{"id":229,"date":"2023-09-05T23:44:32","date_gmt":"2023-09-05T16:44:32","guid":{"rendered":"http:\/\/caroomandboardcoalition.org\/?page_id=229"},"modified":"2025-10-16T10:03:35","modified_gmt":"2025-10-16T18:03:35","slug":"register","status":"publish","type":"page","link":"https:\/\/caroomandboardcoalition.org\/es\/register\/","title":{"rendered":"Register"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"229\" class=\"elementor elementor-229\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e5669a4 e-flex e-con-boxed e-con e-parent\" data-id=\"e5669a4\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-aecefc6 elementor-widget elementor-widget-text-editor\" data-id=\"aecefc6\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><em>This is a free trial membership. You will not be charged during the trial period, and renewal is not automatic. We&#8217;ll notify you when paid membership options become available.<\/em><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-ee9990b e-flex e-con-boxed e-con e-parent\" data-id=\"ee9990b\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-fe2b4ef elementor-widget elementor-widget-shortcode\" data-id=\"fe2b4ef\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">        <form enctype=\"multipart\/form-data\" method=\"post\" id=\"wppb-register-user\" class=\"wppb-user-forms wppb-register-user wppb-user-logged-out\" action=\"https:\/\/caroomandboardcoalition.org\/es\/wp-json\/wp\/v2\/pages\/229\" data-trp-original-action=\"https:\/\/caroomandboardcoalition.org\/es\/wp-json\/wp\/v2\/pages\/229\">\n\t\t\t<ul><li class=\"wppb-form-field wppb-heading\" id=\"wppb-form-element-19\"><h1 class=\"extra_field_heading\">California Room &amp; Board Coalition\u00a9 <br> Member Application Package<\/h1><span class=\"wppb-description-delimiter\">Coalition Membership demonstrates your willingness to maintain housing that is healthy, safe, well- managed, and provides an environment conducive to the wellness and recovery of hospital or Behavioral Health consumers and others. Once you have met all of the membership requirements, your facility will be evaluated, then placed on the California Room &amp; Board Coalition\u00a9 subscriber database to be used as a resource by hospitals, socials workers, Behavioral Health Providers and other interested parties. Please provide requested information.\n\n<\/span><\/li><li class=\"wppb-form-field wppb-heading\" id=\"wppb-form-element-21\"><h3 class=\"extra_field_heading\">CONFLICT OF INTEREST DISCLOSURE STATEMENT<\/h3><span class=\"wppb-description-delimiter\">The purpose of this disclosure statement is to identify, address, and resolve any employment, activity or enterprise that may be inconsistent, incompatible, or in conflict with the duties of a Room &amp; Board Operator associated with the California Room &amp; Board Coalition\u00a9.<\/span><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-22\">\n\t\t\t\t<label for=\"pb_coalition_member_name\">Coalition Member Name<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_coalition_member_name\" maxlength=\"250\" type=\"text\" id=\"pb_coalition_member_name\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-23\">\n\t\t\t\t<label for=\"pb_position\">Position<\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_position\" maxlength=\"250\" type=\"text\" id=\"pb_position\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-24\">\n\t\t\t\t<label for=\"pb_rb_name\">Facility Name<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_rb_name\" maxlength=\"250\" type=\"text\" id=\"pb_rb_name\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-phone\" id=\"wppb-form-element-25\"><\/li><li class=\"wppb-form-field wppb-heading\" id=\"wppb-form-element-10\"><h3 class=\"extra_field_heading\">Facility Address:<\/h3><span class=\"wppb-description-delimiter\"><\/span><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-26\">\n\t\t\t\t<label for=\"pb_address1\">Address line 1<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_address1\" maxlength=\"250\" type=\"text\" id=\"pb_address1\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-27\">\n\t\t\t\t<label for=\"pb_address2\">Address line 2<\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_address2\" maxlength=\"250\" type=\"text\" id=\"pb_address2\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-28\">\n\t\t\t\t<label for=\"pb_city\">City<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_city\" maxlength=\"250\" type=\"text\" id=\"pb_city\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-29\">\n\t\t\t\t<label for=\"pb_state\">State<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_state\" maxlength=\"250\" type=\"text\" id=\"pb_state\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-number\" id=\"wppb-form-element-30\"><\/li><li class=\"wppb-form-field wppb-select\" id=\"wppb-form-element-31\">\n\t\t\t\t<label for=\"pb_employed\">Are you currently employed by (or contracted to provide services for) any California Behavioral Health Organization and\/or Alcohol and Drug Program?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<select name=\"pb_employed\" id=\"pb_employed\" class=\"custom_field_select\" ><option value=\"Yes\" class=\"custom_field_select_option\" >Yes<\/option><option value=\"No\" class=\"custom_field_select_option\" >No<\/option>\n\t\t\t\t<\/select><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-33\">\n\t\t\t\t<label for=\"pb_specify_employed\">Please Specify<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_specify_employed\" maxlength=\"250\" type=\"text\" id=\"pb_specify_employed\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-heading\" id=\"wppb-form-element-7\"><h3 class=\"extra_field_heading\">OPERATOR INFORMATION<\/h3><span class=\"wppb-description-delimiter\"><h4>Owner\/Operator\u2019s Name(s):<\/h4> <\/span><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-46\">\n\t\t\t\t<label for=\"pb_first_name_operator\">First