super

<forms version="1.5.RC3.5">
−
<form labelPlacement="top_label" useCurrentUserAsAuthor="1">
<title>Create Materials</title>
−
<confirmation type="page">
<pageId>22</pageId>
</confirmation>
−
<button type="text">
<text>Generate Now</text>
</button>
−
<fields>
−
<field id="1" isRequired="1" size="medium" type="radio">
<label>I need to...</label>
−
<choices>
−
<choice>
<text>Promote an event</text>
</choice>
−
<choice>
−
<text>
Put up posters or place advertising promoting KidCare
</text>
</choice>
−
<choice>
<text>Make a presentation about KidCare</text>
</choice>
−
<choice>
<text>Hand out something to parents and guardians</text>
</choice>
−
<choice>
<text>Mail something to parents and guardians</text>
</choice>
−
<choice>
−
<text>
Give something to people who will do their own outreach to parents and guardians
</text>
</choice>
−
<choice>
<text>Put something on a website</text>
</choice>
</choices>
</field>
−
<field id="2" isRequired="1" size="medium" type="radio" enableChoiceValue="1">
<label>Where do you plan to use this item?</label>
−
<choices>
−
<choice>
<text>In a meeting with parents</text>
<value>general</value>
</choice>
−
<choice>
<text>At a presentation to a business or community group</text>
<value>general</value>
</choice>
−
<choice>
<text>At a school or on a school website</text>
<value>school</value>
</choice>
−
<choice>
<text>At a preschool or day care center</text>
<value>school</value>
</choice>
−
<choice>
<text>At a faith-based gathering (church, temple, etc)</text>
<value>faith</value>
</choice>
−
<choice>
−
<text>
At a health fair, in a medical facility (hospital, doctor
</text>
<value>general</value>
</choice>
−
<choice>
<text>At a community or sporting event</text>
<value>general</value>
</choice>
−
<choice>
<text>In a workplace or government benefits office</text>
<value>general</value>
</choice>
</choices>
</field>
−
<field id="3" isRequired="1" size="medium" type="radio">
<label>What language should the materials be in?</label>
−
<choices>
−
<choice>
<text>English</text>
</choice>
−
<choice>
<text>Spanish</text>
</choice>
−
<choice>
<text>Creole</text>
</choice>
</choices>
</field>
−
<field id="5" size="medium" type="page" displayOnly="1">
−
<nextButton type="text">
<text>Next</text>
</nextButton>
−
<previousButton type="text">
<text>Previous</text>
</previousButton>
</field>
−
<field id="4" isRequired="1" size="medium" type="radio">
<label>Material Choices</label>
−
<choices>
−
<choice>
<text>Brochure 8.5 x 11</text>
</choice>
−
<choice>
<text>Flyer 8.5 x 11</text>
</choice>
−
<choice>
<text>Postcard 5 x 7</text>
</choice>
−
<choice>
<text>PowerPoint</text>
</choice>
−
<choice>
<text>Poster 11 x 17</text>
</choice>
</choices>
</field>
−
<field id="6" size="medium" type="page" displayOnly="1">
−
<nextButton type="text">
<text>Next</text>
</nextButton>
−
<previousButton type="text">
<text>Previous</text>
</previousButton>
</field>
−
<field id="8" size="medium" type="radio">
<label>We Have Faith in Florida KidCare</label>
−
<choices>
−
<choice>
−
<text>
<p><strong>We Have Faith in Florida KidCare</strong><br /> Why all the fuss about health insurance? Children with health insurance are more likely to:</p> <ul> <li>• Get the help they need when sick or hurt.</li> <li>• Get the shots they need.</li> <li>• Miss fewer days of school.</li> <li>• See their own doctor and nurse who know them.</li> </ul> <p>Eligibility is based on family size and income. For applications or information, call toll free: <br /> 1-888-540-5437 (TTY 1-877-316-8748) <br /> www.floridakidcare.org <br /></p>
</text>
</choice>
</choices>
−
<conditionalLogic actionType="show" logicType="all">
−
<rules>
−
<rule fieldId="4" operator="is">
<value>Flyer 8.5 x 11</value>
</rule>
−
<rule fieldId="3" operator="is">
<value>English</value>
</rule>
</rules>
</conditionalLogic>
</field>
−
<field id="35" isRequired="1" size="medium" type="radio">
<label>Select Copy</label>
−
<choices>
−
<choice>
−
<text>
