{"id":1395,"date":"2022-09-16T19:54:18","date_gmt":"2022-09-16T09:54:18","guid":{"rendered":"https:\/\/wfsoul.com\/?page_id=1395"},"modified":"2023-07-08T10:19:19","modified_gmt":"2023-07-08T00:19:19","slug":"starespite-enquiry","status":"publish","type":"page","link":"https:\/\/wfsoul.com\/index.php\/starespite-enquiry\/","title":{"rendered":"STA Respite Enquiry"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1395\" class=\"elementor elementor-1395\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5f4299cc e-flex e-con-boxed e-con e-parent\" data-id=\"5f4299cc\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-280058d0 elementor-widget elementor-widget-shortcode\" data-id=\"280058d0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><!-- Google tag (gtag.js) -->\n<script async src=\"https:\/\/www.googletagmanager.com\/gtag\/js?id=G-XJJ61ZYQRZ\"><\/script>\n<script>\n  window.dataLayer = window.dataLayer || [];\n  function gtag(){dataLayer.push(arguments);}\n  gtag('js', new Date());\n\n  gtag('config', 'G-XJJ61ZYQRZ');\n<\/script><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-58debf1 e-flex e-con-boxed e-con e-parent\" data-id=\"58debf1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-f9c58d1 e-con-full e-flex e-con e-parent\" data-id=\"f9c58d1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-9d7f187 fluent-form-widget-step-header-yes fluent-form-widget-step-progressbar-yes fluentform-widget-submit-button-custom elementor-widget elementor-widget-fluent-form-widget\" data-id=\"9d7f187\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"fluent-form-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\n            <div class=\"fluentform-widget-wrapper fluentform-widget-align-default\">\n\n            \n            <div class='fluentform ff-default fluentform_wrapper_12 ffs_custom_wrap'><form data-form_id=\"12\" id=\"fluentform_12\" class=\"frm-fluent-form fluent_form_12 ff-el-form-top ff_form_instance_12_1 ff-form-loading ff_has_v3_recptcha ffs_custom\" data-form_instance=\"ff_form_instance_12_1\" method=\"POST\" data-recptcha_key=\"6LcufeglAAAAAKuA5EiHDGEvhj78V4VX1sV5s0bw\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Enquiry Form<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='1395' \/><input type=\"hidden\" id=\"_fluentform_12_fluentformnonce\" name=\"_fluentform_12_fluentformnonce\" value=\"c9fa05f3f7\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/1395\" \/><div data-type=\"name-element\" data-name=\"names\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_12_names_first_name_' id='label_ff_12_names_first_name_'>First Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" id=\"ff_12_names_first_name_\" class=\"ff-el-form-control\" placeholder=\"First Name\" tabindex=\"1\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_12_names_last_name_' id='label_ff_12_names_last_name_'>Last Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[last_name]\" id=\"ff_12_names_last_name_\" class=\"ff-el-form-control\" placeholder=\"Last Name\" tabindex=\"2\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_1\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_12_email' id='label_ff_12_email'>Email<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_12_email\" class=\"ff-el-form-control\" placeholder=\"Email Address\" data-name=\"email\" tabindex=\"3\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_12_phone' id='label_ff_12_phone'>Phone\/Mobile<\/label><\/div><div class='ff-el-input--content'><input name=\"phone\" class=\"ff-el-form-control ff-el-phone\" type=\"tel\" placeholder=\"Mobile Number\" data-name=\"phone\" id=\"ff_12_phone\" tabindex=\"4\" inputmode=\"tel\"  aria-invalid='false' aria-required=true><\/div><\/div><\/div><\/div><input name=\"address_1[latitude]\" type=\"hidden\" data-key_name=\"latitude\" ><input name=\"address_1[longitude]\" type=\"hidden\" data-key_name=\"longitude\" ><div class=\"ff-name-address-wrapper fluent-address ff_map_autocomplete\" data-type=\"address-element\" data-name=\"address_1\" data-ff_with_g_map=\"1\" data-ff_with_auto_locate=\"no\" ><div class='ff-el-input--label'><label aria-label=\"Address\">Address<\/label><\/div><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_12_address_1_address_line_1_' id='label_ff_12_address_1_address_line_1_'>Address Line 1<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[address_line_1]\" id=\"ff_12_address_1_address_line_1_\" class=\"ff-el-form-control\" placeholder=\"Address Line 1\" data-key_name=\"address_line_1\" tabindex=\"5\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_12_address_1_address_line_2_' id='label_ff_12_address_1_address_line_2_'>Address Line 