Name<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_first_name_operator\" maxlength=\"250\" type=\"text\" id=\"pb_first_name_operator\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-47\">\n\t\t\t\t<label for=\"pb_last_name_operator\">Last Name<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_last_name_operator\" maxlength=\"250\" type=\"text\" id=\"pb_last_name_operator\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-heading\" id=\"wppb-form-element-139\"><h4 class=\"extra_field_heading\">Contact Information<\/h4><span class=\"wppb-description-delimiter\"><\/span><\/li><li class=\"wppb-form-field wppb-email\" id=\"wppb-form-element-49\"><\/li><li class=\"wppb-form-field wppb-phone\" id=\"wppb-form-element-50\"><\/li><li class=\"wppb-form-field wppb-phone\" id=\"wppb-form-element-51\"><\/li><li class=\"wppb-form-field wppb-heading\" id=\"wppb-form-element-52\"><h3 class=\"extra_field_heading\">On-site Manager\u2019s Contact Information<\/h3><span class=\"wppb-description-delimiter\"><\/span><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-53\">\n\t\t\t\t<label for=\"facility_name\">Facility Name<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"facility_name\" maxlength=\"250\" type=\"text\" id=\"facility_name\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-54\">\n\t\t\t\t<label for=\"facility_address_room1\">Facility Address<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"facility_address_room1\" maxlength=\"250\" type=\"text\" id=\"facility_address_room1\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-55\">\n\t\t\t\t<label for=\"pb_room_address2\">Address line 2<\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_room_address2\" maxlength=\"250\" type=\"text\" id=\"pb_room_address2\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-56\">\n\t\t\t\t<label for=\"pb_city_room\">City<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_city_room\" maxlength=\"250\" type=\"text\" id=\"pb_city_room\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-57\">\n\t\t\t\t<label for=\"pb_state_room\">State<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_state_room\" maxlength=\"250\" type=\"text\" id=\"pb_state_room\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-number\" id=\"wppb-form-element-58\"><\/li><li class=\"wppb-form-field wppb-select\" id=\"wppb-form-element-59\">\n\t\t\t\t<label for=\"pb_mailing_address\">Mailing Address<\/label>\n\t\t\t\t<select name=\"pb_mailing_address\" id=\"pb_mailing_address\" class=\"custom_field_select\" ><option value=\"Same as Facility Address\" class=\"custom_field_select_option\" >Same as Facility Address<\/option><option value=\"Different address from the Facility Address\" class=\"custom_field_select_option\" >Different address from the Facility Address<\/option>\n\t\t\t\t<\/select><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-60\">\n\t\t\t\t<label for=\"pb_address_room_mail\">Address line 1<\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_address_room_mail\" maxlength=\"250\" type=\"text\" id=\"pb_address_room_mail\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-61\">\n\t\t\t\t<label for=\"pb_address_room_mail2\">Address line 2<\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_address_room_mail2\" maxlength=\"250\" type=\"text\" id=\"pb_address_room_mail2\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-62\">\n\t\t\t\t<label for=\"pb_city_room_mail\">City<\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_city_room_mail\" maxlength=\"250\" type=\"text\" id=\"pb_city_room_mail\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-63\">\n\t\t\t\t<label for=\"pb_state_room_mail\">State<\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_state_room_mail\" maxlength=\"250\" type=\"text\" id=\"pb_state_room_mail\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-number\" id=\"wppb-form-element-64\"><\/li><li class=\"wppb-form-field wppb-heading\" id=\"wppb-form-element-65\"><h3 class=\"extra_field_heading\">FACILITY INFORMATION<\/h3><span class=\"wppb-description-delimiter\"><\/span><\/li><li class=\"wppb-form-field wppb-select\" id=\"wppb-form-element-17\">\n\t\t\t\t<label for=\"pb_type_home\">Type of Facility<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<select name=\"pb_type_home\" id=\"pb_type_home\" class=\"custom_field_select\" ><option value=\"House\" class=\"custom_field_select_option\"  selected>House<\/option><option value=\"Apartment Building\" class=\"custom_field_select_option\" >Apartment Building<\/option><option value=\"Other (Specify)\" class=\"custom_field_select_option\" >Other (Specify)<\/option>\n\t\t\t\t<\/select><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-18\">\n\t\t\t\t<label for=\"pb_specific_home\">Specification<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_specific_home\" maxlength=\"250\" type=\"text\" id=\"pb_specific_home\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-heading\" id=\"wppb-form-element-66\"><h4 class=\"extra_field_heading\">Facilities<\/h4><span class=\"wppb-description-delimiter\"><\/span><\/li><li class=\"wppb-form-field wppb-number\" id=\"wppb-form-element-67\"><\/li><li class=\"wppb-form-field wppb-number\" id=\"wppb-form-element-68\"><\/li><li class=\"wppb-form-field wppb-select\" id=\"wppb-form-element-69\">\n\t\t\t\t<label for=\"pb_kitchen\">Do you have Kitchen?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<select name=\"pb_kitchen\" id=\"pb_kitchen\" class=\"custom_field_select\" ><option value=\"Yes\" class=\"custom_field_select_option\" >Yes<\/option><option value=\"No If no who cooks ?\" class=\"custom_field_select_option\" >No If no who cooks ?<\/option>\n\t\t\t\t<\/select><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-70\">\n\t\t\t\t<label for=\"pb_spectific_kitchen\">Specification for No.