{"id":4,"date":"2020-10-11T21:41:00","date_gmt":"2020-10-11T20:41:00","guid":{"rendered":"https:\/\/fightingchance.org.uk\/babybank\/?page_id=4"},"modified":"2026-03-02T11:37:31","modified_gmt":"2026-03-02T11:37:31","slug":"referral","status":"publish","type":"page","link":"https:\/\/fightingchance.org.uk\/babybank\/","title":{"rendered":""},"content":{"rendered":"<p>[vc_row][vc_column width=&#8221;1\/6&#8243;][\/vc_column][vc_column width=&#8221;2\/3&#8243;][vc_empty_space][vc_empty_space][mpc_image image=&#8221;9&#8243; image_opacity=&#8221;100&#8243; image_inner_border_gap=&#8221;0&#8243; effect=&#8221;none&#8221; image_hover_opacity=&#8221;100&#8243;][vc_empty_space][vc_column_text]<strong>Please complete the below referral form and we will be in touch as quickly as possible.<\/strong><br \/>\nAll information is submitted securely and in confidence.[\/vc_column_text][vc_empty_space]<script>\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<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_1' style='display:none'><div id='gf_1' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_1' id='gform_1'  action='\/babybank\/wp-json\/wp\/v2\/pages\/4#gf_1' data-formid='1' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_1' class='gform_fields top_label form_sublabel_above description_above validation_below' data-column-layout='fill'><li id=\"field_1_41\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"><label id='gfield_label_1_41' class='gfield_label gform-field-label' for='input_1_41'><span class='gform-field-label__text'>Comments<\/span><\/label><div class='gfield_description' id='gfield_description_1_41'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_41' id='input_1_41' type='text' value='' autocomplete='new-password'\/><\/div><\/li><li id=\"field_1_1\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"855477ff\" data-field-span=\"12\"><label id='gfield_label_1_1' class='gfield_label gform-field-label' for='input_1_1'><span class='gform-field-label__text'>Referral Group<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_1' id='input_1_1' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Health Visitor' >Health Visitor<\/option><option value='Midwife' >Midwife<\/option><option value='Social Worker' >Social Worker<\/option><option value='Teacher \/ Early Years Practitioner' >Teacher \/ Early Years Practitioner<\/option><option value='Food Bank Volunteer' >Food Bank Volunteer<\/option><option value='Religious Leader' >Religious Leader<\/option><option value='Local Charity' >Local Charity<\/option><option value='GP \/ Nurses' >GP \/ Nurses<\/option><option value='Family Centre' >Family Centre<\/option><option value='Other' >Other<\/option><\/select><\/div><\/li><li id=\"field_1_2\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"180599d6\" data-field-span=\"12\"><label id='gfield_label_1_2' class='gfield_label gform-field-label' for='input_1_2'><span class='gform-field-label__text'>Please Specify<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_1_2' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_3\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"5f7642a3\" data-field-span=\"12\"><label id='gfield_label_1_3' class='gfield_label gform-field-label' for='input_1_3'><span class='gform-field-label__text'>Organisation Name<\/span><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_1_3' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_5\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"53fe7b54\" data-field-span=\"12\"><label id='gfield_label_1_5' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Your Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_5'>\n                            \n                            <span id='input_1_5_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_1_5_3' id='input_1_5_3_label' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_5.3' id='input_1_5_3' value=''   aria-required='true'     aria-labelledby=\"input_1_5_3_label gfield_label_1_5\"\/>\n                                                <\/span>\n                            \n                            <span id='input_1_5_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_1_5_6' id='input_1_5_6_label' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_5.6' id='input_1_5_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/li><li id=\"field_1_6\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"806382aa\" data-field-span=\"12\"><label id='gfield_label_1_6' class='gfield_label gform-field-label' for='input_1_6'><span class='gform-field-label__text'>Your Email<\/span><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_1_6' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_1_7\" class=\"gfield gfield--type-phone gfield--phone-format-international gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"5984eb4d\" data-field-span=\"12\"><label id='gfield_label_1_7' class='gfield_label gform-field-label' for='input_1_7'><span class='gform-field-label__text'>Your Phone Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_7' id='input_1_7' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"    \/><\/div><\/li><li id=\"field_1_17\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"67988d0b\" data-field-span=\"12\"><label id='gfield_label_1_17' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Is this for someone who is currently pregnant?