{"id":243,"date":"2021-10-25T17:04:24","date_gmt":"2021-10-25T17:04:24","guid":{"rendered":"https:\/\/lassustandartsen.nl\/tilburg\/new-client-registration\/"},"modified":"2026-08-21T12:22:18","modified_gmt":"2026-08-21T12:22:18","slug":"new-client","status":"publish","type":"page","link":"https:\/\/lassustandartsen.nl\/tilburg\/en\/new-client\/","title":{"rendered":"Registration Tilburg"},"content":{"rendered":"\n<h2 id=\"registration\" class=\"wp-block-heading\">REGISTRATION<\/h2>\n\n\n<!-- HTML Forms v1.7.1 - https:\/\/wordpress.org\/plugins\/html-forms\/ -->\n<form method=\"post\"  class=\"hf-form hf-form-1633 \" data-id=\"1633\" data-title=\"Registration\" data-slug=\"registration\" data-message-success=\"Thank you for your registration. We have received your registration and will process it shortly. We will contact you by email as soon as possible.\" data-message-invalid-email=\"This email address appears to be invalid. Please check the email address and try again.\" data-message-required-field-missing=\"Please fill in the required fields.\" data-message-error=\"Unfortunately, something went wrong. We were unable to process your registration at this time. We apologize for the inconvenience. You can still register easily by contacting us at +31 13 210 5009 or tilburg@lassus.nl. We will be happy to assist you.\" data-message-recaptcha-failed=\"reCAPTCHA verification failed. Please try again.\" data-message-recaptcha-low-score=\"Your submission appears to be spam. Please try again.\" data-message-file-too-large=\"Uploaded file is too large.\" data-message-file-upload-error=\"An upload error occurred. Please try again later.\" data-message-submission-limit-reached=\"The submission limit for this form has been reached.\" data-message-require-user-logged-in=\"You must be logged in before you can use this form.\"><input type=\"hidden\" name=\"_hf_form_id\" value=\"1633\" \/><div style=\"display: none;\"><input type=\"text\" name=\"_hf_h1633\" value=\"\" \/><\/div><div class=\"hf-fields-wrap\"><div class=\"grid lg:grid-cols-2 gap-[30px] registration-form\">\r\n\r\n\t<div>\r\n\t\t<label for=\"first-name\" class=\"block mb-2\">First name (Required)<\/label>\r\n\t\t<input type=\"text\" name=\"first-name\" id=\"first-name\" placeholder=\"Enter your first name\" required=\"true\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t<\/div>\r\n\t<div>\r\n\t\t<label for=\"last-name\" class=\"block mb-2\">Last name (Required)<\/label>\r\n\t\t<input type=\"text\" name=\"last-name\" id=\"last-name\" placeholder=\"Enter your last name\" required=\"true\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t<\/div>\r\n\r\n\t<div>\r\n\t\t<label for=\"birth-date\" class=\"block mb-2\">Date of birth (Required)<\/label>\r\n\t\t<input type=\"date\" name=\"birth-date\" id=\"birth-date\" placeholder=\"Enter your birthdate\" required=\"true\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t<\/div>\r\n\t<div>\r\n\t\t<label for=\"gender\" class=\"block mb-2\">Gender (Required)<\/label>\r\n\t\t<select type=\"date\" name=\"gender\" id=\"gender\" placeholder=\"Gender\" required=\"true\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t<option value=\"\">Select<\/option>\t\r\n\t\t\t<option value=\"male\">Male<\/option>\r\n\t\t\t<option value=\"female\">Female<\/option>\r\n\t\t\t<option value=\"other\">Other<\/option>\r\n\t\t<\/select>\r\n\t<\/div>\r\n\r\n\t<div>\r\n\t\t<label for=\"phone\" class=\"block mb-2\">Phone number (Required)<\/label>\r\n\t\t<input type=\"tel\" name=\"phone\" id=\"phone\" placeholder=\"Enter your phone number\" required=\"true\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t<\/div>\r\n\t<div>\r\n\t\t<label for=\"email\" class=\"block mb-2\">Email (Required)<\/label>\r\n\t\t<input type=\"email\" name=\"email\" id=\"email\" placeholder=\"Enter your email\" required=\"true\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t<\/div>\r\n\r\n\t<div class=\"lg:col-span-2\">\r\n\t\t<label for=\"location\" class=\"block mb-2\">Location<\/label>\r\n\t\t<select type=\"date\" name=\"location\" id=\"location\" required=\"true\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t<option value=\"\">Select<\/option>\t\r\n\t\t\t<option value=\"Lassusstraat\">Lassusstraat<\/option>\r\n\t\t\t<option value=\"Keizersgracht\">Keizersgracht<\/option>\r\n\t\t\t<option value=\"Stadionplein\">Stadionplein<\/option>\r\n            <option value=\"Lelystad\">Lelystad<\/option>\r\n            <option value=\"Oisterwijk\">Oisterwijk<\/option>\r\n          \t<option value=\"Tilburg\">Tilburg<\/option>\r\n\t\t<\/select>\r\n\t<\/div>\r\n\r\n\t<div class=\"lg:col-span-2 grid\">\r\n\t\t<section class=\"mt-14 pt-14 border-t border-[#E5E5E5] child child-1\">\r\n\t\t\t<div class=\"grid lg:grid-cols-2 gap-[30px]\">\r\n\t\t\t\t<div class=\"lg:col-span-2 flex justify-between items-center\">\r\n\t\t\t\t\t<div class=\"text-xl uppercase font-title\">\r\n\t\t\t\t\t\t<p class=\"!mb-0\">family member (child)<\/p>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"text-right\">\r\n\t\t\t\t\t\t<div class=\"removeChild cursor-pointer bg-primary