{"id":1219,"date":"2021-05-10T18:56:56","date_gmt":"2021-05-10T18:56:56","guid":{"rendered":"https:\/\/www.kacch.org\/?page_id=1219"},"modified":"2021-05-10T19:19:29","modified_gmt":"2021-05-10T19:19:29","slug":"volunteer-application-form-for-individuals-ar","status":"publish","type":"page","link":"https:\/\/www.kacch.org\/language\/ar\/volunteer-application-form-for-individuals-ar\/","title":{"rendered":"Volunteer Application Form for Individuals"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1224-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"1224\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/mybrand-api\/wp\/v2\/pages\/1219#wpcf7-f1224-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1224\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1224-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"cu-common-form personal-fr\">\n\t<div class=\"row\">\n\t\t<div class=\"col-md-12 1\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<h2>Personal Information\n\t\t\t\t<\/h2>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 2\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0627\u0627\u0644\u0633\u0645 \u0627\u0627\u0644\u0648\u0644<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"first_name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"first_name\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 3\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0627\u0627\u0644\u0633\u0645 \u0627\u0627\u0644\u062e\u064a\u0631:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"last_name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"last_name\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 4\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0627\u0644\u062c\u0646\u0633<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"gender\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"gender\" value=\"Male\" \/><span class=\"wpcf7-list-item-label\">Male<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"gender\" value=\"Female\" \/><span class=\"wpcf7-list-item-label\">Female<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 5\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u062a\u0627\u0631\u064a\u062e \u0627\u0644\u0645\u064a\u0627\u0644\u062f:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date_ofbirth\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control walcf7-datepicker\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"date_ofbirth\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 6\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0627\u0644\u062c\u0646\u0633\u064a\u0629<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"nationality\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nationality\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 7\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0627\u0644\u0644\u063a\u0629 \/ \u0627\u0644\u0644\u063a\u0627\u062a \u0627\u0644\u0645\u062a\u062d\u062f\u062b \u0628\u0647\u0627:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"languages_spoken\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"languages_spoken\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 8\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0642\u0645 \u0627\u0644\u0628\u0637\u0627\u0642\u0629 \u0627\u0644\u0645\u062f\u0646\u064a\u0629:<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"civil_idnumber\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"civil_idnumber\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 9\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0627\u0644\u0648\u0638\u064a\u0641\u0629:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"occupation\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"occupation\" \/><\/span><br \/>\n<span class=\"note\">\u0641\u064a \u062d\u0627\u0644\u0629 \u0627\u0644\u062a\u0642\u0627\u0639\u062f \u060c \u064a\u0631\u062c\u0649 \u062a\u062d\u062f\u064a\u062f \u0627\u0644\u0645\u0647\u0646\u0629 \u0627\u0644\u0633\u0627\u0628\u0642\u0629: <\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 10\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0627\u0644\u062d\u0627\u0644\u0629 \u0627\u0627\u0644\u062c\u062a\u0645\u0627\u0639\u064a\u0629:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"marital_status\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"marital_status\" value=\"\u0623\u0639\u0632\u0628\" \/><span class=\"wpcf7-list-item-label\">\u0623\u0639\u0632\u0628<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"marital_status\" value=\"\u0645\u062a\u0632\u0648\u062c\" \/><span class=\"wpcf7-list-item-label\">\u0645\u062a\u0632\u0648\u062c<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"marital_status\" value=\"\u0645\u0637\u0644\u0642\" \/><span class=\"wpcf7-list-item-label\">\u0645\u0637\u0644\u0642<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 11\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0647\u0644 \u0623\u0646\u062a \u062d\u0627\u0644\u064a\u0627:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"are_youcurrently\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"are_youcurrently\" value=\"\u062a\u0639\u0645\u0644\" \/><span class=\"wpcf7-list-item-label\">\u062a\u0639\u0645\u0644<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"are_youcurrently\" value=\"\u0627\u0644 \u062a\u0639\u0645\u0644\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0644 \u062a\u0639\u0645\u0644<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"are_youcurrently\" value=\"\u0645\u062a\u0642\u0627\u0639\u062f\" \/><span