{"id":2213,"date":"2025-07-03T14:15:53","date_gmt":"2025-07-03T19:15:53","guid":{"rendered":"https:\/\/www.missouriwestern.edu\/workforce\/?page_id=2213"},"modified":"2025-07-03T14:17:39","modified_gmt":"2025-07-03T19:17:39","slug":"home-health-aide-registration","status":"publish","type":"page","link":"https:\/\/www.missouriwestern.edu\/workforce\/home-health-aide-registration\/","title":{"rendered":"Certified Home Health Aide Registration"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"background-color: rgba(255,255,255,0);background-position: center center;background-repeat: no-repeat;border-width: 0px 0px 0px 0px;border-color:#eae9e9;border-style:solid;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-justify-content-center\" style=\"max-width:104%;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_3_4 3_4 fusion-flex-column\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 0px 0px 0px 0px;\"><script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_unknown gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_27' style='display:none'>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_27'  action='\/workforce\/wp-json\/wp\/v2\/pages\/2213' data-formid='27' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_27' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_27_28\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_28\" ><div class='ginput_container ginput_container_text'><input name='input_28' id='input_27_28' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='0519165756973349450' \/><\/div><\/div><div id=\"field_27_29\" class=\"gfield gfield--type-hidden gfield--input-type-hidden gform_hidden field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_29\" ><div class='ginput_container ginput_container_text'><input name='input_29' id='input_27_29' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='No' \/><\/div><\/div><div id=\"field_27_52\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_52\" ><hr \/><\/div><fieldset id=\"field_27_3\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_3\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_27_3'>\n                            \n                            <span id='input_27_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.3' id='input_27_3_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_27_3_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_27_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.6' id='input_27_3_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_27_3_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_27_7\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_7\" ><label class='gfield_label gform-field-label' for='input_27_7'>E-Mail Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_7' id='input_27_7' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_27_5\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_5\" ><label class='gfield_label gform-field-label' for='input_27_5'>Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_27_5' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_27_39\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_39\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_27_39' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_27_39_1_container' >\n                                        <input type='text' name='input_39.1' id='input_27_39_1' value=''    aria-required='true'    \/>\n                                        <label for='input_27_39_1' id='input_27_39_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_27_39_3_container' >\n                                    <input type='text' name='input_39.3' id='input_27_39_3' value=''    aria-required='true'    \/>\n                                    <label for='input_27_39_3' id='input_27_39_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_27_39_4_container' >\n                                        <input type='text' name='input_39.4' id='input_27_39_4' value=''      aria-required='true'    \/>\n                                        <label for='input_27_39_4' id='input_27_39_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_27_39_5_container' >\n                                    <input type='text' name='input_39.5' id='input_27_39_5' value=''    aria-required='true'    \/>\n                                    <label for='input_27_39_5' id='input_27_39_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_39.6' id='input_27_39_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_27_41\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_41\" ><label class='gfield_label gform-field-label' for='input_27_41'>Are you with a business?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_41' id='input_27_41' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choose...<\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/div><div id=\"field_27_10\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_10\" ><label class='gfield_label gform-field-label' for='input_27_10'>Business Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_27_10' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_27_42\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_42\" ><label class='gfield_label gform-field-label' for='input_27_42'>Are you 18+ years of age? (Required to take the training.)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_42' id='input_27_42' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choose...<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/div><div id=\"field_27_60\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_60\" ><label class='gfield_label gform-field-label' for='input_27_60'>Do you have a high school diploma or equivalent (Required to take the training)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_60' id='input_27_60' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choose...<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/div><div id=\"field_27_61\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_61\" ><label class='gfield_label gform-field-label' for='input_27_61'>Have you ever been found guilty of a felony? (大象传媒 law does not allow HHA certification to those with a criminal background.)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_61' id='input_27_61' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choose...<\/option><option value='No' >No<\/option><\/select><\/div><\/div><fieldset id=\"field_27_62\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label gfield_visibility_visible\"  data-js-reload=\"field_27_62\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Untitled<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_27_62'><div class='gchoice gchoice_27_62_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.1' type='checkbox'  value='I am not listed on the 大象传媒 Department of Mental Health&#039;s Disqualified Employee List which prevents me, by law, from becoming an HHA.'  id='choice_27_62_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_27_62_1' id='label_27_62_1' class='gform-field-label gform-field-label--type-inline'>I am not listed on the 大象传媒 Department of Mental Health's Disqualified Employee List which prevents me, by law, from becoming an HHA.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_27_43\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_43\" ><label class='gfield_label gform-field-label' for='input_27_43'>How did you hear about this training opportunity?