{"id":7245,"date":"2025-05-12T12:04:39","date_gmt":"2025-05-12T12:04:39","guid":{"rendered":"https:\/\/rainbowcentrum.nl\/?page_id=7245"},"modified":"2025-11-07T08:33:29","modified_gmt":"2025-11-07T08:33:29","slug":"enrollment","status":"publish","type":"page","link":"https:\/\/rainbowcentrum.nl\/nl\/enrollment\/","title":{"rendered":"Enrollment"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"7245\" class=\"elementor elementor-7245\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-73a9321 e-flex e-con-boxed e-con e-parent\" data-id=\"73a9321\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-12724ff elementor-widget elementor-widget-qi_addons_for_elementor_section_title\" data-id=\"12724ff\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"qi_addons_for_elementor_section_title.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"qodef-shortcode qodef-m qodef-qi-section-title qodef-decoration--italic qodef-link--underline-draw qodef-subtitle-icon--left\">\n\t\t\t\t\t\t\t\t<div class=\"qodef-m-text\"><p class=\"s4\"><span class=\"s5\">At Rainbow Care&amp;Coaching, we are committed to providing a safe, structured, and nurturing environment where every child has the opportunity to grow and thrive. To ensure the well-being of all children and the effectiveness of our program, we apply a clear set of exclusion criteria and begin every new placement with a structured trial period.<\/span><\/p><\/div>\n\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-47fac2b elementor-hidden-desktop elementor-hidden-tablet elementor-widget elementor-widget-image\" data-id=\"47fac2b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"812\" height=\"990\" src=\"https:\/\/rainbowcentrum.nl\/wp-content\/uploads\/2025\/05\/photo_2025-05-18_13-03-38.jpg\" class=\"attachment-large size-large wp-image-8016\" alt=\"\" srcset=\"https:\/\/rainbowcentrum.nl\/wp-content\/uploads\/2025\/05\/photo_2025-05-18_13-03-38.jpg 812w, https:\/\/rainbowcentrum.nl\/wp-content\/uploads\/2025\/05\/photo_2025-05-18_13-03-38-246x300.jpg 246w, https:\/\/rainbowcentrum.nl\/wp-content\/uploads\/2025\/05\/photo_2025-05-18_13-03-38-768x936.jpg 768w, https:\/\/rainbowcentrum.nl\/wp-content\/uploads\/2025\/05\/photo_2025-05-18_13-03-38-510x622.jpg 510w\" sizes=\"(max-width: 812px) 100vw, 812px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-3d25a63 e-flex e-con-boxed e-con e-parent\" data-id=\"3d25a63\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-4b67948 e-con-full e-flex e-con e-child\" data-id=\"4b67948\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b27f6d4 elementor-widget elementor-widget-qi_addons_for_elementor_section_title\" data-id=\"b27f6d4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"qi_addons_for_elementor_section_title.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"qodef-shortcode qodef-m qodef-qi-section-title qodef-decoration--italic qodef-link--underline-draw qodef-subtitle-icon--left\">\n\t\t\t\t\t\t<h4 class=\"qodef-m-title\">\n\t\t Exclusion Criteria &amp; Group Fit\t<\/h4>\n\t\t\t<div class=\"qodef-m-text\"><p class=\"s4\"><span class=\"s5\">While we welcome neurodiverse children with a range of developmental needs, certain criteria may make a child unsuitable for our group-based program. These guidelines help ensure the safety of all children and the sustainability of our therapeutic setting.<\/span><\/p><\/div>\n\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-92bbd6d elementor-widget elementor-widget-qi_addons_for_elementor_section_title\" data-id=\"92bbd6d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"qi_addons_for_elementor_section_title.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"qodef-shortcode qodef-m qodef-qi-section-title qodef-decoration--italic qodef-link--underline-draw qodef-subtitle-icon--left\">\n\t\t\t\t\t\t<h5 class=\"qodef-m-title\">\n\t\ta. Medical Care Beyond Our Scope\t<\/h5>\n\t\t\t<div class=\"qodef-m-text\"><p class=\"p1\">We are not equipped to support children who require:<\/p><ul class=\"ul1\"><li class=\"li1\">Intensive medical interventions or complex procedures<\/li><li class=\"li1\">Continuous medical supervision or ventilator support<\/li><li class=\"li1\">Medication administration during sessions (this must be managed by parents or external providers)<\/li><\/ul><\/div>\n\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d7abf79 elementor-widget elementor-widget-qi_addons_for_elementor_section_title\" data-id=\"d7abf79\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"qi_addons_for_elementor_section_title.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"qodef-shortcode qodef-m qodef-qi-section-title qodef-decoration--italic qodef-link--underline-draw qodef-subtitle-icon--left\">\n\t\t\t\t\t\t<h5 class=\"qodef-m-title\">\n\t\tb. Behavioral Challenges That Pose Safety Risks\t<\/h5>\n\t\t\t<div class=\"qodef-m-text\"><p class=\"p1\">We may not be able to accommodate children who:<\/p>\n\n<ul class=\"ul1\">\n \t<li class=\"li1\">Exhibit frequent aggressive behavior (e.g., hitting, biting, self-injury)<\/li>\n \t<li class=\"li1\">Have uncontrolled outbursts that endanger themselves or others<\/li>\n \t<li class=\"li1\">Regularly elope or run away from supervision<\/li>\n \t<li class=\"li1\">Forcefully engage with peers in a way that compromises safety<\/li>\n \t<li class=\"li1\">Have severe hyperactivity that disrupts group functioning<\/li>\n \t<li class=\"li1\">Require ongoing one-on-one supervision in group setting beyond our staffing capacity<\/li>\n<\/ul><\/div>\n\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b33352b elementor-widget elementor-widget-qi_addons_for_elementor_section_title\" data-id=\"b33352b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"qi_addons_for_elementor_section_title.