{"id":2824,"date":"2020-09-22T22:13:30","date_gmt":"2020-09-23T05:13:30","guid":{"rendered":"https:\/\/100blackmenlasvegas.org\/?page_id=2824"},"modified":"2021-01-14T05:45:06","modified_gmt":"2021-01-14T13:45:06","slug":"crossroads-signup-form","status":"publish","type":"page","link":"https:\/\/100blackmenlasvegas.org\/staging\/crossroads-signup-form\/","title":{"rendered":"CrossRoads Signup"},"content":{"rendered":"[et_pb_section fb_built=&#8221;1&#8243; module_id=&#8221;header-content&#8221; _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#000000&#8243; custom_padding=&#8221;0px||0px|||&#8221; global_module=&#8221;3133&#8243; saved_tabs=&#8221;all&#8221;][et_pb_row column_structure=&#8221;1_4,1_4,1_4,1_4&#8243; _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;10px||10px||true|false&#8221;][et_pb_column type=&#8221;1_4&#8243; _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221;][et_pb_code _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221; text_orientation=&#8221;center&#8221;]<img decoding=\"async\" src=\"https:\/\/100blackmenlasvegas.org\/staging\/wp-content\/uploads\/2020\/10\/phone-call-30.png\" alt=\"phone\" width=\"15px\" \/><span style=\"color:#fff;font-size:16px;font-weight:bold;\"> (702) 720-1273<\/span>[\/et_pb_code][\/et_pb_column][et_pb_column type=&#8221;1_4&#8243; _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221;][et_pb_text _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221; text_text_color=&#8221;#ffffff&#8221; custom_margin=&#8221;|-20px||-20px|false|true&#8221;]<p class=\"p1\"><a style=\"color: #fff;font-weight:bold;font-size:0.9em;\" href=\"mailto:info@100blackmenlasvegas.org\"><img decoding=\"async\" src=\"https:\/\/100blackmenlasvegas.org\/staging\/wp-content\/uploads\/2020\/10\/email-30.png\" alt=\"email\" width=\"15\" \/> info@100blackmenlasvegas.org<\/a><\/p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_4&#8243; _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221;][et_pb_code _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221;]<ul class=\"et_pb_module et_pb_social_media_follow et_pb_social_media_follow_0 clearfix  et_pb_text_align_center et_pb_bg_layout_light\"><!-- [et_pb_line_break_holder] -->\t\t\t\t<li class=\"et_pb_social_media_follow_network_0 et_pb_social_icon et_pb_social_network_link  et-social-facebook et_pb_social_media_follow_network_0\"><a href=\"https:\/\/www.facebook.com\/100BMOLV\/\" class=\"icon et_pb_with_border\" title=\"Follow on Facebook\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"et_pb_social_media_follow_network_name\" aria-hidden=\"true\">Follow<\/span><\/a><\/li><li class=\"et_pb_social_media_follow_network_1 et_pb_social_icon et_pb_social_network_link  et-social-twitter et_pb_social_media_follow_network_1\"><a href=\"https:\/\/twitter.com\/100bmolv\/\" class=\"icon et_pb_with_border\" title=\"Follow on Twitter\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"et_pb_social_media_follow_network_name\" aria-hidden=\"true\">Follow<\/span><\/a><\/li><li class=\"et_pb_social_media_follow_network_2 et_pb_social_icon et_pb_social_network_link  et-social-youtube et_pb_social_media_follow_network_2\"><a href=\"https:\/\/www.youtube.com\/channel\/UClMb3xUZOiKB6KFockuqB2A\" class=\"icon et_pb_with_border\" title=\"Follow on Youtube\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"et_pb_social_media_follow_network_name\" aria-hidden=\"true\">Follow<\/span><\/a><\/li><!-- [et_pb_line_break_holder] -->\t\t\t<\/ul>[\/et_pb_code][\/et_pb_column][et_pb_column type=&#8221;1_4&#8243; _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221;][et_pb_button button_url=&#8221;https:\/\/www.paypal.com\/donate?hosted_button_id=M54G2XX4MF8Q2&#8243; url_new_window=&#8221;on&#8221; button_text=&#8221;DONATE&#8221; _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221; custom_button=&#8221;on&#8221; button_text_size=&#8221;16px&#8221; button_text_color=&#8221;#000000&#8243; button_bg_color=&#8221;#ffcc66&#8243; button_border_width=&#8221;0px&#8221; button_border_radius=&#8221;0px&#8221; button_font=&#8221;|600|||||||&#8221; button_icon=&#8221;%%20%%&#8221; button_icon_color=&#8221;#000000&#8243; background_layout=&#8221;dark&#8221; custom_padding=&#8221;7px||7px||true|false&#8221;][\/et_pb_button][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; fullwidth=&#8221;on&#8221; _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221; global_module=&#8221;3261&#8243;][et_pb_fullwidth_code _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221;]<img decoding=\"async\" style=\"display:block;margin:0 auto;\" src=\"\/staging\/wp-content\/uploads\/2020\/04\/100blackmenlogo.png\" alt=\"logo\" width=\"250\" \/>[\/et_pb_fullwidth_code][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#000000&#8243; custom_padding=&#8221;0px||0px|||&#8221; global_module=&#8221;3511&#8243;][et_pb_row _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221;][et_pb_menu