<\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_spectific_kitchen\" maxlength=\"250\" type=\"text\" id=\"pb_spectific_kitchen\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-heading\" id=\"wppb-form-element-71\"><h4 class=\"extra_field_heading\">Resident Capacity<\/h4><span class=\"wppb-description-delimiter\"><\/span><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-72\">\n\t\t\t\t<label for=\"pb_resident_capacity\">Total Resident Capacity<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_resident_capacity\" maxlength=\"250\" type=\"text\" id=\"pb_resident_capacity\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-number\" id=\"wppb-form-element-73\"><\/li><li class=\"wppb-form-field wppb-checkbox\" id=\"wppb-form-element-74\">\n\t\t\t\t<label for=\"pb_accommodate\">Accommodate<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label><ul class=\"wppb-checkboxes\"><li class=\"wppb-hidden\"><input type=\"hidden\" value=\"\" name=\"pb_accommodate\"><\/li><li><input value=\"Male\" class=\"custom_field_checkbox\" name=\"pb_accommodate[]\" id=\"male_74\" type=\"checkbox\"   \/><label for=\"male_74\" class=\"wppb-rc-value\">Male<\/label><\/li><li><input value=\"Female\" class=\"custom_field_checkbox\" name=\"pb_accommodate[]\" id=\"female_74\" type=\"checkbox\"   \/><label for=\"female_74\" class=\"wppb-rc-value\">Female<\/label><\/li><li><input value=\"Co-ed\" class=\"custom_field_checkbox\" name=\"pb_accommodate[]\" id=\"co-ed_74\" type=\"checkbox\"   \/><label for=\"co-ed_74\" class=\"wppb-rc-value\">Co-ed<\/label><\/li><li><input value=\"Seniors\" class=\"custom_field_checkbox\" name=\"pb_accommodate[]\" id=\"seniors_74\" type=\"checkbox\"   \/><label for=\"seniors_74\" class=\"wppb-rc-value\">Seniors<\/label><\/li><li><input value=\"LGBTQ\" class=\"custom_field_checkbox\" name=\"pb_accommodate[]\" id=\"lgbtq_74\" type=\"checkbox\"   \/><label for=\"lgbtq_74\" class=\"wppb-rc-value\">LGBTQ<\/label><\/li><li><input value=\"Private\" class=\"custom_field_checkbox\" name=\"pb_accommodate[]\" id=\"private_74\" type=\"checkbox\"   \/><label for=\"private_74\" class=\"wppb-rc-value\">Private<\/label><\/li><li><input value=\"Shared\" class=\"custom_field_checkbox\" name=\"pb_accommodate[]\" id=\"shared_74\" type=\"checkbox\"   \/><label for=\"shared_74\" class=\"wppb-rc-value\">Shared<\/label><\/li><li><input value=\"Families\" class=\"custom_field_checkbox\" name=\"pb_accommodate[]\" id=\"families_74\" type=\"checkbox\"   \/><label for=\"families_74\" class=\"wppb-rc-value\">Families<\/label><\/li><li><input value=\"Children friendly\" class=\"custom_field_checkbox\" name=\"pb_accommodate[]\" id=\"children-friendly_74\" type=\"checkbox\"   \/><label for=\"children-friendly_74\" class=\"wppb-rc-value\">Children friendly<\/label><\/li><li><input value=\"Couples\" class=\"custom_field_checkbox\" name=\"pb_accommodate[]\" id=\"couples_74\" type=\"checkbox\"   \/><label for=\"couples_74\" class=\"wppb-rc-value\">Couples<\/label><\/li><li><input value=\"College Students\" class=\"custom_field_checkbox\" name=\"pb_accommodate[]\" id=\"college-students_74\" type=\"checkbox\"   \/><label for=\"college-students_74\" class=\"wppb-rc-value\">College Students<\/label><\/li><\/ul><span class=\"wppb-description-delimiter\">Select all populations your home accommodates. <\/span><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-75\">\n\t\t\t\t<label for=\"pb_rental\">Monthly Rental per Person<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_rental\" maxlength=\"250\" type=\"text\" id=\"pb_rental\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-datepicker\" id=\"wppb-form-element-76\"><\/li><li class=\"wppb-form-field wppb-textarea\" id=\"wppb-form-element-144\">\n\t\t\t\t<label for=\"unusual_reporting\">What is your incident reporting process?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<textarea rows=\"5\" name=\"unusual_reporting\" maxlength=\"\" class=\"custom_field_textarea\" id=\"unusual_reporting\" wrap=\"virtual\" ><\/textarea><\/li><li class=\"wppb-form-field wppb-upload\" id=\"wppb-form-element-145\"><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-146\">\n\t\t\t\t<label for=\"bed_retention\">What is your bed retention policy?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"bed_retention\" maxlength=\"250\" type=\"text\" id=\"bed_retention\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-select\" id=\"wppb-form-element-77\">\n\t\t\t\t<label for=\"pb_receipt\">Tenant Agreement<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<select name=\"pb_receipt\" id=\"pb_receipt\" class=\"custom_field_select\" ><option value=\"Yes\" class=\"custom_field_select_option\" >Yes<\/option><option value=\"No\" class=\"custom_field_select_option\" >No<\/option>\n\t\t\t\t<\/select><\/li><li class=\"wppb-form-field wppb-upload\" id=\"wppb-form-element-78\"><\/li><li class=\"wppb-form-field wppb-heading\" id=\"wppb-form-element-79\"><h4 class=\"extra_field_heading\">What are the Progressive Disciplinary Actions? <\/h4><span class=\"wppb-description-delimiter\"><\/span><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-80\">\n\t\t\t\t<label for=\"pb_first_offense\">First Offense<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_first_offense\" maxlength=\"250\" type=\"text\" id=\"pb_first_offense\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-81\">\n\t\t\t\t<label for=\"pb_second_offense\">Second Offense<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_second_offense\" maxlength=\"250\" type=\"text\" id=\"pb_second_offense\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-82\">\n\t\t\t\t<label for=\"pb_third_offense\">Third Offense<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_third_offense\" maxlength=\"250\" type=\"text\" id=\"pb_third_offense\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-83\">\n\t\t\t\t<label for=\"pb_Fourth_offense\">Fourth Offense<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_Fourth_offense\" maxlength=\"250\" type=\"text\" id=\"pb_Fourth_offense\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-84\">\n\t\t\t\t<label for=\"pb_circumstances\">What are the Terms and Conditions for Eviction? ( FAQs )<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_circumstances\" maxlength=\"250\" type=\"text\" id=\"pb_circumstances\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-heading\" id=\"wppb-form-element-85\"><h4 class=\"extra_field_heading\">Deaf and Hard of Hearing \/ ADA Friendly<\/h4><span class=\"wppb-description-delimiter\"><\/span><\/li><li class=\"wppb-form-field wppb-select\" id=\"wppb-form-element-86\">\n\t\t\t\t<label for=\"pb_aslada_friendly\">Is your accommodation ASL and ADA friendly?