class=\"wpcf7-list-item-label\">\u0645\u062a\u0642\u0627\u0639\u062f<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 12\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0647\u0644 \u0627\u0646\u062a \u0645\u0642\u064a\u0645 \u0641\u064a \u0627\u0644\u0643\u0648\u064a\u062a\u061f<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"are_youaresidentofkuwait\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"are_youaresidentofkuwait\" value=\"\u0646\u0639\u0645\" \/><span class=\"wpcf7-list-item-label\">\u0646\u0639\u0645<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"are_youaresidentofkuwait\" value=\"\u0627\u0627\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0627<\/span><\/label><\/span><\/span><\/span><br \/>\n<span class=\"note col_red\">\u064a\u0631\u062c\u0649 \u0627\u0644\u0639\u0644\u0645 \u0628\u0623\u0646\u0647 \u064a\u062c\u0628 \u0623\u0646 \u062a\u0643\u0648\u0646 \u0645\u0642\u064a \u064b\u0645\u0627 \u0641\u064a \u0627\u0644\u0643\u0648\u064a\u062a \u0625\u0630\u0627 \u0643\u0646\u062a \u062a\u0631\u063a\u0628 \u0641\u064a \u0627\u0627\u0644\u0646\u0636\u0645\u0627\u0645 \u0625\u0644\u0649 \u0628\u0631\u0646\u0627\u0645\u062c \u0627\u0644\u062a\u0637\u0648\u0639 \u0644\u062f\u064a\u0646\u0627.<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 13\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0639\u0646\u0648\u0627\u0646: <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"address\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" name=\"address\"><\/textarea><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 14\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0631\u0642\u0645 \u0627\u0644\u0647\u0627\u062a\u0641:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"phone_number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"phone_number\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 15\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0628\u0631\u064a\u062f \u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 16\">\n\t\t\t<div class=\"from-group\">\n\t\t\t\t<h2>\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0627\u0627\u0644\u062a\u0635\u0627\u0644 \u0641\u064a \u062d\u0627\u0644 \u0627\u0644\u0637\u0648\u0627\u0631\u0626\n\t\t\t\t<\/h2>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 17\">\n\t\t\t<div class=\"from-group\">\n\t\t\t\t<h5>\u062c\u0647\u0629 \u0627\u0627\u0644\u062a\u0635\u0627\u0644 \u0661\n\t\t\t\t<\/h5>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 18\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0627\u0627\u0644\u0633\u0645 \u0627\u0623\u0644\u0648\u0644 <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"cfirst_name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"cfirst_name\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 19\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0648 \u0627\u0627\u0644\u0633\u0645 \u0627\u0627\u0644\u062e\u064a\u0631:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"clast_name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"clast_name\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 20\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0627\u0644\u0639\u0627\u0644\u0642\u0629:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"crelation\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"crelation\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 21\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0627\u0644\u0647\u0627\u062a\u0641 \u0627\u0644\u0646\u0642\u0627\u0644 : <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"cmobile\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"cmobile\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 22\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0647\u0627\u062a\u0641 \u0627\u0644\u0645\u0646\u0632\u0644 :<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"chome_number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"chome_number\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 23\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0647\u0627\u062a\u0641 \u0639\u0645\u0644: <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"cwork_phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"cwork_phone\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 23\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0628\u0631\u064a\u062f \u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"cemail\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"cemail\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 24\">\n\t\t\t<div class=\"from-group\">\n\t\t\t\t<h5>\u062c\u0647\u0629 \u0627\u0627\u0644\u062a\u0635\u0627\u0644 2\n\t\t\t\t<\/h5>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 25\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0627\u0627\u0644\u0633\u0645 \u0627\u0623\u0644\u0648\u0644<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"c2first_name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"c2first_name\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 26\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0627\u0627\u0644\u0633\u0645 \u0627\u0623\u0644\u062e\u064a\u0631:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"c2last_name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"c2last_name\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 