{"id":63377,"date":"2025-02-03T10:10:47","date_gmt":"2025-02-03T18:10:47","guid":{"rendered":"https:\/\/wp.sbcounty.gov\/sheriff\/?page_id=63377"},"modified":"2025-02-03T10:10:48","modified_gmt":"2025-02-03T18:10:48","slug":"juvenile-intervention-program-application-form","status":"publish","type":"page","link":"https:\/\/wp.sbcounty.gov\/sheriff\/juvenile-intervention-program-application-form\/","title":{"rendered":"Juvenile Intervention Program Application Form"},"content":{"rendered":"\n<section class=\"wp-block-isd-layout\"><div class=\"isd-background-fixed-max-width-container\"><div class=\"isd-layout-content-wrapper\" style=\"max-width:1748px;margin-bottom:0rem;margin-top:0rem;padding-bottom:3.75rem;padding-top:3.75rem\">\n<div class=\"wp-block-isd-row large-100 desktop-none desktop-order-1 tablet-none tablet-order-1 mobile-none mobile-order-1 frontend ctnrQueryRow\" style=\"margin-bottom:0rem;margin-top:0rem\">\n<div class=\"wp-block-isd-column\">\n<h1 class=\"wp-block-heading has-text-align-center\">Juvenile Intervention Program Application Form<\/h1>\n\n\n\n<div class=\"wp-block-contact-form-7-contact-form-selector\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f64274-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"64274\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/sheriff\/wp-json\/wp\/v2\/pages\/63377#wpcf7-f64274-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"64274\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f64274-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"vstack gap-3\">\n\t<div class=\"mb-2\">\n\t\t<h2 class=\"sr-only\">Form Overview\n\t\t<\/h2>\n\t\t<p class=\"m-0\">If you would like to apply for the Juvenile Intervention Program, please complete and submit the form below.\n\t\t<\/p>\n\t\t<p class=\"m-0\">You will be asked to supply:\n\t\t<\/p>\n\t\t<ul class=\"mb-3\">\n\t\t\t<li>\n\t\t\t\t<p class=\"m-0\"><a href=\"#form_section_juvenile\">the juvenile's information<\/a>\n\t\t\t\t<\/p>\n\t\t\t<\/li>\n\t\t\t<li>\n\t\t\t\t<p class=\"m-0\"><a href=\"#form_section_primary_guardian\">a primary guardian's information<\/a>\n\t\t\t\t<\/p>\n\t\t\t<\/li>\n\t\t\t<li>\n\t\t\t\t<p class=\"m-0\"><a href=\"#form_section_additional_guardian\">an (optional) additional guardian's information<\/a>\n\t\t\t\t<\/p>\n\t\t\t<\/li>\n\t\t\t<li>\n\t\t\t\t<p class=\"m-0\"><a href=\"#form_section_behavior_questionnaire\">a behavior questionnaire<\/a>\n\t\t\t\t<\/p>\n\t\t\t<\/li>\n\t\t\t<li>\n\t\t\t\t<p class=\"m-0\"><a href=\"#form_section_medical_questionnaire\">a medical questionnaire<\/a>\n\t\t\t\t<\/p>\n\t\t\t<\/li>\n\t\t\t<li>\n\t\t\t\t<p class=\"m-0\"><a href=\"#form_section_school_questionnaire\">a school questionnaire<\/a>\n\t\t\t\t<\/p>\n\t\t\t<\/li>\n\t\t\t<li>\n\t\t\t\t<p class=\"m-0\"><a href=\"#form_section_callback\">a callback number<\/a>\n\t\t\t\t<\/p>\n\t\t\t<\/li>\n\t\t<\/ul>\n\t\t<p class=\"m-0\">All fields marked with an asterisk (<span style=\"color:red\" aria-hidden=\"true\">*<\/span>) are required.\n\t\t<\/p>\n\t<\/div>\n\t<div>\n\t\t<h2 id=\"form_section_juvenile\" class=\"mb-1 text-decoration-underline\" style=\"font-size:1.3rem\">Juvenile Information\n\t\t<\/h2>\n\t\t<div class=\"mb-2 vstack gap-2\">\n\t\t\t<fieldset class=\"p-0\">\n\t\t\t\t<legend class=\"m-0\" style=\"font-size:1.125rem\">\n\t\t\t\t\t<h3 class=\"sr-only\">Juvenile's Personal Details\n\t\t\t\t\t<\/h3>\n\t\t\t\t<\/legend>\n\t\t\t\t<div class=\"mb-2 hstack gap-2 flex-wrap align-items-start\">\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span><span class=\"sr-only\">Juvenile's <\/span>First Name<span style=\"color:red\" aria-hidden=\"true\">*<\/span><\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-first-name\"><input size=\"40\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"juvenile-first-name\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>Middle Name<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-middle-name\"><input size=\"40\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"juvenile-middle-name\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>Last Name<span style=\"color:red\" aria-hidden=\"true\">*<\/span><\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-last-name\"><input size=\"40\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"juvenile-last-name\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"mb-2 hstack gap-2 flex-wrap align-items-start\">\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>Date of Birth<span style=\"color:red\" aria-hidden=\"true\">*<\/span><\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-birth-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"juvenile-birth-date\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<fieldset class=\"p-0\">\n\t\t\t\t\t\t<legend class=\"m-0\" style=\"font-size:1.125rem\"><span>Gender<span style=\"color:red\" aria-hidden=\"true\">*<\/span><\/span>\n\t\t\t\t\t\t<\/legend>\n\t\t\t\t\t\t<p class=\"m-0\"><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-gender\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"juvenile-gender\" value=\"Male\" \/><span class=\"wpcf7-list-item-label\">Male<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"juvenile-gender\" value=\"Female\" \/><span class=\"wpcf7-list-item-label\">Female<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"juvenile-gender\" value=\"Other\" \/><span