{"id":2861,"date":"2018-07-17T15:51:12","date_gmt":"2018-07-17T19:51:12","guid":{"rendered":"https:\/\/www.med.unc.edu\/cspsc\/scheduling\/sim-equipment-request-form\/"},"modified":"2023-12-19T11:33:26","modified_gmt":"2023-12-19T16:33:26","slug":"sim-equipment-request-form","status":"publish","type":"page","link":"https:\/\/www.med.unc.edu\/cspsc\/scheduling\/sim-equipment-request-form\/","title":{"rendered":"SET High Fidelity Equipment Request Form"},"content":{"rendered":"<p>Please visit the\u00a0<a class=\"external-link\" title=\"\" href=\"https:\/\/tinyurl.com\/cspsc-equipment\" target=\"_self\" rel=\"noopener noreferrer\">equipment request calendar\u00a0<\/a>before submitting your requests.<\/p>\n<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_unknown gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_4' >\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Sim Equipment Request Form<\/h3>\n                            <p class='gform_description'>To reserve simulation equipment or request further information about equipment needs, please complete the following form.  We will respond to your request shortly.  Please note that no reservations are added to our calendar until you have received confirmation.<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_4'  action='\/cspsc\/wp-json\/wp\/v2\/pages\/2861\/' data-formid='4' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_4_1\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_1\" ><h2 class=\"gsection_title\">Contact Information<\/h2><\/li><li id=\"field_4_3\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_3\" ><label class='gfield_label gform-field-label' for='input_4_3'>Primary Contact Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_4_3' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_4\" class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_4\" ><label class='gfield_label gform-field-label' for='input_4_4'>Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_4_4' type='tel' value='' class='small'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_5\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_5\" ><label class='gfield_label gform-field-label' for='input_4_5'>Additional Phone Number<\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_4_5' type='tel' value='' class='small'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_6\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_6\" ><label class='gfield_label gform-field-label' for='input_4_6'>Email Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_6' id='input_4_6' type='email' value='' class='small'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_4_7\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_7\" ><label class='gfield_label gform-field-label' for='input_4_7'>Group\/Department Name<\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_4_7' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_8\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_8\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Equipment Request (Please Select All That Apply.)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_4_8'><li class='gchoice gchoice_4_8_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.1' type='checkbox'  value='Laerdal 3G Adult - Frank'  id='choice_4_8_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_1' id='label_4_8_1' class='gform-field-label gform-field-label--type-inline'>Laerdal 3G Adult - Frank<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_8_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.2' type='checkbox'  value='Laerdal ALS Man - Remy'  id='choice_4_8_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_2' id='label_4_8_2' class='gform-field-label gform-field-label--type-inline'>Laerdal ALS Man - Remy<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_8_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.3' type='checkbox'  value='Laerdal Sim Jr - Peter'  id='choice_4_8_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_3' id='label_4_8_3' class='gform-field-label gform-field-label--type-inline'>Laerdal Sim Jr - Peter<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_8_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.4' type='checkbox'  value='Laerdal Sim Jr - Bruce'  id='choice_4_8_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_4' id='label_4_8_4' class='gform-field-label gform-field-label--type-inline'>Laerdal Sim Jr - Bruce<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_8_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.5' type='checkbox'  value='Laerdal Sim Baby - Alice'  id='choice_4_8_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_5' id='label_4_8_5' class='gform-field-label gform-field-label--type-inline'>Laerdal Sim Baby - Alice<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_8_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.6' type='checkbox'  value='Laerdal Sim Baby - Benjamin'  id='choice_4_8_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_6' id='label_4_8_6' class='gform-field-label gform-field-label--type-inline'>Laerdal Sim Baby - Benjamin<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_8_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.7' type='checkbox'  value='Laerdal Sim NewB - Schrodinger'  id='choice_4_8_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_7' id='label_4_8_7' class='gform-field-label gform-field-label--type-inline'>Laerdal Sim NewB - Schrodinger<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_8_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.8' type='checkbox'  value='Laerdal Sim NewB - Janet'  id='choice_4_8_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_8' id='label_4_8_8' class='gform-field-label