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<select name=\"pb_aslada_friendly\" id=\"pb_aslada_friendly\" class=\"custom_field_select\" ><option value=\"Yes\" class=\"custom_field_select_option\" >Yes<\/option><option value=\"No\" class=\"custom_field_select_option\" >No<\/option>\n\t\t\t\t<\/select><\/li><li class=\"wppb-form-field wppb-upload\" id=\"wppb-form-element-90\"><\/li><li class=\"wppb-form-field wppb-html\" id=\"wppb-form-element-147\"><\/li><li class=\"wppb-form-field wppb-html\" id=\"wppb-form-element-92\"><\/li><li class=\"wppb-form-field wppb-heading\" id=\"wppb-form-element-93\"><h3 class=\"extra_field_heading\">HOUSE AMENITIES AND RESPONSIBILITIES<\/h3><span class=\"wppb-description-delimiter\"><\/span><\/li><li class=\"wppb-form-field wppb-radio\" id=\"wppb-form-element-94\">\n\t\t\t\t<label for=\"pb_chores\">Are residents assigned chores?<\/label><ul class=\"wppb-radios\"><li><input value=\"Yes\" class=\"custom_field_radio\" id=\"yes_94\" name=\"pb_chores\" type=\"radio\"   \/><label for=\"yes_94\" class=\"wppb-rc-value\">Yes<\/label><\/li><li><input value=\"No\" class=\"custom_field_radio\" id=\"no_94\" name=\"pb_chores\" type=\"radio\"   \/><label for=\"no_94\" class=\"wppb-rc-value\">No<\/label><\/li><\/ul><\/li><li class=\"wppb-form-field wppb-radio\" id=\"wppb-form-element-95\">\n\t\t\t\t<label for=\"pb_visitor\">Are visitors allowed?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label><ul class=\"wppb-radios\"><li><input value=\"Yes\" class=\"custom_field_radio\" id=\"yes_95\" name=\"pb_visitor\" type=\"radio\"   \/><label for=\"yes_95\" class=\"wppb-rc-value\">Yes<\/label><\/li><li><input value=\"No\" class=\"custom_field_radio\" id=\"no_95\" name=\"pb_visitor\" type=\"radio\"   \/><label for=\"no_95\" class=\"wppb-rc-value\">No<\/label><\/li><\/ul><\/li><li class=\"wppb-form-field wppb-textarea\" id=\"wppb-form-element-96\">\n\t\t\t\t<label for=\"pb_rules_visit\">What are the rules\/policies regarding visitation?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<textarea rows=\"3\" name=\"pb_rules_visit\" maxlength=\"\" class=\"custom_field_textarea\" id=\"pb_rules_visit\" wrap=\"virtual\" ><\/textarea><\/li><li class=\"wppb-form-field wppb-radio\" id=\"wppb-form-element-97\">\n\t\t\t\t<label for=\"pb_curfew\">Is there a curfew?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label><ul class=\"wppb-radios\"><li><input value=\"Yes\" class=\"custom_field_radio\" id=\"yes_97\" name=\"pb_curfew\" type=\"radio\"   \/><label for=\"yes_97\" class=\"wppb-rc-value\">Yes<\/label><\/li><li><input value=\"No\" class=\"custom_field_radio\" id=\"no_97\" name=\"pb_curfew\" type=\"radio\"   \/><label for=\"no_97\" class=\"wppb-rc-value\">No<\/label><\/li><\/ul><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-98\">\n\t\t\t\t<label for=\"pb_curfew_yes\">If yes, what time is the curfew?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_curfew_yes\" maxlength=\"250\" type=\"text\" id=\"pb_curfew_yes\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-radio\" id=\"wppb-form-element-99\">\n\t\t\t\t<label for=\"pb_meal\">Are meals Included?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label><ul class=\"wppb-radios\"><li><input value=\"Yes\" class=\"custom_field_radio\" id=\"yes_99\" name=\"pb_meal\" type=\"radio\"   \/><label for=\"yes_99\" class=\"wppb-rc-value\">Yes<\/label><\/li><li><input value=\"No\" class=\"custom_field_radio\" id=\"no_99\" name=\"pb_meal\" type=\"radio\"   \/><label for=\"no_99\" class=\"wppb-rc-value\">No<\/label><\/li><\/ul><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-100\">\n\t\t\t\t<label for=\"pb_meals_per_day\">How many meals per day?<\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_meals_per_day\" maxlength=\"250\" type=\"text\" id=\"pb_meals_per_day\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-radio\" id=\"wppb-form-element-101\">\n\t\t\t\t<label for=\"pb_snack\">Snacks included?<\/label><ul class=\"wppb-radios\"><li><input value=\"Yes\" class=\"custom_field_radio\" id=\"yes_101\" name=\"pb_snack\" type=\"radio\"   \/><label for=\"yes_101\" class=\"wppb-rc-value\">Yes<\/label><\/li><li><input value=\"No\" class=\"custom_field_radio\" id=\"no_101\" name=\"pb_snack\" type=\"radio\"   \/><label for=\"no_101\" class=\"wppb-rc-value\">No<\/label><\/li><\/ul><\/li><li class=\"wppb-form-field wppb-radio\" id=\"wppb-form-element-102\">\n\t\t\t\t<label for=\"pb_secured\">Is there a secured area available for personal property?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label><ul class=\"wppb-radios\"><li><input value=\"Yes\" class=\"custom_field_radio\" id=\"yes_102\" name=\"pb_secured\" type=\"radio\"   \/><label for=\"yes_102\" class=\"wppb-rc-value\">Yes<\/label><\/li><li><input value=\"No\" class=\"custom_field_radio\" id=\"no_102\" name=\"pb_secured\" type=\"radio\"   \/><label for=\"no_102\" class=\"wppb-rc-value\">No<\/label><\/li><\/ul><\/li><li class=\"wppb-form-field wppb-radio\" id=\"wppb-form-element-103\">\n\t\t\t\t<label for=\"pb_smoking\">Smoking allowed?