<p><strong>Back-to-School Checklist</strong></p> <ul> <li>Backpack </li> <li>Notebooks</li> <li>Pencils</li> <li>Ruler</li> <li>Pens</li> <li>Calculator</li> <li>Binders </li> <li>Lunch box</li> <li>Scissors</li> <li>Florida KidCare health insurance</li> </ul>  <p>Give your child a head start this school year. Make sure health insurance is on your back-to-school checklist. Children with health insurance miss fewer days of school, and applying for Florida KidCare is easy. Any family can apply, and many pay $20 or less per month to insure their children. Most pay nothing at all. </p>  <p>Apply online at www.FloridaKidCare.org or call to request an application by phone at 1-888-540-KIDS (5437).</p>
</text>
</choice>
−
<choice>
−
<text>
<p><strong>Good news for Florida’s families!</strong><br /> Your child may be eligible for health insurance through Florida KidCare, even if one or both parents are working. Getting health insurance for your children before they get sick is very important. Children need to have regular check-ups to make sure they are growing strong and healthy. Healthy children do their best at school and play.</p>  <p><strong>What is Florida KidCare?</strong><br /> It’s health insurance for children, from birth through age 18, who do not have insurance. Eligibility for Florida KidCare is based on income and family size.</p>  <p>Taking your child to the doctor just got easier. . . because help is on the way! Whether you are working, training for a new job, going to school, or staying home with your child, Florida KidCare can help you keep your children healthy.</p>  <p><strong>How do I apply?</strong><br /> It’s easy. Apply online at www.floridakidcare.org. Or fill out the simple Florida KidCare application form and mail it. If eligible, your child is enrolled. If you would like an application, call toll free 1-888-540-5437 or visit www.floridakidcare.org.</p> <p>Note: If you are pregnant, apply now for your unborn child.</p>  <p><strong>How much do I pay each month for coverage?</strong><br /> Monthly premiums depend on your household’s size and income.</p>  <li>• There is no charge for Medicaid.</li> <li>• Most families pay $15 or $20 a month. If you need to pay more, Florida KidCare will let you know.</li> <li>• Small co-payments for some services may apply.</li>  <p><strong>What services are covered?</strong><br />  Here are some services Florida KidCare covers:</p> <ul> <li>• Doctor visits </li> <li>• Prescriptions</li> <li>• Check-ups</li> <li>• Vision</li> <li>• Shots </li> <li>• Hearing</li> <li>• Hospital </li> <li>• Mental Health</li> <li>• Surgery </li> <li>• Emergencies</li> <li>• Dental</li> </ul> <p>For applications or information, call toll free: <br /> 1-888-540-5437 (TTY 1-877-316-8748)<br /> www.floridakidcare.org</p>
</text>
</choice>
</choices>
−
<conditionalLogic actionType="show" logicType="all">
−
<rules>
−
<rule fieldId="4" operator="is">
<value>Brochure 8.5 x 11</value>
</rule>
−
<rule fieldId="3" operator="is">
<value>English</value>
</rule>
−
<rule fieldId="2" operator="isnot">
<value>general</value>
</rule>
−
<rule fieldId="2" operator="isnot">
<value>general</value>
</rule>
−
<rule fieldId="2" operator="isnot">
<value>general</value>
</rule>
</rules>
</conditionalLogic>
</field>
−
<field id="7" size="medium" type="page" displayOnly="1">
−
<nextButton type="text">
<text>Next</text>
</nextButton>
−
<previousButton type="text">
<text>Previous</text>
</previousButton>
</field>
−
<field id="9" size="medium" type="radio">
<label>Select an Image or Upload Your Own</label>
−
<choices>
−
<choice>
<text>First Image</text>
</choice>
−
<choice>
<text>Second Image</text>
</choice>
−
<choice>
<text>Third Image</text>
</choice>
</choices>
</field>
−
<field id="10" size="medium" type="fileupload">
<label>Upload Your Own Image</label>
</field>
−
<field id="11" size="medium" type="page" displayOnly="1">
−
<nextButton type="text">
<text>Next</text>
</nextButton>
−
<previousButton type="text">
<text>Previous</text>
</previousButton>
</field>
−
<field id="12" size="medium" type="html" displayOnly="1">
−
<content>
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Sed eget varius sapien. Cras volutpat nisi sit amet nisi facilisis sit amet viverra nulla accumsan. Fusce ac mi in eros pulvinar commodo non ut nibh. Vivamus egestas nisi sapien, eu consectetur lacus. Curabitur ut diam sit amet mi sagittis auctor sit amet sagittis dui. Nulla mauris velit, luctus eget porta in, lacinia id lorem. Praesent facilisis justo sollicitudin sapien egestas tincidunt. Pellentesque sed ipsum massa. Vivamus a metus in orci hendrerit ultrices a eget est.