<\/span><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_1_17'>\n\t\t\t<li class='gchoice gchoice_1_17_0'>\n\t\t\t\t<input name='input_17' type='radio' value='Yes'  id='choice_1_17_0'    \/>\n\t\t\t\t<label for='choice_1_17_0' id='label_1_17_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_1_17_1'>\n\t\t\t\t<input name='input_17' type='radio' value='No'  id='choice_1_17_1'    \/>\n\t\t\t\t<label for='choice_1_17_1' id='label_1_17_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_28\" class=\"gfield gfield--type-date gfield--input-type-datefield gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"731ce29f\" data-field-span=\"12\"><label id='gfield_label_1_28' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Due Date<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_28'>PLEASE NOTE: We can only provide newborn items when the Mother is at least twenty weeks pregnant. <\/div><div id='input_1_28' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\">\n                                    <div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_1_28_2_container'>\n                                        <label for='input_1_28_2' id='input_1_28_2_label' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                        <input type='number' maxlength='2' name='input_28[]' id='input_1_28_2' value=''   aria-required='true'   aria-labelledby=\"input_1_28_2_label gfield_label_1_28\" aria-describedby=\"gfield_description_1_28\" placeholder='DD' min='1' max='31' step='1'\/>\n                                    <\/div><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_1_28_1_container'>\n                                    <label for='input_1_28_1' id='input_1_28_1_label' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                    <input type='number' maxlength='2' name='input_28[]' id='input_1_28_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                               <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_1_28_3_container'>\n                                        <label for='input_1_28_3' id='input_1_28_3_label' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                                        <input type='number' maxlength='4' name='input_28[]' id='input_1_28_3' value=''   aria-required='true'   placeholder='YYYY' min='1920' max='2027' step='1'\/>\n                                   <\/div>\n                                <\/div><\/div><\/li><li id=\"field_1_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"c7a1dea1\" data-field-span=\"12\"><label id='gfield_label_1_18' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Please confirm the gender.<\/span><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_1_18'>\n\t\t\t<li class='gchoice gchoice_1_18_0'>\n\t\t\t\t<input name='input_18' type='radio' value='Girl'  id='choice_1_18_0'    \/>\n\t\t\t\t<label for='choice_1_18_0' id='label_1_18_0' class='gform-field-label gform-field-label--type-inline'>Girl<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_18_1'>\n\t\t\t\t<input name='input_18' type='radio' value='Boy'  id='choice_1_18_1'    \/>\n\t\t\t\t<label for='choice_1_18_1' id='label_1_18_1' class='gform-field-label gform-field-label--type-inline'>Boy<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_18_2'>\n\t\t\t\t<input name='input_18' type='radio' value='Unknown'  id='choice_1_18_2'    \/>\n\t\t\t\t<label for='choice_1_18_2' id='label_1_18_2' class='gform-field-label gform-field-label--type-inline'>Unknown<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_18_3'>\n\t\t\t\t<input name='input_18' type='radio' value='gf_other_choice'  id='choice_1_18_3'   onfocus=\"jQuery(this).next('input').focus();\" \/>\n\t\t\t\t<input class='small' id='input_1_18_other' name='input_18_other' type='text' value='Other' aria-label='Other' onfocus='jQuery(this).prev(\"input\")[0].click(); if(jQuery(this).val() == \"Other\") { jQuery(this).val(\"\"); }' onblur='if(jQuery(this).val().replace(\" \", \"\") == \"\") { jQuery(this).val(\"Other\"); }'   \/>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_20\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"23933915\" data-field-span=\"12\"><label id='gfield_label_1_20' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Do they have any other children who would need to access the baby bank?<\/span><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_1_20'>\n\t\t\t<li class='gchoice gchoice_1_20_0'>\n\t\t\t\t<input name='input_20' type='radio' value='Yes'  id='choice_1_20_0'    \/>\n\t\t\t\t<label for='choice_1_20_0' id='label_1_20_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_1_20_1'>\n\t\t\t\t<input name='input_20' type='radio' value='No'  id='choice_1_20_1'    \/>\n\t\t\t\t<label for='choice_1_20_1' id='label_1_20_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_10\" class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"a2de4cda\" data-field-span=\"12\"><label id='gfield_label_1_10' class='gfield_label gform-field-label' for='input_1_10'><span class='gform-field-label__text'>Childs Age \/ Gender<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_10'>If the request is for more than one child, please specify. We only ask this to enable us to make an appropriate provision of age \/ gender specific clothing or items, where applicable or requested.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_10' id='input_1_10' class='textarea medium'  aria-describedby=\"gfield_description_1_10\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_22\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"bdfe46b5\" data-field-span=\"12\">[vc_empty_space height=\"16px\"]<H4>Items Required<\/h4><\/li><li id=\"field_1_21\" class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_2col field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"83f58867\" data-field-span=\"12\"><label id='gfield_label_1_21' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Baby\/Child<\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_21'><li class='gchoice gchoice_1_21_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.1' type='checkbox'  value='Nappies'  id='choice_1_21_1'    aria-labelledby=\"label_1_21_1 gfield_label_1_21\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_1' id='label_1_21_1' class='gform-field-label gform-field-label--type-inline'>Nappies<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.2' type='checkbox'  value='Wipes'  id='choice_1_21_2'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_2' id='label_1_21_2' class='gform-field-label gform-field-label--type-inline'>Wipes<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.3' type='checkbox'  