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label><ul class=\"wppb-radios\"><li><input value=\"Yes\" class=\"custom_field_radio\" id=\"yes_103\" name=\"pb_smoking\" type=\"radio\"   \/><label for=\"yes_103\" class=\"wppb-rc-value\">Yes<\/label><\/li><li><input value=\"No\" class=\"custom_field_radio\" id=\"no_103\" name=\"pb_smoking\" type=\"radio\"   \/><label for=\"no_103\" class=\"wppb-rc-value\">No<\/label><\/li><\/ul><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-104\">\n\t\t\t\t<label for=\"pb_where_smoking\">If yes, where can residents smoke?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_where_smoking\" maxlength=\"250\" type=\"text\" id=\"pb_where_smoking\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-radio\" id=\"wppb-form-element-105\">\n\t\t\t\t<label for=\"pb_access_phone\">Do residents have access to a telephone?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label><ul class=\"wppb-radios\"><li><input value=\"Yes\" class=\"custom_field_radio\" id=\"yes_105\" name=\"pb_access_phone\" type=\"radio\"   \/><label for=\"yes_105\" class=\"wppb-rc-value\">Yes<\/label><\/li><li><input value=\"No\" class=\"custom_field_radio\" id=\"no_105\" name=\"pb_access_phone\" type=\"radio\"   \/><label for=\"no_105\" class=\"wppb-rc-value\">No<\/label><\/li><\/ul><\/li><li class=\"wppb-form-field wppb-radio\" id=\"wppb-form-element-106\">\n\t\t\t\t<label for=\"pb_rule_phone\">Are there specific rules that govern the use of phones?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label><ul class=\"wppb-radios\"><li><input value=\"Yes\" class=\"custom_field_radio\" id=\"yes_106\" name=\"pb_rule_phone\" type=\"radio\"   \/><label for=\"yes_106\" class=\"wppb-rc-value\">Yes<\/label><\/li><li><input value=\"No\" class=\"custom_field_radio\" id=\"no_106\" name=\"pb_rule_phone\" type=\"radio\"   \/><label for=\"no_106\" class=\"wppb-rc-value\">No<\/label><\/li><\/ul><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-107\">\n\t\t\t\t<label for=\"pb_distance_transportation\">What is the distance to the nearest public transportation?<\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_distance_transportation\" maxlength=\"250\" type=\"text\" id=\"pb_distance_transportation\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-radio\" id=\"wppb-form-element-142\">\n\t\t\t\t<label for=\"Pet_Friendly\">Pet Friendly?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label><ul class=\"wppb-radios\"><li><input value=\"Yes\" class=\"custom_field_radio\" id=\"yes_142\" name=\"Pet_Friendly\" type=\"radio\"   \/><label for=\"yes_142\" class=\"wppb-rc-value\">Yes<\/label><\/li><li><input value=\"No\" class=\"custom_field_radio\" id=\"no_142\" name=\"Pet_Friendly\" type=\"radio\"   \/><label for=\"no_142\" class=\"wppb-rc-value\">No<\/label><\/li><\/ul><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-143\">\n\t\t\t\t<label for=\"pet_friendly_detail\">Size \/ Kind \/ Number of Pets<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pet_friendly_detail\" maxlength=\"250\" type=\"text\" id=\"pet_friendly_detail\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-heading\" id=\"wppb-form-element-108\"><h5 class=\"extra_field_heading\">AMENITIES<\/h5><span class=\"wppb-description-delimiter\"><\/span><\/li><li class=\"wppb-form-field wppb-radio\" id=\"wppb-form-element-109\">\n\t\t\t\t<label for=\"pb_linens_towels\">Are linens and\/or towels provided?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label><ul class=\"wppb-radios\"><li><input value=\"Yes\" class=\"custom_field_radio\" id=\"yes_109\" name=\"pb_linens_towels\" type=\"radio\"   \/><label for=\"yes_109\" class=\"wppb-rc-value\">Yes<\/label><\/li><li><input value=\"No\" class=\"custom_field_radio\" id=\"no_109\" name=\"pb_linens_towels\" type=\"radio\"   \/><label for=\"no_109\" class=\"wppb-rc-value\">No<\/label><\/li><\/ul><\/li><li class=\"wppb-form-field wppb-radio\" id=\"wppb-form-element-110\">\n\t\t\t\t<label for=\"pb_toiletries_provided\">Are toiletries provided? (Shampoo, conditioner, soap, etc.)<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label><ul class=\"wppb-radios\"><li><input value=\"Yes\" class=\"custom_field_radio\" id=\"yes_110\" name=\"pb_toiletries_provided\" type=\"radio\"   \/><label for=\"yes_110\" class=\"wppb-rc-value\">Yes<\/label><\/li><li><input value=\"No\" class=\"custom_field_radio\" id=\"no_110\" name=\"pb_toiletries_provided\" type=\"radio\"   \/><label for=\"no_110\" class=\"wppb-rc-value\">No<\/label><\/li><\/ul><\/li><li class=\"wppb-form-field wppb-radio\" id=\"wppb-form-element-111\">\n\t\t\t\t<label for=\"pb_toilet_paper\">Is toilet paper provided?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label><ul class=\"wppb-radios\"><li><input value=\"Yes\" class=\"custom_field_radio\" id=\"yes_111\" name=\"pb_toilet_paper\" type=\"radio\"   \/><label for=\"yes_111\" class=\"wppb-rc-value\">Yes<\/label><\/li><li><input value=\"No\" class=\"custom_field_radio\" id=\"no_111\" name=\"pb_toilet_paper\" type=\"radio\"   \/><label for=\"no_111\" class=\"wppb-rc-value\">No<\/label><\/li><\/ul><\/li><li class=\"wppb-form-field wppb-select\" id=\"wppb-form-element-112\">\n\t\t\t\t<label for=\"pb_washer_dryer\">Are washer and dryer available for resident use?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<select name=\"pb_washer_dryer\" id=\"pb_washer_dryer\" class=\"custom_field_select\" ><option value=\"Yes\" class=\"custom_field_select_option\" >Yes<\/option><option value=\"No\" class=\"custom_field_select_option\" >No<\/option>\n\t\t\t\t<\/select><\/li><li class=\"wppb-form-field wppb-select\" id=\"wppb-form-element-113\">\n\t\t\t\t<label for=\"pb_time\">Is it available at all times?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<select name=\"pb_time\" id=\"pb_time\" class=\"custom_field_select\" ><option value=\"Yes\" class=\"custom_field_select_option\" >Yes<\/option><option value=\"No scheduling needed\" class=\"custom_field_select_option\" >No scheduling needed<\/option>\n\t\t\t\t<\/select><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-114\">\n\t\t\t\t<label for=\"pb_explain\">Explain why<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_explain\" maxlength=\"250\" type=\"text\" id=\"pb_explain\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-radio\" id=\"wppb-form-element-115\">\n\t\t\t\t<label for=\"pb_laundry\">Are laundry supplies provided?