text-white w-10 h-10 rounded-full inline-flex items-center justify-center transform hover:scale-105 transition duration-200\">\r\n\t\t\t\t\t\t\t<svg width=\"13\" height=\"13\" viewBox=\"0 0 13 13\" fill=\"none\" >\r\n\t\t\t\t\t\t\t\t<path d=\"M7.82812 6.5L12.6719 11.3438C12.7109 11.4219 12.75 11.5 12.75 11.5781C12.75 11.6562 12.7109 11.7344 12.6719 11.7734L11.7734 12.6719C11.6953 12.75 11.6172 12.75 11.5391 12.75C11.4609 12.75 11.3828 12.75 11.3438 12.6719L6.5 7.82812L1.65625 12.6719C1.57812 12.75 1.5 12.75 1.42188 12.75C1.34375 12.75 1.26562 12.75 1.22656 12.6719L0.328125 11.7734C0.25 11.7344 0.25 11.6562 0.25 11.5781C0.25 11.5 0.25 11.4219 0.328125 11.3438L5.17188 6.5L0.328125 1.65625C0.25 1.61719 0.25 1.53906 0.25 1.46094C0.25 1.38281 0.25 1.30469 0.328125 1.22656L1.22656 0.328125C1.26562 0.289062 1.34375 0.25 1.42188 0.25C1.5 0.25 1.57812 0.289062 1.65625 0.328125L6.5 5.17188L11.3438 0.328125C11.3828 0.289062 11.4609 0.25 11.5391 0.25C11.6172 0.25 11.6953 0.289062 11.7734 0.328125L12.6719 1.22656C12.7109 1.30469 12.75 1.38281 12.75 1.46094C12.75 1.53906 12.7109 1.61719 12.6719 1.65625L11.8516 2.47656L7.82812 6.5Z\" fill=\"currentColor\"\/>\r\n\t\t\t\t\t\t\t<\/svg>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"first-name-child-1\" class=\"block mb-2\">First name (Required)<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"first-name-child-1\" id=\"first-name-child-1\" placeholder=\"Enter your first name\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"last-name-child-1\" class=\"block mb-2\">Last name (Required)<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"last-name-child-1\" id=\"last-name-child-1\" placeholder=\"Enter your last name\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"birth-date-child-1\" class=\"block mb-2\">Date of birth (Required)<\/label>\r\n\t\t\t\t\t<input type=\"date\" name=\"birth-date-child-1\" id=\"birth-date-child-1\" placeholder=\"Enter your birthdate\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"gender-child-1\" class=\"block mb-2\">Gender (Required)<\/label>\r\n\t\t\t\t\t<select type=\"date\" name=\"gender-child-1\" id=\"gender-child-1\" placeholder=\"Gender\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t\t\t<option value=\"\">Select<\/option>\t\r\n\t\t\t\t\t\t<option value=\"male\">Male<\/option>\r\n\t\t\t\t\t\t<option value=\"female\">Female<\/option>\r\n\t\t\t\t\t\t<option value=\"other\">Other<\/option>\r\n\t\t\t\t\t<\/select>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t<\/div>\r\n\t\t<\/section>\r\n\r\n\t\t<section class=\"mt-14 pt-14 border-t border-[#E5E5E5] child child-2\">\r\n\t\t\t<div class=\"grid lg:grid-cols-2 gap-[30px]\">\r\n\t\t\t\t<div class=\"lg:col-span-2 flex justify-between items-center\">\r\n\t\t\t\t\t<div class=\"text-xl uppercase font-title\">\r\n\t\t\t\t\t\t<p class=\"!mb-0\">family member (child)<\/p>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"text-right\">\r\n\t\t\t\t\t\t<div class=\"removeChild cursor-pointer bg-primary text-white w-10 h-10 rounded-full inline-flex items-center justify-center transform hover:scale-105 transition duration-200\">\r\n\t\t\t\t\t\t\t<svg width=\"13\" height=\"13\" viewBox=\"0 0 13 13\" fill=\"none\" >\r\n\t\t\t\t\t\t\t\t<path d=\"M7.82812 6.5L12.6719 11.3438C12.7109 11.4219 12.75 11.5 12.75 11.5781C12.75 11.6562 12.7109 11.7344 12.6719 11.7734L11.7734 12.6719C11.6953 12.75 11.6172 12.75 11.5391 12.75C11.4609 12.75 11.3828 12.75 11.3438 12.6719L6.5 7.82812L1.65625 12.6719C1.57812 12.75 1.5 12.75 1.42188 12.75C1.34375 12.75 1.26562 12.75 1.22656 12.6719L0.328125 11.7734C0.25 11.7344 0.25 11.6562 0.25 11.5781C0.25 11.5 0.25 11.4219 0.328125 11.3438L5.17188 6.5L0.328125 1.65625C0.25 1.61719 0.25 1.53906 0.25 1.46094C0.25 1.38281 0.25 1.30469 0.328125 1.22656L1.22656 0.328125C1.26562 0.289062 1.34375 0.25 1.42188 0.25C1.5 0.25 1.57812 0.289062 1.65625 0.328125L6.5 5.17188L11.3438 0.328125C11.3828 0.289062 11.4609 0.25 11.5391 0.25C11.6172 0.25 11.6953 0.289062 11.7734 0.328125L12.6719 1.22656C12.7109 1.30469 12.75 1.38281 12.75 1.46094C12.75 1.53906 12.7109 1.61719 12.6719 1.65625L11.8516 2.47656L7.82812 6.5Z\" fill=\"currentColor\"\/>\r\n\t\t\t\t\t\t\t<\/svg>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"first-name-child-2\" class=\"block mb-2\">First name (Required)<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"first-name-child-2\" id=\"first-name-child-2\" placeholder=\"Enter your first name\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"last-name-child-2\" class=\"block mb-2\">Last name (Required)<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"last-name-child-2\" id=\"last-name-child-2\" placeholder=\"Enter your last name\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"birth-date-child-2\" class=\"block mb-2\">Date of birth (Required)<\/label>\r\n\t\t\t\t\t<input type=\"date\" name=\"birth-date-child-2\" id=\"birth-date-child-2\" placeholder=\"Enter your birthdate\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"gender-child-2\" class=\"block mb-2\">Gender (Required)<\/label>\r\n\t\t\t\t\t<select