value='Nappy Sacks'  id='choice_1_21_3'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_3' id='label_1_21_3' class='gform-field-label gform-field-label--type-inline'>Nappy Sacks<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.4' type='checkbox'  value='Nappy Cream'  id='choice_1_21_4'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_4' id='label_1_21_4' class='gform-field-label gform-field-label--type-inline'>Nappy Cream<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.5' type='checkbox'  value='Changing Mat'  id='choice_1_21_5'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_5' id='label_1_21_5' class='gform-field-label gform-field-label--type-inline'>Changing Mat<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.6' type='checkbox'  value='Formula'  id='choice_1_21_6'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_6' id='label_1_21_6' class='gform-field-label gform-field-label--type-inline'>Formula<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.7' type='checkbox'  value='Bottles'  id='choice_1_21_7'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_7' id='label_1_21_7' class='gform-field-label gform-field-label--type-inline'>Bottles<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.8' type='checkbox'  value='Dummies'  id='choice_1_21_8'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_8' id='label_1_21_8' class='gform-field-label gform-field-label--type-inline'>Dummies<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.9' type='checkbox'  value='Microwave Steriliser'  id='choice_1_21_9'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_9' id='label_1_21_9' class='gform-field-label gform-field-label--type-inline'>Microwave Steriliser<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.11' type='checkbox'  value='Hairbrush'  id='choice_1_21_11'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_11' id='label_1_21_11' class='gform-field-label gform-field-label--type-inline'>Hairbrush<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.12' type='checkbox'  value='Nail Clippers \/ Scissors'  id='choice_1_21_12'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_12' id='label_1_21_12' class='gform-field-label gform-field-label--type-inline'>Nail Clippers \/ Scissors<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.13' type='checkbox'  value='Cotton Wool'  id='choice_1_21_13'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_13' id='label_1_21_13' class='gform-field-label gform-field-label--type-inline'>Cotton Wool<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.14' type='checkbox'  value='Body Wash'  id='choice_1_21_14'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_14' id='label_1_21_14' class='gform-field-label gform-field-label--type-inline'>Body Wash<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.15' type='checkbox'  value='Moisturiser'  id='choice_1_21_15'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_15' id='label_1_21_15' class='gform-field-label gform-field-label--type-inline'>Moisturiser<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.16' type='checkbox'  value='Talc'  id='choice_1_21_16'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_16' id='label_1_21_16' class='gform-field-label gform-field-label--type-inline'>Talc<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.17' type='checkbox'  value='Baby Bath'  id='choice_1_21_17'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_17' id='label_1_21_17' class='gform-field-label gform-field-label--type-inline'>Baby Bath<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.18' type='checkbox'  value='Toothbrush'  id='choice_1_21_18'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_18' id='label_1_21_18' class='gform-field-label gform-field-label--type-inline'>Toothbrush<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.19' type='checkbox'  value='Toothpaste'  id='choice_1_21_19'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_19' id='label_1_21_19' class='gform-field-label gform-field-label--type-inline'>Toothpaste<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.21' type='checkbox'  value='Muslins'  id='choice_1_21_21'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_21' id='label_1_21_21' class='gform-field-label gform-field-label--type-inline'>Muslins<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.22' type='checkbox'  value='Blankets'  id='choice_1_21_22'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_22' id='label_1_21_22' class='gform-field-label gform-field-label--type-inline'>Blankets<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.23' type='checkbox'  value='Sheets'  id='choice_1_21_23'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_23' id='label_1_21_23' class='gform-field-label gform-field-label--type-inline'>Sheets<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_24'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.24' type='checkbox'  value='Duvet Covers'  id='choice_1_21_24'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_24' id='label_1_21_24' class='gform-field-label gform-field-label--type-inline'>Duvet Covers<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_25'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.25' type='checkbox'  value='Sleeping Bags'  id='choice_1_21_25'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_25' id='label_1_21_25' class='gform-field-label gform-field-label--type-inline'>Sleeping Bags<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_26'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.26' type='checkbox'  value='Bibs'  id='choice_1_21_26'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_26' id='label_1_21_26' class='gform-field-label gform-field-label--type-inline'>Bibs<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_27'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.27' type='checkbox'  value='Hat'  id='choice_1_21_27'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_27' id='label_1_21_27' class='gform-field-label