2<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[address_line_2]\" id=\"ff_12_address_1_address_line_2_\" class=\"ff-el-form-control\" placeholder=\"Address Line 2\" data-key_name=\"address_line_2\" tabindex=\"6\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_12_address_1_city_' id='label_ff_12_address_1_city_'>City<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[city]\" id=\"ff_12_address_1_city_\" class=\"ff-el-form-control\" placeholder=\"City\" data-key_name=\"city\" tabindex=\"7\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_12_address_1_state_' id='label_ff_12_address_1_state_'>State<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[state]\" id=\"ff_12_address_1_state_\" class=\"ff-el-form-control\" placeholder=\"State\" data-key_name=\"state\" tabindex=\"8\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_12_address_1_zip_' id='label_ff_12_address_1_zip_'>Post Code<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[zip]\" id=\"ff_12_address_1_zip_\" class=\"ff-el-form-control\" placeholder=\"Post Code\" data-key_name=\"zip\" tabindex=\"9\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_12_numeric-field_1' id='label_ff_12_numeric-field_1'>NDIS # (if applicable)<\/label><\/div><div class='ff-el-input--content'><input type=\"number\" name=\"numeric-field_1\" id=\"ff_12_numeric-field_1\" class=\"ff-el-form-control\" data-name=\"numeric-field_1\" inputmode=\"numeric\" step=\"any\" tabindex=\"10\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_12_input_text_1' id='label_ff_12_input_text_1'>Preferred Contact Method<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_1\" class=\"ff-el-form-control\" placeholder=\"Phone, Email, SMS\" data-name=\"input_text_1\" tabindex=\"11\" id=\"ff_12_input_text_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_12_input_text' id='label_ff_12_input_text'>Primary Disability\/Disabilities<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" data-name=\"input_text\" tabindex=\"12\" id=\"ff_12_input_text\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  >Funding Type<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_271a67f05a2fccb2e6b7ed427f124521'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"13\" value=\"1:1\"  id='input_radio_271a67f05a2fccb2e6b7ed427f124521' aria-label='1:1' aria-invalid='false' aria-required=false> <span>1:1<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_113466c5103d5c8383680077a36936d9'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"1:2\"  id='input_radio_113466c5103d5c8383680077a36936d9' aria-label='1:2' aria-invalid='false' aria-required=false> <span>1:2<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_8863f3ed7aa2720c3d51f0f701e2e593'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"1:3\"  id='input_radio_8863f3ed7aa2720c3d51f0f701e2e593' aria-label='1:3' aria-invalid='false' aria-required=false> <span>1:3<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_9cf5e10c3bac5318cdedf64de58de805'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"1:4\"  id='input_radio_9cf5e10c3bac5318cdedf64de58de805' aria-label='1:4' aria-invalid='false' aria-required=false> <span>1:4<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  >Plan Type<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_946a1b7b49d3a9f705d66abbc9ac821c'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"14\" value=\"Self-Managed\"  id='input_radio_1_946a1b7b49d3a9f705d66abbc9ac821c' aria-label='Self-Managed' aria-invalid='false' aria-required=false> <span>Self-Managed<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_2e0b8846847ec1ca646a2d22dd4b460b'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"Plan-Managed\"  id='input_radio_1_2e0b8846847ec1ca646a2d22dd4b460b' aria-label='Plan-Managed' aria-invalid='false' aria-required=false> <span>Plan-Managed<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_ff6510122aa06c4c96f4a36e5313fdf3'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"NDIA-Managed\"  id='input_radio_1_ff6510122aa06c4c96f4a36e5313fdf3' aria-label='NDIA-Managed' aria-invalid='false' aria-required=false> <span>NDIA-Managed<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label  >Do you have any mobility issues<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_199c54715bb88755aee76916e5e7bd7b'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"15\" value=\"yes\"  id='input_radio_2_199c54715bb88755aee76916e5e7bd7b' aria-label='Yes' aria-invalid='false' aria-required=true> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_7f506a869b538bfb13d02fdcaf84bf9b'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_2_7f506a869b538bfb13d02fdcaf84bf9b' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_12_description' id='label_ff_12_description'>Please describe your level of Mobility<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"true\" aria-labelledby=\"label_ff_12_description\" name=\"description\" id=\"ff_12_description\" class=\"ff-el-form-control\" placeholder=\"Example: Wheelchair, Ambulatory assisted device use, walker etc.