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"qodef-shortcode qodef-m qodef-qi-section-title qodef-decoration--italic qodef-link--underline-draw qodef-subtitle-icon--left\">\n\t\t\t\t\t\t<h5 class=\"qodef-m-title\">\n\t\tc. Medical Conditions That Affect Group Safety\t<\/h5>\n\t\t\t<div class=\"qodef-m-text\"><ul class=\"ul1\">\n \t<li class=\"li1\">Contagious or communicable diseases that could affect others<\/li>\n \t<li class=\"li1\">Severely compromised immune systems (evaluated on a case-by-case basis)<\/li>\n<\/ul><\/div>\n\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-34bdaa8 e-con-full elementor-hidden-mobile e-flex e-con e-child\" data-id=\"34bdaa8\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-35be6bd elementor-widget elementor-widget-spacer\" data-id=\"35be6bd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7c7b4b4 elementor-widget elementor-widget-image\" data-id=\"7c7b4b4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"812\" height=\"990\" src=\"https:\/\/rainbowcentrum.nl\/wp-content\/uploads\/2025\/05\/photo_2025-05-18_13-03-38.jpg\" class=\"attachment-large size-large wp-image-8016\" alt=\"\" srcset=\"https:\/\/rainbowcentrum.nl\/wp-content\/uploads\/2025\/05\/photo_2025-05-18_13-03-38.jpg 812w, https:\/\/rainbowcentrum.nl\/wp-content\/uploads\/2025\/05\/photo_2025-05-18_13-03-38-246x300.jpg 246w, https:\/\/rainbowcentrum.nl\/wp-content\/uploads\/2025\/05\/photo_2025-05-18_13-03-38-768x936.jpg 768w, https:\/\/rainbowcentrum.nl\/wp-content\/uploads\/2025\/05\/photo_2025-05-18_13-03-38-510x622.jpg 510w\" sizes=\"(max-width: 812px) 100vw, 812px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-40f8d7f e-flex e-con-boxed e-con e-parent\" data-id=\"40f8d7f\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-f722b1d elementor-widget elementor-widget-qi_addons_for_elementor_section_title\" data-id=\"f722b1d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"qi_addons_for_elementor_section_title.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"qodef-shortcode qodef-m qodef-qi-section-title qodef-decoration--italic qodef-link--underline-draw qodef-subtitle-icon--left\">\n\t\t\t\t\t\t\t\t<div class=\"qodef-m-text\"><p class=\"p1\">If any of these criteria apply, we may not be able to proceed with enrollment or may need to discontinue participation. In such cases, we will work closely with the family to suggest alternative options better suited to the child\u2019s needs.<\/p><\/div>\n\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c9093be elementor-widget elementor-widget-qi_addons_for_elementor_section_title\" data-id=\"c9093be\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"qi_addons_for_elementor_section_title.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"qodef-shortcode qodef-m qodef-qi-section-title qodef-decoration--italic qodef-link--underline-draw qodef-subtitle-icon--left\">\n\t\t\t\t\t\t<h4 class=\"qodef-m-title\">\n\t\tTrial Period\t<\/h4>\n\t\t\t<div class=\"qodef-m-text\"><p class=\"p1\">Every child who begins at Rainbow Care&amp;Coaching starts with a <b>6\u20138 week trial period<\/b>. This trial period allows us to carefully assess the child\u2019s:<\/p>\n\n<ul class=\"ul1\">\n \t<li class=\"li1\">Ability to participate in both individual and group sessions<\/li>\n \t<li class=\"li1\">Interaction with peers and staff<\/li>\n \t<li class=\"li1\">Response to daily structure and therapeutic approaches<\/li>\n<\/ul>\n<p class=\"p1\">At the end of this period:<\/p>\n\n<ul>\n \t<li style=\"list-style-type: none\">\n<ul class=\"ul1\">\n \t<li class=\"li1\"><b>If the program is a good fit<\/b>, we\u2019ll create a personalized development plan and begin long-term care.<\/li>\n \t<li class=\"li1\">\n<b>If the group setting isn\u2019t suitable<\/b>, we will provide feedback and referrals to help you find a more appropriate setting.\n<\/li>\n<\/ul>\n<\/li>\n<\/ul><\/div>\n\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-670bd38 elementor-widget elementor-widget-qi_addons_for_elementor_section_title\" data-id=\"670bd38\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"qi_addons_for_elementor_section_title.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"qodef-shortcode qodef-m qodef-qi-section-title qodef-decoration--italic qodef-link--underline-draw qodef-subtitle-icon--left\">\n\t\t\t\t\t\t<h4 class=\"qodef-m-title\">\n\t\tImportant Note\t<\/h4>\n\t\t\t<div class=\"qodef-m-text\"><p class=\"p2\">These criteria are not just guidelines\u2014they are part of the official <b>Terms &amp; Conditions and Client Agreement<\/b> signed during enrollment. By registering for services at Rainbow Care&amp;Coaching, parents or legal guardians confirm that they have read, understood, and accepted these terms.<\/p><p class=\"p2\">In situations where exclusion criteria are met, <b>Rainbow Care&amp;Coaching reserves the right to suspend or terminate services<\/b> at any time, in accordance with our duty to safeguard all children and staff within our care environment.<\/p><\/div>\n\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-da36878 elementor-widget elementor-widget-qi_addons_for_elementor_section_title\" data-id=\"da36878\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"qi_addons_for_elementor_section_title.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"qodef-shortcode qodef-m qodef-qi-section-title qodef-decoration--italic qodef-link--underline-draw qodef-subtitle-icon--left\">\n\t\t\t\t\t\t<h4 class=\"qodef-m-title\">\n\t\tIntake Form\t<\/h4>\n\t\t\t<div class=\"qodef-m-text\"><p class=\"p1\">If you believe Rainbow is the right fit for your child, please complete our <b>online intake form<\/b>. This form helps us understand your child\u2019s strengths, needs, communication style, daily routines, and any relevant medical or behavioral information.