gform-field-label--type-inline'>Laerdal Sim NewB - Janet<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_8_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.9' type='checkbox'  value='Laerdal Sim Premie - Pym'  id='choice_4_8_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_9' id='label_4_8_9' class='gform-field-label gform-field-label--type-inline'>Laerdal Sim Premie - Pym<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_8_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.11' type='checkbox'  value='Laerdal 3G Adult - Anesthesiology - Simon'  id='choice_4_8_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_11' id='label_4_8_11' class='gform-field-label gform-field-label--type-inline'>Laerdal 3G Adult - Anesthesiology - Simon<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_8_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.12' type='checkbox'  value='Laerdal SonoSim - Ultrasound Simulator'  id='choice_4_8_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_12' id='label_4_8_12' class='gform-field-label gform-field-label--type-inline'>Laerdal SonoSim - Ultrasound Simulator<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_8_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.13' type='checkbox'  value='Sonosite S-nerve - Ultrasound Machine'  id='choice_4_8_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_13' id='label_4_8_13' class='gform-field-label gform-field-label--type-inline'>Sonosite S-nerve - Ultrasound Machine<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_8_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.14' type='checkbox'  value='GE LogiQ V2 - Ultrasound Machine 1'  id='choice_4_8_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_14' id='label_4_8_14' class='gform-field-label gform-field-label--type-inline'>GE LogiQ V2 - Ultrasound Machine 1<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_8_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.15' type='checkbox'  value='GE LogiQ V2 - Ultrasound Machine 2'  id='choice_4_8_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_15' id='label_4_8_15' class='gform-field-label gform-field-label--type-inline'>GE LogiQ V2 - Ultrasound Machine 2<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_8_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.16' type='checkbox'  value='GE LogiQ V2 - Ultrasound Machine 3'  id='choice_4_8_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_16' id='label_4_8_16' class='gform-field-label gform-field-label--type-inline'>GE LogiQ V2 - Ultrasound Machine 3<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_8_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.17' type='checkbox'  value='GE LogiQ V2 - Ultrasound Machine 4'  id='choice_4_8_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_17' id='label_4_8_17' class='gform-field-label gform-field-label--type-inline'>GE LogiQ V2 - Ultrasound Machine 4<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_8_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.18' type='checkbox'  value='GE LogiQ V2 - Ultrasound Machine 5'  id='choice_4_8_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_18' id='label_4_8_18' class='gform-field-label gform-field-label--type-inline'>GE LogiQ V2 - Ultrasound Machine 5<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_8_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.19' type='checkbox'  value='GE LogiQ e - Ultrasound Machine 6'  id='choice_4_8_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_19' id='label_4_8_19' class='gform-field-label gform-field-label--type-inline'>GE LogiQ e - Ultrasound Machine 6<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_8_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.21' type='checkbox'  value='Laerdal 3G Adult - Robin - SOM Only'  id='choice_4_8_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_21' id='label_4_8_21' class='gform-field-label gform-field-label--type-inline'>Laerdal 3G Adult - Robin - SOM Only<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_8_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.22' type='checkbox'  value='Laerdal 3G Adult - Alex - SOM Only'  id='choice_4_8_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_22' id='label_4_8_22' class='gform-field-label gform-field-label--type-inline'>Laerdal 3G Adult - Alex - SOM Only<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_8_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.23' type='checkbox'  value='Laerdal 3G Adult - Sam - SOM Only'  id='choice_4_8_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_23' id='label_4_8_23' class='gform-field-label gform-field-label--type-inline'>Laerdal 3G Adult - Sam - SOM Only<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_4_8_24'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.24' type='checkbox'  value='Other item (task trainer, CPR manikin, etc.)'  id='choice_4_8_24'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_4_8_24' id='label_4_8_24' class='gform-field-label gform-field-label--type-inline'>Other item (task trainer, CPR manikin, etc.)<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_10\" ><label class='gfield_label gform-field-label' >Will You Need A Sim Tech For This Session?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_4_10'>Please note that sim tech availability is not guaranteed.