class=\"wpcf7-list-item-label\">Other<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/fieldset>\n\t\t\t\t<\/div>\n\t\t\t<\/fieldset>\n\t\t\t<fieldset class=\"p-0\">\n\t\t\t\t<legend class=\"m-0\" style=\"font-size:1.125rem\">\n\t\t\t\t\t<h3 class=\"mb-1 fw-normal\" style=\"font-size:1.2rem\"><span><span class=\"sr-only\">Juvenile's <\/span><span class=\"text-decoration-underline\">Home Address<\/span><\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t<\/legend>\n\t\t\t\t<div class=\"mb-2 hstack gap-2 flex-wrap align-items-start\">\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span><span class=\"sr-only\">Juvenile's Home <\/span>Street<span style=\"color:red\" aria-hidden=\"true\">*<\/span><\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-home-street\"><input size=\"40\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"juvenile-home-street\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>Apt\/Unit\/Suite<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-home-unit\"><input size=\"8\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"juvenile-home-unit\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"mb-2 hstack gap-2 flex-wrap align-items-start\">\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>City<span style=\"color:red\" aria-hidden=\"true\">*<\/span><\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-home-city\"><input size=\"40\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"juvenile-home-city\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>State<span style=\"color:red\" aria-hidden=\"true\">*<\/span><span class=\"sr-only\"> (2-letter abbreviation)<\/span><\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-home-state\"><input size=\"2\" maxlength=\"2\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"juvenile-home-state\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>ZIP Code<span style=\"color:red\" aria-hidden=\"true\">*<\/span><\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-home-zipcode\"><input size=\"8\" maxlength=\"20\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"juvenile-home-zipcode\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/fieldset>\n\t\t\t<fieldset class=\"p-0\">\n\t\t\t\t<legend class=\"m-0\" style=\"font-size:1.125rem\">\n\t\t\t\t\t<h3 class=\"mb-1 fw-normal\" style=\"font-size:1.2rem\"><span><span class=\"sr-only\">Juvenile's <\/span><span class=\"text-decoration-underline\">Contact Details<\/span><\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t<\/legend>\n\t\t\t\t<div class=\"mb-2 hstack gap-2 flex-wrap align-items-start\">\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span><span class=\"sr-only\">Juvenile's <\/span>Phone<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-phone\"><input size=\"16\" maxlength=\"20\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"juvenile-phone\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>Email<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-email\"><input size=\"40\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"juvenile-email\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/fieldset>\n\t\t<\/div>\n\t<\/div>\n\t<div>\n\t\t<h2 id=\"form_section_primary_guardian\" class=\"mb-1 text-decoration-underline\" style=\"font-size:1.3rem\">Parent or Legal Guardian Information\n\t\t<\/h2>\n\t\t<div class=\"mb-2 vstack gap-2\">\n\t\t\t<fieldset class=\"p-0\">\n\t\t\t\t<legend class=\"m-0\" style=\"font-size:1.125rem\">\n\t\t\t\t\t<h3 class=\"sr-only\">Primary Guardian's Personal Details\n\t\t\t\t\t<\/h3>\n\t\t\t\t<\/legend>\n\t\t\t\t<div class=\"mb-2\">\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span><span class=\"sr-only\">Primary Guardian's <\/span>Full Name<span style=\"color:red\" aria-hidden=\"true\">*<\/span><\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"primary-guardian-full-name\"><input size=\"40\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"primary-guardian-full-name\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"mb-2 hstack gap-2 flex-wrap align-items-start\">\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>Date of Birth<span style=\"color:red\" aria-hidden=\"true\">*<\/span><\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"primary-guardian-birth-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"primary-guardian-birth-date\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>Relationship to Juvenile<span style=\"color:red\" aria-hidden=\"true\">*<\/span><\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"primary-guardian-relationship\"><input size=\"40\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"primary-guardian-relationship\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/fieldset>\n\t\t\t<fieldset class=\"p-0\">\n\t\t\t\t<legend class=\"m-0\" style=\"font-size:1.125rem\">\n\t\t\t\t\t<h3 class=\"mb-1 fw-normal\" style=\"font-size:1.2rem\"><span><span class=\"sr-only\">Primary Guardian's <\/span><span class=\"text-decoration-underline\">Home Address<\/span><span class=\"fst-italic\"> (if different from juvenile's)<\/span><\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t<\/legend>\n\t\t\t\t<div class=\"mb-2 hstack gap-2 flex-wrap align-items-start\">\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span><span class=\"sr-only\">Primary Guardian's Home <\/span>Street<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"primary-guardian-home-street\"><input