type=\"date\" name=\"gender-child-2\" id=\"gender-child-2\" placeholder=\"Gender\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t\t\t<option value=\"\">Select<\/option>\t\r\n\t\t\t\t\t\t<option value=\"male\">Male<\/option>\r\n\t\t\t\t\t\t<option value=\"female\">Female<\/option>\r\n\t\t\t\t\t\t<option value=\"other\">Other<\/option>\r\n\t\t\t\t\t<\/select>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t<\/div>\r\n\t\t<\/section>\r\n\r\n\t\t<section class=\"mt-14 pt-14 border-t border-[#E5E5E5] child child-3\">\r\n\t\t\t<div class=\"grid lg:grid-cols-2 gap-[30px]\">\r\n\t\t\t\t<div class=\"lg:col-span-2 flex justify-between items-center\">\r\n\t\t\t\t\t<div class=\"text-xl uppercase font-title\">\r\n\t\t\t\t\t\t<p class=\"!mb-0\">family member (child)<\/p>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"text-right\">\r\n\t\t\t\t\t\t<div class=\"removeChild cursor-pointer bg-primary text-white w-10 h-10 rounded-full inline-flex items-center justify-center transform hover:scale-105 transition duration-200\">\r\n\t\t\t\t\t\t\t<svg width=\"13\" height=\"13\" viewBox=\"0 0 13 13\" fill=\"none\" >\r\n\t\t\t\t\t\t\t\t<path d=\"M7.82812 6.5L12.6719 11.3438C12.7109 11.4219 12.75 11.5 12.75 11.5781C12.75 11.6562 12.7109 11.7344 12.6719 11.7734L11.7734 12.6719C11.6953 12.75 11.6172 12.75 11.5391 12.75C11.4609 12.75 11.3828 12.75 11.3438 12.6719L6.5 7.82812L1.65625 12.6719C1.57812 12.75 1.5 12.75 1.42188 12.75C1.34375 12.75 1.26562 12.75 1.22656 12.6719L0.328125 11.7734C0.25 11.7344 0.25 11.6562 0.25 11.5781C0.25 11.5 0.25 11.4219 0.328125 11.3438L5.17188 6.5L0.328125 1.65625C0.25 1.61719 0.25 1.53906 0.25 1.46094C0.25 1.38281 0.25 1.30469 0.328125 1.22656L1.22656 0.328125C1.26562 0.289062 1.34375 0.25 1.42188 0.25C1.5 0.25 1.57812 0.289062 1.65625 0.328125L6.5 5.17188L11.3438 0.328125C11.3828 0.289062 11.4609 0.25 11.5391 0.25C11.6172 0.25 11.6953 0.289062 11.7734 0.328125L12.6719 1.22656C12.7109 1.30469 12.75 1.38281 12.75 1.46094C12.75 1.53906 12.7109 1.61719 12.6719 1.65625L11.8516 2.47656L7.82812 6.5Z\" fill=\"currentColor\"\/>\r\n\t\t\t\t\t\t\t<\/svg>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"first-name-child-3\" class=\"block mb-2\">First name (Required)<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"first-name-child-3\" id=\"first-name-child-3\" placeholder=\"Enter your first name\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"last-name-child-3\" class=\"block mb-2\">Last name (Required)<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"last-name-child-3\" id=\"last-name-child-3\" placeholder=\"Enter your last name\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"birth-date-child-3\" class=\"block mb-2\">Date of birth (Required)<\/label>\r\n\t\t\t\t\t<input type=\"date\" name=\"birth-date-child-3\" id=\"birth-date-child-3\" placeholder=\"Enter your birthdate\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"gender-child-3\" class=\"block mb-2\">Gender (Required)<\/label>\r\n\t\t\t\t\t<select type=\"date\" name=\"gender-child-3\" id=\"gender-child-3\" placeholder=\"Gender\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t\t\t<option value=\"\">Select<\/option>\t\r\n\t\t\t\t\t\t<option value=\"male\">Male<\/option>\r\n\t\t\t\t\t\t<option value=\"female\">Female<\/option>\r\n\t\t\t\t\t\t<option value=\"other\">Other<\/option>\r\n\t\t\t\t\t<\/select>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t<\/div>\r\n\t\t<\/section>\r\n\r\n\t\t<section class=\"mt-14 pt-14 border-t border-[#E5E5E5] child child-4\">\r\n\t\t\t<div class=\"grid lg:grid-cols-2 gap-[30px]\">\r\n\t\t\t\t<div class=\"lg:col-span-2 flex justify-between items-center\">\r\n\t\t\t\t\t<div class=\"text-xl uppercase font-title\">\r\n\t\t\t\t\t\t<p class=\"!mb-0\">family member (child)<\/p>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"text-right\">\r\n\t\t\t\t\t\t<div class=\"removeChild cursor-pointer bg-primary text-white w-10 h-10 rounded-full inline-flex items-center justify-center transform hover:scale-105 transition duration-200\">\r\n\t\t\t\t\t\t\t<svg width=\"13\" height=\"13\" viewBox=\"0 0 13 13\" fill=\"none\" >\r\n\t\t\t\t\t\t\t\t<path d=\"M7.82812 6.5L12.6719 11.3438C12.7109 11.4219 12.75 11.5 12.75 11.5781C12.75 11.6562 12.7109 11.7344 12.6719 11.7734L11.7734 12.6719C11.6953 12.75 11.6172 12.75 11.5391 12.75C11.4609 12.75 11.3828 12.75 11.3438 12.6719L6.5 7.82812L1.65625 12.6719C1.57812 12.75 1.5 12.75 1.42188 12.75C1.34375 12.75 1.26562 12.75 1.22656 12.6719L0.328125 11.7734C0.25 11.7344 0.25 11.6562 0.25 11.5781C0.25 11.5 0.25 11.4219 0.328125 11.3438L5.17188 6.5L0.328125 1.65625C0.25 1.61719 0.25 1.53906 0.25 1.46094C0.25 1.38281 0.25 1.30469 0.328125 1.22656L1.22656 0.328125C1.26562 0.289062 1.34375 0.25 1.42188 0.25C1.5 0.25 1.57812 0.289062 1.65625 0.328125L6.5 5.17188L11.3438 0.328125C11.3828 0.289062 11.4609 0.25 11.5391 0.25C11.6172 0.25 11.6953 0.289062 11.7734 0.328125L12.6719 1.22656C12.7109 1.30469 12.75 1.38281 12.75 1.46094C12.75 1.53906 12.7109 1.61719 12.6719 1.65625L11.8516 2.47656L7.82812 6.5Z\" fill=\"currentColor\"\/>\r\n\t\t\t\t\t\t\t<\/svg>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"first-name-child-4\" class=\"block