{"id":4818,"date":"2025-04-03T17:49:51","date_gmt":"2025-04-03T21:49:51","guid":{"rendered":"https:\/\/nomadsofhope.com\/?page_id=4818"},"modified":"2025-04-28T18:14:04","modified_gmt":"2025-04-28T22:14:04","slug":"volunteer-health-profile","status":"publish","type":"page","link":"https:\/\/nomadsofhope.com\/es\/volunteer-health-profile\/","title":{"rendered":"Volunteer Health Profile"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h1 style=\"text-align: center;\">Volunteer Health Profile Form<\/h1>\n<p>[\/et_pb_text][wpforms_selector form_id=&#8221;4807&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][\/wpforms_selector][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.23.1&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#000000&#8243; custom_padding=&#8221;||15px|||&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row column_structure=&#8221;1_2,1_2&#8243; _builder_version=&#8221;4.23.2&#8243; _module_preset=&#8221;default&#8221; min_height=&#8221;30px&#8221; custom_padding=&#8221;||73px|||&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.23.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_blurb title=&#8221;rodney@nomadsofhope.com&#8221; use_icon=&#8221;on&#8221; font_icon=&#8221;&#xf1fa;||fa||900&#8243; icon_color=&#8221;#FFCC00&#8243; icon_placement=&#8221;left&#8221; _builder_version=&#8221;4.23.2&#8243; _module_preset=&#8221;default&#8221; background_layout=&#8221;dark&#8221; custom_padding=&#8221;||16px|||&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_blurb][\/et_pb_column][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.23.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_blurb title=&#8221;122 Peck Bros Rd, Monson, MA 01057&#8243; use_icon=&#8221;on&#8221; font_icon=&#8221;&#xe010;||divi||400&#8243; icon_color=&#8221;#FFCC00&#8243; icon_placement=&#8221;left&#8221; _builder_version=&#8221;4.23.1&#8243; _module_preset=&#8221;default&#8221; background_layout=&#8221;dark&#8221; custom_padding=&#8221;||16px|||&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_blurb][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=&#8221;1_4,1_4,1_4,1_4&#8243; _builder_version=&#8221;4.23.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;1_4&#8243; _builder_version=&#8221;4.23.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_image title_text=&#8221;Screen Shot 2017-08-25 at 3.21.17 PM&#8221; _builder_version=&#8221;4.23.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_image][et_pb_image src=&#8221;http:\/\/nomadsofhope.com\/wp-content\/uploads\/2017\/08\/mobile-logo-e1503621162214.png&#8221; alt=&#8221;Nomads of Hope&#8221; title_text=&#8221;mobile logo&#8221; _builder_version=&#8221;4.23.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_image][et_pb_text _builder_version=&#8221;4.23.1&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;||||||||&#8221; background_layout=&#8221;dark&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p>Nomads of Hope<\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.23.1&#8243; _module_preset=&#8221;default&#8221; text_text_color=&#8221;#FFFFFF&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p>Follow Your Heart Change the World<\/p>\n<p>[\/et_pb_text][et_pb_social_media_follow _builder_version=&#8221;4.23.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_social_media_follow_network social_network=&#8221;facebook&#8221; url=&#8221;https:\/\/www.facebook.com\/nomadsofhope\/&#8221; _builder_version=&#8221;4.23.1&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;RGBA(255,255,255,0)&#8221; background_enable_color=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221; follow_button=&#8221;off&#8221; url_new_window=&#8221;on&#8221;]facebook[\/et_pb_social_media_follow_network][et_pb_social_media_follow_network social_network=&#8221;instagram&#8221; url=&#8221;https:\/\/instagram.com\/nomadsofhope?igshid=MmVlMjlkMTBhMg==&#8221; _builder_version=&#8221;4.23.1&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;RGBA(255,255,255,0)&#8221; background_enable_color=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221; follow_button=&#8221;off&#8221; url_new_window=&#8221;on&#8221;]instagram[\/et_pb_social_media_follow_network][\/et_pb_social_media_follow][\/et_pb_column][et_pb_column type=&#8221;1_4&#8243; _builder_version=&#8221;4.23.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_column][et_pb_column type=&#8221;1_4&#8243; _builder_version=&#8221;4.23.