size=\"40\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"primary-guardian-home-street\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>Apt\/Unit\/Suite<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"primary-guardian-home-unit\"><input size=\"8\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"primary-guardian-home-unit\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"mb-2 hstack gap-2 flex-wrap align-items-start\">\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>City<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"primary-guardian-home-city\"><input size=\"40\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"primary-guardian-home-city\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>State<span class=\"sr-only\"> (2-letter abbreviation)<\/span><\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"primary-guardian-home-state\"><input size=\"2\" maxlength=\"2\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"primary-guardian-home-state\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>ZIP Code<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"primary-guardian-home-zipcode\"><input size=\"8\" maxlength=\"20\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"primary-guardian-home-zipcode\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/fieldset>\n\t\t\t<fieldset class=\"p-0\">\n\t\t\t\t<legend class=\"m-0\" style=\"font-size:1.125rem\">\n\t\t\t\t\t<h3 class=\"mb-1 fw-normal\" style=\"font-size:1.2rem\"><span><span class=\"sr-only\">Primary Guardian's <\/span><span class=\"text-decoration-underline\">Contact Details<\/span><\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t<\/legend>\n\t\t\t\t<div class=\"mb-2 hstack gap-2 flex-wrap align-items-start\">\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span><span class=\"sr-only\">Primary Guardian's <\/span>Phone<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"primary-guardian-phone\"><input size=\"16\" maxlength=\"20\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"primary-guardian-phone\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>Email<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"primary-guardian-email\"><input size=\"40\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"primary-guardian-email\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/fieldset>\n\t\t<\/div>\n\t<\/div>\n\t<div>\n\t\t<h2 id=\"form_section_additional_guardian\" class=\"mb-1 text-decoration-underline\" style=\"font-size:1.3rem\"><span class=\"fw-normal fst-italic\">(Optional) <\/span>Additional Parent or Legal Guardian Information\n\t\t<\/h2>\n\t\t<div class=\"mb-2 vstack gap-2\">\n\t\t\t<fieldset class=\"p-0\">\n\t\t\t\t<legend class=\"m-0\" style=\"font-size:1.125rem\">\n\t\t\t\t\t<h3 class=\"sr-only\">Additional Guardian's Personal Details\n\t\t\t\t\t<\/h3>\n\t\t\t\t<\/legend>\n\t\t\t\t<div class=\"mb-2\">\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span><span class=\"sr-only\">Additional Guardian's <\/span>Full Name<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"additional-guardian-full-name\"><input size=\"40\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"additional-guardian-full-name\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"mb-2 hstack gap-2 flex-wrap align-items-start\">\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>Date of Birth<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"additional-guardian-birth-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"additional-guardian-birth-date\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>Relationship to Juvenile<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"additional-guardian-relationship\"><input size=\"40\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"additional-guardian-relationship\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/fieldset>\n\t\t\t<fieldset class=\"p-0\">\n\t\t\t\t<legend class=\"m-0\" style=\"font-size:1.125rem\">\n\t\t\t\t\t<h3 class=\"mb-1 fw-normal\" style=\"font-size:1.2rem\"><span><span class=\"sr-only\">Additional Guardian's <\/span><span class=\"text-decoration-underline\">Home Address<\/span><span class=\"fst-italic\"> (if different from juvenile's)<\/span><\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t<\/legend>\n\t\t\t\t<div class=\"mb-2 hstack gap-2 flex-wrap align-items-start\">\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span><span class=\"sr-only\">Additional Guardian's Home <\/span>Street<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"additional-guardian-home-street\"><input size=\"40\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"additional-guardian-home-street\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>Apt\/Unit\/Suite<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"additional-guardian-home-unit\"><input size=\"8\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"additional-guardian-home-unit\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"mb-2 hstack gap-2 flex-wrap align-items-start\">\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>City<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"additional-guardian-home-city\"><input size=\"40\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"additional-guardian-home-city\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>State<span