{"id":965,"date":"2015-04-12T21:09:14","date_gmt":"2015-04-12T21:09:14","guid":{"rendered":"http:\/\/trustyourwings.ca\/?page_id=965"},"modified":"2015-04-24T17:39:20","modified_gmt":"2015-04-24T17:39:20","slug":"registration-page","status":"publish","type":"page","link":"https:\/\/trustyourwings.ca\/?page_id=965","title":{"rendered":"Retreat Registration Page"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f960-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"960\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F965#wpcf7-f960-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"960\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.3\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f960-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<p>Retreat Date\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"menu-90\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"menu-90\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"October 2024\">October 2024<\/option><\/select><\/span>\n<\/p>\n<p>Name (required)\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span>\n<\/p>\n<p>Address (required)\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-Address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Address\" \/><\/span>\n<\/p>\n<p>City (Required)\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"text-city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-city\" \/><\/span>\n<\/p>\n<p style=\"width: 230px;\">Phone (required)\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-Phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Phone\" \/><\/span>\n<\/p>\n<p>Email (required)\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span>\n<\/p>\n<p>Where did you find out about Dragonfly Wellness for Women?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Find-out\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Find-out\" \/><\/span>\n<\/p>\n<p style=\"width: 230px;\">Date of birth (yyyy-mm-dd)\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DOB-183\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"DOB-183\" \/><\/span>\n<\/p>\n<p>What is your Diagnosis and Stage?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"text-stage\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-stage\" \/><\/span>\n<\/p>\n<p>Emergency Contact & Number (required)\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-Emer-Contact-Num\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-Emer-Contact-Num\" \/><\/span>\n<\/p>\n<p style=\"width: 230px;\">Date of diagnosis (yyyy-mm-dd)\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Diagnosis-598\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"Diagnosis-598\" \/><\/span>\n<\/p>\n<p>Dietary allergies: (we will be offering healthy vegetarian meals and snacks with vegan options)\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DietaryAllergies-587\"><textarea cols=\"40\" rows=\"4\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"DietaryAllergies-587\"><\/textarea><\/span>\n<\/p>\n<p>What are some of your expectations from this wellness weekend retreat?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Expectations-762\"><textarea cols=\"40\" rows=\"4\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"Expectations-762\"><\/textarea><\/span>\n<\/p>\n<p>Do you have any special health issues or needs that we should know about? Are Stairs an issue for you?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"HealthIssues-608\"><textarea cols=\"40\" rows=\"4\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"HealthIssues-608\"><\/textarea><\/span>\n<\/p>\n<p>Do you have any experience with yoga? <span class=\"wpcf7-form-control-wrap\" data-name=\"radio-801\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-801\" value=\"YES\" \/><span class=\"wpcf7-list-item-label\">YES<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-801\" value=\"NO\" \/><span class=\"wpcf7-list-item-label\">NO<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Describe: <span class=\"wpcf7-form-control-wrap\" data-name=\"Yoga-151\"><textarea cols=\"40\" rows=\"3\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"Yoga-151\"><\/textarea><\/span>\n<\/p>\n<p>Complementary treatments are going to be offered on Saturday afternoon. Each session will be 40 minutes. Please indicate whether or not you would like to receive a treatment. <span class=\"wpcf7-form-control-wrap\" data-name=\"ComplementaryTreatments-828\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"ComplementaryTreatments-828\" value=\"YES\" \/><span class=\"wpcf7-list-item-label\">YES<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"ComplementaryTreatments-828\" value=\"NO\" \/><span class=\"wpcf7-list-item-label\">NO<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Indicate in order of preference the treatments you would like to receive:\n<\/p>\n<table style=\" border: none;\">\n\t<colgroup>\n\t<col span=\"2\" style=\"background-color:white\" \/>\n\t<\/colgroup>\n\t<tr>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"RegisteredMassage-190\"><select class=\"wpcf7-form-control wpcf7-select regnum\" aria-invalid=\"false\" name=\"RegisteredMassage-190\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><\/select><\/span><br \/>\nRegistered massage\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Reiki-191\"><select class=\"wpcf7-form-control wpcf7-select regnum\" aria-invalid=\"false\" name=\"Reiki-191\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><\/select><\/span><br \/>\nReiki treatment\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr style=\" background: none;\">\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Facial-192\"><select class=\"wpcf7-form-control wpcf7-select regnum\" aria-invalid=\"false\" name=\"Facial-192\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><\/select><\/span><br \/>\nMini Facial (organic skin products)\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Caniosacral-193\"><select class=\"wpcf7-form-control wpcf7-select regnum\" aria-invalid=\"false\" name=\"Caniosacral-193\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><\/select><\/span><br \/>\nCaniosacral Treatment\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n<p><span id=\"wpcf7-6a628a12ee8a7-wrapper\" class=\"wpcf7-form-control-wrap email-559-wrap\" style=\"display:none !important; visibility:hidden !important;\"><label for=\"213\" class=\"hp-message\">Please leave this field empty.<\/label><input id=\"213\"  class=\"wpcf7-form-control wpcf7-text\" type=\"text\" name=\"email-559\" value=\"\" size=\"40\" tabindex=\"-1\" autocomplete=\"new-password\" \/><\/span>\n<\/p>\n<p>The group will be staying in both the Edgar House and Fensom Cottage; both facilities are located at Loretto Maryholme. All bedrooms are double rooms with 2 twin beds. If you would like to share a room with someone you know who is also attending the retreat, please indicate below:\n<\/p>\n<p>I would like to share a room with: <span class=\"wpcf7-form-control-wrap\" data-name=\"ShareRoom-433\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"ShareRoom-433\" \/><\/span>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n<\/p><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"116\"\/><script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_EventAllDay":false,"_EventTimezone":"","_EventStartDate":"","_EventEndDate":"","_EventStartDateUTC":"","_EventEndDateUTC":"","_EventShowMap":false,"_EventShowMapLink":false,"_EventURL":"","_EventCost":"","_EventCostDescription":"","_EventCurrencySymbol":"","_EventCurrencyCode":"","_EventCurrencyPosition":"","_EventDateTimeSeparator":"","_EventTimeRangeSeparator":"","_EventOrganizerID":[],"_EventVenueID":[],"_OrganizerEmail":"","_OrganizerPhone":"","_OrganizerWebsite":"","_VenueAddress":"","_VenueCity":"","_VenueCountry":"","_VenueProvince":"","_VenueState":"","_VenueZip":"","_VenuePhone":"","_VenueURL":"","_VenueStateProvince":"","_VenueLat":"","_VenueLng":"","_VenueShowMap":false,"_VenueShowMapLink":false,"jetpack_post_was_ever_published":false,"footnotes":""},"class_list":["post-965","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/P5XNAb-fz","_links":{"self":[{"href":"https:\/\/trustyourwings.ca\/index.php?rest_route=\/wp\/v2\/pages\/965","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/trustyourwings.ca\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/trustyourwings.ca\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/trustyourwings.ca\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/trustyourwings.ca\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=965"}],"version-history":[{"count":5,"href":"https:\/\/trustyourwings.ca\/index.php?rest_route=\/wp\/v2\/pages\/965\/revisions"}],"predecessor-version":[{"id":1013,"href":"https:\/\/trustyourwings.ca\/index.php?rest_route=\/wp\/v2\/pages\/965\/revisions\/1013"}],"wp:attachment":[{"href":"https:\/\/trustyourwings.ca\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=965"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}