container\" class=\"frm_form_field frm_section_heading form-field  frm12 frm_first\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Details of the the registrant<\/h3>\r\n\r\n\r\n<div id=\"frm_field_124_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third\">\r\n\t<div  id=\"field_x4gu83_label\" class=\"frm_primary_label\">Name: \r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<fieldset aria-labelledby=\"field_x4gu83_label\">\n\t<legend class=\"frm_screen_reader frm_hidden\">\n\t\tName: \t<\/legend>\n\n\t<div  class=\"frm_combo_inputs_container\" id=\"frm_combo_inputs_container_124\" data-name-layout=\"first_last\">\n\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_124-first_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-first  frm6\"\n\t\t\t\tdata-sub-field-name=\"first\"\n\t\t\t>\n\t\t\t\t<label for=\"field_x4gu83_first\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tFirst Name\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_x4gu83_first\" value=\"\" name=\"item_meta[124][first]\" autocomplete=\"given-name\" data-sectionid=\"123\"  data-reqmsg=\"Name:  kan niet leeg zijn.\" aria-required=\"true\" data-invmsg=\"Name:  is invalid\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_124_first_desc\">First Name<\/div>\t\t\t<\/div>\n\t\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_124-last_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-last  frm6\"\n\t\t\t\tdata-sub-field-name=\"last\"\n\t\t\t>\n\t\t\t\t<label for=\"field_x4gu83_last\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tLast Name\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_x4gu83_last\" value=\"\" name=\"item_meta[124][last]\" autocomplete=\"family-name\" data-sectionid=\"123\"  data-reqmsg=\"Name:  kan niet leeg zijn.\" aria-required=\"true\" data-invmsg=\"Name:  is invalid\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_124_last_desc\">Last Name<\/div>\t\t\t<\/div>\n\t\t\t\t<\/div>\n<\/fieldset>\n\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_125_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third\">\r\n\t<label for=\"field_4gjee3\" id=\"field_4gjee3_label\" class=\"frm_primary_label\">E-mail:\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"email\" id=\"field_4gjee3\" name=\"item_meta[125]\" value=\"\"  data-sectionid=\"123\"  autocomplete=\"email\"  data-reqmsg=\"E-mail: kan niet leeg zijn.\" aria-required=\"true\" data-invmsg=\"E-mail: is ongeldig\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_126_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third\">\r\n\t<label for=\"field_wsyd73\" id=\"field_wsyd73_label\" class=\"frm_primary_label\">Phone:\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"tel\" id=\"field_wsyd73\" name=\"item_meta[126]\" value=\"\"  data-reqmsg=\"Phone: kan niet leeg zijn.\" aria-required=\"true\" data-invmsg=\"Phone: is ongeldig\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_127_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third\">\r\n\t<label for=\"field_j7kar3\" id=\"field_j7kar3_label\" class=\"frm_primary_label\">Relationship to the patient:\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_j7kar3\" name=\"item_meta[127]\" value=\"for example; family, friend, doctor, etc.\"  data-sectionid=\"123\"  data-frmval=\"for example; family, friend, doctor, etc.\" data-reqmsg=\"Relationship to the patient: kan niet leeg zijn.\" aria-required=\"true\" data-invmsg=\"Relationship to the patient: is ongeldig\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_128_container\" class=\"frm_form_field form-field  frm_top_container frm_first frm_third vertical_radio frm_other_container\">\r\n\t<div  id=\"field_576lh3_label\" class=\"frm_primary_label\">Are you also riding in the ambulance? (max. 1 person)\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_576lh3_label\" role=\"radiogroup\">\t\t<div class=\"frm_radio\" id=\"frm_radio_128-123-0\">\t\t\t<label  for=\"field_576lh3-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[128]\" id=\"field_576lh3-0\" value=\"yes\"\n\t\t   data-sectionid=\"123\"  data-invmsg=\"Are you also riding in the