gform-field-label--type-inline'>Hat<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_28'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.28' type='checkbox'  value='Scratch Mitts'  id='choice_1_21_28'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_28' id='label_1_21_28' class='gform-field-label gform-field-label--type-inline'>Scratch Mitts<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_29'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.29' type='checkbox'  value='Clothing'  id='choice_1_21_29'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_29' id='label_1_21_29' class='gform-field-label gform-field-label--type-inline'>Clothing<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_31'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.31' type='checkbox'  value='Shoes'  id='choice_1_21_31'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_31' id='label_1_21_31' class='gform-field-label gform-field-label--type-inline'>Shoes<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_32'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.32' type='checkbox'  value='Wellies'  id='choice_1_21_32'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_32' id='label_1_21_32' class='gform-field-label gform-field-label--type-inline'>Wellies<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_33'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.33' type='checkbox'  value='Coat'  id='choice_1_21_33'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_33' id='label_1_21_33' class='gform-field-label gform-field-label--type-inline'>Coat<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_34'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.34' type='checkbox'  value='Snowsuit'  id='choice_1_21_34'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_34' id='label_1_21_34' class='gform-field-label gform-field-label--type-inline'>Snowsuit<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_35'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.35' type='checkbox'  value='Toys'  id='choice_1_21_35'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_35' id='label_1_21_35' class='gform-field-label gform-field-label--type-inline'>Toys<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_36'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.36' type='checkbox'  value='Books'  id='choice_1_21_36'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_36' id='label_1_21_36' class='gform-field-label gform-field-label--type-inline'>Books<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_37'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.37' type='checkbox'  value='Feeding \/ Weaning Items'  id='choice_1_21_37'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_37' id='label_1_21_37' class='gform-field-label gform-field-label--type-inline'>Feeding \/ Weaning Items<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_38'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.38' type='checkbox'  value='Bouncer Chair'  id='choice_1_21_38'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_38' id='label_1_21_38' class='gform-field-label gform-field-label--type-inline'>Bouncer Chair<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_39'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.39' type='checkbox'  value='Baby Carrier \/ Sling'  id='choice_1_21_39'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_39' id='label_1_21_39' class='gform-field-label gform-field-label--type-inline'>Baby Carrier \/ Sling<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_41'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.41' type='checkbox'  value='Moses Basket'  id='choice_1_21_41'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_41' id='label_1_21_41' class='gform-field-label gform-field-label--type-inline'>Moses Basket<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_42'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.42' type='checkbox'  value='High Chair'  id='choice_1_21_42'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_42' id='label_1_21_42' class='gform-field-label gform-field-label--type-inline'>High Chair<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_43'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.43' type='checkbox'  value='Baby Monitor'  id='choice_1_21_43'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_43' id='label_1_21_43' class='gform-field-label gform-field-label--type-inline'>Baby Monitor<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_21_44'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.44' type='checkbox'  value='Thermometer'  id='choice_1_21_44'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_21_44' id='label_1_21_44' class='gform-field-label gform-field-label--type-inline'>Thermometer<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_23\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"307b6b42\" data-field-span=\"12\"><label id='gfield_label_1_23' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Mum<\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_23'><li class='gchoice gchoice_1_23_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.1' type='checkbox'  value='Maternity Clothing'  id='choice_1_23_1'    aria-labelledby=\"label_1_23_1 gfield_label_1_23\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_23_1' id='label_1_23_1' class='gform-field-label gform-field-label--type-inline'>Maternity Clothing<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_23_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.2' type='checkbox'  value='Breast Pads'  id='choice_1_23_2'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_23_2' id='label_1_23_2' class='gform-field-label gform-field-label--type-inline'>Breast Pads<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_23_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.3' type='checkbox'  value='Maternity Pads'  id='choice_1_23_3'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_23_3' id='label_1_23_3' class='gform-field-label