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label><ul class=\"wppb-radios\"><li><input value=\"Yes\" class=\"custom_field_radio\" id=\"yes_115\" name=\"pb_laundry\" type=\"radio\"   \/><label for=\"yes_115\" class=\"wppb-rc-value\">Yes<\/label><\/li><li><input value=\"No\" class=\"custom_field_radio\" id=\"no_115\" name=\"pb_laundry\" type=\"radio\"   \/><label for=\"no_115\" class=\"wppb-rc-value\">No<\/label><\/li><\/ul><\/li><li class=\"wppb-form-field wppb-select\" id=\"wppb-form-element-116\">\n\t\t\t\t<label for=\"pb_access_area\">Do residents have access to common areas in the Room &amp; Board (ex. living room, patio, pool, etc.)?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<select name=\"pb_access_area\" id=\"pb_access_area\" class=\"custom_field_select\" ><option value=\"Yes\" class=\"custom_field_select_option\" >Yes<\/option><option value=\"No\" class=\"custom_field_select_option\" >No<\/option>\n\t\t\t\t<\/select><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-117\">\n\t\t\t\t<label for=\"pb_rules_access\">What are the common area rules?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_rules_access\" maxlength=\"250\" type=\"text\" id=\"pb_rules_access\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-radio\" id=\"wppb-form-element-118\">\n\t\t\t\t<label for=\"pb_bed\">Does each bed have a mattress and box spring encasement to prevent the infestation of bed bugs?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label><ul class=\"wppb-radios\"><li><input value=\"Yes\" class=\"custom_field_radio\" id=\"yes_118\" name=\"pb_bed\" type=\"radio\"   \/><label for=\"yes_118\" class=\"wppb-rc-value\">Yes<\/label><\/li><li><input value=\"No\" class=\"custom_field_radio\" id=\"no_118\" name=\"pb_bed\" type=\"radio\"   \/><label for=\"no_118\" class=\"wppb-rc-value\">No<\/label><\/li><\/ul><\/li><li class=\"wppb-form-field wppb-upload\" id=\"wppb-form-element-120\"><\/li><li class=\"wppb-form-field wppb-heading\" id=\"wppb-form-element-121\"><h3 class=\"extra_field_heading\">HOUSE MANAGER INFO<\/h3><span class=\"wppb-description-delimiter\"><\/span><\/li><li class=\"wppb-form-field wppb-select\" id=\"wppb-form-element-122\">\n\t\t\t\t<label for=\"pb_house_manager\">Do you have a House Manager?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<select name=\"pb_house_manager\" id=\"pb_house_manager\" class=\"custom_field_select\" ><option value=\"Yes\" class=\"custom_field_select_option\" >Yes<\/option><option value=\"No\" class=\"custom_field_select_option\" >No<\/option>\n\t\t\t\t<\/select><\/li><li class=\"wppb-form-field wppb-select\" id=\"wppb-form-element-123\">\n\t\t\t\t<label for=\"pb_house_manager_alltime\">Is the operator\/house manager on premises at all times?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<select name=\"pb_house_manager_alltime\" id=\"pb_house_manager_alltime\" class=\"custom_field_select\" ><option value=\"Yes\" class=\"custom_field_select_option\" >Yes<\/option><option value=\"No\" class=\"custom_field_select_option\" >No<\/option>\n\t\t\t\t<\/select><\/li><li class=\"wppb-form-field wppb-html\" id=\"wppb-form-element-124\"><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-125\">\n\t\t\t\t<label for=\"pb_fname_owner\">First Name<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_fname_owner\" maxlength=\"250\" type=\"text\" id=\"pb_fname_owner\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-126\">\n\t\t\t\t<label for=\"pb_lname_ower\">Last Name<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"pb_lname_ower\" maxlength=\"250\" type=\"text\" id=\"pb_lname_ower\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-datepicker\" id=\"wppb-form-element-127\"><\/li><li class=\"wppb-form-field wppb-html\" id=\"wppb-form-element-128\"><\/li><li class=\"wppb-form-field wppb-email\" id=\"wppb-form-element-129\"><\/li><li class=\"wppb-form-field wppb-phone\" id=\"wppb-form-element-130\"><\/li><li class=\"wppb-form-field wppb-phone\" id=\"wppb-form-element-131\"><\/li><li class=\"wppb-form-field wppb-heading\" id=\"wppb-form-element-140\"><h4 class=\"extra_field_heading\">PHOTO RELEASE<\/h4><span class=\"wppb-description-delimiter\"><\/span><\/li><li class=\"wppb-form-field wppb-checkbox-terms-and-conditions\" id=\"wppb-form-element-132\"><\/li><li class=\"wppb-form-field wppb-heading\" id=\"wppb-form-element-133\"><h4 class=\"extra_field_heading\">RELEASE OF LIABILITY<\/h4><span class=\"wppb-description-delimiter\">(Insurance and Business License)\nAs an active member of the California Room and Board Coalition, I understand that it is my responsibility as the owner\/operator of the room and board facility indicated to provide evidence of licensing and\/or general liability insurance that properly identifies the property use as recommended.<br><\/span><\/li><li class=\"wppb-form-field wppb-checkbox-terms-and-conditions\" id=\"wppb-form-element-134\"><\/li><li class=\"wppb-form-field wppb-html\" id=\"wppb-form-element-135\"><\/li><li class=\"wppb-form-field wppb-html\" id=\"wppb-form-element-137\"><\/li><li class=\"wppb-form-field wppb-checkbox-terms-and-conditions\" id=\"wppb-form-element-136\"><\/li><li class=\"wppb-form-field wppb-heading\" id=\"wppb-form-element-1\"><h3 class=\"extra_field_heading\">Website Profile<\/h3><span class=\"wppb-description-delimiter\"><\/span><\/li><li class=\"wppb-form-field wppb-html\" id=\"wppb-form-element-141\"><\/li><li class=\"wppb-form-field wppb-default-username\" id=\"wppb-form-element-2\">\n\t\t\t<label for=\"username\">Username<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t<input class=\"text-input default_field_username\" name=\"username\" maxlength=\"70\" type=\"text\" id=\"username\" value=\"\"  \/><\/li><li class=\"wppb-form-field wppb-default-password\" id=\"wppb-form-element-12\">\n\t\t\t<label for=\"passw1\">Password<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n            <span class=\"wppb-password-field-container\">\n\t\t\t    <input class=\"text-input\" name=\"passw1\" maxlength=\"70\" type=\"password\" id=\"passw1\" value=\"\" autocomplete=\"off\" \/>\n\t\t\t    \n            <button type=\"button\" class=\"wppb-toggle-pw wppb-show-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\" tabindex=\"-1\">\n                <img decoding=\"async\" loading=\"lazy\" src=\"https:\/\/caroomandboardcoalition.org\/wp-content\/plugins\/profile-builder\/\/assets\/images\/eye-outline.svg\" title=\"Show password\" width=\"20px\" height=\"20px\" \/>\n            <\/button> <!