{"id":4390,"date":"2021-06-15T10:49:31","date_gmt":"2021-06-15T14:49:31","guid":{"rendered":"https:\/\/can.girlguides.ca\/?page_id=4390"},"modified":"2023-10-23T11:30:57","modified_gmt":"2023-10-23T15:30:57","slug":"qc-property-equipment-booking-request","status":"publish","type":"page","link":"https:\/\/can.girlguides.ca\/index.php\/qc-property-equipment-booking-request\/","title":{"rendered":"QC &#8211; Property equipment booking request"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_415' ><form method='post' enctype='multipart\/form-data'  id='gform_415'  action='\/index.php\/wp-json\/wp\/v2\/pages\/4390' data-formid='415' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_415' class='gform_fields top_label form_sublabel_below description_above validation_below' data-column-layout='fill'><div id=\"field_415_1\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"779c68a3\" data-field-span=\"12\"><br><p>The purpose of this form is for Guiders to request use of available equipment at Girl Guides of Canada, Qu&eacute;bec Council properties. The intention of the form is to make sure that the equipment you need is available and accessible for you to use at camps or other facilities, as well as to assist you in planning and to use as a reference for what you have requested. If you are not booking as a Guiding unit (i.e. event, training) please contact <a href=\"mailto:QC-PropertyBookings@girlguides.ca\">QC-PropertyBookings@girlguides.ca.<\/a><\/p>\n<p>Please refer to the Qu&eacute;bec Council properties pages for a list of available equipment at each property. Some of this equipment requires certification or proficiency for use in order to meet Safe Guide.<\/p><\/div><div id=\"field_415_2\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"5808dd6a\" data-field-span=\"12\"><label id='gfield_label_415_2' class='gfield_label gform-field-label' for='input_415_2'><span class='gform-field-label__text'>Unit Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_415_2' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_415_3\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"de8acc4b\" data-field-span=\"12\"><label id='gfield_label_415_3' class='gfield_label gform-field-label' for='input_415_3'><span class='gform-field-label__text'>Unit Banking Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_415_3'>Payments are transferred directly from the booking unit\u2019s account in our centralized banking system. Once your booking is confirmed, no other action is required to submit payment, other than making sure there are enough funds are in your centralized unit banking account.\nPlease refer to the payment schedule for each property for information on payment policies, and for information on cancellations, as these are specific to each property.\nIf there are insufficient funds in the centralized account, the person booking will be notified, and the booking might be cancelled.<\/div><div class='ginput_container ginput_container_text'><input name='input_3' id='input_415_3' type='text' value='' class='large'  aria-describedby=\"gfield_description_415_3\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_415_4\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"475f61d0\" data-field-span=\"12\"><label id='gfield_label_415_4' class='gfield_label gform-field-label' for='input_415_4'><span class='gform-field-label__text'>Name of Property Booked<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_4' id='input_415_4' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Camp Peaceful Waters' >Camp Peaceful Waters<\/option><\/select><\/div><\/div><div id=\"field_415_6\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"bcc10e87\" data-field-span=\"6\"><label id='gfield_label_415_6' class='gfield_label gform-field-label' for='input_415_6'><span class='gform-field-label__text'>Arrival Date<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_415_6'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_6'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_415_6' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_415_6' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_415_6' aria-label='Arrival Date: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_415_5\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"bcc10e87\" data-field-span=\"6\"><label id='gfield_label_415_5' class='gfield_label gform-field-label' for='input_415_5'><span class='gform-field-label__text'>Departure Date<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/dd\/yyyy'\n\t\t\t\t\tid='input_415_5'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_5'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_415_5' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_415_5' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_415_5' aria-label='Departure Date: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><fieldset id=\"field_415_7\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"53042e12\" data-field-span=\"12\"><legend id='gfield_label_415_7' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Guider Contact Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_415_7'>\n                            \n                            <span id='input_415_7_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_7.3' id='input_415_7_3' value=''   aria-required='true'     aria-labelledby=\"input_415_7_3_label gfield_label_415_7\"\/>\n                                                    <label for='input_415_7_3' id='input_415_7_3_label' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_415_7_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_7.6' id='input_415_7_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_415_7_6' id='input_415_7_6_label' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_415_8\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"4563b4f2\" data-field-span=\"12\"><label id='gfield_label_415_8' class='gfield_label gform-field-label' for='input_415_8'><span class='gform-field-label__text'>Contact phone number while using the equipment<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_8' id='input_415_8' type='tel' value='' class='large'  placeholder='(999) 999-9999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><fieldset id=\"field_415_9\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"0eae8367\" data-field-span=\"12\"><legend id='gfield_label_415_9' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Contact Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_415_9_container'>\n                                <span id='input_415_9_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_9' id='input_415_9' value=''    