active_link_color=&#8221;#ffffff&#8221; _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221; menu_font=&#8221;|700|||||||&#8221; menu_text_color=&#8221;#ffffff&#8221; menu_font_size=&#8221;20px&#8221; background_color=&#8221;#000000&#8243; text_orientation=&#8221;center&#8221;][\/et_pb_menu][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; admin_label=&#8221;section&#8221; _builder_version=&#8221;3.22&#8243; custom_padding=&#8221;0px|||||&#8221;][et_pb_row admin_label=&#8221;row&#8221; _builder_version=&#8221;3.25&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;3.25&#8243; custom_padding=&#8221;|||&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text admin_label=&#8221;Text&#8221; _builder_version=&#8221;4.6.1&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; hover_enabled=&#8221;0&#8243; sticky_enabled=&#8221;0&#8243;]<p style=\"text-align: center;\">\n<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/100blackmenlasvegas.org\/wp-content\/uploads\/2020\/09\/crossroads-e1601515877233.png\" alt=\"Cross Roads\" itemprop=\"image\" height=\"229\" width=\"300\" title=\"crossroads\" onerror=\"this.style.display='none'\" \/><\/p>\n<p style=\"text-align: center;\"><strong>New CrossRoads Participant request form.<\/strong><\/p>\n<p style=\"text-align: center;\">Please fill out all text fields below this is <strong>required<\/strong> information.<\/p>\n<div class=\"formContainer\"><p style=\"text-align: center;\"><div role=\"form\" class=\"wpcf7\" id=\"wpcf7-f3795-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/staging\/wp-json\/wp\/v2\/pages\/2824#wpcf7-f3795-o1\" method=\"post\" class=\"wpcf7-form init\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"3795\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.3.2\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f3795-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<p>\n<label> Name of Participant: (required)<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap participant-name\"><input type=\"text\" name=\"participant-name\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"participant-name\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Enter Name of Participant (Required)...\" \/><\/span><\/p>\n<p><label> Age: (required)<\/label><br \/>\n    <span class=\"wpcf7-form-control-wrap participant-age\"><input type=\"text\" name=\"participant-age\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"participant-age\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Enter ages 13 to 16 (7th to 10th grade) (Required)...\" \/><\/span><\/p>\n<p><label> Select Male\/Female: (required)<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap radio-gender\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"radio-gender\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Male<\/span><input type=\"radio\" name=\"radio-gender\" value=\"Male\" checked=\"checked\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">Female<\/span><input type=\"radio\" name=\"radio-gender\" value=\"Female\" \/><\/span><\/span><\/span><\/p>\n<p><label> School:<br \/>\n    <span class=\"wpcf7-form-control-wrap participant-school\"><input type=\"text\" name=\"participant-school\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"participant-school\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Enter School name (Required)...\" \/><\/span><\/label><\/p>\n<p><label>Parent\/Legal Guardian Contact Information:<br \/>\n<span class=\"wpcf7-form-control-wrap participant-guardian\"><input type=\"text\" name=\"participant-guardian\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"participant-guardian\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Enter Parent\/Legal Guardian (Required)...\" \/><\/span><\/label><\/p>\n<p><span class=\"wpcf7-form-control-wrap participant-tel\"><input type=\"text\" name=\"participant-tel\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"participant-age\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Enter Phone number (Required)...\" \/><\/span><\/p>\n<p><span class=\"wpcf7-form-control-wrap participant-email\"><input type=\"email\" name=\"participant-email\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email\" id=\"participant-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Enter Email address (Required)...\" \/><\/span><\/p>\n<p><label> Address: (required)<br \/>\n<span class=\"wpcf7-form-control-wrap participant-address\"><input type=\"text\" name=\"participant-address\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"participant-address\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Enter Participant Address (Required)...\" \/><\/span><\/label><\/p>\n<p><span class=\"wpcf7-form-control-wrap participant-state\"><input type=\"text\" name=\"participant-state\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"participant-state\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Enter State (Required)...\" \/><\/span><\/p>\n<p><span class=\"wpcf7-form-control-wrap participant-zipcode\"><input type=\"text\" name=\"participant-zipcode\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" id=\"participant-zipcode\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Enter Zip Code (Required)...