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_column][et_pb_column type=&#8221;1_4&#8243; _builder_version=&#8221;4.23.1&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n<span class=\"et_bloom_bottom_trigger\"><\/span>","protected":false},"excerpt":{"rendered":"<p>Volunteer Health Profile Form<div class=\"et_pb_module wpforms_selector wpforms_selector_0\">\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<div class=\"et_pb_module_inner\">\n\t\t\t\t\t<style id=\"wpforms-css-vars-4807\">\n\t\t\t\t#wpforms-4807 {\n\t\t\t\t--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-4807\"><form id=\"wpforms-form-4807\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"4807\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/es\/wp-json\/wp\/v2\/pages\/4818\" data-token=\"0aee023e80efac4f9b0138c1d9ad06b4\" data-token-time=\"1781356881\"><noscript class=\"wpforms-error-noscript\">Por favor, activa JavaScript en tu navegador para completar este formulario.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Por favor, activa JavaScript en tu navegador para completar este formulario.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-4807-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"0\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-4807-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" aria-errormessage=\"wpforms-4807-field_0-error\" required><label for=\"wpforms-4807-field_0\" class=\"wpforms-field-sublabel after\">Nombre<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-4807-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" aria-errormessage=\"wpforms-4807-field_0-last-error\" required><label for=\"wpforms-4807-field_0-last\" class=\"wpforms-field-sublabel after\">Apellidos<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-4807-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-4807-field_1\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-4807-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" spellcheck=\"false\" aria-errormessage=\"wpforms-4807-field_1-error\" required><\/div><div id=\"wpforms-4807-field_11-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-4807-field_11\">Gender <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-4807-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" required=\"required\"><option value=\"Male\"  class=\"choice-1 depth-1\"  >Male<\/option><option value=\"Female\"  class=\"choice-2 depth-1\"  >Female<\/option><option value=\"Transgender\"  class=\"choice-3 depth-1\"  >Transgender<\/option><option value=\"Other\"  class=\"choice-4 depth-1\"  >Other<\/option><option value=\"Prefer not to say\"  class=\"choice-5 depth-1\"  >Prefer not to say<\/option><\/select><\/div><div id=\"wpforms-4807-field_12-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"12\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-4807-field_12\">If other, please specify<\/label><input type=\"text\" id=\"wpforms-4807-field_12\" class=\"wpforms-field-medium\" name=\"wpforms[fields][12]\" aria-errormessage=\"wpforms-4807-field_12-error\" ><\/div><div id=\"wpforms-4807-field_13-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"13\"><h3 id=\"wpforms-4807-field_13\" aria-errormessage=\"wpforms-4807-field_13-error\">EMERGENCY CONTACT<\/h3><\/div><div id=\"wpforms-4807-field_36-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"36\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-4807-field_36\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][36][first]\" aria-errormessage=\"wpforms-4807-field_36-error\" required><label for=\"wpforms-4807-field_36\" class=\"wpforms-field-sublabel after\">Nombre<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-4807-field_36-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][36][last]\" aria-errormessage=\"wpforms-4807-field_36-last-error\" required><label for=\"wpforms-4807-field_36-last\" class=\"wpforms-field-sublabel after\">Apellidos<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-4807-field_38-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"38\"><label class=\"wpforms-field-label\" for=\"wpforms-4807-field_38\">Relationship <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4807-field_38\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][38]\" aria-errormessage=\"wpforms-4807-field_38-error\" required><\/div><div id=\"wpforms-4807-field_7-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"7\"><fieldset><legend class=\"wpforms-field-label\">Address<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-4807-field_7\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][7][address1]\" aria-errormessage=\"wpforms-4807-field_7-error\" ><label for=\"wpforms-4807-field_7\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-4807-field_7-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][7][address2]\" aria-errormessage=\"wpforms-4807-field_7-address2-error\" ><label for=\"wpforms-4807-field_7-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-4807-field_7-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][7][city]\" aria-errormessage=\"wpforms-4807-field_7-city-error\" ><label for=\"wpforms-4807-field_7-city\" class=\"wpforms-field-sublabel after\">Ciudad<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-4807-field_7-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][7][state]\" aria-errormessage=\"wpforms-4807-field_7-state-error\" ><label