aria-required=\"true\" aria-invalid=\"false\"  aria-labelledby=\"input_415_9_label gfield_label_415_9\" \/>\n                                    <label for='input_415_9' id='input_415_9_label' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_415_9_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_9_2' id='input_415_9_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_415_9_2' id='input_415_9_2_label' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><fieldset id=\"field_415_10\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"1ab0cffa\" data-field-span=\"12\"><legend id='gfield_label_415_10' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Camp Peaceful Waters equipment:<\/span><\/legend><div class='gfield_description' id='gfield_description_415_10'>Please select the equipment you would like to use<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_415_10'><div class='gchoice gchoice_415_10_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.1' type='checkbox'  value='BBQ with Propane'  id='choice_415_10_1'   aria-describedby=\"gfield_description_415_10\" aria-labelledby=\"label_415_10_1 gfield_label_415_10\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_415_10_1' id='label_415_10_1' class='gform-field-label gform-field-label--type-inline'>BBQ with Propane<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_415_10_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.2' type='checkbox'  value='Propane'  id='choice_415_10_2'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_415_10_2' id='label_415_10_2' class='gform-field-label gform-field-label--type-inline'>Propane<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_415_10_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.3' type='checkbox'  value='Canoes'  id='choice_415_10_3'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_415_10_3' id='label_415_10_3' class='gform-field-label gform-field-label--type-inline'>Canoes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_415_10_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.4' type='checkbox'  value='Kayaks'  id='choice_415_10_4'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_415_10_4' id='label_415_10_4' class='gform-field-label gform-field-label--type-inline'>Kayaks<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_415_10_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.5' type='checkbox'  value='Rowboats'  id='choice_415_10_5'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_415_10_5' id='label_415_10_5' class='gform-field-label gform-field-label--type-inline'>Rowboats<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_415_10_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.6' type='checkbox'  value='Snowshoes'  id='choice_415_10_6'    \/>\n\t\t\t\t\t\t\t\t<label for='choice_415_10_6' id='label_415_10_6' class='gform-field-label gform-field-label--type-inline'>Snowshoes<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_415_11\" class=\"gfield gfield--type-list gfield--input-type-list field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"5287fb6d\" data-field-span=\"12\"><legend id='gfield_label_415_11' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Rental details<\/span><\/legend><div class='gfield_description' id='gfield_description_415_11'>To add a row, click the + symbol<\/div><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\" id=\"gfield_list_415_11_header_1\">Equipment<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\" id=\"gfield_list_415_11_header_2\">Number of Equipment required<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\" id=\"gfield_list_415_11_header_3\">Total number of participants using equipment<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\" id=\"gfield_list_415_11_header_4\">Guider facilitating activity (First and Last Name)<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\" id=\"gfield_list_415_11_header_5\">Certification for safe use (N\/A, ORCKA Basic 3)<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\" id=\"gfield_list_415_11_header_6\">Time Requested<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_11_cell1 gform-grid-col' data-label='Equipment'><input aria-invalid='false'  aria-describedby=\"gfield_description_415_11\" aria-labelledby=\"gfield_list_415_11_header_1 gfield_label_415_11\" data-aria-label-template='Equipment, Row {0}' type='text' name='input_11[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_11_cell2 gform-grid-col' data-label='Number of Equipment required'><input aria-invalid='false'   aria-label='Number of Equipment required, Row 1' data-aria-label-template='Number of Equipment required, Row {0}' type='text' name='input_11[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_11_cell3 gform-grid-col' data-label='Total number of participants using equipment'><input aria-invalid='false'   aria-label='Total number of participants using equipment, Row 1' data-aria-label-template='Total number of participants using equipment, Row {0}' type='text' name='input_11[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_11_cell4 gform-grid-col' data-label='Guider facilitating activity (First and Last Name)'><input aria-invalid='false'   aria-label='Guider facilitating activity (First and Last Name), Row 1' data-aria-label-template='Guider facilitating activity (First and Last Name), Row {0}' type='text' name='input_11[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_11_cell5 gform-grid-col' data-label='Certification for safe use (N\/A, ORCKA Basic 3)'><input aria-invalid='false'   aria-label='Certification for safe use (N\/A, ORCKA Basic 3), Row 1' data-aria-label-template='Certification for safe use (N\/A, ORCKA Basic 3), Row {0}' type='text' name='input_11[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_11_cell6 gform-grid-col' data-label='Time Requested'><input aria-invalid='false'   aria-label='Time Requested, Row 1' data-aria-label-template='Time Requested, Row {0}' type='text' name='input_11[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type='button'  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_415_12\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\" data-group-id=\"cd1527dd\" data-field-span=\"12\"><label id='gfield_label_415_12' class='gfield_label gform-field-label' for='input_415_12'><span class='gform-field-label__text'>Additional comments<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_12' id='input_415_12' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_415' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit<\/button> \n            <input 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