\" \/><\/span><\/p>\n<p><label>Additional Information:<br \/>\n<span class=\"wpcf7-form-control-wrap textarea-mentoringneeds\"><textarea name=\"textarea-mentoringneeds\" cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"textarea-mentoringneeds\" aria-invalid=\"false\" placeholder=\"Enter Mentoring Needs...\"><\/textarea><\/span><\/label><\/p>\n<p><span class=\"wpcf7-form-control-wrap textarea-expectations\"><textarea name=\"textarea-expectations\" cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"textarea-expectations\" aria-invalid=\"false\" placeholder=\"Enter Expectations of Program...\"><\/textarea><\/span><\/p>\n<p><span class=\"wpcf7-form-control-wrap textarea-challenges\"><textarea name=\"textarea-challenges\" cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"textarea-challenges\" aria-invalid=\"false\" placeholder=\"Enter Academic\/Behavioral Challenges...\"><\/textarea><\/span><\/p>\n<p><P><label>Do you have a computer or device and Wi fi access for virtual mentoring and training?<\/label><br\/><br \/>\n<span class=\"wpcf7-form-control-wrap radio-computer\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"radio-computer\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Yes<\/span><input type=\"radio\" name=\"radio-computer\" value=\"Yes\" checked=\"checked\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">No<\/span><input type=\"radio\" name=\"radio-computer\" value=\"No\" \/><\/span><\/span><\/span><\/p>\n<p><center><label>mentoring@100bmlv.org<br\/>(702)720-1273<\/label><\/center><\/p>\n<p><input type=\"submit\" value=\"Send\" class=\"wpcf7-form-control wpcf7-submit\" id=\"submit\" \/><\/p>\n<div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div><\/form><\/div><\/p><\/div>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]","protected":false},"excerpt":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; module_id=&#8221;header-content&#8221; _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#000000&#8243; custom_padding=&#8221;0px||0px|||&#8221; global_module=&#8221;3133&#8243; saved_tabs=&#8221;all&#8221;][et_pb_row column_structure=&#8221;1_4,1_4,1_4,1_4&#8243; _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;10px||10px||true|false&#8221;][et_pb_column type=&#8221;1_4&#8243; _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221;][et_pb_code _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221; text_orientation=&#8221;center&#8221;] (702) 720-1273[\/et_pb_code][\/et_pb_column][et_pb_column type=&#8221;1_4&#8243; _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221;][et_pb_text _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221; text_text_color=&#8221;#ffffff&#8221; custom_margin=&#8221;|-20px||-20px|false|true&#8221;] info@100blackmenlasvegas.org [\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_4&#8243; _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221;][et_pb_code _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221;] Follow Follow Follow [\/et_pb_code][\/et_pb_column][et_pb_column type=&#8221;1_4&#8243; _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221;][et_pb_button button_url=&#8221;https:\/\/www.paypal.com\/donate?hosted_button_id=M54G2XX4MF8Q2&#8243; url_new_window=&#8221;on&#8221; button_text=&#8221;DONATE&#8221; _builder_version=&#8221;4.6.1&#8243; _module_preset=&#8221;default&#8221; custom_button=&#8221;on&#8221; button_text_size=&#8221;16px&#8221; button_text_color=&#8221;#000000&#8243; button_bg_color=&#8221;#ffcc66&#8243; button_border_width=&#8221;0px&#8221; button_border_radius=&#8221;0px&#8221; button_font=&#8221;|600|||||||&#8221; button_icon=&#8221;%%20%%&#8221; [&hellip;]<\/p>\n","protected":false},"author":15,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"<!-- wp:fl-builder\/layout -->\n<img src=\"https:\/\/100blackmenlasvegas.org\/wp-content\/uploads\/2020\/09\/crossroads-e1601515877233.png\" alt=\"Cross Roads\" itemprop=\"image\" height=\"229\" width=\"300\" title=\"crossroads\" onerror=\"this.style.display='none'\">\n\t<p><strong>New CrossRoads Participant request form.<\/strong><\/p>\n<p>Please fill out all text fields below this is <strong>required<\/strong> information.<\/p>\n<p>[contact-form-7 id=\"2823\" title=\"CrossRoads Signup\"]<\/p>\n<!-- \/wp:fl-builder\/layout -->","_et_gb_content_width":"","footnotes":""},"class_list":["post-2824","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/100blackmenlasvegas.org\/staging\/wp-json\/wp\/v2\/pages\/2824","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/100blackmenlasvegas.org\/staging\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/100blackmenlasvegas.org\/staging\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/100blackmenlasvegas.org\/staging\/wp-json\/wp\/v2\/users\/15"}],"replies":[{"embeddable":true,"href":"https:\/\/100blackmenlasvegas.org\/staging\/wp-json\/wp\/v2\/comments?post=2824"}],"version-history":[{"count":20,"href":"https:\/\/100blackmenlasvegas.org\/staging\/wp-json\/wp\/v2\/pages\/2824\/revisions"}],"predecessor-version":[{"id":3804,"href":"https:\/\/100blackmenlasvegas.org\/staging\/wp-json\/wp\/v2\/pages\/2824\/revisions\/3804"}],"wp:attachment":[{"href":"https:\/\/100blackmenlasvegas.org\/staging\/wp-json\/wp\/v2\/media?parent=2824"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}