<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_10'>\n\t\t\t<li class='gchoice gchoice_4_10_0'>\n\t\t\t\t<input name='input_10' type='radio' value='Yes'  id='choice_4_10_0'    \/>\n\t\t\t\t<label for='choice_4_10_0' id='label_4_10_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_4_10_1'>\n\t\t\t\t<input name='input_10' type='radio' value='No'  id='choice_4_10_1'    \/>\n\t\t\t\t<label for='choice_4_10_1' id='label_4_10_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_18\" ><label class='gfield_label gform-field-label' >I Understand The Confirmed Times Will Include 30 Minutes Before And After The Requested Times<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_18'>\n\t\t\t<li class='gchoice gchoice_4_18_0'>\n\t\t\t\t<input name='input_18' type='radio' value='Yes'  id='choice_4_18_0'    \/>\n\t\t\t\t<label for='choice_4_18_0' id='label_4_18_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_4_11\" class=\"gfield gfield--type-date gfield--input-type-datefield gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_11\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Start Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_4_11' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\"><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_4_11_1_container'>\n                                            <input type='number' maxlength='2' name='input_11[]' id='input_4_11_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_4_11_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_4_11_2_container'>\n                                            <input type='number' maxlength='2' name='input_11[]' id='input_4_11_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                            <label for='input_4_11_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_4_11_3_container'>\n                                            <input type='number' maxlength='4' name='input_11[]' id='input_4_11_3' value=''   aria-required='true'   placeholder='YYYY' min='1920' max='2026' step='1'\/>\n                                            <label for='input_4_11_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                       <\/div>\n                                   <\/div><\/div><\/li><li id=\"field_4_12\" class=\"gfield gfield--type-time gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_12\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Start Time<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class=\"ginput_container ginput_complex gform-grid-row\"><div class=\"clear-multi\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_4_12'>\n                            <input type='number' maxlength='2' name='input_12[]' id='input_4_12_1' value=''  min='0' max='12' step='1'  placeholder='HH' aria-required='true'   \/> <i>:<\/i>\n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_4_12_1'>Hours<\/label>\n                        <\/div>\n                        \n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' maxlength='2' name='input_12[]' id='input_4_12_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='true'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_4_12_2'>Minutes<\/label>\n                        <\/div>\n                        <div class='gfield_time_ampm ginput_container ginput_container_time below gform-grid-col' >\n                                \n                                <select name='input_12[]' id='input_4_12_3'  >\n                                    <option value='am' >AM<\/option>\n                                    <option value='pm' >PM<\/option>\n                                <\/select> \n                                <label class='gform-field-label gform-field-label--type-sub am_pm_label screen-reader-text' for='input_4_12_3'>AM\/PM<\/label>                                \n                           <\/div>\n                    <\/div><\/div><\/li><li id=\"field_4_13\" class=\"gfield gfield--type-date 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screen-reader-text'>Year<\/label>\n                                       <\/div>\n                                   <\/div><\/div><\/li><li id=\"field_4_14\" class=\"gfield gfield--type-time gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_14\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >End Time<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class=\"ginput_container ginput_complex gform-grid-row\"><div class=\"clear-multi\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_4_14'>\n                            <input type='number' maxlength='2' name='input_14[]' id='input_4_14_1' value=''  min='0' max='12' step='1'  placeholder='HH' aria-required='true'   \/> <i>:<\/i>\n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_4_14_1'>Hours<\/label>\n                        <\/div>\n                        \n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' maxlength='2' name='input_14[]' id='input_4_14_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='true'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_4_14_2'>Minutes<\/label>\n                        <\/div>\n                        <div class='gfield_time_ampm ginput_container ginput_container_time below gform-grid-col' >\n                                \n                                <select name='input_14[]' id='input_4_14_3'  >\n                                    <option value='am' >AM<\/option>\n                                    <option value='pm' >PM<\/option>\n                                <\/select> \n                                <label class='gform-field-label gform-field-label--type-sub am_pm_label screen-reader-text' for='input_4_14_3'>AM\/PM<\/label>                                \n                           <\/div>\n                    <\/div><\/div><\/li><li id=\"field_4_15\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_15\" ><label class='gfield_label gform-field-label' for='input_4_15'>Is This A Recurring Event? 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