27\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0627\u0644\u0639\u0627\u0644\u0642\u0629:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"c2relation\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"c2relation\" value=\"Male\" \/><span class=\"wpcf7-list-item-label\">Male<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"c2relation\" value=\"Female\" \/><span class=\"wpcf7-list-item-label\">Female<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 28\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0627\u0644\u0647\u0627\u062a\u0641 \u0627\u0644\u0646\u0642\u0627\u0644 :<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"c2mobile_phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"c2mobile_phone\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 29\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0647\u0627\u062a\u0641 \u0627\u0644\u0645\u0646\u0632\u0644 :<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"c2home_number\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"c2home_number\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 30\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0647\u0627\u062a\u0641 \u0639\u0645\u0644: <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"c2work_phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"c2work_phone\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 31\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0628\u0631\u064a\u062f \u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"c2email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"c2email\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 32\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<h2>\u0627\u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0627\u0644\u062f\u0631\u0627\u0633\u064a\u0629\n\t\t\t\t<\/h2>\n\t\t\t\t<p>\u0623\u0639\u0644\u0649 \u0645\u0633\u062a\u0648\u0649 \u062a\u0639\u0644\u064a\u0645\u064a \u062a\u0645 \u062a\u0644\u0642\u064a\u0647\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 33\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0633\u0645 \u0627\u0644\u0645\u0624\u0633\u0633\u0629 \u0627\u0623\u0644\u0643\u0627\u062f\u064a\u0645\u064a\u0629:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"name_ofacademicinstitution\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"name_ofacademicinstitution\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<p>\u064a\u0631\u062c\u0649 \u0643\u062a\u0627\u0628\u0629 A \/ N \u0627\u0646 \u0644\u0645 \u062a\u062a\u0648\u0641\u0631\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 34\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0627\u0644\u062f\u0631\u062c\u0629 \u0623\u0648 \u0627\u0644\u062a\u062e\u0635\u0635:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"degree\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text form-control\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"degree\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<p>\u064a\u0631\u062c\u0649 \u0643\u062a\u0627\u0628\u0629 A \/ N \u0627\u0646 \u0644\u0645 \u062a\u062a\u0648\u0641\u0631\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 32\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<h2>\u062e\u0628\u0631\u0629 \u0627\u0644\u0639\u0645\u0644\n\t\t\t\t<\/h2>\n\t\t\t\t<p>\u064a\u0631\u062c\u0649 \u062a\u062d\u0645\u064a\u0644 \u0633\u064a\u0631\u062a\u0643 \u0627\u0644\u0630\u0627\u062a\u064a\u0629 \u0623\u0648 \u0643\u062a\u0627\u0628\u0629 A \/ N \u0625\u0630\u0627 \u0644\u0645 \u062a\u062a\u0648\u0641\u0631\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 32\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u062a\u062d\u0645\u064a\u0644 \u0627\u0644\u0633\u064a\u0631\u0629 \u0627\u0644\u0630\u0627\u062a\u064a\u0629:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"resume\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".pdf,.doc,.docx\" aria-invalid=\"false\" type=\"file\" name=\"resume\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 38\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<h2>\u062e\u0628\u0631\u0627\u062a \u0627\u0644\u062a\u0637\u0648\u0639\n\t\t\t\t<\/h2>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 39\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0647\u0644 \u0644\u062f\u064a\u0643 \u062e\u0628\u0631\u0629 \u0633\u0627\u0628\u0642\u0629 \u0641\u064a \u0627\u0644\u062a\u0637\u0648\u0639\u061f<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"volunteer_experience\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"volunteer_experience\" value=\"\u0646\u0639\u0645\" \/><span class=\"wpcf7-list-item-label\">\u0646\u0639\u0645<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"volunteer_experience\" value=\"\u0627\" \/><span class=\"wpcf7-list-item-label\">\u0627<\/span><\/label><\/span><\/span><\/span><br \/>\n<span class=\"note\">\u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0627\u0625\u0644\u062c\u0627\u0628\u0629 \u0628\u0646\u0639\u0645 \u060c \u064a\u0631\u062c\u0649 \u062a\u0639\u0628\u0626\u0629 \u0627\u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0627\u0644\u062a\u0627\u0644\u064a\u0629<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 40\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>1 .