for=\"wpforms-4807-field_7-state\" class=\"wpforms-field-sublabel after\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-4807-field_7-postal\" class=\"wpforms-field-address-postal\" name=\"wpforms[fields][7][postal]\" aria-errormessage=\"wpforms-4807-field_7-postal-error\" ><label for=\"wpforms-4807-field_7-postal\" class=\"wpforms-field-sublabel after\">Postal Code<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-4807-field_7-country\" class=\"wpforms-field-address-country\" name=\"wpforms[fields][7][country]\" aria-errormessage=\"wpforms-4807-field_7-country-error\" ><option class=\"placeholder\" value=\"\" selected disabled>--- Select country ---<\/option><option value=\"AF\" >Afganist\u00e1n<\/option><option value=\"AL\" >Albania<\/option><option value=\"DE\" >Alemania<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguila<\/option><option value=\"AG\" >Antigua y Barbuda<\/option><option value=\"AQ\" >Ant\u00e1rtica<\/option><option value=\"DZ\" >Argelia<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaiy\u00e1n<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BH\" >Bar\u00e9in<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Ben\u00edn<\/option><option value=\"BM\" >Bermudas<\/option><option value=\"BY\" >Bielorrusia<\/option><option value=\"BO\" >Bolivia (Estado Plurinacional de)<\/option><option value=\"BQ\" >Bonaire, San Eustaquio y Saba<\/option><option value=\"BA\" >Bosnia y Herzegovina<\/option><option value=\"BW\" >Botsuana<\/option><option value=\"BR\" >Brasil<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"BT\" >But\u00e1n<\/option><option value=\"BE\" >B\u00e9lgica<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Camboya<\/option><option value=\"CM\" >Camer\u00fan<\/option><option value=\"CA\" >Canad\u00e1<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CY\" >Chipre<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoras<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Rep\u00fablica Democr\u00e1tica del)<\/option><option value=\"KR\" >Corea (Rep\u00fablica de)<\/option><option value=\"KP\" >Corea del Norte<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"CI\" >Costa de Marfil<\/option><option value=\"HR\" >Croacia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Curazao<\/option><option value=\"DK\" >Dinamarca<\/option><option value=\"DM\" >Dominica<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egipto<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"AE\" >Emiratos \u00c1rabes Unidos<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"SK\" >Eslovaquia<\/option><option value=\"SI\" >Eslovenia<\/option><option value=\"ES\" >Espa\u00f1a<\/option><option value=\"VA\" >Estado de la Ciudad del Vaticano<\/option><option value=\"US\" >Estados Unidos de America<\/option><option value=\"EE\" >Estonia<\/option><option value=\"ET\" >Etiop\u00eda<\/option><option value=\"RU\" >Federaci\u00f3n Rusa<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"PH\" >Filipinas<\/option><option value=\"FI\" >Finlandia<\/option><option value=\"FR\" >Francia<\/option><option value=\"GA\" >Gab\u00f3n<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GD\" >Granada<\/option><option value=\"GR\" >Grecia<\/option><option value=\"GL\" >Groenlandia<\/option><option value=\"GP\" >Guadalupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GF\" >Guayana Francesa<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GQ\" >Guinea Ecuatorial<\/option><option value=\"GW\" >Guinea-Bis\u00e1u<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Hait\u00ed<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungr\u00eda<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Irlanda (Rep\u00fablica de)<\/option><option value=\"IR\" >Ir\u00e1n (Rep\u00fablica Isl\u00e1mica de)<\/option><option value=\"BV\" >Isla Bouvet<\/option><option value=\"NF\" >Isla Norfolk<\/option><option value=\"IM\" >Isla de Man<\/option><option value=\"CX\" >Isla de Navidad<\/option><option value=\"IS\" >Islandia<\/option><option value=\"KY\" >Islas Caim\u00e1n<\/option><option value=\"CC\" >Islas Cocos<\/option><option value=\"CK\" >Islas Cook<\/option><option value=\"FO\" >Islas Faroe<\/option><option value=\"HM\" >Islas Heard y McDonald<\/option><option value=\"FK\" >Islas Malvinas (Falkland)<\/option><option value=\"MP\" >Islas Marianas del Norte<\/option><option value=\"MH\" >Islas Marshall<\/option><option value=\"SB\" >Islas Salom\u00f3n<\/option><option value=\"TC\" >Islas Turcas y Caicos<\/option><option value=\"UM\" >Islas Ultramarinas Menores de Estados Unidos<\/option><option value=\"VI\" >Islas V\u00edrgenes (EE.UU.)