mb-2\">First name (Required)<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"first-name-child-4\" id=\"first-name-child-4\" placeholder=\"Enter your first name\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"last-name-child-4\" class=\"block mb-2\">Last name (Required)<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"last-name-child-4\" id=\"last-name-child-4\" placeholder=\"Enter your last name\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"birth-date-child-4\" class=\"block mb-2\">Date of birth (Required)<\/label>\r\n\t\t\t\t\t<input type=\"date\" name=\"birth-date-child-4\" id=\"birth-date-child-4\" placeholder=\"Enter your birthdate\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"gender-child-4\" class=\"block mb-2\">Gender (Required)<\/label>\r\n\t\t\t\t\t<select type=\"date\" name=\"gender-child-4\" id=\"gender-child-4\" placeholder=\"Gender\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t\t\t<option value=\"\">Select<\/option>\t\r\n\t\t\t\t\t\t<option value=\"male\">Male<\/option>\r\n\t\t\t\t\t\t<option value=\"female\">Female<\/option>\r\n\t\t\t\t\t\t<option value=\"other\">Other<\/option>\r\n\t\t\t\t\t<\/select>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t<\/div>\r\n\t\t<\/section>\r\n\r\n\t\t<section class=\"mt-14 pt-14 border-t border-[#E5E5E5] child child-5\">\r\n\t\t\t<div class=\"grid lg:grid-cols-2 gap-[30px]\">\r\n\t\t\t\t<div class=\"lg:col-span-2 flex justify-between items-center\">\r\n\t\t\t\t\t<div class=\"text-xl uppercase font-title\">\r\n\t\t\t\t\t\t<p class=\"!mb-0\">family member (child)<\/p>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"text-right\">\r\n\t\t\t\t\t\t<div class=\"removeChild cursor-pointer bg-primary text-white w-10 h-10 rounded-full inline-flex items-center justify-center transform hover:scale-105 transition duration-200\">\r\n\t\t\t\t\t\t\t<svg width=\"13\" height=\"13\" viewBox=\"0 0 13 13\" fill=\"none\" >\r\n\t\t\t\t\t\t\t\t<path d=\"M7.82812 6.5L12.6719 11.3438C12.7109 11.4219 12.75 11.5 12.75 11.5781C12.75 11.6562 12.7109 11.7344 12.6719 11.7734L11.7734 12.6719C11.6953 12.75 11.6172 12.75 11.5391 12.75C11.4609 12.75 11.3828 12.75 11.3438 12.6719L6.5 7.82812L1.65625 12.6719C1.57812 12.75 1.5 12.75 1.42188 12.75C1.34375 12.75 1.26562 12.75 1.22656 12.6719L0.328125 11.7734C0.25 11.7344 0.25 11.6562 0.25 11.5781C0.25 11.5 0.25 11.4219 0.328125 11.3438L5.17188 6.5L0.328125 1.65625C0.25 1.61719 0.25 1.53906 0.25 1.46094C0.25 1.38281 0.25 1.30469 0.328125 1.22656L1.22656 0.328125C1.26562 0.289062 1.34375 0.25 1.42188 0.25C1.5 0.25 1.57812 0.289062 1.65625 0.328125L6.5 5.17188L11.3438 0.328125C11.3828 0.289062 11.4609 0.25 11.5391 0.25C11.6172 0.25 11.6953 0.289062 11.7734 0.328125L12.6719 1.22656C12.7109 1.30469 12.75 1.38281 12.75 1.46094C12.75 1.53906 12.7109 1.61719 12.6719 1.65625L11.8516 2.47656L7.82812 6.5Z\" fill=\"currentColor\"\/>\r\n\t\t\t\t\t\t\t<\/svg>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"first-name-child-5\" class=\"block mb-2\">First name (Required)<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"first-name-child-5\" id=\"first-name-child-5\" placeholder=\"Enter your first name\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"last-name-child-5\" class=\"block mb-2\">Last name (Required)<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"last-name-child-5\" id=\"last-name-child-5\" placeholder=\"Enter your last name\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"birth-date-child-5\" class=\"block mb-2\">Date of birth (Required)<\/label>\r\n\t\t\t\t\t<input type=\"date\" name=\"birth-date-child-5\" id=\"birth-date-child-5\" placeholder=\"Enter your birthdate\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"gender-child-5\" class=\"block mb-2\">Gender (Required)<\/label>\r\n\t\t\t\t\t<select type=\"date\" name=\"gender-child-5\" id=\"gender-child-5\" placeholder=\"Gender\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t\t\t<option value=\"\">Select<\/option>\t\r\n\t\t\t\t\t\t<option value=\"male\">Male<\/option>\r\n\t\t\t\t\t\t<option value=\"female\">Female<\/option>\r\n\t\t\t\t\t\t<option value=\"other\">Other<\/option>\r\n\t\t\t\t\t<\/select>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t<\/div>\r\n\t\t<\/section>\r\n\r\n\t\t\r\n\t\t<section class=\"mt-14 pt-14 border-t border-[#E5E5E5] adult adult-1\">\r\n\t\t\t<div class=\"grid lg:grid-cols-2 gap-[30px]\">\r\n\t\t\t\t<div class=\"lg:col-span-2 flex justify-between items-center\">\r\n\t\t\t\t\t<div class=\"text-xl uppercase font-title\">\r\n\t\t\t\t\t\t<p class=\"!mb-0\">family member (adult)<\/p>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"text-right\">\r\n\t\t\t\t\t\t<div class=\"removeAdult cursor-pointer bg-primary text-white w-10 h-10 rounded-full inline-flex items-center justify-center transform hover:scale-105 transition duration-200\">\r\n\t\t\t\t\t\t\t<svg width=\"13\" height=\"13\" viewBox=\"0 0 13 13\" fill=\"none\" >\r\n\t\t\t\t\t\t\t\t<path d=\"M7.82812 6.5L12.6719 11.3438C12.7109 11.4219 12.75 11.5 12.75 11.5781C12.75 11.6562 