<\/p><\/div>\n\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-2acb76b e-flex e-con-boxed e-con e-parent\" data-id=\"2acb76b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-692552b elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"692552b\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;step_type&quot;:&quot;none&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Intake form\" novalidate=\"\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"7245\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"692552b\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Enrollment\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"7245\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-Child elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Intake form\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-Legal_Name_of_child elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-Legal_Name_of_child\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLegal name of child\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[Legal_Name_of_child]\" id=\"form-field-Legal_Name_of_child\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-DateofBirth elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-DateofBirth\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate of birth\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[DateofBirth]\" id=\"form-field-DateofBirth\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field elementor-use-native\" required=\"required\" aria-required=\"true\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\" min=\"2010-07-01\" max=\"2025-05-13\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-BSNNumber elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-BSNNumber\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBSN number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[BSNNumber]\" id=\"form-field-BSNNumber\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_76fff49 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_76fff49\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLanguages spoken at home\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_76fff49]\" id=\"form-field-field_76fff49\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ff099b4 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ff099b4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPrimary language of the child \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ff099b4]\" id=\"form-field-field_ff099b4\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_317f306 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_317f306\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAddress\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_317f306]\" id=\"form-field-field_317f306\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_ee5b0e4 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ee5b0e4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIs the child under guardianship?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_ee5b0e4-0\" name=\"form_fields[field_ee5b0e4]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_ee5b0e4-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_ee5b0e4-1\" name=\"form_fields[field_ee5b0e4]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_ee5b0e4-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_a1532ce elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a1532ce\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tName(s) of legal guardian(s)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_a1532ce]\" id=\"form-field-field_a1532ce\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ada16f9 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ada16f9\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGuardian's address (if different\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ada16f9]\" id=\"form-field-field_ada16f9\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_1e5fb02 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1e5fb02\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMother\u2019s phone number \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_1e5fb02]\" id=\"form-field-field_1e5fb02\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_66c7f04 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_66c7f04\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFather\u2019s phone number\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_66c7f04]\" id=\"form-field-field_66c7f04\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_5b6473d elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5b6473d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMother\u2019s email address\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[field_5b6473d]\" id=\"form-field-field_5b6473d\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_13a4505 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_13a4505\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFather\u2019s email address\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[field_13a4505]\" id=\"form-field-field_13a4505\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_58da9b5 elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_58da9b5\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPreferred method of contact\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Email\" id=\"form-field-field_58da9b5-0\" name=\"form_fields[field_58da9b5][]\"> <label for=\"form-field-field_58da9b5-0\">Email<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Phone\" id=\"form-field-field_58da9b5-1\" name=\"form_fields[field_58da9b5][]\"> <label for=\"form-field-field_58da9b5-1\">Phone<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"SMS\" id=\"form-field-field_58da9b5-2\" name=\"form_fields[field_58da9b5][]\"> <label for=\"form-field-field_58da9b5-2\">SMS<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_e0b4a72 elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e0b4a72\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDo you check your email daily?