<\/option><option value=\"VG\" >Islas V\u00edrgenes (brit\u00e1nicas)<\/option><option value=\"GS\" >Islas del sur de Georgia y del sur de Sandwich<\/option><option value=\"AX\" >Islas \u00c5land<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italia<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Jap\u00f3n<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordania<\/option><option value=\"QA\" >Katar<\/option><option value=\"KZ\" >Kazajist\u00e1n<\/option><option value=\"KE\" >Kenia<\/option><option value=\"KG\" >Kirguist\u00e1n<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"LS\" >Lesoto<\/option><option value=\"LV\" >Letonia<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libia<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lituania<\/option><option value=\"LU\" >Luxemburgo<\/option><option value=\"LB\" >L\u00edbano<\/option><option value=\"MO\" >Macao<\/option><option value=\"MK\" >Macedonia del Norte (Rep\u00fablica de)<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MY\" >Malasia<\/option><option value=\"MW\" >Malaui<\/option><option value=\"MV\" >Maldivas<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MA\" >Marruecos<\/option><option value=\"MQ\" >Martinica<\/option><option value=\"MU\" >Mauricio<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"FM\" >Micronesia (Estados Federados de)<\/option><option value=\"MD\" >Moldavia (Rep\u00fablica de)<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"MX\" >M\u00e9xico<\/option><option value=\"MC\" >M\u00f3naco<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NO\" >Noruega<\/option><option value=\"NC\" >Nueva Caledonia<\/option><option value=\"NZ\" >Nueva Zelanda <\/option><option value=\"NE\" >N\u00edger<\/option><option value=\"OM\" >Om\u00e1n<\/option><option value=\"PK\" >Pakist\u00e1n<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestina (Estado de)<\/option><option value=\"PA\" >Panam\u00e1<\/option><option value=\"PG\" >Pap\u00faa Nueva Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"NL\" >Pa\u00edses Bajos<\/option><option value=\"PE\" >Per\u00fa<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PF\" >Polinesia Francesa<\/option><option value=\"PL\" >Polonia<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"GB\" >Reino Unido de Gran Breta\u00f1a e Irlanda del Norte<\/option><option value=\"CF\" >Rep\u00fablica Central de \u00c1frica <\/option><option value=\"CZ\" >Rep\u00fablica Checa<\/option><option value=\"DO\" >Rep\u00fablica Dominicana<\/option><option value=\"LA\" >Rep\u00fablica Popular Democr\u00e1tica de Laos<\/option><option value=\"SY\" >Rep\u00fablica \u00c1rabe Siria<\/option><option value=\"RE\" >Reuni\u00f3n<\/option><option value=\"RW\" >Ruanda<\/option><option value=\"RO\" >Ruman\u00eda<\/option><option value=\"KN\" >Saint Kitts y Nevis<\/option><option value=\"WS\" >Samoa<\/option><option value=\"AS\" >Samoa Americana<\/option><option value=\"BL\" >San Bartolom\u00e9<\/option><option value=\"SM\" >San Marino<\/option><option value=\"MF\" >San Mart\u00edn (parte francesa)<\/option><option value=\"SX\" >San Mart\u00edn (parte holandesa)<\/option><option value=\"PM\" >San Pedro y Miquel\u00f3n<\/option><option value=\"VC\" >San Vicente y las Granadinas <\/option><option value=\"SH\" >Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option value=\"LC\" >Santa Luc\u00eda<\/option><option value=\"ST\" >Santo Tom\u00e9 y Pr\u00edncipe<\/option><option value=\"SA\" >Saud\u00ed Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leona<\/option><option value=\"SG\" >Singapur<\/option><option value=\"SO\" >Somalia<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SZ\" >Suazilandia (Reino de)<\/option><option value=\"ZA\" >Sud\u00e1frica<\/option><option value=\"SD\" >Sud\u00e1n<\/option><option value=\"SS\" >Sud\u00e1n del sur<\/option><option value=\"SE\" >Suecia<\/option><option value=\"CH\" >Suiza<\/option><option value=\"SR\" >Surinam<\/option><option value=\"SJ\" >Svalbard y Jan Mayen<\/option><option value=\"EH\" >S\u00e1hara Occidental<\/option><option value=\"TH\" >Tailandia<\/option><option value=\"TW\" >Taiw\u00e1n, Rep\u00fablica de China<\/option><option value=\"TZ\" >Tanzania (Rep\u00fablica Unida de)<\/option><option value=\"TJ\" >Tayikist\u00e1n<\/option><option value=\"IO\" >Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option value=\"TF\" >Tierras Australes y Ant\u00e1rticas Francesas<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad y Tobago<\/option><option value=\"TM\" >Turkmenist\u00e1n<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TN\" >T\u00fanez<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UA\" >Ucrania<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekist\u00e1n<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VE\" >Venezuela (Rep\u00fablica Bolivariana de)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"WF\" >Wallis y Futuna<\/option><option value=\"YE\" >Yemen<\/option><option value=\"DJ\" >Yibuti<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabue<\/option><\/select><label for=\"wpforms-4807-field_7-country\" class=\"wpforms-field-sublabel after\">Pa\u00eds<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-4807-field_37-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"37\"><label