class=\"sr-only\"> (2-letter abbreviation)<\/span><\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"additional-guardian-home-state\"><input size=\"2\" maxlength=\"2\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"additional-guardian-home-state\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>ZIP Code<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"additional-guardian-home-zipcode\"><input size=\"8\" maxlength=\"20\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"additional-guardian-home-zipcode\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/fieldset>\n\t\t\t<fieldset class=\"p-0\">\n\t\t\t\t<legend class=\"m-0\" style=\"font-size:1.125rem\">\n\t\t\t\t\t<h3 class=\"mb-1 fw-normal\" style=\"font-size:1.2rem\"><span><span class=\"sr-only\">Additional Guardian's <\/span><span class=\"text-decoration-underline\">Contact Details<\/span><\/span>\n\t\t\t\t\t<\/h3>\n\t\t\t\t<\/legend>\n\t\t\t\t<div class=\"mb-2 hstack gap-2 flex-wrap align-items-start\">\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span><span class=\"sr-only\">Additional Guardian's <\/span>Phone<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"additional-guardian-phone\"><input size=\"16\" maxlength=\"20\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"additional-guardian-phone\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>Email<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"additional-guardian-email\"><input size=\"40\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"additional-guardian-email\" \/><\/span><\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/fieldset>\n\t\t<\/div>\n\t<\/div>\n\t<div>\n\t\t<h2 id=\"form_section_behavior_questionnaire\" class=\"mb-1 text-decoration-underline\" style=\"font-size:1.3rem\">Behavior Questionnaire\n\t\t<\/h2>\n\t\t<div class=\"mb-2\">\n\t\t\t<p class=\"m-0 d-flex flex-row flex-grow-1\"><label class=\"flex-grow-1\"><span class=\"d-flex flex-row\"><span>Has the juvenile ever been arrested or received a citation? If yes, please explain:<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-arrest-history\"><textarea cols=\"40\" rows=\"4\" maxlength=\"800\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"juvenile-arrest-history\"><\/textarea><\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<p class=\"m-0 d-flex flex-row justify-content-end\"><span class=\"fst-italic\" style=\"font-size:1rem\"><span class=\"wpcf7-character-count down\" data-target-name=\"juvenile-arrest-history\" data-starting-value=\"800\" data-current-value=\"800\" data-maximum-value=\"800\">800<\/span><span> characters available<\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"mb-2\">\n\t\t\t<p class=\"m-0 d-flex flex-row flex-grow-1\"><label class=\"flex-grow-1\"><span class=\"d-flex flex-row\"><span>Has the juvenile ever been affiliated with any gang or tagger group? If yes, please explain:<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-gang-history\"><textarea cols=\"40\" rows=\"4\" maxlength=\"800\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"juvenile-gang-history\"><\/textarea><\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<p class=\"m-0 d-flex flex-row justify-content-end\"><span class=\"fst-italic\" style=\"font-size:1rem\"><span class=\"wpcf7-character-count down\" data-target-name=\"juvenile-gang-history\" data-starting-value=\"800\" data-current-value=\"800\" data-maximum-value=\"800\">800<\/span><span> characters available<\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"mb-2\">\n\t\t\t<fieldset class=\"p-0\">\n\t\t\t\t<legend class=\"m-0\" style=\"font-size:1.125rem\"><span>Has the juvenile ever performed any of the following illicit activities?<span class=\"fst-italic\"> (Please check all that apply)<\/span><\/span>\n\t\t\t\t<\/legend>\n\t\t\t\t<p class=\"m-0\"><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-illicit-activities\"><span class=\"wpcf7-form-control wpcf7-checkbox vstack\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"juvenile-illicit-activities[]\" value=\"Assault and battery (fighting)\" \/><span class=\"wpcf7-list-item-label\">Assault and battery (fighting)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"juvenile-illicit-activities[]\" value=\"Auto theft\" \/><span class=\"wpcf7-list-item-label\">Auto theft<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"juvenile-illicit-activities[]\" value=\"Petty theft (less than $950)\" \/><span class=\"wpcf7-list-item-label\">Petty theft (less than $950)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"juvenile-illicit-activities[]\" value=\"Grand theft (more than $950)\" \/><span class=\"wpcf7-list-item-label\">Grand theft (more than $950)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"juvenile-illicit-activities[]\" value=\"Vandalism\" \/><span class=\"wpcf7-list-item-label\">Vandalism<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"juvenile-illicit-activities[]\" value=\"Property crimes (e.g. burglary, forgery, arson)\" \/><span class=\"wpcf7-list-item-label\">Property crimes (e.g. burglary, forgery, arson)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"juvenile-illicit-activities[]\" value=\"Truancy from school\" \/><span class=\"wpcf7-list-item-label\">Truancy from school<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"juvenile-illicit-activities[]\" value=\"Cybercrimes (e.g. cyberbullying, hacking)\" \/><span class=\"wpcf7-list-item-label\">Cybercrimes (e.g. cyberbullying, hacking)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"juvenile-illicit-activities[]\" value=\"Traffic violations (e.g. driving without a license, reckless driving)\" \/><span class=\"wpcf7-list-item-label\">Traffic violations (e.g. driving without a license, reckless driving)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"juvenile-illicit-activities[]\" value=\"Smoking and\/or vaping\" \/><span class=\"wpcf7-list-item-label\">Smoking and\/or vaping<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"juvenile-illicit-activities[]\" value=\"Drug sales\" \/><span class=\"wpcf7-list-item-label\">Drug sales<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"juvenile-illicit-activities[]\" value=\"Usage of depressants (e.g. alcohol, Valium, Librium, Xanax, Prozac, GHB, Rohypnol, Zoloft, Paxil)\" \/><span class=\"wpcf7-list-item-label\">Usage of depressants (e.g. alcohol, Valium, Librium, Xanax, Prozac, GHB, Rohypnol, Zoloft, Paxil)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"juvenile-illicit-activities[]\" value=\"Usage of stimulants (e.g. cocaine, crack, amphetamines, methamphetamine)\" \/><span class=\"wpcf7-list-item-label\">Usage of stimulants (e.g. cocaine, crack, amphetamines, methamphetamine)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"juvenile-illicit-activities[]\" value=\"Usage of hallucinogens (e.g. LSD, peyote, mushrooms, Ecstasy)\" \/><span class=\"wpcf7-list-item-label\">Usage of hallucinogens (e.g. LSD, peyote, mushrooms, Ecstasy)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"juvenile-illicit-activities[]\" value=\"Usage of dissociative anesthetics (e.g. PCP, nitrous oxide, ketamine, DXM, salvia divinorum)\" \/><span class=\"wpcf7-list-item-label\">Usage of dissociative anesthetics (e.g. PCP, nitrous oxide, ketamine, DXM, salvia divinorum)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"juvenile-illicit-activities[]\" value=\"Usage of narcotic analgesics (e.g. opium, codeine, heroin, morphine, methadone, Vicodin, Oxycontin)\" \/><span class=\"wpcf7-list-item-label\">Usage of narcotic analgesics (e.g. opium, codeine, heroin, morphine, methadone, Vicodin, Oxycontin)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"juvenile-illicit-activities[]\" value=\"Usage of inhalants (e.g. toluene, paint, gasoline, sprays, glues)\" \/><span class=\"wpcf7-list-item-label\">Usage of inhalants (e.g. toluene, paint, gasoline, sprays, glues)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"juvenile-illicit-activities[]\" value=\"Usage of cannabis (e.g. marijuana, &#039;honey oil&#039;, hash, edibles)\" \/><span class=\"wpcf7-list-item-label\">Usage of cannabis (e.g. marijuana, &#039;honey oil&#039;, hash, edibles)<\/span><\/label><\/span><span class=\"wpcf7-list-item last has-free-text\"><label><input type=\"checkbox\" name=\"juvenile-illicit-activities[]\" value=\"Other:\" \/><span class=\"wpcf7-list-item-label\">Other:<\/span><\/label> <input type=\"text\" name=\"_wpcf7_free_text_juvenile-illicit-activities\" class=\"wpcf7-free-text\" \/><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/fieldset>\n\t\t<\/div>\n\t\t<div class=\"mb-2\">\n\t\t\t<p class=\"m-0 d-flex flex-row flex-grow-1\"><label class=\"flex-grow-1\"><span class=\"d-flex flex-row\"><span>Please provide details for each of the illicit activities checked above:<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-illicit-activities-details\"><textarea cols=\"40\" rows=\"6\" maxlength=\"1600\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"juvenile-illicit-activities-details\"><\/textarea><\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<p class=\"m-0 d-flex flex-row justify-content-end\"><span class=\"fst-italic\" style=\"font-size:1rem\"><span class=\"wpcf7-character-count down\" data-target-name=\"juvenile-illicit-activities-details\" data-starting-value=\"1600\" data-current-value=\"1600\" data-maximum-value=\"1600\">1600<\/span><span> characters available<\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"mb-2\">\n\t\t\t<p class=\"m-0 d-flex flex-row flex-grow-1\"><label class=\"flex-grow-1\"><span class=\"d-flex flex-row\"><span>Please describe any other negative behaviors displayed by the juvenile:<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-negative-behaviors\"><textarea cols=\"40\" rows=\"6\" maxlength=\"1600\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"juvenile-negative-behaviors\"><\/textarea><\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<p class=\"m-0 d-flex flex-row justify-content-end\"><span class=\"fst-italic\" style=\"font-size:1rem\"><span class=\"wpcf7-character-count down\" data-target-name=\"juvenile-negative-behaviors\" data-starting-value=\"1600\" data-current-value=\"1600\" data-maximum-value=\"1600\">1600<\/span><span> characters available<\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div>\n\t\t<h2 id=\"form_section_medical_questionnaire\" class=\"mb-1 text-decoration-underline\" style=\"font-size:1.3rem\" aria-describedby=\"form_description_medical_questionnaire\">Medical Questionnaire\n\t\t<\/h2>\n\t\t<div id=\"form_description_medical_questionnaire\" class=\"mb-3\">\n\t\t\t<p class=\"m-0 fst-italic\">If the juvenile is accepted into the program, they will receive a tour of the jails, learn about booking procedures, be given on-on-one counseling, and will be provided a free lunch on the day of the tour. Due to the nature of the program, the juvenile may feel some stress, anxiety, or other emotional discomfort. The following questions are asked to ensure their safety and the safety of the staff.