{"id":1372,"date":"2023-02-17T21:42:04","date_gmt":"2023-02-17T21:42:04","guid":{"rendered":"https:\/\/research.uregina.ca\/cah\/?page_id=1372"},"modified":"2024-04-05T19:46:56","modified_gmt":"2024-04-05T19:46:56","slug":"participant-sign-up-form","status":"publish","type":"page","link":"https:\/\/research.uregina.ca\/cah\/participate-in-research\/participants\/participant-sign-up-form\/","title":{"rendered":"Participant Sign-Up Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1372\" class=\"elementor elementor-1372\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-332d528 e-con-full e-flex e-con e-parent\" data-id=\"332d528\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-912662f elementor-widget elementor-widget-template\" data-id=\"912662f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"template.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-template\">\n\t\t\t\t\t<div data-elementor-type=\"container\" data-elementor-id=\"1375\" class=\"elementor elementor-1375\" data-elementor-post-type=\"elementor_library\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1edb9e1 e-con-full e-flex e-con e-parent\" data-id=\"1edb9e1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-aaec7d5 elementor-button-align-center elementor-widget elementor-widget-form\" data-id=\"aaec7d5\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next step&quot;,&quot;step_previous_label&quot;:&quot;Previous step&quot;,&quot;step_type&quot;:&quot;text&quot;,&quot;dce_confirm_dialog_enabled&quot;:&quot;no&quot;,&quot;label_icon_size&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;field_icon_size&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]}}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Participant Sign Up Form\" aria-label=\"Participant Sign Up Form\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"1375\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"aaec7d5\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Centre on Aging and Health\" \/>\n\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_9a555eb elementor-col-100\">\n\t\t\t\t\tI grant permission to the Centre on Aging and Health, University of Regina to include my name, age and the contact information listed below in its Directory of Potential Research Participants. In doing so, I understand that I may be contacted by researchers involved in aging and\/or health research.\u00a0 Access to the directory will only be given to persons who have a formal affiliation with the Centre on Aging and Health.\u00a0 I also understand that I can arrange for my name to be withdrawn from the directory at any time by contacting the Centre on Aging and Health (Centre on Aging and Health, University of Regina, Regina, SK, S4S 0A2) or the Directory Coordinator directly ( 306-337-8477, <a href=\"mailto:cah@uregina.ca\">cah@uregina.ca<\/a>).\u00a0 Moreover, I understand that each time I am contacted and asked to participate in research, details of the specific project will be provided to me before I give my consent. I have the right to refuse participation or withdraw from any study at any time without penalty.\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_da00454 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_da00454\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTerms Acceptance\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_da00454]\" id=\"form-field-field_da00454\" class=\"elementor-field elementor-size-sm  elementor-acceptance-field\" required=\"required\">\n\t\t\t\t<label for=\"form-field-field_da00454\">Yes. I have read the above agreement and accept the terms presented.<\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_99fdf5f elementor-col-100\">\n\t\t\t\t\t<h3>Tell us how to get in touch with you:<\/h3>\n<p><i>* Indicates a required field<\/i><\/p>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_3dd74e5 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3dd74e5\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tName\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_3dd74e5]\" id=\"form-field-field_3dd74e5\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text\">\n\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_8dc6cb3]\" id=\"form-field-field_8dc6cb3\" class=\"elementor-field elementor-size-sm \" style=\"display:none !important;\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_2e50810 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2e50810\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAge\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_2e50810]\" id=\"form-field-field_2e50810\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_ee1a3f1 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ee1a3f1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAddress\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_ee1a3f1]\" id=\"form-field-field_ee1a3f1\" rows=\"5\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text\">\n\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_0081813]\" id=\"form-field-field_0081813\" class=\"elementor-field elementor-size-sm \" style=\"display:none !important;\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_a5dac0a elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a5dac0a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTelephone\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_a5dac0a]\" id=\"form-field-field_a5dac0a\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_46a4570 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_46a4570\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEmail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[field_46a4570]\" id=\"form-field-field_46a4570\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_8086fbd elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8086fbd\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNote\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Please contact me as soon as possible regarding this matter.\" id=\"form-field-field_8086fbd-0\" name=\"form_fields[field_8086fbd]\"> <label for=\"form-field-field_8086fbd-0\">Please contact me as soon as possible regarding this matter.<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Submit<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-23fbf33 elementor-widget elementor-widget-text-editor\" data-id=\"23fbf33\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<hr><br>\n\nCopyright \u00a9 2003 Centre on Aging and Health. All rights reserved. V.3\nRevised:\u00a002\/14\/14\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Copyright \u00a9 2003 Centre on Aging and Health. All rights reserved. V.3 Revised:\u00a002\/14\/14<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":1368,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-1372","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/research.uregina.ca\/cah\/wp-json\/wp\/v2\/pages\/1372","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/research.uregina.ca\/cah\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/research.uregina.ca\/cah\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/research.uregina.ca\/cah\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/research.uregina.ca\/cah\/wp-json\/wp\/v2\/comments?post=1372"}],"version-history":[{"count":8,"href":"https:\/\/research.uregina.ca\/cah\/wp-json\/wp\/v2\/pages\/1372\/revisions"}],"predecessor-version":[{"id":2631,"href":"https:\/\/research.uregina.ca\/cah\/wp-json\/wp\/v2\/pages\/1372\/revisions\/2631"}],"up":[{"embeddable":true,"href":"https:\/\/research.uregina.ca\/cah\/wp-json\/wp\/v2\/pages\/1368"}],"wp:attachment":[{"href":"https:\/\/research.uregina.ca\/cah\/wp-json\/wp\/v2\/media?parent=1372"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}