[de_fb_form title=”UA Event Sign Up” form_id=”Event Signup” disable_submit_for_required=”on” use_preload_animation=”on” success_hide_form=”on” message_position=”after_title” success_message_type=”layout” success_layout=”10207″ use_custom_email=”off” custom_contact_email=”justin.kirk@mediabarninc.com” from_name=”custom” custom_from_name=”UA Event Sign Up” email_template_html=”on” email_template=”

Uplifting Experience Sign-Up

Signup for %%event_title%% has been submitted

Name: %%name%%
Email Address: %%email%%
Age: %%age%%
Phone Number: %%phone%%
T-Shirt Size: %%shirt_size%%

Second Person

Name (Person 2): %%name_2%%
Email Address (Person 2): %%email_2%%
Age (Person 2): %%age_2%%
Phone Number (Person 2): %%phone_2%%
T-Shirt Size (Person 2): %%shirt_size_2%%

---

Dietary Restrictions: %%dietary_restrictions%%
Referring Patient: %%referring%%
Accommodations: %%accommodations%%
Other: %%other%%
Grant Photography: %%consent%%
Opt-In: %%optin%%

Spots Remaining: %%spots_remaining%%
” send_copy_to_sender=”on” sender_email_field=”email” reply_email_title=”Uplifting Experience Webform Submission” reply_email_template_html=”on” reply_email_template=”

Thank you for your submission to the Uplifting Experience

Hi, %%name%%

Your sign-up for %%event_title%% has been received and someone at Uplifting Athletes will follow up with you in 1-2 business days with further details. Your submission is currently considered pending and will be completed once Uplifting Athletes confirms all of your details.

Thank you,
Uplifting Athletes

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field_placeholder=”T-Shirt Size” conditional_logic=”on” conditional_logic_rules=”%91{%22field%22:%22addperson%22,%22condition%22:%22is%22,%22value%22:%22Add Another Person%22}%93″ _builder_version=”4.19.5″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Dietary Restrictions” admin_title=”Dietary Restrictions” field_id=”dietary_restrictions” field_placeholder=”Dietary Restrictions” _builder_version=”4.19.5″ _module_preset=”default” custom_margin=”40px||||false|false” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Your Phone Number” admin_title=”Phone” field_id=”phone_2″ allowed_symbols=”numbers” field_grid_column=”et_pb_column_1_2″ field_placeholder=”Phone for Second Person” conditional_logic=”on” conditional_logic_rules=”%91{%22field%22:%22addperson%22,%22condition%22:%22is%22,%22value%22:%22Add Another Person%22}%93″ _builder_version=”4.19.5″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Accommodations” admin_title=”Accommodations” field_id=”accommodations” field_type=”checkbox” checkbox_options=”%91{%22value%22:%22Wheelchair accessibility%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22ADA parking%22,%22checked%22:0,%22dragID%22:0},{%22value%22:%22Attendance of service animal%22,%22checked%22:0,%22dragID%22:1},{%22value%22:%22Attendance of nurse and/or medical caregiver%22,%22checked%22:0,%22dragID%22:2},{%22value%22:%22Dietary accommodations%22,%22checked%22:0,%22dragID%22:3},{%22value%22:%22Visual and/or hearing accommodations%22,%22checked%22:0,%22dragID%22:4},{%22value%22:%22Noise and/or light sensitivity accommodations%22,%22checked%22:0,%22dragID%22:5},{%22value%22:%22Other%22,%22checked%22:0,%22dragID%22:6}%93″ radio_checkbox_margin=”|40px|||false|false” _builder_version=”4.19.5″ _module_preset=”default” custom_css_before=”content:’Please note below any necessary accommodations that will make this Uplifting Experience a safe, comfortable, and enjoyable time for your family.’;|| margin-bottom:10px;” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Anything Else” admin_title=”Anything Else” field_id=”other” field_type=”text” radio_checkbox_margin=”|||40px|false|false” field_placeholder=”Please include anything else we need to know that may be pertinent to the Uplifting Experience event.” _builder_version=”4.19.5″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Grant” admin_title=”Grant” field_id=”consent” field_type=”radio” checkbox_options=”%91{%22value%22:%22Yes%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22No%22,%22checked%22:0,%22dragID%22:0}%93″ radio_options=”%91{%22value%22:%22Yes%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22No%22,%22checked%22:0,%22dragID%22:0}%93″ checkbox_radio_inline=”on” checkbox_radio_inline_full=”on” radio_checkbox_margin=”|40px|||false|false” description_text=”on” description_text_text=”I grant to Uplifting Athletes, its representatives and employees the right to photograph me and my property in connection with this Uplifting Experiences event. I authorize Uplifting Athletes, its assignees and transferees to copyright, use and publish the same in print and/or electronically. I agree that Uplifting Athletes may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. I have read and understand the above.” _builder_version=”4.19.5″ _module_preset=”default” global_colors_info=”{}” radio_checkbox_button_text_color__hover_enabled=”on|desktop” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Opt-In” admin_title=”Opt-In” field_id=”optin” field_type=”radio” checkbox_options=”%91{%22value%22:%22Yes%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22No%22,%22checked%22:0,%22dragID%22:0}%93″ radio_options=”%91{%22value%22:%22Yes%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22No%22,%22checked%22:0,%22dragID%22:0}%93″ checkbox_radio_inline=”on” checkbox_radio_inline_full=”on” radio_checkbox_margin=”|40px|||false|false” description_text=”on” description_text_text=”I would like to opt-in to digital communications from Uplifting Athletes.” _builder_version=”4.19.5″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Referring Patient” admin_title=”Referring Patient” field_id=”referring” field_placeholder=”Referring Patient Advocacy Organization, Healthcare Provider, or Group” _builder_version=”4.19.5″ _module_preset=”default” custom_margin=”||||false|false” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Agree” admin_title=”Agree” field_id=”agree” field_type=”checkbox” checkbox_options=”%91{%22value%22:%22By selecting Submit, I agree to the terms.%22,%22checked%22:0,%22dragID%22:-1}%93″ required_mark=”on” checkbox_radio_inline=”on” _builder_version=”4.19.5″ _module_preset=”default” form_field_text_align=”left” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Spots Remaining” field_id=”spots_remaining” field_type=”hidden” hidden_value=”acf” hidden_value_acf=”field_646d2d70a53fb” _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][/de_fb_form]