ambulance? (max. 1 person) is invalid\"  \/> yes<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_128-123-1\">\t\t\t<label  for=\"field_576lh3-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[128]\" id=\"field_576lh3-1\" value=\"no\"\n\t\t   data-sectionid=\"123\"  data-invmsg=\"Are you also riding in the ambulance? (max. 1 person) is invalid\"  \/> no<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_128-123-2\">\t\t\t<label  for=\"field_576lh3-2\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[128]\" id=\"field_576lh3-2\" value=\"not sure yet\"\n\t\t   data-sectionid=\"123\"  data-invmsg=\"Are you also riding in the ambulance? (max. 1 person) is invalid\"  \/> not sure yet<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_128-123-other_3\">\t\t\t<label  for=\"field_576lh3-other_3\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[128]\" id=\"field_576lh3-other_3\" value=\"someone else, namely\"\n\t\t   data-sectionid=\"123\"  data-invmsg=\"Are you also riding in the ambulance? (max. 1 person) is invalid\"  \/> someone else, namely<\/label><label for=\"field_576lh3-other_3-otext\" class=\"frm_screen_reader frm_hidden\">someone else, namely<\/label><input type=\"text\" id=\"field_576lh3-other_3-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][128]\" value=\"\" \/><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<div id=\"frm_field_130_container\" class=\"frm_form_field frm_section_heading form-field\">\r\n<h3 class=\"frm_pos_top frm_section_spacing\">Patient information<\/h3>\r\n\r\n\r\n<div id=\"frm_field_131_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third\">\r\n\t<div  id=\"field_6ivm03_label\" class=\"frm_primary_label\">Name\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<fieldset aria-labelledby=\"field_6ivm03_label\">\n\t<legend class=\"frm_screen_reader frm_hidden\">\n\t\tName\t<\/legend>\n\n\t<div  class=\"frm_combo_inputs_container\" id=\"frm_combo_inputs_container_131\" data-name-layout=\"first_last\">\n\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_131-first_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-first  frm6\"\n\t\t\t\tdata-sub-field-name=\"first\"\n\t\t\t>\n\t\t\t\t<label for=\"field_6ivm03_first\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tFirst Name\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_6ivm03_first\" value=\"\" name=\"item_meta[131][first]\" data-sectionid=\"130\"  data-reqmsg=\"Name kan niet leeg zijn.\" aria-required=\"true\" data-invmsg=\"Name is invalid\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_131_first_desc\">First Name<\/div>\t\t\t<\/div>\n\t\t\t\t\t\t<div\n\t\t\t\tid=\"frm_field_131-last_container\"\n\t\t\t\tclass=\"frm_form_field form-field frm_form_subfield-last  frm6\"\n\t\t\t\tdata-sub-field-name=\"last\"\n\t\t\t>\n\t\t\t\t<label for=\"field_6ivm03_last\" class=\"frm_screen_reader frm_hidden\">\n\t\t\t\t\tLast Name\t\t\t\t<\/label>\n\n\t\t\t\t<input  type=\"text\" id=\"field_6ivm03_last\" value=\"\" name=\"item_meta[131][last]\" data-sectionid=\"130\"  data-reqmsg=\"Name kan niet leeg zijn.\" aria-required=\"true\" data-invmsg=\"Name is invalid\" aria-invalid=\"false\"  \/><div class=\"frm_description\" id=\"frm_field_131_last_desc\">Last Name<\/div>\t\t\t<\/div>\n\t\t\t\t<\/div>\n<\/fieldset>\n\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_132_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first vertical_radio\">\r\n\t<div  id=\"field_y6mg13_label\" class=\"frm_primary_label\">Gender:\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_y6mg13_label\" role=\"radiogroup\" aria-required=\"true\">\t\t<div class=\"frm_radio\" id=\"frm_radio_132-130-0\">\t\t\t<label  for=\"field_y6mg13-0\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[132]\" id=\"field_y6mg13-0\" value=\"Male\"\n\t\t   data-sectionid=\"130\"  data-reqmsg=\"Gender: kan niet leeg zijn.\" data-invmsg=\"Gender: is invalid\"  \/> Male<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_132-130-1\">\t\t\t<label  for=\"field_y6mg13-1\">\n\t\t\t\t\t<input type=\"radio\" name=\"item_meta[132]\" id=\"field_y6mg13-1\" value=\"Female\"\n\t\t   data-sectionid=\"130\"  data-reqmsg=\"Gender: kan niet leeg zijn.