gform-field-label--type-inline'>Maternity Pads<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_23_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.4' type='checkbox'  value='Nipple Cream'  id='choice_1_23_4'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_23_4' id='label_1_23_4' class='gform-field-label gform-field-label--type-inline'>Nipple Cream<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_23_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.5' type='checkbox'  value='Nursing Bra'  id='choice_1_23_5'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_23_5' id='label_1_23_5' class='gform-field-label gform-field-label--type-inline'>Nursing Bra<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_23_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.6' type='checkbox'  value='Breast Pump'  id='choice_1_23_6'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_23_6' id='label_1_23_6' class='gform-field-label gform-field-label--type-inline'>Breast Pump<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_1_23_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.7' type='checkbox'  value='Changing Bag'  id='choice_1_23_7'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_23_7' id='label_1_23_7' class='gform-field-label gform-field-label--type-inline'>Changing Bag<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_36\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"6cc2572c\" data-field-span=\"12\"><label id='gfield_label_1_36' class='gfield_label gform-field-label' for='input_1_36'><span class='gform-field-label__text'>Bra Size<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_1_36' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_35\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"><label id='gfield_label_1_35' class='gfield_label gform-field-label' for='input_1_35'><span class='gform-field-label__text'>Maternity Clothing Size<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_1_35' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_11\" class=\"gfield gfield--type-textarea field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"><label id='gfield_label_1_11' class='gfield_label gform-field-label' for='input_1_11'><span class='gform-field-label__text'>Is there anything else the family are in desperate need of that hasn&#039;t been listed above?<\/span><\/label><div class='gfield_description' id='gfield_description_1_11'>Please be aware that we do not store cots, cot beds, car seats or prams.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_11' id='input_1_11' class='textarea medium'  aria-describedby=\"gfield_description_1_11\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_24\" class=\"gfield gfield--type-textarea field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"8cee4692\" data-field-span=\"12\"><label id='gfield_label_1_24' class='gfield_label gform-field-label' for='input_1_24'><span class='gform-field-label__text'>Is there any further information regarding the items required?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_24' id='input_1_24' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_25\" class=\"gfield gfield--type-textarea field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"e25d75dc\" data-field-span=\"12\"><label id='gfield_label_1_25' class='gfield_label gform-field-label' for='input_1_25'><span class='gform-field-label__text'>Is there any other relevant information?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_25' id='input_1_25' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_12\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"e0dd2085\" data-field-span=\"12\"><label id='gfield_label_1_12' class='gfield_label gform-field-label' for='input_1_12'><span class='gform-field-label__text'>Where Did You Hear About Us?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_1_12' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_30\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"><label id='gfield_label_1_30' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>We provide both collection and delivery. Please select the most appropriate option below.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_30'>Please select collection wherever possible. This is quicker and reduces pressure on our volunteers.<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_30'>\n\t\t\t<li class='gchoice gchoice_1_30_0'>\n\t\t\t\t<input name='input_30' type='radio' value='I will be collecting on behalf of the family.'  id='choice_1_30_0'    \/>\n\t\t\t\t<label for='choice_1_30_0' id='label_1_30_0' class='gform-field-label gform-field-label--type-inline'>I will be collecting on behalf of the family.<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_30_1'>\n\t\t\t\t<input name='input_30' type='radio' value='The family will be collecting.'  id='choice_1_30_1'    \/>\n\t\t\t\t<label for='choice_1_30_1' id='label_1_30_1' class='gform-field-label gform-field-label--type-inline'>The family will be collecting.<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_30_2'>\n\t\t\t\t<input name='input_30' type='radio' value='The family requires a delivery.'  id='choice_1_30_2'    \/>\n\t\t\t\t<label for='choice_1_30_2' id='label_1_30_2' class='gform-field-label gform-field-label--type-inline'>The family requires a delivery.<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_40\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"><label id='gfield_label_1_40' class='gfield_label gform-field-label' for='input_1_40'><span class='gform-field-label__text'>Name of Recipient<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_1_40' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_31\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"17328e27\" data-field-span=\"12\">Our address is Unit K, The Old Bakery, Golden Square, Petworth. GU28 0AP.