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_e0b4a72-0\" name=\"form_fields[field_e0b4a72]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_e0b4a72-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_e0b4a72-1\" name=\"form_fields[field_e0b4a72]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_e0b4a72-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_951695e elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_951695e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAre you planning to move?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_951695e-0\" name=\"form_fields[field_951695e]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_951695e-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_951695e-1\" name=\"form_fields[field_951695e]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_951695e-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_b622f62 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b622f62\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tName of contact person at municipality\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_b622f62]\" id=\"form-field-field_b622f62\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_07a7297 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_07a7297\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPhone number and email\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_07a7297]\" id=\"form-field-field_07a7297\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_f311a9e elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Communication &amp; Development\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_c4c4ead elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c4c4ead\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHow does your child typically communicate?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Verbal\" id=\"form-field-field_c4c4ead-0\" name=\"form_fields[field_c4c4ead][]\"> <label for=\"form-field-field_c4c4ead-0\">Verbal<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"PECS\" id=\"form-field-field_c4c4ead-1\" name=\"form_fields[field_c4c4ead][]\"> <label for=\"form-field-field_c4c4ead-1\">PECS<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Tablet\/device\" id=\"form-field-field_c4c4ead-2\" name=\"form_fields[field_c4c4ead][]\"> <label for=\"form-field-field_c4c4ead-2\">Tablet\/device<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Gestures\/Pointing\" id=\"form-field-field_c4c4ead-3\" name=\"form_fields[field_c4c4ead][]\"> <label for=\"form-field-field_c4c4ead-3\">Gestures\/Pointing<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Crying\" id=\"form-field-field_c4c4ead-4\" name=\"form_fields[field_c4c4ead][]\"> <label for=\"form-field-field_c4c4ead-4\">Crying<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Other\" id=\"form-field-field_c4c4ead-5\" name=\"form_fields[field_c4c4ead][]\"> <label for=\"form-field-field_c4c4ead-5\">Other<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_443e3ee elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_443e3ee\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAt what age was your child diagnosed?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_443e3ee]\" id=\"form-field-field_443e3ee\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_89f0861 elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_89f0861\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDiagnosis(es)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_89f0861]\" id=\"form-field-field_89f0861\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_8976368 elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8976368\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAllergies or medical conditions\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_8976368]\" id=\"form-field-field_8976368\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_211d724 elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_211d724\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIs your child on medication?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_211d724]\" id=\"form-field-field_211d724\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_ed82f84 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ed82f84\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIs your child potty trained?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_ed82f84-0\" name=\"form_fields[field_ed82f84]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_ed82f84-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_ed82f84-1\" name=\"form_fields[field_ed82f84]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_ed82f84-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_911767d elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_911767d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDescribe toilet routine\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_911767d]\" id=\"form-field-field_911767d\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_7af6500 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7af6500\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCan your child dress\/undress independently?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_7af6500-0\" name=\"form_fields[field_7af6500]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_7af6500-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_7af6500-1\" name=\"form_fields[field_7af6500]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_7af6500-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_3e0bdda elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3e0bdda\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCan your child eat independently?