-- add the HTML for the visibility toggle -->\n\t\t\t<\/span><span class=\"wppb-description-delimiter\">Minimum length of 10 characters. <br>The password must have a minimum strength of Strong<\/span><span id=\"pass-strength-result\">Strength indicator<\/span>\n        <input type=\"hidden\" value=\"\" name=\"wppb_password_strength\" id=\"wppb_password_strength\"\/><\/li><li class=\"wppb-form-field wppb-default-repeat-password\" id=\"wppb-form-element-13\">\n\t\t\t<label for=\"passw2\">Repeat Password<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t<span class=\"wppb-password-field-container\">\n\t\t\t    <input class=\"text-input\" name=\"passw2\" maxlength=\"70\" type=\"password\" id=\"passw2\" value=\"\" autocomplete=\"off\" \/>\n\t\t\t    \n            <button type=\"button\" class=\"wppb-toggle-pw wppb-show-pw hide-if-no-js\" data-toggle=\"0\" aria-label=\"Show password\" tabindex=\"-1\">\n                <img decoding=\"async\" loading=\"lazy\" src=\"https:\/\/caroomandboardcoalition.org\/wp-content\/plugins\/profile-builder\/\/assets\/images\/eye-outline.svg\" title=\"Show password\" width=\"20px\" height=\"20px\" \/>\n            <\/button> <!-- add the HTML for the visibility toggle -->\n\t\t\t<\/span><\/li><li class=\"wppb-form-field wppb-default-first-name\" id=\"wppb-form-element-3\">\n\t\t\t<label for=\"first_name\">First Name<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t<input class=\"text-input default_field_firstname\" name=\"first_name\" maxlength=\"70\" type=\"text\" id=\"first_name\" value=\"\"  \/><\/li><li class=\"wppb-form-field wppb-default-last-name\" id=\"wppb-form-element-4\">\n\t\t\t<label for=\"last_name\">Last Name<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t<input class=\"text-input default_field_lastname\" name=\"last_name\" maxlength=\"70\" type=\"text\" id=\"last_name\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-avatar\" id=\"wppb-form-element-15\"><label for=\"picture_profile\">Picture Profile<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label><a href=\"#\" class=\"button wppb_upload_button\" id=\"upload_picture_profile_button\"  data-uploader_title=\"Picture Profile\" data-uploader_button_text=\"Select File\" data-upload_mn=\"picture_profile\" data-upload_input=\"picture_profile\" data-multiple_upload=\"false\">Upload <\/a><input id=\"picture_profile\" type=\"hidden\" size=\"36\" name=\"picture_profile\" value=\"\"\/><span class=\"wppb-description-delimiter\"><br>\n<h6>(We recommend a photograph that includes the front of the house without any individuals in the frame).<\/h6><\/span><\/li><li class=\"wppb-form-field wppb-default-e-mail\" id=\"wppb-form-element-8\">\n\t\t\t<label for=\"email\">E-mail<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t<input class=\"text-input default_field_email\" name=\"email\" maxlength=\"70\" type=\"email\" id=\"email\" value=\"\"   \/><\/li><li class=\"wppb-form-field wppb-input\" id=\"wppb-form-element-16\">\n\t\t\t\t<label for=\"phone\">Phone<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label>\n\t\t\t\t<input class=\"extra_field_input\" name=\"phone\" maxlength=\"250\" type=\"text\" id=\"phone\" value=\"\" \/><\/li><li class=\"wppb-form-field wppb-radio\" id=\"wppb-form-element-148\">\n\t\t\t\t<label for=\"home_license_status\">Is your home licensed or unlicensed?<span class=\"wppb-required\" title=\"This field is required\">*<\/span><\/label><ul class=\"wppb-radios\"><li><input value=\"Licensed\" class=\"custom_field_radio\" id=\"licensed_148\" name=\"home_license_status\" type=\"radio\"   \/><label for=\"licensed_148\" class=\"wppb-rc-value\">Licensed<\/label><\/li><li><input value=\"Unlicensed\" class=\"custom_field_radio\" id=\"unlicensed_148\" name=\"home_license_status\" type=\"radio\"   \/><label for=\"unlicensed_148\" class=\"wppb-rc-value\">Unlicensed<\/label><\/li><\/ul><\/li><li class=\"wppb-form-field wppb-subscription-plans\" id=\"wppb-form-element-138\"><h4>Subscription Plans<\/h4><div class=\"pms-subscription-plan pms-subscription-plan-5328\"><label><input type=\"radio\" name=\"subscription_plans\" data-price=\"0\" data-duration=\"6\" data-fixed_membership=\"\" data-allow_renew=\"\" data-sign_up_fee=\"0\" data-trial=\"0\" data-recurring=\"3\"  value=\"5328\" data-default-checked=\"false\" \/><span class=\"pms-subscription-plan-name\">Housing Provider - Free<\/span><span class=\"pms-subscription-plan-price\"><span class=\"pms-divider\"> - <\/span><span class=\"pms-subscription-plan-price-value\">Free<\/span><span class=\"pms-divider pms-duration-divider\"> \/ <\/span><span class=\"pms-subscription-plan-duration\">6 Months<\/span><\/span><span class=\"pms-subscription-plan-trial\"><\/span><span class=\"pms-subscription-plan-sign-up-fee\"><\/span><\/label><div class=\"pms-subscription-plan-description\">Free trial membership for Housing Providers. List your home at no cost for 6 months while we finalize our membership benefits package.