Online Inquiry
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<ul class="er_fld_row"><li class="er_fld_type_content" draggable="false" style="width: 50%;"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_info"> Foster/Adoptive Parent Inquiry</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_Name_First_A"> <i class="fa fa-font"></i><label class="er_fld_label required">Parent 1 First Name</label><input name="CST_1" type="text" class="er_fld_required"><div data-lastpass-icon-root="true" style="position: relative !important; height: 0px !important; width: 0px !important; float: left !important;"></div><div data-lastpass-icon-root="true" style="position: relative !important; height: 0px !important; width: 0px !important; float: left !important;"></div><div data-lastpass-icon-root="true" style="position: relative !important; height: 0px !important; width: 0px !important; float: left !important;"></div></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 100%;" map_to="FH_Name_Last_A"> <i class="fa fa-font"></i><label class="er_fld_label required">Parent 1 Last Name</label><input name="CST_2" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="FH_EMail"> <i class="fa fa-font"></i><label class="er_fld_label required">Parent 1 Email Address</label><input name="CST_11" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 100%;" map_to="FH_Phone_Home"> <i class="fa fa-font"></i><label class="er_fld_label">Phone Number</label><input name="CST_10" type="text" class=""></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Name_First_B"> <i class="fa fa-font"></i><label class="er_fld_label">Parent 2 First Name</label><input name="CST_3" type="text"><div data-lastpass-icon-root="true" style="position: relative !important; height: 0px !important; width: 0px !important; float: left !important;"></div><div data-lastpass-icon-root="true" style="position: relative !important; height: 0px !important; width: 0px !important; float: left !important;"></div></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="FH_Name_Last_B"> <i class="fa fa-font"></i><label class="er_fld_label">Parent 2 Last Name</label><input name="CST_4" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_EMail_2" style="width: 50%;"> <i class="fa fa-font"></i><label class="er_fld_label">Parent 2 Email Address</label><input name="CST_19" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Address_Street_1" style="width: 100%;"> <i class="fa fa-font"></i><label class="er_fld_label">Street Address</label><input name="CST_5" type="text" class=""></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Address_City"> <i class="fa fa-font"></i><label class="er_fld_label required">City</label><input name="CST_6" type="text" class="er_fld_required"></li><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Address_State"> <i class="fa fa-font"></i><label class="er_fld_label">State</label><input name="CST_18" type="text"></li><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Address_Zip"> <i class="fa fa-font"></i><label class="er_fld_label">Zip</label><input name="CST_8" type="text" class=""></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox er_fld_type_radio_col4" style="white-space: normal; width: 33.3333%;" draggable="false" map_to="FH_Interest"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">Please indicate your interest(s):</label> <label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_13" value="Foster Care">Foster Care</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_13" value="Special Needs Adoption">Special Needs Adoption</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_13" value="Kinship Foster Care">Kinship Foster Care</label><label class="er_option er_option_other"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_13" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_13_Other" type="text"></label></li><li class="er_fld_type_content" draggable="false" style="width: 33.3333%;"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content"></div></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox er_fld_type_radio_col4" style="white-space: normal; width: 50%;" draggable="false" map_to="FH_ReferralSource"><i class="fa fa-check-square-o"></i><label class="er_fld_label">How did you hear about HOPE Foster Care & Adoption?</label> <label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_17" value="Internet Search">Internet Search</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_17" value="Google Ad">Google Ad</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_17" value="Agency Website">Agency Website</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_17" value="Social Media">Social Media</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_17" value="HOPE Foster/Adoptive Parent">HOPE Foster/Adoptive Parent</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_17" value="Agency Employee">Agency Employee</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_17" value="DFCS/Kinship Referral">DFCS/Kinship Referral</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_17" value="Church/Pastor">Church/Pastor</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_17" value="Community Event">Community Event</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_17" value="Other Agency">Other Agency</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_17" value="Billboard/Yard Sign">Billboard/Yard Sign</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_17" value="Radio/TV ">Radio/TV </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_17" value="News Story">News Story</label><label class="er_option er_option_other"><input class="type_checkbox er_option_other" type="checkbox" name="CST_17" value="Other:">Other:<input class="cst_Other" name="CST_17_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_medium" draggable="false"> <i class="fa fa-paragraph"></i><label class="er_fld_label">If you have specific questions or comments, please include those below. A HOPE team member will be in contact with you soon. Thank you for your interest in HOPE Foster Care & Adoption!</label><textarea name="CST_20" style="width:100%;"></textarea></li></ul>
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