\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"mb-2\">\n\t\t\t<p class=\"m-0 d-flex flex-row flex-grow-1\"><label class=\"flex-grow-1\"><span class=\"d-flex flex-row\"><span>Does the juvenile have any medical conditions? If yes, please explain:<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-medical-conditions\"><textarea cols=\"40\" rows=\"4\" maxlength=\"800\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"juvenile-medical-conditions\"><\/textarea><\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<p class=\"m-0 d-flex flex-row justify-content-end\"><span class=\"fst-italic\" style=\"font-size:1rem\"><span class=\"wpcf7-character-count down\" data-target-name=\"juvenile-medical-conditions\" data-starting-value=\"800\" data-current-value=\"800\" data-maximum-value=\"800\">800<\/span><span> characters available<\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"mb-2\">\n\t\t\t<p class=\"m-0 d-flex flex-row flex-grow-1\"><label class=\"flex-grow-1\"><span class=\"d-flex flex-row\"><span>Does the juvenile have any prescribed medications? If yes, please explain:<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-prescribed-medications\"><textarea cols=\"40\" rows=\"4\" maxlength=\"800\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"juvenile-prescribed-medications\"><\/textarea><\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<p class=\"m-0 d-flex flex-row justify-content-end\"><span class=\"fst-italic\" style=\"font-size:1rem\"><span class=\"wpcf7-character-count down\" data-target-name=\"juvenile-prescribed-medications\" data-starting-value=\"800\" data-current-value=\"800\" data-maximum-value=\"800\">800<\/span><span> characters available<\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"mb-2\">\n\t\t\t<p class=\"m-0 d-flex flex-row flex-grow-1\"><label class=\"flex-grow-1\"><span class=\"d-flex flex-row\"><span>Does the juvenile have any known allergies? If yes, please explain:<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-known-allergies\"><textarea cols=\"40\" rows=\"4\" maxlength=\"800\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"juvenile-known-allergies\"><\/textarea><\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<p class=\"m-0 d-flex flex-row justify-content-end\"><span class=\"fst-italic\" style=\"font-size:1rem\"><span class=\"wpcf7-character-count down\" data-target-name=\"juvenile-known-allergies\" data-starting-value=\"800\" data-current-value=\"800\" data-maximum-value=\"800\">800<\/span><span> characters available<\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"mb-2\">\n\t\t\t<p class=\"m-0 d-flex flex-row flex-grow-1\"><label class=\"flex-grow-1\"><span class=\"d-flex flex-row\"><span>Does the juvenile have any history of, or is currently displaying, symptoms of depression or suicidal tendencies? If yes, please explain:<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-depression-suicide\"><textarea cols=\"40\" rows=\"4\" maxlength=\"800\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"juvenile-depression-suicide\"><\/textarea><\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<p class=\"m-0 d-flex flex-row justify-content-end\"><span class=\"fst-italic\" style=\"font-size:1rem\"><span class=\"wpcf7-character-count down\" data-target-name=\"juvenile-depression-suicide\" data-starting-value=\"800\" data-current-value=\"800\" data-maximum-value=\"800\">800<\/span><span> characters available<\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"mb-2\">\n\t\t\t<p class=\"m-0 d-flex flex-row flex-grow-1\"><label class=\"flex-grow-1\"><span class=\"d-flex flex-row\"><span>Has the juvenile ever been admitted to a mental health facility, either voluntarily or involuntarily? If yes, please explain:<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-psychiatric-hospitalization\"><textarea cols=\"40\" rows=\"4\" maxlength=\"800\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"juvenile-psychiatric-hospitalization\"><\/textarea><\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<p class=\"m-0 d-flex flex-row justify-content-end\"><span class=\"fst-italic\" style=\"font-size:1rem\"><span class=\"wpcf7-character-count down\" data-target-name=\"juvenile-psychiatric-hospitalization\" data-starting-value=\"800\" data-current-value=\"800\" data-maximum-value=\"800\">800<\/span><span> characters available<\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div>\n\t\t<h2 id=\"form_section_school_questionnaire\" class=\"mb-1 text-decoration-underline\" style=\"font-size:1.3rem\">School Questionnaire\n\t\t<\/h2>\n\t\t<fieldset class=\"p-0\">\n\t\t\t<legend class=\"m-0\" style=\"font-size:1.125rem\"><span class=\"sr-only\">Juvenile's School Details (Use current or most recent school)<\/span>\n\t\t\t<\/legend>\n\t\t\t<div class=\"mb-2\">\n\t\t\t\t<p class=\"m-0 fst-italic\">Please refer to the school that the juvenile is currently attending or has most recently attended.