{"id":19,"date":"2020-11-23T05:58:10","date_gmt":"2020-11-23T05:58:10","guid":{"rendered":"http:\/\/www.chaseswarriorfoundation.org\/?page_id=19"},"modified":"2020-11-24T15:10:33","modified_gmt":"2020-11-24T15:10:33","slug":"request-help","status":"publish","type":"page","link":"https:\/\/www.chaseswarriorfoundation.org\/request-help\/","title":{"rendered":"Request Help"},"content":{"rendered":"<p>[vc_row][vc_column el_class=&#8221;container&#8221;][vc_custom_heading text=&#8221;Apply For Help&#8221; font_container=&#8221;tag:h1|text_align:left&#8221; use_theme_fonts=&#8221;yes&#8221; el_class=&#8221;title1&#8243;][vc_row_inner equal_height=&#8221;yes&#8221; gap=&#8221;15&#8243; css=&#8221;.vc_custom_1606229876230{margin-bottom: 30px !important;}&#8221;][vc_column_inner css=&#8221;.vc_custom_1606229587343{border-top-width: 2px !important;border-right-width: 2px !important;border-bottom-width: 2px !important;border-left-width: 2px !important;padding-top: 20px !important;padding-right: 20px !important;padding-bottom: 20px !important;padding-left: 20px !important;border-left-color: #000000 !important;border-left-style: solid !important;border-right-color: #000000 !important;border-right-style: solid !important;border-top-color: #000000 !important;border-top-style: solid !important;border-bottom-color: #000000 !important;border-bottom-style: solid !important;}&#8221;][vc_column_text css=&#8221;.vc_custom_1606230630225{margin-bottom: 0px !important;}&#8221;]<\/p>\n<h3 style=\"color: #1c4094;\">We are here to help!<\/h3>\n<p>Please our online application below to apply for assistance.<\/p>\n<p>If you prefer you can download the <a href=\"http:\/\/www.chaseswarriorfoundation.org\/wp-content\/uploads\/2020\/11\/CWF-Grant-Application-Form.pdf\">PDF Application<\/a> and email it to info@cwfusa.org or mail it to us at CWF, PO Box 197, Prior Lake, MN 55372<\/p>\n<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_2_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form \" id=\"form_contact3\"  >\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_hidden\">Apply for Help<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"2\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_2\" id=\"frm_hide_fields_2\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"contact3\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_2\" name=\"frm_submit_entry_2\" value=\"4ba9b5adb3\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/pages\/19\" \/><div id=\"frm_field_6_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_qh4icy3\" class=\"frm_primary_label\">Applicant's Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qh4icy3\" name=\"item_meta[6]\" value=\"\"  data-reqmsg=\"Applicant&#039;s Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Applicant&#039;s Name is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_ocfup12\" class=\"frm_primary_label\">Date of Birth\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ocfup12\" name=\"item_meta[7]\" value=\"\"  data-reqmsg=\"Date of Birth cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date of Birth is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_ocfup12\"\/>\r\n    <div id=\"frm_desc_field_ocfup12\" class=\"frm_description\">\n(dd\/mm\/yyyy)<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_8_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_itt5me3\" class=\"frm_primary_label\">Phone Number\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_itt5me3\" name=\"item_meta[8]\" value=\"\"  data-reqmsg=\"Phone Number cannot be blank.\" aria-required=\"true\" data-invmsg=\"Please enter a valid website\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_9_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_29yf4d3\" class=\"frm_primary_label\">Email Address\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_29yf4d3\" name=\"item_meta[9]\" value=\"\"  data-reqmsg=\"Email Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Please enter a valid email address\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_10_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_e6lis63\" class=\"frm_primary_label\">Address\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_e6lis63\" name=\"item_meta[10]\" value=\"\"  data-reqmsg=\"Address cannot be blank.\" aria-required=\"true\" data-invmsg=\"Address is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_11_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_three_col frm_third\">\r\n    <label for=\"field_6ij8g\" class=\"frm_primary_label\">City\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_6ij8g\" name=\"item_meta[11]\" value=\"\"  data-reqmsg=\"City cannot be blank.\" aria-required=\"true\" data-invmsg=\"City is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_12_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_sixth frm_three_col frm_third\">\r\n    <label for=\"field_kjfi2\" class=\"frm_primary_label\">State\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_kjfi2\" name=\"item_meta[12]\" value=\"\"  data-reqmsg=\"State cannot be blank.\" aria-required=\"true\" data-invmsg=\"State is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_13_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_three_col frm_third\">\r\n    <label for=\"field_ommo4\" class=\"frm_primary_label\">Zip\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ommo4\" name=\"item_meta[13]\" value=\"\"  data-reqmsg=\"Zip cannot be blank.