<\/li><li id=\"field_1_32\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"05f4b587\" data-field-span=\"12\">Our volunteers are happy to deliver within an eight mile radius of Petworth (GU28 0AP)<\/li><li id=\"field_1_38\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"><label id='gfield_label_1_38' class='gfield_label gform-field-label' for='input_1_38'><span class='gform-field-label__text'>Name of Recipient<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_1_38' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_39\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"><label id='gfield_label_1_39' class='gfield_label gform-field-label' for='input_1_39'><span class='gform-field-label__text'>Phone number of Recipient<\/span><\/label><div class='gfield_description' id='gfield_description_1_39'>This is optional and only used if we have a problem with the delivery.<\/div><div class='ginput_container ginput_container_text'><input name='input_39' id='input_1_39' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_39\"    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_33\" class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"1c1b6a20\" data-field-span=\"12\"><label id='gfield_label_1_33' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Delivery Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_zip ginput_container_address gform-grid-row' id='input_1_33' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_33_1_container' >\n                                        <input type='text' name='input_33.1' id='input_1_33_1' value=''    aria-required='true'    aria-labelledby=\"input_1_33_1_label gfield_label_1_33\"\/>\n                                        <label for='input_1_33_1' id='input_1_33_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_1_33_2_container' >\n                                        <input type='text' name='input_33.2' id='input_1_33_2' value=''     aria-required='false'   \/>\n                                        <label for='input_1_33_2' id='input_1_33_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_33_3_container' >\n                                    <input type='text' name='input_33.3' id='input_1_33_3' value=''    aria-required='true'    \/>\n                                    <label for='input_1_33_3' id='input_1_33_3_label' class='gform-field-label gform-field-label--type-sub '>Town<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_33.4' id='input_1_33_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_1_33_5_container' >\n                                    <input type='text' name='input_33.5' id='input_1_33_5' value=''    aria-required='true'    \/>\n                                    <label for='input_1_33_5' id='input_1_33_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_33.6' id='input_1_33_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_1_14\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"7e15c314\" data-field-span=\"12\"><label id='gfield_label_1_14' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>By submitting this form you are agreeing to our privacy and disclosure policy as well as our assumption of risk policy.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_1_14'>Please ensure you've taken the time to read and understand both policies fully. <a href=\"https:\/\/fightingchancebabybank.org.uk\/documents\" target=\"_blank\">Click here to view these policies<\/a>.<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_14'><li class='gchoice gchoice_1_14_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.1' type='checkbox'  value='I have read and agree to both policies'  id='choice_1_14_1'   aria-describedby=\"gfield_description_1_14\" aria-labelledby=\"label_1_14_1 gfield_label_1_14\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_14_1' id='label_1_14_1' class='gform-field-label gform-field-label--type-inline'>I have read and agree to both policies<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_27\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"b7f78c39\" data-field-span=\"12\">We understand all families will have different needs regarding the items they require from the Baby Bank. We will always do our best to provide as many of the items required as possible but we won't always be able to fulfil 100% of the referral.<\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_1' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit Referral<\/button> <a type='button' href=\"javascript:void(0);\" id='gform_save_1_footer_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary'  > Save and Continue Later<\/a><input type='hidden' name='gform_ajax' value='form_id=1&amp;title=&amp;description=&amp;tabindex=0&amp;theme=legacy&amp;styles=[]&amp;hash=b0413266555dc70b6482185b414b5dab' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_1' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_1' id='gform_theme_1' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_1' id='gform_style_settings_1' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_save' id='gform_save_1' value='' \/>\n                             <input type='hidden' class='gform_hidden' name='gform_resume_token' id='gform_resume_token_1' value='' \/>\n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='GBP' value='Tt9a1yabAkAjZgCOLeF7Vh0ZZEyXlUjjZfwlRfEssvVw2mvVxhCKVJWQ4i4XPMi96DPPrLogvgnx56\/22eG6oKUFcU2nVw\/qIdkDIsOTOZA1mUU=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_1' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_1' id='gform_target_page_number_1' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_1' id='gform_source_page_number_1' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div>\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_1' id='gform_ajax_frame_1' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n\t\t                <script>\ngform.initializeOnLoaded( function() {jQuery('#gform_ajax_frame_1').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_1');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_1').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! 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