12.7109 11.7344 12.6719 11.7734L11.7734 12.6719C11.6953 12.75 11.6172 12.75 11.5391 12.75C11.4609 12.75 11.3828 12.75 11.3438 12.6719L6.5 7.82812L1.65625 12.6719C1.57812 12.75 1.5 12.75 1.42188 12.75C1.34375 12.75 1.26562 12.75 1.22656 12.6719L0.328125 11.7734C0.25 11.7344 0.25 11.6562 0.25 11.5781C0.25 11.5 0.25 11.4219 0.328125 11.3438L5.17188 6.5L0.328125 1.65625C0.25 1.61719 0.25 1.53906 0.25 1.46094C0.25 1.38281 0.25 1.30469 0.328125 1.22656L1.22656 0.328125C1.26562 0.289062 1.34375 0.25 1.42188 0.25C1.5 0.25 1.57812 0.289062 1.65625 0.328125L6.5 5.17188L11.3438 0.328125C11.3828 0.289062 11.4609 0.25 11.5391 0.25C11.6172 0.25 11.6953 0.289062 11.7734 0.328125L12.6719 1.22656C12.7109 1.30469 12.75 1.38281 12.75 1.46094C12.75 1.53906 12.7109 1.61719 12.6719 1.65625L11.8516 2.47656L7.82812 6.5Z\" fill=\"currentColor\"\/>\r\n\t\t\t\t\t\t\t<\/svg>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"first-name-adult-1\" class=\"block mb-2\">First name (Required)<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"first-name-adult-1\" id=\"first-name-adult-1\" placeholder=\"Enter your first name\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"last-name-adult-1\" class=\"block mb-2\">Last name (Required)<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"last-name-adult-1\" id=\"last-name-adult-1\" placeholder=\"Enter your last name\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"birth-date-adult-1\" class=\"block mb-2\">Date of birth (Required)<\/label>\r\n\t\t\t\t\t<input type=\"date\" name=\"birth-date-adult-1\" id=\"birth-date-adult-1\" placeholder=\"Enter your birthdate\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"gender-adult-1\" class=\"block mb-2\">Gender (Required)<\/label>\r\n\t\t\t\t\t<select type=\"date\" name=\"gender-adult-1\" id=\"gender-adult-1\" placeholder=\"Gender\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t\t\t<option value=\"\">Select<\/option>\t\r\n\t\t\t\t\t\t<option value=\"male\">Male<\/option>\r\n\t\t\t\t\t\t<option value=\"female\">Female<\/option>\r\n\t\t\t\t\t\t<option value=\"other\">Other<\/option>\r\n\t\t\t\t\t<\/select>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"phone-adult-1\" class=\"block mb-2\">Phone number (Required)<\/label>\r\n\t\t\t\t\t<input type=\"tel\" name=\"phone-adult-1\" id=\"phone-adult-1\" placeholder=\"Enter your phone number\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"email-adult-1\" class=\"block mb-2\">Email (Required)<\/label>\r\n\t\t\t\t\t<input type=\"email\" name=\"email-adult-1\" id=\"email-adult-1\" placeholder=\"Enter your email\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t<\/div>\r\n\t\t<\/section>\r\n\r\n\t\t<section class=\"mt-14 pt-14 border-t border-[#E5E5E5] adult adult-2\">\r\n\t\t\t<div class=\"grid lg:grid-cols-2 gap-[30px]\">\r\n\t\t\t\t<div class=\"lg:col-span-2 flex justify-between items-center\">\r\n\t\t\t\t\t<div class=\"text-xl uppercase font-title\">\r\n\t\t\t\t\t\t<p class=\"!mb-0\">family member (adult)<\/p>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"text-right\">\r\n\t\t\t\t\t\t<div class=\"removeAdult cursor-pointer bg-primary text-white w-10 h-10 rounded-full inline-flex items-center justify-center transform hover:scale-105 transition duration-200\">\r\n\t\t\t\t\t\t\t<svg width=\"13\" height=\"13\" viewBox=\"0 0 13 13\" fill=\"none\" >\r\n\t\t\t\t\t\t\t\t<path d=\"M7.82812 6.5L12.6719 11.3438C12.7109 11.4219 12.75 11.5 12.75 11.5781C12.75 11.6562 12.7109 11.7344 12.6719 11.7734L11.7734 12.6719C11.6953 12.75 11.6172 12.75 11.5391 12.75C11.4609 12.75 11.3828 12.75 11.3438 12.6719L6.5 7.82812L1.65625 12.6719C1.57812 12.75 1.5 12.75 1.42188 12.75C1.34375 12.75 1.26562 12.75 1.22656 12.6719L0.328125 11.7734C0.25 11.7344 0.25 11.6562 0.25 11.5781C0.25 11.5 0.25 11.4219 0.328125 11.3438L5.17188 6.5L0.328125 1.65625C0.25 1.61719 0.25 1.53906 0.25 1.46094C0.25 1.38281 0.25 1.30469 0.328125 1.22656L1.22656 0.328125C1.26562 0.289062 1.34375 0.25 1.42188 0.25C1.5 0.25 1.57812 0.289062 1.65625 0.328125L6.5 5.17188L11.3438 0.328125C11.3828 0.289062 11.4609 0.25 11.5391 0.25C11.6172 0.25 11.6953 0.289062 11.7734 0.328125L12.6719 1.22656C12.7109 1.30469 12.75 1.38281 12.75 1.46094C12.75 1.53906 12.7109 1.61719 12.6719 1.65625L11.8516 2.47656L7.82812 6.5Z\" fill=\"currentColor\"\/>\r\n\t\t\t\t\t\t\t<\/svg>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"first-name-adult-2\" class=\"block mb-2\">First name (Required)<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"first-name-adult-2\" id=\"first-name-adult-2\" placeholder=\"Enter your first name\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"last-name-adult-2\" class=\"block mb-2\">Last name (Required)<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"last-name-adult-2\" id=\"last-name-adult-2\" placeholder=\"Enter your last name\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"birth-date-adult-2\" class=\"block mb-2\">Date of birth (Required)<\/label>\r\n\t\t\t\t\t<input type=\"date\" name=\"birth-date-adult-2\" id=\"birth-date-adult-2\" placeholder=\"Enter your