{"id":1593,"date":"2026-01-05T15:36:54","date_gmt":"2026-01-05T15:36:54","guid":{"rendered":"https:\/\/baseheatrd.com\/?page_id=1593"},"modified":"2026-01-19T23:03:47","modified_gmt":"2026-01-20T03:03:47","slug":"bh-experience-application-form","status":"publish","type":"page","link":"https:\/\/baseheatrd.com\/es\/bh-experience-application-form\/","title":{"rendered":"Formulario de solicitud de experiencia en BH"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1593\" class=\"elementor elementor-1593\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b48b1fc e-flex e-con-boxed e-con e-parent\" data-id=\"b48b1fc\" 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-72f78d4 elementor-widget-mobile__width-initial elementor-invisible elementor-widget elementor-widget-heading\" data-id=\"72f78d4\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeIn&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\">BH Experience Application Form<\/span>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a59da2b elementor-widget__width-initial elementor-invisible elementor-widget elementor-widget-text-editor\" data-id=\"a59da2b\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeIn&quot;}\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>A full immersion into Baseheat Academy\u2019s culture, methodology, and performance standards. Elite training, advanced technology analysis, physical and mental development, and an environment built to shape discipline, character, and purpose.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6a4dd55 fluent-form-widget-step-header-yes fluent-form-widget-step-progressbar-yes fluentform-widget-submit-button-custom elementor-invisible elementor-widget elementor-widget-fluent-form-widget\" data-id=\"6a4dd55\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeIn&quot;}\" 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-custom-radio-checkbox fluentform-widget-align-default\">\n\n            \n            <div class='fluentform ff-default fluentform_wrapper_4 ffs_default_wrap'><form data-form_id=\"4\" id=\"fluentform_4\" class=\"frm-fluent-form fluent_form_4 ff-el-form-top ff_form_instance_4_1 ff-form-loading ff_has_v3_recptcha ffs_default\" data-form_instance=\"ff_form_instance_4_1\" method=\"POST\" data-recptcha_key=\"6LfJCVMsAAAAAFOuGGxwk0ePazucYjqrSPSA5Om-\" ><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;\">BH Experience Application Form<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='1593' \/><input type=\"hidden\" id=\"_fluentform_4_fluentformnonce\" name=\"_fluentform_4_fluentformnonce\" value=\"be12d7cc63\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/es\/wp-json\/wp\/v2\/pages\/1593\" \/><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-4_1\" ><h3 class='ff-el-section-title'>Personal Information<\/h3><div class='ff-section_break_desk'><p>Athlete's personal information<\/p><\/div><hr \/><\/div><div data-name=\"ff_cn_id_1\"  class='ff-t-container ff-column-container ff_columns_total_3 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><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_4_names_first_name_' id='label_ff_4_names_first_name_' >Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" id=\"ff_4_names_first_name_\" class=\"ff-el-form-control\" placeholder=\"Write your name here\" 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 asterisk-right\"><label for='ff_4_names_last_name_' id='label_ff_4_names_last_name_' >Last Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[last_name]\" id=\"ff_4_names_last_name_\" class=\"ff-el-form-control\" placeholder=\"Write your last name here\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 30%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_datetime' id='label_ff_4_datetime' aria-label=\"Your date of birth\">Your date of birth<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Your date of birth 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_4_datetime\" class=\"ff-el-form-control ff-el-datepicker\" placeholder=\"Write here your date\" data-name=\"datetime\"  aria-invalid='false' aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 30%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_numeric_field' id='label_ff_4_numeric_field' aria-label=\"Years old\">Years old<\/label><\/div><div class='ff-el-input--content'><input type=\"number\" name=\"numeric_field\" id=\"ff_4_numeric_field\" class=\"ff-el-form-control\" placeholder=\"How old are you?\" data-name=\"numeric_field\" inputmode=\"numeric\" step=\"any\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_2\"  class='ff-t-container ff-column-container ff_columns_total_4 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_input_text' id='label_ff_4_input_text' aria-label=\"Nationality\">Nationality<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" placeholder=\"Where are you from?\" data-name=\"input_text\" id=\"ff_4_input_text\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_phone' id='label_ff_4_phone' aria-label=\"Athlete&#039;s Phone Number\">Athlete's Phone Number<\/label><\/div><div class='ff-el-input--content'><input name=\"phone\" class=\"ff-el-form-control ff-el-phone\" type=\"tel\" placeholder=\"+1 (555) 555-4444\" data-name=\"phone\" id=\"ff_4_phone\" inputmode=\"tel\"  aria-invalid='false' aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_email' id='label_ff_4_email' aria-label=\"Email Address\">Email Address<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_4_email\" class=\"ff-el-form-control\" placeholder=\"your@email.com\" data-name=\"email\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-4' style='flex-basis: 25%;'><\/div><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_left\" data-name=\"section_break-4_2\" ><h3 class='ff-el-section-title'>Name of Parent\/Guardian<\/h3><div class='ff-section_break_desk'><p>Information from parents or guardians if the person is a minor<\/p><\/div><hr \/><\/div><div