class=\"wpforms-field-label\" for=\"wpforms-4807-field_37\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-4807-field_37\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][37]\" spellcheck=\"false\" aria-errormessage=\"wpforms-4807-field_37-error\" required><\/div><div id=\"wpforms-4807-field_8-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-4807-field_8\">Phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-4807-field_8\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][8]\" aria-label=\"Phone\" aria-errormessage=\"wpforms-4807-field_8-error\" required><\/div><div id=\"wpforms-4807-field_35-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"35\"><h3 id=\"wpforms-4807-field_35\" aria-errormessage=\"wpforms-4807-field_35-error\">DOCTOR&#039;S DETAILS <\/h3><\/div><div id=\"wpforms-4807-field_14-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"14\"><fieldset><legend class=\"wpforms-field-label\">Doctor Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-4807-field_14\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][14][first]\" aria-errormessage=\"wpforms-4807-field_14-error\" required><label for=\"wpforms-4807-field_14\" class=\"wpforms-field-sublabel after\">Nombre<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-4807-field_14-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][14][last]\" aria-errormessage=\"wpforms-4807-field_14-last-error\" required><label for=\"wpforms-4807-field_14-last\" class=\"wpforms-field-sublabel after\">Apellidos<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-4807-field_39-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"39\"><label class=\"wpforms-field-label\" for=\"wpforms-4807-field_39\">Doctor&#039;s Phone Number<\/label><input type=\"tel\" id=\"wpforms-4807-field_39\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][39]\" aria-label=\"Doctor&#039;s Phone Number\" aria-errormessage=\"wpforms-4807-field_39-error\" ><\/div><div id=\"wpforms-4807-field_16-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"16\"><h3 id=\"wpforms-4807-field_16\" aria-errormessage=\"wpforms-4807-field_16-error\">MEDICAL HISTORY<\/h3><\/div><div id=\"wpforms-4807-field_17-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-4807-field_17\">Are you curently receiving medical treatment? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-4807-field_17\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][17]\" required=\"required\"><option value=\"No\"  class=\"choice-1 depth-1\"  >No<\/option><option value=\"Yes\"  class=\"choice-2 depth-1\"  >Yes<\/option><\/select><\/div><div id=\"wpforms-4807-field_18-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"textarea\" data-field-id=\"18\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-4807-field_18\">If yes, please provide details<\/label><textarea id=\"wpforms-4807-field_18\" class=\"wpforms-field-medium\" name=\"wpforms[fields][18]\" aria-errormessage=\"wpforms-4807-field_18-error\" ><\/textarea><\/div><div id=\"wpforms-4807-field_19-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-4807-field_19\">Are you currently taking any medication? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-4807-field_19\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][19]\" required=\"required\"><option value=\"No\"  class=\"choice-1 depth-1\"  >No<\/option><option value=\"Yes\"  class=\"choice-2 depth-1\"  >Yes<\/option><\/select><\/div><div id=\"wpforms-4807-field_20-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"textarea\" data-field-id=\"20\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-4807-field_20\">If yes, please provide details<\/label><textarea id=\"wpforms-4807-field_20\" class=\"wpforms-field-medium\" name=\"wpforms[fields][20]\" aria-errormessage=\"wpforms-4807-field_20-error\" ><\/textarea><\/div><div id=\"wpforms-4807-field_21-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-4807-field_21\">Have you ever suffered a serious illness or injury? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-4807-field_21\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][21]\" required=\"required\"><option value=\"No\"  class=\"choice-1 depth-1\"  >No<\/option><option value=\"Yes\"  class=\"choice-2 depth-1\"  >Yes<\/option><\/select><\/div><div id=\"wpforms-4807-field_22-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"textarea\" data-field-id=\"22\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-4807-field_22\">If yes, please provide details<\/label><textarea id=\"wpforms-4807-field_22\" class=\"wpforms-field-medium\" name=\"wpforms[fields][22]\" aria-errormessage=\"wpforms-4807-field_22-error\" ><\/textarea><\/div><div id=\"wpforms-4807-field_27-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-4807-field_27\">Are you allergic to any medication? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-4807-field_27\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][27]\" required=\"required\"><option value=\"No\"  class=\"choice-1 depth-1\"  >No<\/option><option value=\"Yes\"  class=\"choice-2 depth-1\"  >Yes<\/option><\/select><\/div><div id=\"wpforms-4807-field_28-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"textarea\" data-field-id=\"28\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-4807-field_28\">If yes, please provide details<\/label><textarea id=\"wpforms-4807-field_28\" class=\"wpforms-field-medium\" name=\"wpforms[fields][28]\" aria-errormessage=\"wpforms-4807-field_28-error\" ><\/textarea><\/div><div id=\"wpforms-4807-field_25-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-4807-field_25\">Do you have a congenital condition? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-4807-field_25\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][25]\" required=\"required\"><option value=\"No\"  class=\"choice-1 depth-1\"  >No<\/option><option value=\"Yes\"  class=\"choice-2 depth-1\"  >Yes<\/option><\/select><\/div><div id=\"wpforms-4807-field_26-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"textarea\" data-field-id=\"26\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-4807-field_26\">If yes, please provide details<\/label><textarea id=\"wpforms-4807-field_26\" class=\"wpforms-field-medium\" name=\"wpforms[fields][26]\" aria-errormessage=\"wpforms-4807-field_26-error\" ><\/textarea><\/div><div id=\"wpforms-4807-field_29-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-4807-field_29\">Any other disabilities or conditions not mentioned above? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-4807-field_29\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][29]\" required=\"required\"><option value=\"No\"  class=\"choice-1 depth-1\"  >No<\/option><option value=\"Yes\"  class=\"choice-2 depth-1\"  >Yes<\/option><\/select><\/div><div id=\"wpforms-4807-field_30-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"textarea\" data-field-id=\"30\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-4807-field_30\">If yes, please provide details<\/label><textarea id=\"wpforms-4807-field_30\" class=\"wpforms-field-medium\" name=\"wpforms[fields][30]\" aria-errormessage=\"wpforms-4807-field_30-error\" ><\/textarea><\/div><div id=\"wpforms-4807-field_9-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"9\"><fieldset><legend class=\"wpforms-field-label\">Volunteer Health Profile Form Terms &amp; Conditions <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-4807-field_9\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-4807-field_9_1\" name=\"wpforms[fields][9][]\" value=\"Please read the Terms &amp; Conditions carefully before completeing and submitting your Volunteer Health Profile Form\" aria-errormessage=\"wpforms-4807-field_9_1-error\" aria-describedby=\"wpforms-4807-field_9-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-4807-field_9_1\">Please read the Terms &amp; Conditions carefully before completeing and submitting your Volunteer Health Profile Form<\/label><\/li><\/ul><div id=\"wpforms-4807-field_9-description\" class=\"wpforms-field-description wpforms-disclaimer-description\">1. Introduction<br \/>\nThank you for your willingness to volunteer with Nomads of Hope, Inc. To help ensure your safety, well-being, and appropriate placement during your volunteer service, and to allow us to respond effectively in case of an emergency, we ask you to provide certain health-related information. This form collects personal and potentially sensitive health information. These Terms &amp; Conditions govern the collection, use, storage, and disclosure of the Health Information you provide.<br \/>\n2. Purpose of Collection<br \/>\nNomads of Hope, Inc collects your Health Information solely for the following purposes:<br \/>\n* To understand any health conditions, allergies, or physical limitations that may affect your ability to safely perform certain volunteer tasks.<br \/>\n* To identify any necessary accommodations or adjustments we might reasonably make to support your volunteer role.<br \/>\n* To have relevant information readily available to assist you or provide to emergency responders in the event of a medical emergency during your volunteer service.<br \/>\n* To maintain accurate emergency contact information.<br \/>\n* To assess overall suitability for specific volunteer roles requiring certain physical or health standards (clearly defined for the role).<br \/>\n3. Consent to Provide Information<br \/>\nBy completing and submitting this Volunteer Health Profile form, you:<br \/>\n* Voluntarily consent to provide the requested Health Information to Nomads of Hope, Inc.<br \/>\n* Acknowledge that providing this information is a condition for certain volunteer roles or activities to ensure safety and suitability. You understand that you may choose not to provide certain information, but this may limit the volunteer opportunities available to you.