\u0627\u0633\u0645 \u0627\u0644\u0645\u0646\u0638\u0645\u0629<\/label>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 41\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label> \u0627\u0644\u0645\u0646\u0635\u0628<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"title_orposition_1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"title_orposition_1\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 42\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0645\u0646:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"from_1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control walcf7-datepicker\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"from_1\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 43\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>2 .\u0627\u0633\u0645 \u0627\u0644\u0645\u0646\u0638\u0645\u0629<\/label>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 44\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0627\u0644\u0645\u0646\u0635\u0628<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"title_orposition_2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"title_orposition_2\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 45\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0645\u0646:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"from_2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control walcf7-datepicker\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"from_2\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 46\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<h2>\u0623\u0633\u0626\u0644\u0629\n\t\t\t\t<\/h2>\n\t\t\t\t<p>\u0627\u0644\u0631\u062c\u0627\u0621 \u0627\u0625\u0644\u062c\u0627\u0628\u0629 \u0639\u0644\u0649 \u0627\u0623\u0644\u0633\u0626\u0644\u0629 \u0627\u0644\u062a\u0627\u0644\u064a\u0629\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 47\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>1 .\u0644\u0645\u0627\u0630\u0627 \u062a\u062a\u0642\u062f\u0645 \u0644\u0644\u062a\u0637\u0648\u0639 \u0645\u0639 \u0643\u0627\u062a\u0634 \u0648 \u0628\u064a\u062a \u0639\u0628\u062f\u0647\u0644\u0644\u0627\u061f <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"why_kachh\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"why_kachh\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-8 48\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>2 .\u0647\u0644 \u0644\u062f\u064a\u0643 \u0645\u0634\u0643\u0644\u0629 \u0641\u064a \u0627\u0644\u0639\u0645\u0644 \u0645\u0639 \u0627\u0623\u0644\u0637\u0641\u0627\u0644 \u062d\u062a\u0649 \u0633\u0646 16 \u0633\u0646\u0629 )\u0630\u0643\u0631 \/ \u0623\u0646\u062b\u0649(\u061f<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"do_youhaveaproblem\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"do_youhaveaproblem\" value=\"\u0646\u0639\u0645\" \/><span class=\"wpcf7-list-item-label\">\u0646\u0639\u0645<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"do_youhaveaproblem\" value=\"\u0627\u0644\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0644<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-4 49\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>3 .\u0647\u0644 \u062a\u062a\u0646\u0627\u0648\u0644 \u062d\u0627\u0644\u064a\u0627 \u0623\u064a \u062f\u0648\u0627\u0621\u061f<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"are_youpresentlyonanymedication\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"are_youpresentlyonanymedication\" value=\"\u0646\u0639\u0645\" \/><span class=\"wpcf7-list-item-label\">\u0646\u0639\u0645<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"are_youpresentlyonanymedication\" value=\"\u0627\u0644\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0644<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 50\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0627\u0625\u0644\u062c\u0627\u0628\u0629 \u0628\u0646\u0639\u0645 \u060c \u064a\u0631\u062c\u0649 \u062a\u0648\u0636\u064a\u062d \u0627\u0644\u0633\u0628\u0628<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"if_yespleaseindicatethereason\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"if_yespleaseindicatethereason\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 51\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>4 .\u0647\u0644 \u0644\u062f\u064a\u0643 \u0623\u064a \u062e\u0628\u0631\u0629 \u0634\u062e\u0635\u064a\u0629 \u0641\u064a \u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649\u061f<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"do_youhaveanypersonalexperienceinahospital\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"do_youhaveanypersonalexperienceinahospital\" value=\"\u0646\u0639\u0645\" \/><span class=\"wpcf7-list-item-label\">\u0646\u0639\u0645<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"do_youhaveanypersonalexperienceinahospital\" value=\"\u0627\u0644\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0644<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 52\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0625\u0630\u0627 \u0643\u0627\u0646\u062a \u0627\u0625\u0644\u062c\u0627\u0628\u0629 \u0628\u0646\u0639\u0645 \u060c \u064a\u0631\u062c\u0649 \u062a\u0648\u0636\u064a\u062d \u0627\u0644\u0645\u0632\u064a\u062f.<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"if_yespleaseexplainmore\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" name=\"if_yespleaseexplainmore\"><\/textarea><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 53\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>5 .