data-name=\"ff_cn_id_3\"  class='ff-t-container ff-column-container ff_columns_total_2 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div data-type=\"name-element\" data-name=\"names_1\" 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_4_names_1_first_name_' id='label_ff_4_names_1_first_name_' >Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_1[first_name]\" id=\"ff_4_names_1_first_name_\" class=\"ff-el-form-control\" placeholder=\"Write name here\" 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 asterisk-right\"><label for='ff_4_names_1_last_name_' id='label_ff_4_names_1_last_name_' >Last Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_1[last_name]\" id=\"ff_4_names_1_last_name_\" class=\"ff-el-form-control\" placeholder=\"Write last name here\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/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_4_phone_1' id='label_ff_4_phone_1' aria-label=\"Phone Number\">Phone Number<\/label><\/div><div class='ff-el-input--content'><input name=\"phone_1\" class=\"ff-el-form-control ff-el-phone\" type=\"tel\" placeholder=\"+1 (555) 555-4444\" data-name=\"phone_1\" id=\"ff_4_phone_1\" inputmode=\"tel\"  aria-invalid='false' aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_4\"  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 ff-el-section-break  ff_left\" data-name=\"section_break-4_3\" ><h3 class='ff-el-section-title'>Sports Profile<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><\/div><\/div><div data-name=\"ff_cn_id_5\"  class='ff-t-container ff-column-container ff_columns_total_4 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_input_text_1' id='label_ff_4_input_text_1' aria-label=\"Primary Position\">Primary Position<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_1\" class=\"ff-el-form-control\" placeholder=\"Write here\" data-name=\"input_text_1\" id=\"ff_4_input_text_1\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_input_text_2' id='label_ff_4_input_text_2' aria-label=\"Secondary Position\">Secondary Position<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_2\" class=\"ff-el-form-control\" placeholder=\"Write here\" data-name=\"input_text_2\" id=\"ff_4_input_text_2\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Throws\">Throws<\/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_33b60b908c38ce8f1d6e119a24787e19'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Right\"  id='input_radio_33b60b908c38ce8f1d6e119a24787e19' aria-label='Right' aria-invalid='false' aria-required=true> <span>Right<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_0ec71ffacb9976a6d2255c267e233e45'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Left\"  id='input_radio_0ec71ffacb9976a6d2255c267e233e45' aria-label='Left' aria-invalid='false' aria-required=true> <span>Left<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-4' style='flex-basis: 25%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Bats\">Bats<\/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_3c33f3c4da8606584b4e9907cc9876cc'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Right\"  id='input_radio_1_3c33f3c4da8606584b4e9907cc9876cc' aria-label='Right' aria-invalid='false' aria-required=true> <span>Right<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_dac1ff5f2821ba88b95ec4ec28d39c19'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Left\"  id='input_radio_1_dac1ff5f2821ba88b95ec4ec28d39c19' aria-label='Left' aria-invalid='false' aria-required=true> <span>Left<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_e9cef5ede7b0b34d7dd1685ebcae723f'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Switch\"  id='input_radio_1_e9cef5ede7b0b34d7dd1685ebcae723f' aria-label='Switch' aria-invalid='false' aria-required=true> <span>Switch<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_6\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 40%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_input_text_3' id='label_ff_4_input_text_3' aria-label=\"Current Academy or Team\">Current Academy or Team<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_3\" class=\"ff-el-form-control\" placeholder=\"Write here\" data-name=\"input_text_3\" id=\"ff_4_input_text_3\"  aria-invalid=\"false\" aria-required=false><\/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 asterisk-right\"><label   aria-label=\"Skill Level\">Skill Level<\/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_6257d914ae5810a9a9a4e3f7f7e2cd72'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Beginner\"  id='input_radio_2_6257d914ae5810a9a9a4e3f7f7e2cd72' aria-label='Beginner' aria-invalid='false' aria-required=false> <span>Beginner<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_c7f5c099d05dc5a54f011aba0310399a'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Intermediate\"  id='input_radio_2_c7f5c099d05dc5a54f011aba0310399a' aria-label='Intermediate' aria-invalid='false' aria-required=false> <span>Intermediate<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_c254242dcfa9270d5bf3185ed1cf3857'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Advanced\"  id='input_radio_2_c254242dcfa9270d5bf3185ed1cf3857' aria-label='Advanced' aria-invalid='false' aria-required=false> <span>Advanced<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_4c7048c526633026c16cac3afba10faa'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Pro\"  id='input_radio_2_4c7048c526633026c16cac3afba10faa' aria-label='Pro' aria-invalid='false' aria-required=false> <span>Pro<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-4_4\" ><h3 class='ff-el-section-title'>Basic Metrics<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div data-name=\"ff_cn_id_7\"  class='ff-t-container ff-column-container ff_columns_total_3 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_input_text_4' id='label_ff_4_input_text_4' aria-label=\"Release Velocity\">Release