\" data-invmsg=\"Gender: is invalid\"  \/> Female<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_133_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n\t<label for=\"field_uryy3\" id=\"field_uryy3_label\" class=\"frm_primary_label\">Date of Birth\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_uryy3\" name=\"item_meta[133]\" value=\"\"  data-sectionid=\"130\"  maxlength=\"10\" data-reqmsg=\"Date of Birth kan niet leeg zijn.\" aria-required=\"true\" data-invmsg=\"Date of Birth is ongeldig\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_134_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third\">\r\n\t<label for=\"field_ka7n3\" id=\"field_ka7n3_label\" class=\"frm_primary_label\">E-mail\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"email\" id=\"field_ka7n3\" name=\"item_meta[134]\" value=\"\"  data-sectionid=\"130\"  autocomplete=\"email\"  data-reqmsg=\"E-mail kan niet leeg zijn.\" aria-required=\"true\" data-invmsg=\"E-mail is ongeldig\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_135_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third\">\r\n\t<label for=\"field_b4qag3\" id=\"field_b4qag3_label\" class=\"frm_primary_label\">Phone number\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"tel\" id=\"field_b4qag3\" name=\"item_meta[135]\" value=\"\"  data-sectionid=\"130\"  data-reqmsg=\"Phone number kan niet leeg zijn.\" aria-required=\"true\" data-invmsg=\"Phone number is ongeldig\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_136_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third\">\r\n\t<label for=\"field_fxuz43\" id=\"field_fxuz43_label\" class=\"frm_primary_label\">Current Residence\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_fxuz43\" name=\"item_meta[136]\" value=\"\"  data-sectionid=\"130\"  data-reqmsg=\"Current Residence kan niet leeg zijn.\" aria-required=\"true\" data-invmsg=\"Current Residence is ongeldig\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_137_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third frm_other_container\">\r\n\t<label for=\"field_m86go3\" id=\"field_m86go3_label\" class=\"frm_primary_label\">Nationality\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t\t\t<select name=\"item_meta[137]\" id=\"field_m86go3\"  data-sectionid=\"130\"  data-frmval=\"Bonaire\" data-reqmsg=\"Nationality kan niet leeg zijn.\" aria-required=\"true\" data-invmsg=\"Nationality is invalid\" aria-invalid=\"false\"  >\n\t\t<option  value=\"Bonaire\" selected='selected'>Bonaire<\/option><option  value=\"Netherlands\">Netherlands<\/option><option  value=\"United States\">United States<\/option><option  value=\"Others\" class=\"frm_other_trigger\">Others<\/option>\t<\/select>\n\t<label for=\"field_m86go3-otext\" class=\"frm_screen_reader frm_hidden\">Nationality<\/label><input type=\"text\" id=\"field_m86go3-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][137]\" value=\"\" \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_138_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_third vertical_radio frm_other_container\">\r\n\t<div  id=\"field_ktlr3_label\" class=\"frm_primary_label\">Spoken languages\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_ktlr3_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_138-130-0\">\t\t\t<label  for=\"field_ktlr3-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[138][]\" id=\"field_ktlr3-0\" value=\"Papiaments\"  data-sectionid=\"130\"  data-frmmin=\"1\"  data-reqmsg=\"Spoken languages kan niet leeg zijn.\" data-invmsg=\"Spoken languages is invalid\"   aria-required=\"true\"  \/> Papiaments<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_138-130-4\">\t\t\t<label  for=\"field_ktlr3-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[138][]\" id=\"field_ktlr3-4\" value=\"Dutch\"  data-sectionid=\"130\"  data-frmmin=\"1\"  data-reqmsg=\"Spoken languages kan niet leeg zijn.