\" aria-required=\"true\" data-invmsg=\"Zip is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_14_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_mhv7j\" class=\"frm_primary_label\">Individual or Family's Name\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_mhv7j\" name=\"item_meta[14]\" value=\"\"  data-reqmsg=\"Individual or Family&#039;s Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Individual or Family&#039;s Name is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_mhv7j\"\/>\r\n    <div id=\"frm_desc_field_mhv7j\" class=\"frm_description\">If you are completing this application on behalf of an individual or family affected by anoxic brain injury or near drowning please include his\/her\/their names here.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_15_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_9o6h8\" class=\"frm_primary_label\">Date of Accident\/Injury\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_9o6h8\" name=\"item_meta[15]\" value=\"\"  data-reqmsg=\"Date of Accident\/Injury cannot be blank.\" aria-required=\"true\" data-invmsg=\"Date of Accident\/Injury is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_9o6h8\"\/>\r\n    <div id=\"frm_desc_field_9o6h8\" class=\"frm_description\">(dd\/mm\/yyyy)<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_16_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_9ixt\" class=\"frm_primary_label\">What was the cause of the injury?\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[16]\" id=\"field_9ixt\" rows=\"5\"  data-reqmsg=\"What was the cause of the injury? cannot be blank.\" aria-required=\"true\" data-invmsg=\"What was the cause of the injury? is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_17_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_4oguo\" class=\"frm_primary_label\">Description of Impacts\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[17]\" id=\"field_4oguo\" rows=\"5\"  data-reqmsg=\"Description of Impacts cannot be blank.\" aria-required=\"true\" data-invmsg=\"Description of Impacts is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_4oguo\"><\/textarea>\r\n    <div id=\"frm_desc_field_4oguo\" class=\"frm_description\">In the space provided, please provide a brief description of the impacts caused by the injuries, daily challenges, and how Chase's Warrior FOundation can assist this individual and their family.<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_18_container\" class=\"frm_form_field form-field  frm_none_container\">\r\n    <label for=\"g-recaptcha-response\" class=\"frm_primary_label\">Captcha\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    \r\n    \r\n    \r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t\t<div class=\"frm__6556e43f21101\">\n\t\t\t\t<label for=\"frm_email_2\" >\n\t\t\t\t\tIf you are human, leave this field blank.\t\t\t\t<\/label>\n\t\t\t\t<input  id=\"frm_email_2\" type=\"text\" class=\"frm_verify\" name=\"frm__6556e43f21101\" value=\"\" autocomplete=\"false\"  \/>\n\t\t\t<\/div>\n\t\t<div class=\"frm_submit\">\r\n\r\n<input type=\"submit\" value=\"Submit\"  \/>\r\n<img decoding=\"async\" class=\"frm_ajax_loading\" src=\"https:\/\/www.chaseswarriorfoundation.org\/wp-content\/plugins\/formidable\/images\/ajax_loader.gif\" alt=\"Sending\"\/>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n<\/form>\n<\/div>\n[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column el_class=&#8221;container&#8221;][vc_custom_heading text=&#8221;Apply For Help&#8221; font_container=&#8221;tag:h1|text_align:left&#8221; use_theme_fonts=&#8221;yes&#8221; el_class=&#8221;title1&#8243;][vc_row_inner equal_height=&#8221;yes&#8221; gap=&#8221;15&#8243; css=&#8221;.vc_custom_1606229876230{margin-bottom: 30px !important;}&#8221;][vc_column_inner css=&#8221;.vc_custom_1606229587343{border-top-width: 2px !important;border-right-width: 2px !important;border-bottom-width: 2px !important;border-left-width: 2px !important;padding-top: 20px !important;padding-right: 20px !important;padding-bottom: 20px !important;padding-left: 20px !important;border-left-color: #000000 !important;border-left-style: solid !important;border-right-color: #000000 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Please [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Request Help - Chase&#039;s Warrior Foundation<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.chaseswarriorfoundation.org\/request-help\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Request Help - Chase&#039;s Warrior Foundation\" \/>\n<meta property=\"og:description\" content=\"[vc_row][vc_column el_class=&#8221;container&#8221;][vc_custom_heading text=&#8221;Apply For Help&#8221; font_container=&#8221;tag:h1|text_align:left&#8221; use_theme_fonts=&#8221;yes&#8221; el_class=&#8221;title1&#8243;][vc_row_inner equal_height=&#8221;yes&#8221; gap=&#8221;15&#8243; css=&#8221;.vc_custom_1606229876230{margin-bottom: 30px !important;}&#8221;][vc_column_inner css=&#8221;.vc_custom_1606229587343{border-top-width: 2px !important;border-right-width: 2px !important;border-bottom-width: 2px !important;border-left-width: 2px !important;padding-top: 20px !important;padding-right: 20px !important;padding-bottom: 20px !important;padding-left: 20px !important;border-left-color: #000000 !important;border-left-style: solid !important;border-right-color: #000000 !important;border-right-style: solid !important;border-top-color: #000000 !important;border-top-style: solid !important;border-bottom-color: #000000 !important;border-bottom-style: solid !important;}&#8221;][vc_column_text css=&#8221;.vc_custom_1606230630225{margin-bottom: 0px !important;}&#8221;] We are here to help! 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