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_43' id='input_27_43' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_27_53\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_53\" ><hr \/><\/div><div id=\"field_27_46\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_46\" ><label class='gfield_label gform-field-label' for='input_27_46'>Gender<\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_27_46' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_27_47\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_47\" ><label class='gfield_label gform-field-label' for='input_27_47'>Race<\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_27_47' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_27_48\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_48\" ><label class='gfield_label gform-field-label' for='input_27_48'>Is English your primary language?<\/label><div class='ginput_container ginput_container_select'><select name='input_48' id='input_27_48' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choose...<\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/div><div id=\"field_27_54\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_54\" ><hr \/><\/div><fieldset id=\"field_27_57\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_27_57\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >GENERAL HOLD HARMLESS, VOLUNTARY WAIVER, AND ASSUMPTION OF RISKS FOR PARTICIPATION IN WORKFORCE DEVELOPMENT PROGRAMMING.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_27_57'>PLEASE READ THIS \u201cAGREEMENT\u201d CAREFULLY BEFORE SIGNING. THIS IS A LEGALLY BINDING DOCUMENT. THIS FULLY SIGNED FORM MUST BE SUBMITTED BEFORE ANY PERSON IS ALLOWED TO PARTICIPATE IN THE PROGRAM. <br \/>\n<br \/>\nI wish to voluntarily participate in workforce development programming (the \u201cProgram\u201d), organized by the Center for Workforce Development, and located or occurring at the Houlne Center for Convergent Technology at 4141 Mitchell Avenue in Saint Joseph, 大象传媒 (the \u201cProgram\u201d). In consideration for my participation, I hereby agree as follows: <br \/>\n<br \/>\n<b>Assumption of Risks.<\/b> I understand that I have voluntarily and freely elected to participate in this Program, and that I am not required to do so. I understand that participation in the Program involves certain foreseeable and unforeseeable dangers, hazards, and risks to myself that I may be exposed to that 大象传媒 (\u201cMWSU\u201d) cannot eliminate. The dangers, hazards, and risks that MWSU cannot eliminate include, among others, the risk of property damage, illness, bodily injury, and temporary or permanent disability. I agree that if I am not knowledgeable of the risks associated with participation in the Program, then I will obtain proper instruction in order to gain a full appreciation of the risks, dangers, and hazards associated with these activities. I voluntarily take responsibility for all risks of participating in the Program. <br \/>\n<br \/>\n<b>Assumption of Medical and Other Health Obligations.<\/b> I declare and affirm my medical and physical condition allows me to participate in the Program and does not pose any danger to my health. As appropriate, I have arranged for disability-related accommodations through MWSU\u2019s Accessibility Resource Center or otherwise, as appropriate, and I understand the limitations of the program location. I am fully aware and understand MWSU will not employ or contract with any medical services, or directly provide for ordinary or emergency medical services. I agree unequivocally that I will not participate in the Program under any state of impairment, such as that induced by the use of drugs or alcohol or through consumption of validly prescribed medications, and I acknowledge that I am solely responsible for evaluating my fitness to participate safely. I understand that I am responsible for my insurance and that if I require medical care during my participation in the Program, MWSU is not responsible for the cost or quality of such care.<br \/>\n<br \/>\n<b>Authorization for Medical Care.<\/b> In the event of an accident or serious illness, I hereby authorize representatives of MWSU to obtain medical treatment for me and on my behalf. I hereby hold harmless and agree to indemnify MWSU from any claims, causes of action, damages, and\/or liabilities arising out of or resulting from said medical treatment. I further agree to accept full responsibility for any and all expenses, including medical expenses that may derive from any injuries that may occur during my participation in the Program. <br \/>\n<br \/>\n<b>Release.<\/b> In exchange for MWSU allowing me to participate in the Program, I release 大象传媒, its Board of Governors, Administration, Faculty, Staff, Student Leaders, and all other officers, directors, employees, and agents (hereafter \u201cMWSU\u201d) from any and all legal liability and financial responsibility as to any right of action that may accrue to myself or my heirs or representatives for any injury or loss that I may suffer while participating in the Program. <br \/>\n<br \/>\n<b>Indemnification and Hold Harmless.<\/b> To the fullest extent permitted by law, I agree to indemnify and hold harmless MWSU from and against any and all liability, actions, debts, claims, and demands of every kind whatsoever, specifically including, but not limited to, any claim for negligence or negligent acts or omissions and any present or future claim, loss, or liability for injury to person or property that I may suffer, for which I may be liable to any other person, that may or does arise out of my participation in the Program. <br \/>\n<br \/>\n<b>Choice of Law.<\/b> This Agreement shall be governed by and construed under the laws of 大象传媒. I agree that any legal action or proceeding relating to this Agreement, or arising out of any injury, death, damage, or loss as a result of my participation in the Program, shall be brought only in Buchanan County, 大象传媒. <br \/>\nOff-Campus Programs and Transportation. If event is off-campus, check one of the following concerning transportation: <br \/>\n<br \/>\n<u>N\/A<\/u> If University transportation is offered, I desire to travel with the University group. I fully understand and appreciate the dangers, hazards, and risks inherent in the transportation to, from, and during this Program, which dangers include, but are not limited to serious or even mortal injuries and property damage. <br \/>\n<br \/>\n<u>N\/A<\/u> If allowed, I choose to use personal transportation (of my own vehicle, another student\u2019s, or other third party) and agree that the University has no liability regarding transportation and I travel at my own risk. <br \/>\n<br \/>\n<b>Binding Agreement.<\/b> This Agreement shall legally bind me, and my family members, spouse, estate, heirs, administrators, or personal representatives. <br \/>\n<br \/>\n<b>Before you sign this Agreement, please read it carefully because it affects your legal rights.<\/b><\/div><div class='ginput_container ginput_container_consent'><input name='input_57.1' id='input_27_57_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_27_57\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_27_57_1' >I have read the <i>\"General Hold Harmless, Voluntary Waiver, and Assumption of Risks for Participation in Workforce Development Programming<\/i>.\"<\/label><input type='hidden' name='input_57.2' value='I have read the &lt;i&gt;&quot;General Hold Harmless, Voluntary Waiver, and Assumption of Risks for Participation in Workforce Development Programming&lt;\/i&gt;.&quot;' class='gform_hidden' \/><input type='hidden' name='input_57.3' value='21' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_27_58\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_27_58\" ><label class='gfield_label gform-field-label' for='input_27_58'>Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_27_58_Container' class='gfield_signature_container ginput_container' style='height:180px; 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