{"id":84,"date":"2021-04-14T14:15:03","date_gmt":"2021-04-14T14:15:03","guid":{"rendered":"https:\/\/samaritansza.co.za\/?page_id=84"},"modified":"2021-04-14T14:19:20","modified_gmt":"2021-04-14T14:19:20","slug":"form1","status":"publish","type":"page","link":"https:\/\/samaritansza.co.za\/index.php\/form1\/","title":{"rendered":"form1"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"84\" class=\"elementor elementor-84\" data-elementor-settings=\"[]\">\n\t\t\t\t\t\t\t<div class=\"elementor-section-wrap\">\n\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-54eea2f elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"54eea2f\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-68291f3\" data-id=\"68291f3\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-9f10914 elementor-widget elementor-widget-heading\" data-id=\"9f10914\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">You are here, Thank You. Please fill out the form below to get started.<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-f3812d8 elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"f3812d8\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-8a08575\" data-id=\"8a08575\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-162e722 elementor-widget elementor-widget-aep-contact-form_7\" data-id=\"162e722\" data-element_type=\"widget\" data-widget_type=\"aep-contact-form_7.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<div class=\"elementor-shortcode aep-cf7  aep-cf7-52\"><h3 class=\"cf7-title\"><\/h3><div class=\"cf7-sub-title\"><\/div><div role=\"form\" class=\"wpcf7\" id=\"wpcf7-f52-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/84#wpcf7-f52-o1\" method=\"post\" class=\"wpcf7-form init\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"52\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.4\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f52-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<p><label> Your name<br \/>\n    <span class=\"wpcf7-form-control-wrap your-name\"><input type=\"text\" name=\"your-name\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><br \/>\nWould you prefer to remain anonymous<br \/>\n<span class=\"wpcf7-form-control-wrap your-country\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"your-country[]\" value=\"YES\" \/><span class=\"wpcf7-list-item-label\">YES<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"your-country[]\" value=\"NO\" \/><span class=\"wpcf7-list-item-label\">NO<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"your-country[]\" value=\"Situation Dependant\" \/><span class=\"wpcf7-list-item-label\">Situation Dependant<\/span><\/label><\/span><\/span><\/span><br \/>\n<label> Your email<br \/>\n    <span class=\"wpcf7-form-control-wrap your-email\"><input type=\"email\" name=\"your-email\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><br \/>\n<label> Your contact number<br \/>\n<span class=\"wpcf7-form-control-wrap TeleNum\"><input type=\"tel\" name=\"TeleNum\" value=\"Cell Number\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-tel\" aria-invalid=\"false\" \/><\/span><\/p>\n<p>What would you like to help with or donate? You can select more that one.<br \/>\n<span class=\"wpcf7-form-control-wrap Donate\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Gift Card<\/span><input type=\"checkbox\" name=\"Donate\" value=\"Gift Card\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Food Voucher<\/span><input type=\"checkbox\" name=\"Donate\" value=\"Food Voucher\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Service<\/span><input type=\"checkbox\" name=\"Donate\" value=\"Service\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Appliances<\/span><input type=\"checkbox\" name=\"Donate\" value=\"Appliances\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Other<\/span><input type=\"checkbox\" name=\"Donate\" value=\"Other\" \/><\/span><span class=\"wpcf7-list-item\"><span class=\"wpcf7-list-item-label\">Clothes<\/span><input type=\"checkbox\" name=\"Donate\" value=\"Clothes\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">Medical Equipment<\/span><input type=\"checkbox\" name=\"Donate\" value=\"Medical Equipment\" \/><\/span><\/span><\/span><br \/>\n<label> Other<br \/>\n    <span class=\"wpcf7-form-control-wrap your-other\"><input type=\"text\" name=\"your-other\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" \/><\/span> <\/p>\n<p><label> Your message (optional)<br \/>\n    <span class=\"wpcf7-form-control-wrap your-message\"><textarea name=\"your-message\" cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\"><\/textarea><\/span> <\/p>\n<p> Could we add your email address to our mail list for bi-weekly notices?<br \/>\n<span class=\"wpcf7-form-control-wrap biweekly\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">YES<\/span><input type=\"checkbox\" name=\"biweekly[]\" value=\"YES\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">NO<\/span><input type=\"checkbox\" name=\"biweekly[]\" value=\"NO\" \/><\/span><\/span><\/span><\/p>\n<p>Or Monthly notices<br \/>\n<span class=\"wpcf7-form-control-wrap monthy\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"monthy[]\" value=\"YES\" \/><span class=\"wpcf7-list-item-label\">YES<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"monthy[]\" value=\"NO\" \/><span class=\"wpcf7-list-item-label\">NO<\/span><\/label><\/span><\/span><\/span><\/p>\n<p>Samaritansa declares that we will only use your contact information for correspondence dedicated to this website. Samaritansa will not in any way share information. Should you want unscribe from our database please email us directly or use this form inserting \" Unscribe me\" in the message body. <\/p>\n<p><input type=\"submit\" value=\"Submit\" class=\"wpcf7-form-control wpcf7-submit\" \/><\/p>\n<div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div><\/form><\/div><\/div>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>You are here, Thank You. Please fill out the form below to get started. Your name Would you prefer to remain anonymous YESNOSituation Dependant Your email Your contact number What would you like to help with or donate? You can select more that one. Gift CardFood VoucherServiceAppliancesOtherClothesMedical Equipment Other Your message (optional) Could we add &#8230; <a title=\"form1\" class=\"read-more\" href=\"https:\/\/samaritansza.co.za\/index.php\/form1\/\" aria-label=\"More on form1\">Read more<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":[],"_links":{"self":[{"href":"https:\/\/samaritansza.co.za\/index.php\/wp-json\/wp\/v2\/pages\/84"}],"collection":[{"href":"https:\/\/samaritansza.co.za\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/samaritansza.co.za\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/samaritansza.co.za\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/samaritansza.co.za\/index.php\/wp-json\/wp\/v2\/comments?post=84"}],"version-history":[{"count":10,"href":"https:\/\/samaritansza.co.za\/index.php\/wp-json\/wp\/v2\/pages\/84\/revisions"}],"predecessor-version":[{"id":94,"href":"https:\/\/samaritansza.co.za\/index.php\/wp-json\/wp\/v2\/pages\/84\/revisions\/94"}],"wp:attachment":[{"href":"https:\/\/samaritansza.co.za\/index.php\/wp-json\/wp\/v2\/media?parent=84"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}