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_3e0bdda-0\" name=\"form_fields[field_3e0bdda]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_3e0bdda-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_3e0bdda-1\" name=\"form_fields[field_3e0bdda]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_3e0bdda-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_88e34f9 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_88e34f9\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDescribe eating habits\/restrictions\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_88e34f9]\" id=\"form-field-field_88e34f9\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_a40f462 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a40f462\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDescribe daily routines\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_a40f462]\" id=\"form-field-field_a40f462\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_6710a09 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Behavioral &amp; Sensory Profile\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_c4fdaa0 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c4fdaa0\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCheck any behaviors\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Aggressive\" id=\"form-field-field_c4fdaa0-0\" name=\"form_fields[field_c4fdaa0][]\"> <label for=\"form-field-field_c4fdaa0-0\">Aggressive<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Self-injury\" id=\"form-field-field_c4fdaa0-1\" name=\"form_fields[field_c4fdaa0][]\"> <label for=\"form-field-field_c4fdaa0-1\">Self-injury<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Tantrums\" id=\"form-field-field_c4fdaa0-2\" name=\"form_fields[field_c4fdaa0][]\"> <label for=\"form-field-field_c4fdaa0-2\">Tantrums<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Running away\" id=\"form-field-field_c4fdaa0-3\" name=\"form_fields[field_c4fdaa0][]\"> <label for=\"form-field-field_c4fdaa0-3\">Running away<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Sensory sensitivities\" id=\"form-field-field_c4fdaa0-4\" name=\"form_fields[field_c4fdaa0][]\"> <label for=\"form-field-field_c4fdaa0-4\">Sensory sensitivities<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Other\" id=\"form-field-field_c4fdaa0-5\" name=\"form_fields[field_c4fdaa0][]\"> <label for=\"form-field-field_c4fdaa0-5\">Other<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_c95c505 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c95c505\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDescribe triggers and management\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_c95c505]\" id=\"form-field-field_c95c505\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_00b12de elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_00b12de\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHas your child ever posed risk to others?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_00b12de-0\" name=\"form_fields[field_00b12de]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_00b12de-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_00b12de-1\" name=\"form_fields[field_00b12de]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_00b12de-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_c19a04c elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c19a04c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFavorite activities or toys\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_c19a04c]\" id=\"form-field-field_c19a04c\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_e061910 elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e061910\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat motivates your child?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_e061910]\" id=\"form-field-field_e061910\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_a1cdc44 elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a1cdc44\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWhat is your child really good at?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_a1cdc44]\" id=\"form-field-field_a1cdc44\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_18ef56b elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Learning &amp; Social Behavior\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_9f38c7f elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9f38c7f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCan your child follow simple instructions?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_9f38c7f-0\" name=\"form_fields[field_9f38c7f]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_9f38c7f-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_9f38c7f-1\" name=\"form_fields[field_9f38c7f]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_9f38c7f-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_5f15a9f elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5f15a9f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHow does your child respond to other children?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_5f15a9f]\" id=\"form-field-field_5f15a9f\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_4b220d1 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4b220d1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPreferred learning environment\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_4b220d1]\" id=\"form-field-field_4b220d1\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_d8ef09a elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d8ef09a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHas your child received therapy before?