\" rows=\"3\" cols=\"2\" data-name=\"description\" tabindex=\"16\" ><\/textarea><\/div><\/div><div data-name=\"ff_cn_id_2\"  class='ff-t-container ff-column-container ff_columns_total_1 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label  >Service\/s I am interested in (select as many as you would like)<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_f26b0cb8a2ee36902060b71f12d5ff58'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"17\" value=\"Community Access &amp; Daily Living Support\"  id='checkbox_1_f26b0cb8a2ee36902060b71f12d5ff58' aria-label='Community Access &amp; Daily Living Support' aria-invalid='false' aria-required=true> <span>Community Access &amp; Daily Living Support<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_37d0ad43fac24c911afafcf5ea5e0e33'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Psychosocial Recovery Coaching\"  id='checkbox_1_37d0ad43fac24c911afafcf5ea5e0e33' aria-label='Psychosocial Recovery Coaching' aria-invalid='false' aria-required=true> <span>Psychosocial Recovery Coaching<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_5591ae3cfbaad9ced755a6542205c9ba'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Support Coordination\"  id='checkbox_1_5591ae3cfbaad9ced755a6542205c9ba' aria-label='Support Coordination' aria-invalid='false' aria-required=true> <span>Support Coordination<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_6e2438206de00ffb0799cbc262126133'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Respite\/STA\"  id='checkbox_1_6e2438206de00ffb0799cbc262126133' aria-label='Respite\/STA' aria-invalid='false' aria-required=true> <span>Respite\/STA<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_3162ba548cfb5c642858b8a82a2caec5'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Yoga\/Meditation\/Reiki\/Sound Healing\"  id='checkbox_1_3162ba548cfb5c642858b8a82a2caec5' aria-label='Yoga\/Meditation\/Reiki\/Sound Healing' aria-invalid='false' aria-required=true> <span>Yoga\/Meditation\/Reiki\/Sound Healing<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_52989da6a45b1201983e2007b83c66cd'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Other\"  id='checkbox_1_52989da6a45b1201983e2007b83c66cd' aria-label='Other' aria-invalid='false' aria-required=true> <span>Other<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_12_input_text_2' id='label_ff_12_input_text_2'>Other Services Required<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_2\" class=\"ff-el-form-control\" data-name=\"input_text_2\" tabindex=\"18\" id=\"ff_12_input_text_2\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div data-name=\"ff_cn_id_3\"  class='ff-t-container ff-column-container ff_columns_total_1 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_left\" data-name=\"section_break-12_1\" ><h3 class='ff-el-section-title'>Respite\/STA<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_12_numeric-field' id='label_ff_12_numeric-field'>Length of Stay<\/label><\/div><div class='ff-el-input--content'><input type=\"number\" name=\"numeric-field\" id=\"ff_12_numeric-field\" class=\"ff-el-form-control\" placeholder=\"Number of nights required\" data-name=\"numeric-field\" inputmode=\"numeric\" step=\"any\" tabindex=\"19\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_12_datetime' id='label_ff_12_datetime'>Preferred start date of STA\/Respite<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Preferred start date of STA\/Respite Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime\" id=\"ff_12_datetime\" class=\"ff-el-form-control ff-el-datepicker\" placeholder=\"Entered your preferred start date and we will see if we can accommodate it\" data-name=\"datetime\" tabindex=\"20\"  aria-invalid='false' aria-required=false><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label  >Activities - please select all that you would like to do<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_a7524ee1f5a125881d86f9a204da5fc7'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"21\" value=\"Reiki\"  id='checkbox_a7524ee1f5a125881d86f9a204da5fc7' aria-label='Reiki' aria-invalid='false' aria-required=false> <span>Reiki<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_a6a1f0c520bdc1637429acc6dcfadcc2'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Yoga\"  