\u0641\u064a \u0627\u0644\u0639\u0627\u0645\u064a\u0646 \u0627\u0644\u0645\u0627\u0636\u064a\u064a\u0646 \u060c \u0647\u0644 \u0641\u0642\u062f\u062a \u0634\u062e\u0635 \u0642\u0631\u064a\u0628 \u0645\u0646\u0643 \u060c \u0623\u0648 \u0643\u0627\u0646\u062a \u0644\u062f\u064a\u0643 \u0623\u064a \u062a\u062c\u0631\u0628\u0629 \u0634\u062e\u0635\u064a\u0629 \u0623\u062e\u0631\u0649 \u0645\u0624\u0644\u0645\u0629\u061f<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"in_thelast2years\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" name=\"in_thelast2years\"><\/textarea><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 54\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>6 .\u0645\u0627 \u0647\u064a \u0627\u0647\u062a\u0645\u0627\u0645\u0627\u062a\u0643 \u0648\u0647\u0648\u0627\u064a\u0627\u062a\u0643 \u0648\u0645\u0647\u0627\u0631\u0627\u062a\u0643\u061f<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"what_areyouinterestsyourhobbiesandskills\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" name=\"what_areyouinterestsyourhobbiesandskills\"><\/textarea><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 55\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<h2>\u0627\u0623\u0644\u0648\u0642\u0627\u062a \u0627\u0644\u0645\u062a\u0627\u062d\u0629\n\t\t\t\t<\/h2>\n\t\t\t\t<p>\u064a\u0631\u062c\u0649 \u062a\u062d\u062f\u064a\u062f \u0648\u0642\u062a\/\u0623\u0648\u0642\u0627\u062a \u0627\u0644\u062a\u0637\u0648\u0639 \u0627\u0644\u0645\u0641\u0636\u0644\u0629 \u0644\u062f\u064a\u0643:\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 56\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<h2 class=\"col_red\">\u063a\u0631\u0641 \u0627\u0623\u0644\u0644\u0639\u0627\u0628 \u0628\u0627\u0644\u0645\u0633\u062a\u0634\u0641\u0649:\n\t\t\t\t<\/h2>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 57\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0627\u0644\u062a\u0648\u0642\u064a\u062a:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"timing_hospital\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first last\"><label><input type=\"radio\" name=\"timing_hospital\" value=\"0:9 \u0635\u0628\u0627 \u064b\u062d\u0627 - 00:12 \u0645\u0633\u0627\u064b\" \/><span class=\"wpcf7-list-item-label\">0:9 \u0635\u0628\u0627 \u064b\u062d\u0627 - 00:12 \u0645\u0633\u0627\u064b<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 59\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0627\u0623\u0644\u064a\u0627\u0645:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"days_hospital\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"days_hospital\" value=\"\u0627\u0623\u0644\u062d\u062f\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0623\u0644\u062d\u062f<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"days_hospital\" value=\"\u0627\u0627\u0644\u062b\u0646\u064a\u0646\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0627\u0644\u062b\u0646\u064a\u0646<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"days_hospital\" value=\"\u0627\u0644\u062b\u0627\u0644\u062b\u0627\u0621\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0644\u062b\u0627\u0644\u062b\u0627\u0621<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"days_hospital\" value=\"\u0627\u0623\u0644\u0631\u0628\u0639\u0627\u0621\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0623\u0644\u0631\u0628\u0639\u0627\u0621<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"days_hospital\" value=\"\u0627\u0644\u062e\u0645\u064a\u0633\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0644\u062e\u0645\u064a\u0633<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 60\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u063a\u0631\u0641 \u0627\u0644\u0644\u0639\u0628:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"playrooms_hospital\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"playrooms_hospital\" value=\"\u063a\u0631\u0641\u0629 \u0623\u0644\u0639\u0627\u0628 \u0645\u0633\u062a\u0634\u0641\u0649 \u0627\u0623\u0644\u0645\u064a\u0631\u064a\" \/><span class=\"wpcf7-list-item-label\">\u063a\u0631\u0641\u0629 \u0623\u0644\u0639\u0627\u0628 \u0645\u0633\u062a\u0634\u0641\u0649 \u0627\u0623\u0644\u0645\u064a\u0631\u064a<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"playrooms_hospital\" value=\"\u063a\u0631\u0641\u0629 \u0623\u0644\u0639\u0627\u0628 \u0645\u0633\u062a\u0634\u0641\u0649 \u0627\u0644\u0641\u0631\u0648\u0627\u0646\u064a\u0629\" \/><span class=\"wpcf7-list-item-label\">\u063a\u0631\u0641\u0629 \u0623\u0644\u0639\u0627\u0628 \u0645\u0633\u062a\u0634\u0641\u0649 \u0627\u0644\u0641\u0631\u0648\u0627\u0646\u064a\u0629<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"playrooms_hospital\" value=\"\u063a\u0631\u0641\u0629 \u0623\u0644\u0639\u0627\u0628 \u0645\u0633\u062a\u0634\u0641\u0649 \u0627\u0644\u062c\u0647\u0631\u0627\u0621\" \/><span class=\"wpcf7-list-item-label\">\u063a\u0631\u0641\u0629 \u0623\u0644\u0639\u0627\u0628 \u0645\u0633\u062a\u0634\u0641\u0649 \u0627\u0644\u062c\u0647\u0631\u0627\u0621<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"playrooms_hospital\" value=\"\u063a\u0631\u0641\u0629 \u0623\u0644\u0639\u0627\u0628 \u0645\u0633\u062a\u0634\u0641\u0649 \u0627\u0644\u0648\u0637\u0646\u064a \u0644\u0623\u0644\u0637\u0641\u0627\u0644\" \/><span class=\"wpcf7-list-item-label\">\u063a\u0631\u0641\u0629 \u0623\u0644\u0639\u0627\u0628 \u0645\u0633\u062a\u0634\u0641\u0649 \u0627\u0644\u0648\u0637\u0646\u064a \u0644\u0623\u0644\u0637\u0641\u0627\u0644<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"playrooms_hospital\" value=\"\u063a\u0631\u0641\u0629 \u0623\u0644\u0639\u0627\u0628 \u0645\u0633\u062a\u0634\u0641\u0649 \u0627\u0644\u0631\u0627\u0632\u064a\" \/><span class=\"wpcf7-list-item-label\">\u063a\u0631\u0641\u0629 \u0623\u0644\u0639\u0627\u0628 \u0645\u0633\u062a\u0634\u0641\u0649 \u0627\u0644\u0631\u0627\u0632\u064a<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"playrooms_hospital\" value=\"\u063a\u0631\u0641\u0629 \u0623\u0644\u0639\u0627\u0628 \u0645\u0633\u062a\u0634\u0641\u0649 \u0627\u0628\u0646 \u0633\u064a\u0646\u0627\" \/><span class=\"wpcf7-list-item-label\">\u063a\u0631\u0641\u0629 \u0623\u0644\u0639\u0627\u0628 \u0645\u0633\u062a\u0634\u0641\u0649 \u0627\u0628\u0646 \u0633\u064a\u0646\u0627<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"playrooms_hospital\" value=\"\u063a\u0631\u0641\u0629 \u0623\u0644\u0639\u0627\u0628 \u0645\u0633\u062a\u0634\u0641\u0649 \u062c\u0627\u0628\u0631\" \/><span class=\"wpcf7-list-item-label\">\u063a\u0631\u0641\u0629 \u0623\u0644\u0639\u0627\u0628 \u0645\u0633\u062a\u0634\u0641\u0649 \u062c\u0627\u0628\u0631<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 61\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<h2 class=\"col_red\">\u0645\u0633\u062a\u0634\u0641\u0649 \u0628\u064a\u062a \u0639\u0628\u062f \u0647\u0644\u0644\u0627 \u0644\u0644\u0631\u0639\u0627\u064a\u0629 \u0623\u0644\u0637\u0641\u0627\u0644\n\t\t\t\t<\/h2>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 62\">\n\t\t\t<div class=\"row\">\n\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t\t<p><label class=\"col_red\">\u0623\u0646\u0634\u0637\u0629 \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0627\u0644\u0646\u0647\u0627\u0631\u064a\u0629 \u0641\u064a \u0628\u064a\u062a \u0639\u0628\u062f\u0647<\/label>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t\t\t<p><label>\u0627\u0644\u062a\u0648\u0642\u064a\u062a:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"timing_bcch_day_care\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first last\"><label><input type=\"radio\" name=\"timing_bcch_day_care\" value=\"0:9 \u0635\u0628\u0627 \u064b\u062d\u0627 - 00:12 \u0645\u0633\u0627\u064b\u0621 00:12 \u0645\u0633\u0627\u064b\u0621 - 00:3 \u0645\u0633\u0627\u064b\" \/><span class=\"wpcf7-list-item-label\">0:9 \u0635\u0628\u0627 \u064b\u062d\u0627 - 00:12 \u0645\u0633\u0627\u064b\u0621 00:12 \u0645\u0633\u0627\u064b\u0621 - 00:3 \u0645\u0633\u0627\u064b<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t\t\t<p><label>\u0627\u0623\u0644\u064a\u0627\u0645:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"days_bcch_day_care\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"days_bcch_day_care\" value=\"\u0627\u0623\u0644\u062d\u062f\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0623\u0644\u062d\u062f<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"days_bcch_day_care\" value=\"\u0627\u0627\u0644\u062b\u0646\u064a\u0646\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0627\u0644\u062b\u0646\u064a\u0646<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"days_bcch_day_care\" value=\"\u0627\u0644\u062b\u0627\u0644\u062b\u0627\u0621\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0644\u062b\u0627\u0644\u062b\u0627\u0621<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"days_bcch_day_care\" value=\"\u0627\u0623\u0644\u0631\u0628\u0639\u0627\u0621\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0623\u0644\u0631\u0628\u0639\u0627\u0621<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"days_bcch_day_care\" value=\"\u0627\u0644\u062e\u0645\u064a\u0633\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0644\u062e\u0645\u064a\u0633<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t\t<p><label class=\"col_red\">\u0641\u0639\u0627\u0644\u064a\u0627\u062a \u0628\u064a\u062a \u0639\u0628\u062f\u0647<\/label><br \/>\n<label>:\u0627\u0644\u062a<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"timing_bcch_events\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"timing_bcch_events\" value=\"\u064b\u0645\u0633\u0627 12:00 - \u062d\u0627 \u064b\u0635\u0628\u0627 9:00\" \/><span class=\"wpcf7-list-item-label\">\u064b\u0645\u0633\u0627 12:00 - \u062d\u0627 \u064b\u0635\u0628\u0627 9:00<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"timing_bcch_events\" value=\"\u0621\u064b\u0645\u0633\u0627 3:00 - \u0621\u064b\u0645\u0633\u0627 12:00\" \/><span class=\"wpcf7-list-item-label\">\u0621\u064b\u0645\u0633\u0627 3:00 - \u0621\u064b\u0645\u0633\u0627 12:00<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"timing_bcch_events\" value=\"3\u064b\u0645\u0633\u0627 5:00 - \u0621\u064b\u0645\u0633\u0627 3:00\" \/><span class=\"wpcf7-list-item-label\">3\u064b\u0645\u0633\u0627 5:00 - \u0621\u064b\u0645\u0633\u0627 3:00<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t\t<p><label>\u0627\u0623\u0644\u064a\u0627\u0645:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"days_bcch_events\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"days_bcch_events\" value=\"\u0627\u0623\u0644\u062d\u062f\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0623\u0644\u062d\u062f<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"days_bcch_events\" value=\"\u0627\u0627\u0644\u062b\u0646\u064a\u0646\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0627\u0644\u062b\u0646\u064a\u0646<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"days_bcch_events\" value=\"\u0627\u0644\u062b\u0627\u0644\u062b\u0627\u0621\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0644\u062b\u0627\u0644\u062b\u0627\u0621<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"days_bcch_events\" value=\"\u0627\u0623\u0644\u0631\u0628\u0639\u0627\u0621\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0623\u0644\u0631\u0628\u0639\u0627\u0621<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"days_bcch_events\" value=\"\u0627\u0644\u062e\u0645\u064a\u0633\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0644\u062e\u0645\u064a\u0633<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"days_bcch_events\" value=\"\u0627\u0644\u062c\u0645\u0639\u0629\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0644\u062c\u0645\u0639\u0629<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"days_bcch_events\" value=\"\u0627\u0644\u0633\u0628\u062a\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0644\u0633\u0628\u062a<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"col-md-4\">\n\t\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t\t<p><label