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_d8ef09a-0\" name=\"form_fields[field_d8ef09a]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_d8ef09a-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_d8ef09a-1\" name=\"form_fields[field_d8ef09a]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_d8ef09a-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_8cdefa2 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8cdefa2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIf yes, provide details \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_8cdefa2]\" id=\"form-field-field_8cdefa2\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_d255150 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Support Network\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_702b5e5 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_702b5e5\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tOther professionals\/institutions supporting your child\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_702b5e5]\" id=\"form-field-field_702b5e5\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_72febfa elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_72febfa\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAny siblings?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_72febfa-0\" name=\"form_fields[field_72febfa]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_72febfa-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_72febfa-1\" name=\"form_fields[field_72febfa]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_72febfa-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_098aded elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_098aded\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPreferred days for therapy\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_098aded]\" id=\"form-field-field_098aded\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_b64a555 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b64a555\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTransportation plan\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_b64a555]\" id=\"form-field-field_b64a555\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_ff4c188 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ff4c188\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPlanned holidays\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_ff4c188]\" id=\"form-field-field_ff4c188\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_e8ec574 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e8ec574\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMedical\/logistical barriers\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_e8ec574]\" id=\"form-field-field_e8ec574\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_b031d88 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b031d88\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHow do you plan to fund services?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Private\" id=\"form-field-field_b031d88-0\" name=\"form_fields[field_b031d88]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_b031d88-0\">Private<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"PGB\" id=\"form-field-field_b031d88-1\" name=\"form_fields[field_b031d88]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_b031d88-1\">PGB<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_cd3438c elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Goals &amp; Expectations\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_2b70e4a elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2b70e4a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGoals for the next 6\u201312 months\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_2b70e4a]\" id=\"form-field-field_2b70e4a\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_dd8e187 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_dd8e187\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBiggest hopes and concerns\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_dd8e187]\" id=\"form-field-field_dd8e187\" rows=\"4\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_eb140aa elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_eb140aa\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAll children begin with a 6\u20138 week trial period. We assess program fit and provide guidance or referrals if needed.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_eb140aa-0\" name=\"form_fields[field_eb140aa]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_eb140aa-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_eb140aa-1\" name=\"form_fields[field_eb140aa]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_eb140aa-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_2526f21 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2526f21\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHave you read and understood our exclusion criteria and group suitability guidelines?  To ensure a safe and supportive environment, Rainbow Care & Coaching may not be able to offer placement if a child: \t\u2022 Requires intensive or ongoing medical care beyond our scope \t\u2022 Displays frequent aggression or self-injury that poses a safety risk \t\u2022 Has persistent elopement behavior (e.g., running from supervision) \t\u2022 Requires constant one-on-one supervision beyond our capacity \t\u2022 Has a contagious condition or severely compromised immune system (evaluated case by case)  All children begin with a 6\u20138 week trial period to assess group fit and individual needs. If the program is not suitable, we will support families with referrals and guidance toward more appropriate care options.