id='checkbox_a6a1f0c520bdc1637429acc6dcfadcc2' aria-label='Yoga' aria-invalid='false' aria-required=false> <span>Yoga<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_14b6f99c4b592bb2cc68c08f972ccfd6'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Meditation\"  id='checkbox_14b6f99c4b592bb2cc68c08f972ccfd6' aria-label='Meditation' aria-invalid='false' aria-required=false> <span>Meditation<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_59e64cd809758e25cfabe63d9475d523'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Singing Bowl Therapy\"  id='checkbox_59e64cd809758e25cfabe63d9475d523' aria-label='Singing Bowl Therapy' aria-invalid='false' aria-required=false> <span>Singing Bowl Therapy<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1babc12330f0301e2e5064034039f413'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"E-Scooter \/ Bike Riding\"  id='checkbox_1babc12330f0301e2e5064034039f413' aria-label='E-Scooter \/ Bike Riding' aria-invalid='false' aria-required=false> <span>E-Scooter \/ Bike Riding<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_6da5cdbeceae1ce555a24ae996bc6c09'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Table Tennis\"  id='checkbox_6da5cdbeceae1ce555a24ae996bc6c09' aria-label='Table Tennis' aria-invalid='false' aria-required=false> <span>Table Tennis<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_ce8e82c9ad910e4b3b8cdf264437c6be'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Electronic Gaming\"  id='checkbox_ce8e82c9ad910e4b3b8cdf264437c6be' aria-label='Electronic Gaming' aria-invalid='false' aria-required=false> <span>Electronic Gaming<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_4663c84e340e41993994171257d6c544'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Board Games\"  id='checkbox_4663c84e340e41993994171257d6c544' aria-label='Board Games' aria-invalid='false' aria-required=false> <span>Board Games<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_a6e78fe9f79d6e602cc1b261a8104961'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Bushwalking\"  id='checkbox_a6e78fe9f79d6e602cc1b261a8104961' aria-label='Bushwalking' aria-invalid='false' aria-required=false> <span>Bushwalking<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_9b97545bd594705b47043ec2164a3171'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Cinema\"  id='checkbox_9b97545bd594705b47043ec2164a3171' aria-label='Cinema' aria-invalid='false' aria-required=false> <span>Cinema<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_73496688708942b61c0e9936629c20d4'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Shopping Centre Visit\"  id='checkbox_73496688708942b61c0e9936629c20d4' aria-label='Shopping Centre Visit' aria-invalid='false' aria-required=false> <span>Shopping Centre Visit<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5fb5f49fdd808be611862731e1f5d27a'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Local Market\"  id='checkbox_5fb5f49fdd808be611862731e1f5d27a' aria-label='Local Market' aria-invalid='false' aria-required=false> <span>Local Market<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_e835362c601ee29bf5bd282e4679bc02'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Arts &amp; Crafts\"  id='checkbox_e835362c601ee29bf5bd282e4679bc02' aria-label='Arts &amp; Crafts' aria-invalid='false' aria-required=false> <span>Arts &amp; Crafts<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_600dd47bd64cdcafc63704391a0cced6'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Queensland Museum Visit\"  id='checkbox_600dd47bd64cdcafc63704391a0cced6' aria-label='Queensland Museum Visit' aria-invalid='false' aria-required=false> <span>Queensland Museum Visit<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_d628713f7ff2a010ccbb1e0795aa8193'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Ten Pin Bowls\"  id='checkbox_d628713f7ff2a010ccbb1e0795aa8193' aria-label='Ten Pin Bowls' aria-invalid='false' aria-required=false> <span>Ten Pin Bowls<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_12_description_1' id='label_ff_12_description_1'>Further Information<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_12_description_1\" name=\"description_1\" 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<\/div>\n\n            \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\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>Custom Package First Name Last Name Email Phone\/Mobile Preferred Contact Method Primary Disability Funding Type 1:1 1:2 1:3 1:4Plan Type Self-Managed Plan-Managed NDIA-ManagedDo you have any mobility issues Yes NoPlease describe your level of Mobility Length of Stay Preferred start date of STA\/Respite Activities &#8211; please select all that you would like to do Reiki 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