<\/div><\/div><div class=\"pms-subscription-plan pms-subscription-plan-3474\"><label><input type=\"radio\" name=\"subscription_plans\" data-price=\"2200\" data-duration=\"1\" data-fixed_membership=\"\" data-allow_renew=\"\" data-sign_up_fee=\"0\" data-trial=\"1\" data-recurring=\"3\"  value=\"3474\" data-default-checked=\"false\" \/><span class=\"pms-subscription-plan-name\">Yearly<\/span><span class=\"pms-subscription-plan-price\"><span class=\"pms-divider\"> - <\/span><span class=\"pms-subscription-plan-currency\">&#36;<\/span><span class=\"pms-subscription-plan-price-value\">2,200<\/span><span class=\"pms-divider pms-duration-divider\"> \/ <\/span><span class=\"pms-subscription-plan-duration\">1 Year<\/span><\/span><span class=\"pms-subscription-plan-trial\"> with a 3 months free trial<\/span><span class=\"pms-subscription-plan-sign-up-fee\"><\/span><\/label><div class=\"pms-subscription-plan-description\">Sign up now to be listed as a room and board facility at no cost. Enjoy free access to CRBC's advocacy network, resources, and referrals. A paid subscription with added benefits will be introduced later- but your spot is secure when you join today.<\/div><\/div><div class=\"pms-subscription-plan pms-subscription-plan-3281\"><label><input type=\"radio\" name=\"subscription_plans\" data-price=\"1650\" data-duration=\"6\" data-fixed_membership=\"\" data-allow_renew=\"\" data-sign_up_fee=\"0\" data-trial=\"1\" data-recurring=\"3\"  value=\"3281\" data-default-checked=\"false\" \/><span class=\"pms-subscription-plan-name\">6 Monthly<\/span><span class=\"pms-subscription-plan-price\"><span class=\"pms-divider\"> - <\/span><span class=\"pms-subscription-plan-currency\">&#36;<\/span><span class=\"pms-subscription-plan-price-value\">1,650<\/span><span class=\"pms-divider pms-duration-divider\"> \/ <\/span><span class=\"pms-subscription-plan-duration\">6 Months<\/span><\/span><span class=\"pms-subscription-plan-trial\"> with a 3 months free trial<\/span><span class=\"pms-subscription-plan-sign-up-fee\"><\/span><\/label><div class=\"pms-subscription-plan-description\">Sign up now to be listed as a room and board facility at no cost. Enjoy free access to CRBC's advocacy network, resources, and referrals. A paid subscription with added benefits will be introduced later- but your spot is secure when you join today.<\/div><\/div><div class=\"pms-subscription-plan pms-subscription-plan-252\"><label><input type=\"radio\" name=\"subscription_plans\" data-price=\"275\" data-duration=\"1\" data-fixed_membership=\"\" data-allow_renew=\"\" data-sign_up_fee=\"0\" data-trial=\"1\" data-recurring=\"3\"  value=\"252\" data-default-checked=\"false\" \/><span class=\"pms-subscription-plan-name\">Month to Month<\/span><span class=\"pms-subscription-plan-price\"><span class=\"pms-divider\"> - <\/span><span class=\"pms-subscription-plan-currency\">&#36;<\/span><span class=\"pms-subscription-plan-price-value\">275<\/span><span class=\"pms-divider pms-duration-divider\"> \/ <\/span><span class=\"pms-subscription-plan-duration\">1 Month<\/span><\/span><span class=\"pms-subscription-plan-trial\"> with a 3 months free trial<\/span><span class=\"pms-subscription-plan-sign-up-fee\"><\/span><\/label><div class=\"pms-subscription-plan-description\">Sign up now to be listed as a room and board facility at no cost. Enjoy free access to CRBC's advocacy network, resources, and referrals. A paid subscription with added benefits will be introduced later- but your spot is secure when you join today.<\/div><\/div><input type=\"hidden\" name=\"pms_default_recurring\" value=\"2\" \/><\/li><div id=\"pms-paygates-wrapper\"><input type=\"hidden\" class=\"pms_pay_gate\" name=\"pay_gate\" value=\"paypal_standard\" data-sign_up_fee=\"1\" data-trial=\"1\" data-recurring=\"1\"  \/><\/div><\/ul><span id=\"pms-submit-button-loading-placeholder-text\" style=\"display: none;\">Processing. Please wait...<\/span><\/ul><ul><input id=\"send_credentials_via_email\" type=\"hidden\" name=\"send_credentials_via_email\" value=\"sending\"\/><\/ul>\t\t\t<p class=\"form-submit\"  >\n\t\t\t\t                \t\t\t\t<input name=\"register\" type=\"submit\" id=\"register\" class=\"submit button\" value=\"Register\" \/>\n                <input name=\"redirect_to\" type=\"hidden\" value=\"\" \/>\n                \t\t\t\t<input name=\"action\" type=\"hidden\" id=\"action\" value=\"register\" \/>\n\t\t\t\t<input name=\"form_name\" type=\"hidden\" id=\"form_name\" value=\"unspecified\" \/>\n\t\t\t\t<input name=\"form_id\" type=\"hidden\" id=\"form_id\" value=\"\" \/>\n\t\t\t\t<input type=\"hidden\" name=\"wppb_referer_url\" value=\"\"\/>\t\t\t<\/p><!-- .form-submit -->\n\t\t\t<input type=\"hidden\" id=\"register_unspecified_nonce_field\" name=\"register_unspecified_nonce_field\" value=\"d98df3060f\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/es\/wp-json\/wp\/v2\/pages\/229\" \/>\t\t<input type=\"hidden\" name=\"trp-form-language\" value=\"es\"\/><\/form>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>This is a free trial membership. You will not be charged during the trial period, and renewal is not automatic. We&#8217;ll notify you when paid membership options become available.<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"nf_dc_page":"","footnotes":""},"class_list":["post-229","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/caroomandboardcoalition.org\/es\/wp-json\/wp\/v2\/pages\/229","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/caroomandboardcoalition.org\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/caroomandboardcoalition.org\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/caroomandboardcoalition.org\/es\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/caroomandboardcoalition.org\/es\/wp-json\/wp\/v2\/comments?post=229"}],"version-history":[{"count":20,"href":"https:\/\/caroomandboardcoalition.org\/es\/wp-json\/wp\/v2\/pages\/229\/revisions"}],"predecessor-version":[{"id":4906,"href":"https:\/\/caroomandboardcoalition.org\/es\/wp-json\/wp\/v2\/pages\/229\/revisions\/4906"}],"wp:attachment":[{"href":"https:\/\/caroomandboardcoalition.org\/es\/wp-json\/wp\/v2\/media?parent=229"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}