<br \/>\n4. Accuracy and Updates<br \/>\nYou declare that the information you provide on this form is true, accurate, and complete to the best of your knowledge. You agree to promptly inform Nomads of Hope, Inc's designated contact: Linda Shorette, the Project Coordinator at shorettelw@gmail.com of any significant changes to your health status, medications, allergies, or emergency contact details that may be relevant to your volunteer role or safety.<br \/>\n5. Use of Information<br \/>\nYour Health Information will be used by Nomads of Hope, Inc strictly for the purposes outlined in Section 2. It will primarily be accessed by Linda Shorette, the Project Coordinator, relevant program managers, designated first aid\/emergency personnel on a need-to-know basis.<br \/>\n6. Confidentiality and Data Security<br \/>\nNomads of Hope, Inc is committed to protecting the privacy and confidentiality of your Health Information. We will:<br \/>\n* Implement reasonable administrative, technical, and physical safeguards to protect your Health Information against unauthorized access, disclosure, alteration, or destruction.<br \/>\n* Limit access to your Health Information to authorized personnel who require it for the purposes stated above.<br \/>\n* Store the information securely (e.g., encrypted digital storage, locked physical files).<br \/>\n* Comply with applicable data protection and privacy laws relevant to our operations in Ecuador<br \/>\n7. Disclosure of Information<br \/>\nYour Health Information will be kept confidential and will not be disclosed to third parties except in the following limited circumstances:<br \/>\n* To emergency services personnel (e.g., paramedics, hospital staff) if required during a medical emergency involving you.<br \/>\n* If required by law, court order, or other legal process.<br \/>\n* With your explicit written consent for a specific purpose not covered here.<br \/>\n8. Data Retention<br \/>\nYour Health Information will be retained by Nomads of Hope, Inc for the duration of your active volunteer service and for a reasonable period afterward as required for administrative purposes or as mandated by law or our internal data retention policy. After this period, your Health Information will be securely destroyed or anonymized.<br \/>\n9. Your Rights<br \/>\nSubject to applicable laws, you have the right to:<br \/>\n* Request access to the Health Information Nomads of Hope, Inc holds about you.<br \/>\n* Request correction of any inaccurate or incomplete Health Information.<br \/>\n* Request the deletion of your Health Information (subject to legal or operational retention requirements).<br \/>\n* Withdraw your consent for the processing of your Health Information, understanding this may affect your ability to continue volunteering in certain capacities.<br \/>\nTo exercise these rights, please contact Linda Shorette, the Project Coordinator at shorettelw@gmail.com.<br \/>\n10. Disclaimer and Limitation of Liability<br \/>\n* The collection of this Health Information does not constitute medical advice or diagnosis by Nomads of Hope, Inc. We are not a healthcare provider.<br \/>\n* Nomads of Hope, Inc relies on the accuracy and completeness of the information you provide. We are not liable for any injury, illness, or adverse event arising from inaccurate, incomplete, or outdated information provided by you.<br \/>\n* You acknowledge that volunteering activities may involve inherent risks, and providing this health information does not eliminate those risks, nor does it guarantee that Nomads of Hope, Inc can prevent all health-related incidents.<br \/>\n11. Emergency Contact Consent<br \/>\nBy providing emergency contact information, you confirm that you have obtained the consent of your emergency contact(s) for Nomads of Hope, Inc to hold their details and contact them in the event of an emergency involving you. You also consent to Nomads of Hope, Inc contacting them and sharing relevant information (including necessary Health Information) in such an emergency situation.<br \/>\n12. Acceptance<br \/>\nBy checking the box above and submitting this form you confirm that:<br \/>\n* You have read, understood, and agree to these Terms &amp; Conditions.<br \/>\n* You consent to the collection, use, storage, and disclosure of your Health Information by Nomads of Hope, Inc as described herein.<br \/>\n* The information you are providing is accurate and complete to the best of your knowledge.<br \/>\n<\/div><\/fieldset><\/div><div id=\"wpforms-4807-field_31-container\" class=\"wpforms-field wpforms-field-signature\" data-field-type=\"signature\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-4807-field_31\">Volunteer or Guardian Signature <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-4807-field_31\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][31]\" autocomplete=\"off\" inputmode=\"none\" 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