class=\"col_red\">\u0623\u064a\u0627\u0645 \u0627\u0644\u0631\u0627\u062d\u0629 \u0641\u064a \u0639\u0637\u0644\u0629 \u0646\u0647\u0627\u064a\u0629 \u0627\u0623\u0644\u0633\u0628\u0648\u0639 \u0641\u064a \u0628\u064a\u062a \u0639\u0628\u062f\u0647<\/label><br \/>\n<label>:\u0627\u0644\u062a<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"timing_bcch_respite\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"timing_bcch_respite\" value=\"\u0621\u064b\u0645\u0633\u0627 12:00 - \u062d\u0627 \u064b\u0635\u0628\u0627 9:00\" \/><span class=\"wpcf7-list-item-label\">\u0621\u064b\u0645\u0633\u0627 12:00 - \u062d\u0627 \u064b\u0635\u0628\u0627 9:00<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"timing_bcch_respite\" value=\"\u0621\u064b\u0645\u0633\u0627 3:00 - \u0621\u064b\u0645\u0633\u0627 12:00\" \/><span class=\"wpcf7-list-item-label\">\u0621\u064b\u0645\u0633\u0627 3:00 - \u0621\u064b\u0645\u0633\u0627 12:00<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"timing_bcch_respite\" value=\"\u064b\u0645\u0633\u0627 5:00 - \u0621\u064b\u0645\u0633\u0627 3:00\" \/><span class=\"wpcf7-list-item-label\">\u064b\u0645\u0633\u0627 5:00 - \u0621\u064b\u0645\u0633\u0627 3:00<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t\t<p><label>\u0627\u0623\u0644\u064a\u0627\u0645:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"days_bcch_respite\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"days_bcch_respite\" value=\"\u0627\u0644\u062e\u0645\u064a\u0633\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0644\u062e\u0645\u064a\u0633<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"days_bcch_respite\" value=\"\u0627\u0644\u062c\u0645\u0639\u0629\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0644\u062c\u0645\u0639\u0629<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"days_bcch_respite\" value=\"\u0627\u0644\u0633\u0628\u062a\" \/><span class=\"wpcf7-list-item-label\">\u0627\u0644\u0633\u0628\u062a<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 71\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<h2>\u0627\u0644\u062a\u0648\u0635\u064a\u0627\u062a\n\t\t\t\t<\/h2>\n\t\t\t\t<p>\u064a\u0631\u062c\u0649 \u062a\u0642\u062f\u064a\u0645 \u0645\u0639\u0644\u0648\u0645\u0627\u062a \u0639\u0646 \u0634\u062e\u0635\u064a\u0646 \u0642\u0645\u062a \u0628\u0627\u0644\u0637\u0644\u0628 \u0645\u0646\u0647\u0645\u0627 \u0627\u0633\u062a\u0643\u0645\u0627\u0644 \u0646\u0645\u0648\u0630\u062c \u0627\u0644\u062a\u0648\u0635\u064a\u0629 \u0627\u0644\u062a\u0627\u0644\u064a \u0623\u0648 \u062a\u062d\u0645\u064a\u0644 \u062e\u0637\u0627\u0628\u064a\u0646 \u0645\u0646 \u0627\u0644\u062a\u0648\u0635\u064a\u0629.\n\t\t\t\t<\/p>\n\t\t\t\t<p>\u0623\u0645\u062b\u0644\u0629 \u0639\u0644\u0649 \u0627\u0623\u0644\u0634\u062e\u0627\u0635 \u0627\u0644\u0630\u064a\u0646 \u0645\u0646 \u0627\u0644\u0645\u0645\u0643\u0646 \u0627\u0646 \u064a\u0633\u062a\u0643\u0645\u0644\u0648\u0627 \u0627\u0644\u0646\u0645\u0648\u0630\u062c : \u0635\u0627\u062d\u0628 \u0639\u0645\u0644 \u060c \u0632\u0645\u064a\u0644 \u0639\u0645\u0644 \u060c \u0623\u0633\u062a\u0627\u0630 \u060c \u0645\u062f\u0631\u0633 \u060c \u062c\u0627\u0631 \u060c \u0635\u062f\u064a\u0642. \u0627\u0644\u062a\u0648\u0635\u064a\u0627\u062a \u0645\u0646 \u0623\u0641\u0631\u0627\u062f \u0627\u0623\u0644\u0633\u0631\u0629 \u063a\u064a\u0631 \u0645\u0642\u0628\u0648\u0644\u0629.\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 72\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0627\u0633\u0645 \u0627\u0644\u0634\u062e\u0635 #\u0627\u0622\u0644\u0648\u0644 : <\/label>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 73\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label> \u0627\u0627\u0644\u0633\u0645:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"referee_name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"referee_name\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 74\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0627\u0644\u0639\u0627\u0644\u0642\u0629:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"relationship_rafere\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"relationship_rafere\" value=\"\u0635\u0627\u062d\u0628 \u0639\u0645\u0644\" \/><span class=\"wpcf7-list-item-label\">\u0635\u0627\u062d\u0628 \u0639\u0645\u0644<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"relationship_rafere\" value=\"\u0632\u0645\u064a\u0644 \u0639\u0645\u0644\" \/><span class=\"wpcf7-list-item-label\">\u0632\u0645\u064a\u0644 \u0639\u0645\u0644<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"relationship_rafere\" value=\"\u0623\u0633\u062a\u0627\u0630\" \/><span class=\"wpcf7-list-item-label\">\u0623\u0633\u062a\u0627\u0630<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"relationship_rafere\" value=\"\u0645\u062f\u0631\u0633\" \/><span class=\"wpcf7-list-item-label\">\u0645\u062f\u0631\u0633<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"relationship_rafere\" value=\"\u062c\u0627\u0631\" \/><span class=\"wpcf7-list-item-label\">\u062c\u0627\u0631<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"relationship_rafere\" value=\"\u0635\u062f\u064a\u0642.