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_2526f21-0\" name=\"form_fields[field_2526f21]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_2526f21-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_2526f21-1\" name=\"form_fields[field_2526f21]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_2526f21-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Send<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-394e70d e-flex e-con-boxed e-con e-parent\" data-id=\"394e70d\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-825823a e-con-full e-flex e-con e-child\" data-id=\"825823a\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-69b9bfa elementor-widget elementor-widget-heading\" data-id=\"69b9bfa\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Contact Info<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-576b6b7 elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"576b6b7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/g.co\/kgs\/42FHX8h\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-map-marker-alt\" viewBox=\"0 0 384 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M172.268 501.67C26.97 291.031 0 269.413 0 192 0 85.961 85.961 0 192 0s192 85.961 192 192c0 77.413-26.97 99.031-172.268 309.67-9.535 13.774-29.93 13.773-39.464 0zM192 272c44.183 0 80-35.817 80-80s-35.817-80-80-80-80 35.817-80 80 35.817 80 80 80z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Duikerlaan 260, 2903 AC Capelle aan den Ijssel<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-far-envelope\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M464 64H48C21.49 64 0 85.49 0 112v288c0 26.51 21.49 48 48 48h416c26.51 0 48-21.49 48-48V112c0-26.51-21.49-48-48-48zm0 48v40.805c-22.422 18.259-58.168 46.651-134.587 106.49-16.841 13.247-50.201 45.072-73.413 44.701-23.208.375-56.579-31.459-73.413-44.701C106.18 199.465 70.425 171.067 48 152.805V112h416zM48 400V214.398c22.914 18.251 55.409 43.862 104.938 82.646 21.857 17.205 60.134 55.186 103.062 54.955 42.717.231 80.509-37.199 103.053-54.947 49.528-38.783 82.032-64.401 104.947-82.653V400H48z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">info@rainbowcentrum.nl<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">KvK-number: 86498355<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-b0503d1 e-con-full elementor-hidden-mobile e-flex e-con e-child\" data-id=\"b0503d1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-7ad7233 e-con-full e-flex e-con e-child\" data-id=\"7ad7233\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-17bdf1b elementor-widget elementor-widget-heading\" data-id=\"17bdf1b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Social Media<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5fad5a6 e-grid-align-left e-grid-align-mobile-left elementor-shape-rounded elementor-grid-0 elementor-widget elementor-widget-social-icons\" data-id=\"5fad5a6\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"social-icons.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-social-icons-wrapper elementor-grid\" role=\"list\">\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\" role=\"listitem\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-linkedin-in elementor-animation-push elementor-repeater-item-ba71140\" href=\"https:\/\/www.linkedin.com\/company\/rainbow-care-coaching\/\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Linkedin-in<\/span>\n\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fab-linkedin-in\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M100.28 448H7.4V148.9h92.88zM53.79 108.1C24.09 108.1 0 83.5 0 53.8a53.79 53.79 0 0 1 107.58 0c0 29.7-24.1 54.3-53.79 54.3zM447.9 448h-92.68V302.4c0-34.7-.7-79.2-48.29-79.2-48.29 0-55.69 37.7-55.69 76.7V448h-92.78V148.9h89.08v40.8h1.3c12.4-23.5 42.69-48.3 87.88-48.3 94 0 111.28 61.9 111.28 142.3V448z\"><\/path><\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\" role=\"listitem\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-instagram elementor-animation-push elementor-repeater-item-ee5d380\" href=\"https:\/\/www.instagram.com\/rainbow_care_coaching?igsh=bnd5dHdvN2E3MjR3\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Instagram<\/span>\n\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fab-instagram\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M224.1 141c-63.6 0-114.9 51.3-114.9 114.9s51.3 114.9 114.9 114.9S339 319.5 339 255.9 287.7 141 224.1 141zm0 189.6c-41.1 0-74.7-33.5-74.7-74.7s33.5-74.7 74.7-74.7 74.7 33.5 74.7 74.7-33.6 74.7-74.7 74.7zm146.4-194.3c0 14.9-12 26.8-26.8 26.8-14.9 0-26.8-12-26.8-26.8s12-26.8 26.8-26.8 26.8 12 26.8 26.8zm76.1 27.2c-1.7-35.9-9.9-67.7-36.2-93.9-26.2-26.2-58-34.4-93.9-36.2-37-2.1-147.9-2.1-184.9 0-35.8 1.7-67.6 9.9-93.9 36.1s-34.4 58-36.2 93.9c-2.1 37-2.1 147.9 0 184.9 1.7 35.9 9.9 67.7 36.2 93.9s58 34.4 93.9 36.2c37 2.1 147.9 2.1 184.9 0 35.9-1.7 67.7-9.9 93.9-36.2 26.2-26.2 34.4-58 36.2-93.9 2.1-37 2.1-147.8 0-184.8zM398.8 388c-7.8 19.6-22.9 34.7-42.6 42.6-29.5 11.7-99.5 9-132.1 9s-102.7 2.6-132.1-9c-19.6-7.8-34.7-22.9-42.6-42.6-11.7-29.5-9-99.5-9-132.1s-2.6-102.7 9-132.1c7.8-19.6 22.9-34.7 42.6-42.6 29.5-11.7 99.5-9 132.1-9s102.7-2.6 132.1 9c19.6 7.8 34.7 22.9 42.6 42.6 11.7 29.5 9 99.5 9 132.1s2.7 102.7-9 132.1z\"><\/path><\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-32efd7b e-flex e-con-boxed e-con e-parent\" data-id=\"32efd7b\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-2ffb2c4 e-con-full e-flex e-con e-child\" data-id=\"2ffb2c4\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5fca108 elementor-widget elementor-widget-text-editor\" data-id=\"5fca108\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\u00a9 2026 Rainbow Care&amp;Coaching. 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