</content>
<label>Personalize It!</label>
</field>
<field id="13" size="medium" type="section" displayOnly="1">
            </field>
−
<field id="14" size="medium" type="text">
<label>Organization Name</label>
</field>
−
<field id="15" size="medium" type="address" addressType="us" hideAddress2="1" hideCountry="1">
<label>Address</label>
<defaultCountry>United States</defaultCountry>
−
<inputs>
−
<input id="15.1">
<label>Street Address</label>
</input>
−
<input id="15.2">
<label>Address Line 2</label>
</input>
−
<input id="15.3">
<label>City</label>
</input>
−
<input id="15.4">
<label>State / Province</label>
</input>
−
<input id="15.5">
<label>Zip / Postal Code</label>
</input>
−
<input id="15.6">
<label>Country</label>
</input>
</inputs>
</field>
−
<field id="16" size="medium" type="phone" phoneFormat="standard">
<label>Phone</label>
</field>
<field id="33" size="medium" type="section" displayOnly="1">
            </field>
−
<field id="17" size="medium" type="text">
<label>Event</label>
</field>
−
<field id="18" size="medium" type="address" addressType="us" hideAddress2="1">
<label>Event Location</label>
<defaultCountry>United States</defaultCountry>
−
<inputs>
−
<input id="18.1">
<label>Street Address</label>
</input>
−
<input id="18.2">
<label>Address Line 2</label>
</input>
−
<input id="18.3">
<label>City</label>
</input>
−
<input id="18.4">
<label>State / Province</label>
</input>
−
<input id="18.5">
<label>Zip / Postal Code</label>
</input>
−
<input id="18.6">
<label>Country</label>
</input>
</inputs>
</field>
−
<field id="19" size="medium" type="date" calendarIconType="none">
<label>Event Date</label>
</field>
−
<field id="20" size="medium" type="time">
<cssClass>gf_left_half</cssClass>
<label>Start Time</label>
</field>
−
<field id="21" size="medium" type="time">
<cssClass>gf_right_half</cssClass>
<label>End Time</label>
</field>
−
<field id="22" size="medium" type="website">
<label>Website</label>
</field>
−
<field id="23" size="medium" type="email">
<label>Email</label>
</field>
<field id="34" size="medium" type="section" displayOnly="1">
            </field>
−
<field id="24" size="large" type="text">
<label>Does your event have a Tag Line? Add it!</label>
</field>
−
<field id="25" size="medium" type="fileupload">
<label>Upload your logo</label>
</field>
−
<field id="26" size="medium" type="html" displayOnly="1">
<label>Upload Event Partner/Sponsor Logos (limit to 3)</label>
</field>
<field id="27" size="medium" type="fileupload">
            </field>
<field id="28" size="medium" type="fileupload">
            </field>
<field id="29" size="medium" type="fileupload">
            </field>
−
<field id="30" size="medium" type="html" displayOnly="1">
−
<content>
<p><strong>All items generated will include the Florida Kid Care Logo and the following copy:</strong></p>
<p>Apply online at www.FloridaKidCare.org or call to request an application by phone at 1-888-540-KIDS (5437).<br />
1-888-540-KIDS (5437) | www.FloridaKidCare.org</p>
</content>
<label>Please Note -</label>
</field>
−
<field id="31" size="medium" type="page" displayOnly="1">
−
<nextButton type="text">
<text>Next</text>
</nextButton>
−
<previousButton type="text">
<text>Previous</text>
</previousButton>
</field>
−
<field id="32" size="medium" type="html" displayOnly="1">
−
<content>
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Sed eget varius sapien. Cras volutpat nisi sit amet nisi facilisis sit amet viverra nulla accumsan. Fusce ac mi in eros pulvinar commodo non ut nibh. Vivamus egestas nisi sapien, eu consectetur lacus. Curabitur ut diam sit amet mi sagittis auctor sit amet sagittis dui. Nulla mauris velit, luctus eget porta in, lacinia id lorem. Praesent facilisis justo sollicitudin sapien egestas tincidunt. Pellentesque sed ipsum massa. Vivamus a metus in orci hendrerit ultrices a eget est.
</content>
<label>All Finished! Now Generate Your Files!</label>
</field>
</fields>
−
<lastPageButton type="text">
<text>Previous</text>
</lastPageButton>
<pagination type="percentage" style="blue">
        </pagination>
−
<notification>
<to>[email protected]</to>
<subject>New submission from {form_title}</subject>
<message>{all_fields}</message>
</notification>
</form>
</forms>