\" \/><span class=\"wpcf7-list-item-label\">\u0635\u062f\u064a\u0642.<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 75\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0647\u0627\u062a\u0641: <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"phone_reffere\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"phone_reffere\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 76\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0628\u0631\u064a\u062f \u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"email_reffere\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email_reffere\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 77\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0627\u0633\u0645 \u0627\u0644\u0634\u062e\u0635 #\u0627\u0644\u062b\u0627\u0646\u064a: <\/label>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 78\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label> \u0627\u0627\u0644\u0633\u0645<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"referee_name2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"referee_name2\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-6 79\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>Relationship<\/label>\n\t\t\t\t<\/p>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"relationship_rafere2\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"relationship_rafere2\" value=\"\u0635\u0627\u062d\u0628 \u0639\u0645\u0644\" \/><span class=\"wpcf7-list-item-label\">\u0635\u0627\u062d\u0628 \u0639\u0645\u0644<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"relationship_rafere2\" value=\"\u0632\u0645\u064a\u0644 \u0639\u0645\u0644\" \/><span class=\"wpcf7-list-item-label\">\u0632\u0645\u064a\u0644 \u0639\u0645\u0644<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"relationship_rafere2\" value=\"\u0633\u062a\u0627\u0630\" \/><span class=\"wpcf7-list-item-label\">\u0633\u062a\u0627\u0630<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"relationship_rafere2\" value=\"\u0645\u062f\u0631\u0633\" \/><span class=\"wpcf7-list-item-label\">\u0645\u062f\u0631\u0633<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"relationship_rafere2\" value=\"\u062c\u0627\u0631\" \/><span class=\"wpcf7-list-item-label\">\u062c\u0627\u0631<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"relationship_rafere2\" value=\"\u0635\u062f\u064a\u0642.\" \/><span class=\"wpcf7-list-item-label\">\u0635\u062f\u064a\u0642.<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 80\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0647\u0627\u062a\u0641: <\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"phone_reffere2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"phone_reffere2\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 81\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0628\u0631\u064a\u062f \u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"email_reffere2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email_reffere2\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 82\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>1 .\u062e\u0637\u0627\u0628 \u062a\u0648\u0635\u064a\u0629 \u0625\u0630\u0627 \u0643\u0627\u0646 \u0645\u062a\u0627 \u064b\u062d\u0627: <\/label>\n\t\t\t\t<\/p>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"recomandation_letter\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".pdf,.doc,.docx\" aria-invalid=\"false\" type=\"file\" name=\"recomandation_letter\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 83\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>2 .\u062e\u0637\u0627\u0628 \u062a\u0648\u0635\u064a\u0629 \u0625\u0630\u0627 \u0643\u0627\u0646 \u0645\u062a\u0627 \u064b\u062d\u0627:<\/label>\n\t\t\t\t<\/p>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"recomandation_letter2\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".pdf,.doc,.docx\" aria-invalid=\"false\" type=\"file\" name=\"recomandation_letter2\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 84\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0627\u0644\u062a\u062d\u0642\u0642 \u0645\u0646 \u0627\u0644\u0645\u0639\u0644\u0648\u0645\u0627\u062a<\/label>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"col-md-12 85\">\n\t\t\t<div class=\"form-group\">\n\t\t\t\t<p><label>\u0647\u0644 \u0633\u0628\u0642 \u0623\u0646 \u062a\u0645\u062a \u0625\u062f\u0627\u0646\u062a\u0643 \u0628\u0623\u064a\u0629 \u062c\u0631\u064a\u0645\u0629 \u0623\u0648 \u0643\u0627\u0646 \u0644\u062f\u064a\u0643 \u062a\u0627\u0631\u064a\u062e \u0641\u064a \u0647\u0630\u0627 \u0627\u0644\u0635\u062f\u062f \u0633\u0648\u0627\u0621 \u062f\u0627\u062e\u0644 \u0627\u0644\u0643\u0648\u064a\u062a \u0623\u0648 \u062e\u0627\u0631\u062c\u0647\u0627\u061f<\/label>\n\t\t\t\t<\/p>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"crime_record\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"crime_record\" value=\"\u0646\u0639\u0645\" \/><span 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