\" data-invmsg=\"Spoken languages is invalid\"   \/> Dutch<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_138-130-1\">\t\t\t<label  for=\"field_ktlr3-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[138][]\" id=\"field_ktlr3-1\" value=\"English\"  data-sectionid=\"130\"  data-frmmin=\"1\"  data-reqmsg=\"Spoken languages kan niet leeg zijn.\" data-invmsg=\"Spoken languages is invalid\"   \/> English<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_138-130-other_3\">\t\t\t<label  for=\"field_ktlr3-other_3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[138][other_3]\" id=\"field_ktlr3-other_3\" value=\"Other\"  data-sectionid=\"130\"  data-frmmin=\"1\"  data-reqmsg=\"Spoken languages kan niet leeg zijn.\" data-invmsg=\"Spoken languages is invalid\"   \/> Other<\/label><label for=\"field_ktlr3-other_3-otext\" class=\"frm_screen_reader frm_hidden\">Other<\/label><input type=\"text\" id=\"field_ktlr3-other_3-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][138][other_3]\" value=\"\" \/><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<\/div>\n<input type=\"hidden\" name=\"frm_page_order_5\" id=\"frm_page_order_5\" value=\"35\" \/><input type=\"hidden\" name=\"item_meta[141]\" id=\"field_y1jp03\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[142]\" id=\"field_7nnn43\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[143]\" id=\"field_xjqqd3\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[144]\" id=\"field_38114a3\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[145]\" id=\"field_n6asm3\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[146]\" id=\"field_fnr4i3\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[147]\" id=\"field_5lein3\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[148]\" id=\"field_tdmkn3\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[149]\" id=\"field_phrpm3\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[150]\" id=\"field_b4co63\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[151]\" id=\"field_v35jn3\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[152]\" id=\"field_k7p3v3-0\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[153]\" id=\"field_12ca3-0\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[154]\" id=\"field_80nkt3\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[155]\" id=\"field_2abbt3\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[156]\" id=\"field_uqas3\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[157]\" id=\"field_s8zfu3\" value=\"\"     \/>\n<input type=\"hidden\" name=\"item_meta[158]\" id=\"field_verzenden4\" value=\"\"     \/>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_160_container\">\n\t\t\t<label for=\"field_x1cs4\" >\n\t\t\t\tIf you are human, leave this field blank.\t\t\t<\/label>\n\t\t\t<input  id=\"field_x1cs4\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[160]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"mEDw1ROCuqHiAc4tv7adJ5IF2foZUMYjRNrJtz4Ijxc2r6\/Re\/7Qr\/xVyrx9UeW6\" \/><div class=\"frm_submit frm_flex\">\r\n<button class=\"frm_button_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Next<\/button>\r\n\r\n\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n\n<p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"ak_\"><label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"218\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><input type=\"hidden\" name=\"trp-form-language\" value=\"pap\"\/><\/form>\n<\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-8191","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/fadb.nu\/pap\/wp-json\/wp\/v2\/pages\/8191","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/fadb.nu\/pap\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/fadb.nu\/pap\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/fadb.nu\/pap\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/fadb.nu\/pap\/wp-json\/wp\/v2\/comments?post=8191"}],"version-history":[{"count":2,"href":"https:\/\/fadb.nu\/pap\/wp-json\/wp\/v2\/pages\/8191\/revisions"}],"predecessor-version":[{"id":8194,"href":"https:\/\/fadb.nu\/pap\/wp-json\/wp\/v2\/pages\/8191\/revisions\/8194"}],"wp:attachment":[{"href":"https:\/\/fadb.nu\/pap\/wp-json\/wp\/v2\/media?parent=8191"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}