Velocity<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_4\" class=\"ff-el-form-control\" placeholder=\"Write here\" data-name=\"input_text_4\" id=\"ff_4_input_text_4\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_input_text_5' id='label_ff_4_input_text_5' aria-label=\"60-Yard Sprint\">60-Yard Sprint<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_5\" class=\"ff-el-form-control\" placeholder=\"Write here\" data-name=\"input_text_5\" id=\"ff_4_input_text_5\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_input_text_6' id='label_ff_4_input_text_6' aria-label=\"Pop Time\">Pop Time<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_6\" class=\"ff-el-form-control\" placeholder=\"Write here\" data-name=\"input_text_6\" id=\"ff_4_input_text_6\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_8\"  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 asterisk-right\"><label for='ff_4_url' id='label_ff_4_url' aria-label=\"Recent Videos (YouTube Link)\">Recent Videos (YouTube Link)<\/label><\/div><div class='ff-el-input--content'><input type=\"url\" name=\"url\" class=\"ff-el-form-control\" placeholder=\"Paste the full link here. (https:\/\/www.youtube.com\/watch..........)\" data-name=\"url\" id=\"ff_4_url\"  aria-invalid=\"false\" aria-required=false><\/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 asterisk-right\"><label for='ff_4_description' id='label_ff_4_description' aria-label=\"Athlete&#039;s Goal within the BH Experience\">Athlete's Goal within the BH Experience<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_4_description\" name=\"description\" id=\"ff_4_description\" class=\"ff-el-form-control\" placeholder=\"Write here\" rows=\"3\" cols=\"2\" data-name=\"description\" ><\/textarea><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_9\"  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 ff-el-section-break  ff_left\" data-name=\"section_break-4_5\" ><h3 class='ff-el-section-title'>Dates and Availability<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><\/div><\/div><div data-name=\"ff_cn_id_10\"  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_4_datetime_1' id='label_ff_4_datetime_1' aria-label=\"Desired Date to Begin the BH Experience\">Desired Date to Begin the BH Experience<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Desired Date to Begin the BH Experience 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_1\" id=\"ff_4_datetime_1\" class=\"ff-el-form-control ff-el-datepicker\" placeholder=\"Date to Begin \" data-name=\"datetime_1\"  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 ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Duration\">Duration<\/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_3_854f70f8fbb6d549c84b5e3cf192a3b7'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"2 Weeks\"  id='input_radio_3_854f70f8fbb6d549c84b5e3cf192a3b7' aria-label='2 Weeks' aria-invalid='false' aria-required=true> <span>2 Weeks<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_e756382d31204285e40ceeb577c832e3'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"4 Weeks\"  id='input_radio_3_e756382d31204285e40ceeb577c832e3' aria-label='4 Weeks' aria-invalid='false' aria-required=true> <span>4 Weeks<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_873f4fe6083df4bf7b6dc134ee8edc28'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"6+ Weeks\"  id='input_radio_3_873f4fe6083df4bf7b6dc134ee8edc28' aria-label='6+ Weeks' aria-invalid='false' aria-required=true> <span>6+ Weeks<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_11\"  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 ff-el-section-break  ff_left\" data-name=\"section_break-4_6\" ><h3 class='ff-el-section-title'>Health<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><\/div><\/div><div data-name=\"ff_cn_id_12\"  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 asterisk-right\"><label for='ff_4_description_1' id='label_ff_4_description_1' aria-label=\"Allergies\">Allergies<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_4_description_1\" name=\"description_1\" id=\"ff_4_description_1\" class=\"ff-el-form-control\" placeholder=\"Write here if applicable, otherwise leave blank..\" rows=\"3\" cols=\"2\" data-name=\"description_1\" ><\/textarea><\/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 asterisk-right\"><label for='ff_4_description_2' id='label_ff_4_description_2' aria-label=\"Current Injuries\">Current Injuries<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_4_description_2\" name=\"description_2\" id=\"ff_4_description_2\" class=\"ff-el-form-control\" placeholder=\"Write here if applicable, otherwise leave blank..\" rows=\"3\" cols=\"2\" data-name=\"description_2\" ><\/textarea><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_13\"  class='ff-t-container ff-column-container ff_columns_total_3 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_description_3' id='label_ff_4_description_3' aria-label=\"Medications\">Medications<\/label><\/div><div class='ff-el-input--content'><textarea 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class=\"ff-el-input--label asterisk-right\"><label for='ff_4_names_2_last_name_' id='label_ff_4_names_2_last_name_' >Last name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_2[last_name]\" id=\"ff_4_names_2_last_name_\" class=\"ff-el-form-control\" placeholder=\"Write the last name\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 20%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_phone_2' id='label_ff_4_phone_2' aria-label=\"Contact phone\">Contact phone<\/label><\/div><div class='ff-el-input--content'><input name=\"phone_2\" class=\"ff-el-form-control ff-el-phone\" type=\"tel\" placeholder=\"+1 (555) 555-4444\" data-name=\"phone_2\" id=\"ff_4_phone_2\" inputmode=\"tel\"  aria-invalid='false' aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_14\"  class='ff-t-container ff-column-container 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