\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"mb-2 hstack gap-2 flex-wrap align-items-start\">\n\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span><span class=\"sr-only\">School <\/span>Name<span style=\"color:red\" aria-hidden=\"true\">*<\/span><\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"school-name\"><input size=\"40\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"school-name\" \/><\/span><\/label>\n\t\t\t\t<\/p>\n\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>City<span style=\"color:red\" aria-hidden=\"true\">*<\/span><\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"school-city\"><input size=\"40\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"school-city\" \/><\/span><\/label>\n\t\t\t\t<\/p>\n\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>Phone<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"school-phone\"><input size=\"16\" maxlength=\"20\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"school-phone\" \/><\/span><\/label>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"mb-2\">\n\t\t\t\t<fieldset class=\"p-0\">\n\t\t\t\t\t<legend class=\"m-0\" style=\"font-size:1.125rem\"><span>Grade<span style=\"color:red\" aria-hidden=\"true\">*<\/span><\/span>\n\t\t\t\t\t<\/legend>\n\t\t\t\t\t<p class=\"m-0\"><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-grade-level\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"juvenile-grade-level\" value=\"7th\" \/><span class=\"wpcf7-list-item-label\">7th<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"juvenile-grade-level\" value=\"8th\" \/><span class=\"wpcf7-list-item-label\">8th<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"juvenile-grade-level\" value=\"9th\" \/><span class=\"wpcf7-list-item-label\">9th<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"juvenile-grade-level\" value=\"10th\" \/><span class=\"wpcf7-list-item-label\">10th<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"juvenile-grade-level\" value=\"11th\" \/><span class=\"wpcf7-list-item-label\">11th<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"juvenile-grade-level\" value=\"12th\" \/><span class=\"wpcf7-list-item-label\">12th<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"juvenile-grade-level\" value=\"Other\" \/><span class=\"wpcf7-list-item-label\">Other<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/fieldset>\n\t\t\t<\/div>\n\t\t\t<div class=\"mb-4\">\n\t\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span>How does the juvenile get to school?<span style=\"color:red\" aria-hidden=\"true\">*<\/span><\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-school-transportation\"><input size=\"40\" maxlength=\"200\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"juvenile-school-transportation\" \/><\/span><\/label>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"mb-2\">\n\t\t\t\t<fieldset class=\"p-0\">\n\t\t\t\t\t<legend class=\"m-0\" style=\"font-size:1.125rem\"><span>Please rate the juvenile's <span class=\"fw-bold\">academic performance<\/span>:<span style=\"color:red\" aria-hidden=\"true\">*<\/span><\/span>\n\t\t\t\t\t<\/legend>\n\t\t\t\t\t<p class=\"m-0\"><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-school-performance\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"juvenile-school-performance\" value=\"Passing\" \/><span class=\"wpcf7-list-item-label\">Passing<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"juvenile-school-performance\" value=\"Failing\" \/><span class=\"wpcf7-list-item-label\">Failing<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/fieldset>\n\t\t\t<\/div>\n\t\t\t<div class=\"mb-2\">\n\t\t\t\t<p class=\"m-0 d-flex flex-row flex-grow-1\"><label class=\"flex-grow-1\"><span class=\"d-flex flex-row\"><span><span class=\"fst-italic\">(Optional) <\/span>Comments on academic performance:<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-school-performance-comments\"><textarea cols=\"40\" rows=\"4\" maxlength=\"800\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"juvenile-school-performance-comments\"><\/textarea><\/span><\/label>\n\t\t\t\t<\/p>\n\t\t\t\t<p class=\"m-0 d-flex flex-row justify-content-end\"><span class=\"fst-italic\" style=\"font-size:1rem\"><span class=\"wpcf7-character-count down\" data-target-name=\"juvenile-school-performance-comments\" data-starting-value=\"800\" data-current-value=\"800\" data-maximum-value=\"800\">800<\/span><span> characters available<\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"mb-2\">\n\t\t\t\t<fieldset class=\"p-0\">\n\t\t\t\t\t<legend class=\"m-0\" style=\"font-size:1.125rem\"><span>Please rate the juvenile's <span class=\"fw-bold\">school attendance<\/span>:<span style=\"color:red\" aria-hidden=\"true\">*<\/span><\/span>\n\t\t\t\t\t<\/legend>\n\t\t\t\t\t<p class=\"m-0\"><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-school-attendance\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"juvenile-school-attendance\" value=\"Good\" \/><span class=\"wpcf7-list-item-label\">Good<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"juvenile-school-attendance\" value=\"Fair\" \/><span class=\"wpcf7-list-item-label\">Fair<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"juvenile-school-attendance\" value=\"Poor\" \/><span class=\"wpcf7-list-item-label\">Poor<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/fieldset>\n\t\t\t<\/div>\n\t\t\t<div class=\"mb-2\">\n\t\t\t\t<p class=\"m-0 d-flex flex-row