birthdate\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"gender-adult-2\" class=\"block mb-2\">Gender (Required)<\/label>\r\n\t\t\t\t\t<select type=\"date\" name=\"gender-adult-2\" id=\"gender-adult-2\" placeholder=\"Gender\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t\t\t<option value=\"\">Select<\/option>\t\r\n\t\t\t\t\t\t<option value=\"male\">Male<\/option>\r\n\t\t\t\t\t\t<option value=\"female\">Female<\/option>\r\n\t\t\t\t\t\t<option value=\"other\">Other<\/option>\r\n\t\t\t\t\t<\/select>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"phone-adult-2\" class=\"block mb-2\">Phone number (Required)<\/label>\r\n\t\t\t\t\t<input type=\"tel\" name=\"phone-adult-2\" id=\"phone-adult-2\" placeholder=\"Enter your phone number\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"email-adult-2\" class=\"block mb-2\">Email (Required)<\/label>\r\n\t\t\t\t\t<input type=\"email\" name=\"email-adult-2\" id=\"email-adult-2\" placeholder=\"Enter your email\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t<\/div>\r\n\t\t<\/section>\r\n\r\n\t\t<section class=\"mt-14 pt-14 border-t border-[#E5E5E5] adult adult-3\">\r\n\t\t\t<div class=\"grid lg:grid-cols-2 gap-[30px]\">\r\n\t\t\t\t<div class=\"lg:col-span-2 flex justify-between items-center\">\r\n\t\t\t\t\t<div class=\"text-xl uppercase font-title\">\r\n\t\t\t\t\t\t<p class=\"!mb-0\">family member (adult)<\/p>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"text-right\">\r\n\t\t\t\t\t\t<div class=\"removeAdult cursor-pointer bg-primary text-white w-10 h-10 rounded-full inline-flex items-center justify-center transform hover:scale-105 transition duration-200\">\r\n\t\t\t\t\t\t\t<svg width=\"13\" height=\"13\" viewBox=\"0 0 13 13\" fill=\"none\" >\r\n\t\t\t\t\t\t\t\t<path d=\"M7.82812 6.5L12.6719 11.3438C12.7109 11.4219 12.75 11.5 12.75 11.5781C12.75 11.6562 12.7109 11.7344 12.6719 11.7734L11.7734 12.6719C11.6953 12.75 11.6172 12.75 11.5391 12.75C11.4609 12.75 11.3828 12.75 11.3438 12.6719L6.5 7.82812L1.65625 12.6719C1.57812 12.75 1.5 12.75 1.42188 12.75C1.34375 12.75 1.26562 12.75 1.22656 12.6719L0.328125 11.7734C0.25 11.7344 0.25 11.6562 0.25 11.5781C0.25 11.5 0.25 11.4219 0.328125 11.3438L5.17188 6.5L0.328125 1.65625C0.25 1.61719 0.25 1.53906 0.25 1.46094C0.25 1.38281 0.25 1.30469 0.328125 1.22656L1.22656 0.328125C1.26562 0.289062 1.34375 0.25 1.42188 0.25C1.5 0.25 1.57812 0.289062 1.65625 0.328125L6.5 5.17188L11.3438 0.328125C11.3828 0.289062 11.4609 0.25 11.5391 0.25C11.6172 0.25 11.6953 0.289062 11.7734 0.328125L12.6719 1.22656C12.7109 1.30469 12.75 1.38281 12.75 1.46094C12.75 1.53906 12.7109 1.61719 12.6719 1.65625L11.8516 2.47656L7.82812 6.5Z\" fill=\"currentColor\"\/>\r\n\t\t\t\t\t\t\t<\/svg>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"first-name-adult-3\" class=\"block mb-2\">First name (Required)<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"first-name-adult-3\" id=\"first-name-adult-3\" placeholder=\"Enter your first name\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"last-name-adult-3\" class=\"block mb-2\">Last name (Required)<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"last-name-adult-3\" id=\"last-name-adult-3\" placeholder=\"Enter your last name\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"birth-date-adult-3\" class=\"block mb-2\">Date of birth (Required)<\/label>\r\n\t\t\t\t\t<input type=\"date\" name=\"birth-date-adult-3\" id=\"birth-date-adult-3\" placeholder=\"Enter your birthdate\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"gender-adult-3\" class=\"block mb-2\">Gender (Required)<\/label>\r\n\t\t\t\t\t<select type=\"date\" name=\"gender-adult-3\" id=\"gender-adult-3\" placeholder=\"Gender\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t\t\t<option value=\"\">Select<\/option>\t\r\n\t\t\t\t\t\t<option value=\"male\">Male<\/option>\r\n\t\t\t\t\t\t<option value=\"female\">Female<\/option>\r\n\t\t\t\t\t\t<option value=\"other\">Other<\/option>\r\n\t\t\t\t\t<\/select>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"phone-adult-3\" class=\"block mb-2\">Phone number (Required)<\/label>\r\n\t\t\t\t\t<input type=\"tel\" name=\"phone-adult-3\" id=\"phone-adult-3\" placeholder=\"Enter your phone number\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"email-adult-3\" class=\"block mb-2\">Email (Required)<\/label>\r\n\t\t\t\t\t<input type=\"email\" name=\"email-adult-3\" id=\"email-adult-3\" placeholder=\"Enter your email\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t<\/div>\r\n\t\t<\/section>\r\n\r\n\t\t<section class=\"mt-14 pt-14 border-t border-[#E5E5E5] adult adult-4\">\r\n\t\t\t<div class=\"grid lg:grid-cols-2 gap-[30px]\">\r\n\t\t\t\t<div class=\"lg:col-span-2 flex justify-between items-center\">\r\n\t\t\t\t\t<div class=\"text-xl uppercase font-title\">\r\n\t\t\t\t\t\t<p class=\"!mb-0\">family member (adult)<\/p>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"text-right\">\r\n\t\t\t\t\t\t<div class=\"removeAdult cursor-pointer bg-primary text-white w-10 h-10 rounded-full inline-flex items-center justify-center transform hover:scale-105 transition duration-200\">\r\n\t\t\t\t\t\t\t<svg