flex-grow-1\"><label class=\"flex-grow-1\"><span class=\"d-flex flex-row\"><span><span class=\"fst-italic\">(Optional) <\/span>Comments on school attendance:<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-school-attendance-comments\"><textarea cols=\"40\" rows=\"4\" maxlength=\"800\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"juvenile-school-attendance-comments\"><\/textarea><\/span><\/label>\n\t\t\t\t<\/p>\n\t\t\t\t<p class=\"m-0 d-flex flex-row justify-content-end\"><span class=\"fst-italic\" style=\"font-size:1rem\"><span class=\"wpcf7-character-count down\" data-target-name=\"juvenile-school-attendance-comments\" data-starting-value=\"800\" data-current-value=\"800\" data-maximum-value=\"800\">800<\/span><span> characters available<\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"mb-2\">\n\t\t\t\t<fieldset class=\"p-0\">\n\t\t\t\t\t<legend class=\"m-0\" style=\"font-size:1.125rem\"><span>Please rate the juvenile's <span class=\"fw-bold\">behavior at school<\/span>:<span style=\"color:red\" aria-hidden=\"true\">*<\/span><\/span>\n\t\t\t\t\t<\/legend>\n\t\t\t\t\t<p class=\"m-0\"><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-school-behavior\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"juvenile-school-behavior\" value=\"Good\" \/><span class=\"wpcf7-list-item-label\">Good<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"juvenile-school-behavior\" value=\"Fair\" \/><span class=\"wpcf7-list-item-label\">Fair<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"juvenile-school-behavior\" value=\"Poor\" \/><span class=\"wpcf7-list-item-label\">Poor<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/fieldset>\n\t\t\t<\/div>\n\t\t\t<div class=\"mb-2\">\n\t\t\t\t<p class=\"m-0 d-flex flex-row flex-grow-1\"><label class=\"flex-grow-1\"><span class=\"d-flex flex-row\"><span><span class=\"fst-italic\">(Optional) <\/span>Comments on school behavior:<\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"juvenile-school-behavior-comments\"><textarea cols=\"40\" rows=\"4\" maxlength=\"800\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"juvenile-school-behavior-comments\"><\/textarea><\/span><\/label>\n\t\t\t\t<\/p>\n\t\t\t\t<p class=\"m-0 d-flex flex-row justify-content-end\"><span class=\"fst-italic\" style=\"font-size:1rem\"><span class=\"wpcf7-character-count down\" data-target-name=\"juvenile-school-behavior-comments\" data-starting-value=\"800\" data-current-value=\"800\" data-maximum-value=\"800\">800<\/span><span> characters available<\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/fieldset>\n\t<\/div>\n\t<div>\n\t\t<h2 id=\"form_section_callback\" class=\"mb-1 text-decoration-underline\" style=\"font-size:1.3rem\">Form Submission\n\t\t<\/h2>\n\t\t<div class=\"mb-5\">\n\t\t\t<p class=\"m-0\"><label><span class=\"d-flex flex-row\"><span><strong>Notice: <\/strong>To ensure that the program properly accommodates all enrollees, we may need to ask follow-up questions regarding your application.<strong> Please provide a phone number that we can call for questions and to deliver status updates.<\/strong><span style=\"color:red\" aria-hidden=\"true\">*<\/span><\/span> <\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"callback-phone\"><input size=\"16\" maxlength=\"20\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"(***)-***-****\" value=\"\" type=\"tel\" name=\"callback-phone\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div id=\"form_description_submission\" class=\"mb-4\">\n\t\t\t<p class=\"m-0\"><strong>By submitting this form, you understand that:<\/strong>\n\t\t\t<\/p>\n\t\t\t<ul class=\"m-0\">\n\t\t\t\t<li>\n\t\t\t\t\t<p class=\"m-0\">The provided information will be used to evaluate the juvenile's participation in the Juvenile Intervention Program.\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/li>\n\t\t\t\t<li>\n\t\t\t\t\t<p class=\"m-0\">The submission of this form does not guarantee the juvenile's acceptance into said program.\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/li>\n\t\t\t<\/ul>\n\t\t<\/div>\n\t\t<div class=\"mb-2\">\n\t\t\t<p class=\"m-0\"><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div><input type='hidden' class='wpcf7-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div><\/div><\/section>\n\n\n\n\n","protected":false},"excerpt":{"rendered":"<p>Juvenile Intervention Program Application Form<\/p>\n","protected":false},"author":1567,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-63377","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/wp.sbcounty.gov\/sheriff\/wp-json\/wp\/v2\/pages\/63377","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wp.sbcounty.gov\/sheriff\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/wp.sbcounty.gov\/sheriff\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/wp.sbcounty.gov\/sheriff\/wp-json\/wp\/v2\/users\/1567"}],"replies":[{"embeddable":true,"href":"https:\/\/wp.sbcounty.gov\/sheriff\/wp-json\/wp\/v2\/comments?post=63377"}],"version-history":[{"count":7,"href":"https:\/\/wp.sbcounty.gov\/sheriff\/wp-json\/wp\/v2\/pages\/63377\/revisions"}],"predecessor-version":[{"id":64669,"href":"https:\/\/wp.sbcounty.gov\/sheriff\/wp-json\/wp\/v2\/pages\/63377\/revisions\/64669"}],"wp:attachment":[{"href":"https:\/\/wp.sbcounty.gov\/sheriff\/wp-json\/wp\/v2\/media?parent=63377"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}