width=\"13\" height=\"13\" viewBox=\"0 0 13 13\" fill=\"none\" >\r\n\t\t\t\t\t\t\t\t<path d=\"M7.82812 6.5L12.6719 11.3438C12.7109 11.4219 12.75 11.5 12.75 11.5781C12.75 11.6562 12.7109 11.7344 12.6719 11.7734L11.7734 12.6719C11.6953 12.75 11.6172 12.75 11.5391 12.75C11.4609 12.75 11.3828 12.75 11.3438 12.6719L6.5 7.82812L1.65625 12.6719C1.57812 12.75 1.5 12.75 1.42188 12.75C1.34375 12.75 1.26562 12.75 1.22656 12.6719L0.328125 11.7734C0.25 11.7344 0.25 11.6562 0.25 11.5781C0.25 11.5 0.25 11.4219 0.328125 11.3438L5.17188 6.5L0.328125 1.65625C0.25 1.61719 0.25 1.53906 0.25 1.46094C0.25 1.38281 0.25 1.30469 0.328125 1.22656L1.22656 0.328125C1.26562 0.289062 1.34375 0.25 1.42188 0.25C1.5 0.25 1.57812 0.289062 1.65625 0.328125L6.5 5.17188L11.3438 0.328125C11.3828 0.289062 11.4609 0.25 11.5391 0.25C11.6172 0.25 11.6953 0.289062 11.7734 0.328125L12.6719 1.22656C12.7109 1.30469 12.75 1.38281 12.75 1.46094C12.75 1.53906 12.7109 1.61719 12.6719 1.65625L11.8516 2.47656L7.82812 6.5Z\" fill=\"currentColor\"\/>\r\n\t\t\t\t\t\t\t<\/svg>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"first-name-adult-4\" class=\"block mb-2\">First name (Required)<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"first-name-adult-4\" id=\"first-name-adult-4\" placeholder=\"Enter your first name\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"last-name-adult-4\" class=\"block mb-2\">Last name (Required)<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"last-name-adult-4\" id=\"last-name-adult-4\" placeholder=\"Enter your last name\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"birth-date-adult-4\" class=\"block mb-2\">Date of birth (Required)<\/label>\r\n\t\t\t\t\t<input type=\"date\" name=\"birth-date-adult-4\" id=\"birth-date-adult-4\" placeholder=\"Enter your birthdate\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"gender-adult-4\" class=\"block mb-2\">Gender (Required)<\/label>\r\n\t\t\t\t\t<select type=\"date\" name=\"gender-adult-4\" id=\"gender-adult-4\" placeholder=\"Gender\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t\t\t<option value=\"\">Select<\/option>\t\r\n\t\t\t\t\t\t<option value=\"male\">Male<\/option>\r\n\t\t\t\t\t\t<option value=\"female\">Female<\/option>\r\n\t\t\t\t\t\t<option value=\"other\">Other<\/option>\r\n\t\t\t\t\t<\/select>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"phone-adult-4\" class=\"block mb-2\">Phone number (Required)<\/label>\r\n\t\t\t\t\t<input type=\"tel\" name=\"phone-adult-4\" id=\"phone-adult-4\" placeholder=\"Enter your phone number\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"email-adult-4\" class=\"block mb-2\">Email (Required)<\/label>\r\n\t\t\t\t\t<input type=\"email\" name=\"email-adult-4\" id=\"email-adult-4\" placeholder=\"Enter your email\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t<\/div>\r\n\t\t<\/section>\r\n\r\n\t\t<section class=\"mt-14 pt-14 border-t border-[#E5E5E5] adult adult-5\">\r\n\t\t\t<div class=\"grid lg:grid-cols-2 gap-[30px]\">\r\n\t\t\t\t<div class=\"lg:col-span-2 flex justify-between items-center\">\r\n\t\t\t\t\t<div class=\"text-xl uppercase font-title\">\r\n\t\t\t\t\t\t<p class=\"!mb-0\">family member (adult)<\/p>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"text-right\">\r\n\t\t\t\t\t\t<div class=\"removeAdult cursor-pointer bg-primary text-white w-10 h-10 rounded-full inline-flex items-center justify-center transform hover:scale-105 transition duration-200\">\r\n\t\t\t\t\t\t\t<svg width=\"13\" height=\"13\" viewBox=\"0 0 13 13\" fill=\"none\" >\r\n\t\t\t\t\t\t\t\t<path d=\"M7.82812 6.5L12.6719 11.3438C12.7109 11.4219 12.75 11.5 12.75 11.5781C12.75 11.6562 12.7109 11.7344 12.6719 11.7734L11.7734 12.6719C11.6953 12.75 11.6172 12.75 11.5391 12.75C11.4609 12.75 11.3828 12.75 11.3438 12.6719L6.5 7.82812L1.65625 12.6719C1.57812 12.75 1.5 12.75 1.42188 12.75C1.34375 12.75 1.26562 12.75 1.22656 12.6719L0.328125 11.7734C0.25 11.7344 0.25 11.6562 0.25 11.5781C0.25 11.5 0.25 11.4219 0.328125 11.3438L5.17188 6.5L0.328125 1.65625C0.25 1.61719 0.25 1.53906 0.25 1.46094C0.25 1.38281 0.25 1.30469 0.328125 1.22656L1.22656 0.328125C1.26562 0.289062 1.34375 0.25 1.42188 0.25C1.5 0.25 1.57812 0.289062 1.65625 0.328125L6.5 5.17188L11.3438 0.328125C11.3828 0.289062 11.4609 0.25 11.5391 0.25C11.6172 0.25 11.6953 0.289062 11.7734 0.328125L12.6719 1.22656C12.7109 1.30469 12.75 1.38281 12.75 1.46094C12.75 1.53906 12.7109 1.61719 12.6719 1.65625L11.8516 2.47656L7.82812 6.5Z\" fill=\"currentColor\"\/>\r\n\t\t\t\t\t\t\t<\/svg>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"first-name-adult-5\" class=\"block mb-2\">First name (Required)<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"first-name-adult-5\" id=\"first-name-adult-5\" placeholder=\"Enter your first name\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"last-name-adult-5\" class=\"block mb-2\">Last name (Required)<\/label>\r\n\t\t\t\t\t<input type=\"text\" name=\"last-name-adult-5\" id=\"last-name-adult-5\" placeholder=\"Enter your last name\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"birth-date-adult-5\" class=\"block mb-2\">Date of birth (Required)<\/label>\r\n\t\t\t\t\t<input type=\"date\" name=\"birth-date-adult-5\" id=\"birth-date-adult-5\" placeholder=\"Enter your birthdate\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"gender-adult-5\" class=\"block mb-2\">Gender (Required)<\/label>\r\n\t\t\t\t\t<select type=\"date\" name=\"gender-adult-5\" id=\"gender-adult-5\" placeholder=\"Gender\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t\t\t<option value=\"\">Select<\/option>\t\r\n\t\t\t\t\t\t<option value=\"male\">Male<\/option>\r\n\t\t\t\t\t\t<option value=\"female\">Female<\/option>\r\n\t\t\t\t\t\t<option value=\"other\">Other<\/option>\r\n\t\t\t\t\t<\/select>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"phone-adult-5\" class=\"block mb-2\">Phone number (Required)<\/label>\r\n\t\t\t\t\t<input type=\"tel\" name=\"phone-adult-5\" id=\"phone-adult-5\" placeholder=\"Enter your phone number\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div>\r\n\t\t\t\t\t<label for=\"email-adult-5\" class=\"block mb-2\">Email (Required)<\/label>\r\n\t\t\t\t\t<input type=\"email\" name=\"email-adult-5\" id=\"email-adult-5\" placeholder=\"Enter your email\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t<\/div>\r\n\t\t<\/section>\r\n\t<\/div>\r\n\r\n\t<div>\r\n\t\t<div class=\"buttonAddAdult bg-primary-lighter rounded-full text-lg w-full mt-[10px] py-4 px-7 flex uppercase justify-center items-center cursor-pointer font-title hover:bg-primary hover:text-white transition duration-200 select-none disabled:opacity-80 disabled:hover:cursor-not-allowed\">Add a family member (adult)<\/div>\r\n\t<\/div>\r\n\t<div>\r\n\t\t<div class=\"buttonAddChild bg-primary-lighter rounded-full text-lg w-full mt-[10px] py-4 px-7 flex uppercase justify-center items-center cursor-pointer font-title hover:bg-primary hover:text-white transition duration-200 select-none disabled:opacity-80 disabled:hover:cursor-not-allowed\">Add a family member (child)<\/div>\r\n\t<\/div>\r\n\t\r\n\t\r\n\t<div class=\"lg:col-span-2 text-center\">\r\n\t\t<hr class=\"mt-[10px] mb-[60px] h-px border-[#E5E5E5]\">\r\n        <!-- Added hCaptcha widget manually because automatic hCaptcha integration does not render in HTML Forms -->\r\n        <div class=\"lg:col-span-2\">\r\n            <h-captcha\r\n                class=\"h-captcha\"\r\n                data-sitekey=\"5828f8b0-ff46-482c-9d1a-153a63b0b9e4\"\r\n                data-theme=\"light\"\r\n                data-size=\"normal\"\r\n                data-auto=\"false\"\r\n                data-force=\"true\"\r\n                style=\"display: flex; justify-content: center;\">\r\n            <\/h-captcha>\r\n        <\/div>\r\n\t\t<button type=\"submit\" class=\"bg-primary-medium rounded-full text-xl py-4 px-12 inline-flex uppercase text-white justify-center items-center font-title hover:bg-primary-dark transition duration-200 select-none\">Submit<\/button>\r\n\t<\/div>\r\n\r\n<\/div><noscript>Please enable JavaScript for this form to work.<\/noscript><\/div><\/form><!-- \/ HTML Forms -->","protected":false},"excerpt":{"rendered":"<p>REGISTRATION<\/p>\n","protected":false},"author":2,"featured_media":244,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-243","page","type-page","status-publish","has-post-thumbnail","hentry"],"acf":{"subtitle":"","page_bg":{"background_image":{"ID":5851,"id":5851,"title":"inschrijven","filename":"inschrijven.jpg","filesize":104582,"url":"https:\/\/lassustandartsen.nl\/oisterwijk\/wp-content\/uploads\/sites\/5\/2025\/03\/inschrijven.jpg","link":"https:\/\/lassustandartsen.nl\/tilburg\/en\/new-client\/inschrijven-2\/","alt":"","author":"20","description":"","caption":"","name":"inschrijven-2","status":"inherit","uploaded_to":243,"date":"2025-03-13 15:11:50","modified":"2025-03-13 15:11:50","menu_order":0,"mime_type":"image\/jpeg","type":"image","subtype":"jpeg","icon":"https:\/\/lassustandartsen.nl\/tilburg\/wp-includes\/images\/media\/default.png","width":1800,"height":1020,"sizes":{"thumbnail":"https:\/\/lassustandartsen.nl\/oisterwijk\/wp-content\/uploads\/sites\/5\/2025\/03\/inschrijven-150x150.jpg","thumbnail-width":150,"thumbnail-height":150,"medium":"https:\/\/lassustandartsen.nl\/oisterwijk\/wp-content\/uploads\/sites\/5\/2025\/03\/inschrijven-300x170.jpg","medium-width":300,"medium-height":170,"medium_large":"https:\/\/lassustandartsen.nl\/oisterwijk\/wp-content\/uploads\/sites\/5\/2025\/03\/inschrijven-768x435.jpg","medium_large-width":768,"medium_large-height":435,"large":"https:\/\/lassustandartsen.nl\/oisterwijk\/wp-content\/uploads\/sites\/5\/2025\/03\/inschrijven-1024x580.jpg","large-width":1024,"large-height":580,"1536x1536":"https:\/\/lassustandartsen.nl\/oisterwijk\/wp-content\/uploads\/sites\/5\/2025\/03\/inschrijven-1536x870.jpg","1536x1536-width":1536,"1536x1536-height":870,"2048x2048":"https:\/\/lassustandartsen.nl\/oisterwijk\/wp-content\/uploads\/sites\/5\/2025\/03\/inschrijven.jpg","2048x2048-width":1800,"2048x2048-height":1020}},"add_video_background":false,"video_for_backgrounds":false,"poster":false}},"yoast_head":"<!-- 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