Consent Statement
[Organization: replace this block with the specific consent language, treatment description, media use terms, or program rules that apply to your form.]
","container_class":"","element_class":"","admin_label":"","drawerDisabled":"","field_label":"Consent Statement","field_key":"consent_statement_1785851642995","order":6},{"objectType":"Field","objectDomain":"fields","editActive":false,"idAttribute":"id","type":"textarea","label":"Purpose or Details of Consent","key":"purpose_or_details_1785851643995","label_pos":"default","required":false,"default":"","placeholder":"","input_limit":"","input_limit_type":"characters","input_limit_msg":"Character(s) left","textarea_rte":"","disable_rte_mobile":"","textarea_media":"","value":"","container_class":"","element_class":"","admin_label":"","help_text":"","desc_text":"Note the specific procedure, event, or activity this consent covers, if applicable.","drawerDisabled":"","field_label":"Purpose or Details of Consent","field_key":"purpose_or_details_1785851643995","order":7},{"objectType":"Field","objectDomain":"fields","editActive":false,"idAttribute":"id","type":"file_upload","label":"Supporting Document Upload","key":"supporting_document_upload_1785851644995","label_pos":"default","required":false,"default":"","placeholder":"","container_class":"","element_class":"","admin_label":"","help_text":"","desc_text":"Attach a related document, such as an ID or referral letter, if applicable. Requires the File Uploads add-on to be active.","restrict_ext":"0","restrict_ext_array":[],"restrict_size":"1","max_size":"10","upload_dir":"","num_files":"1","drawerDisabled":"","field_label":"Supporting Document Upload","field_key":"supporting_document_upload_1785851644995","order":8},{"objectType":"Field","objectDomain":"fields","editActive":false,"idAttribute":"id","type":"hr","label":"Divider","key":"hr_1785851645995","container_class":"","element_class":"","admin_label":"","drawerDisabled":"","field_label":"Divider","field_key":"hr_1785851645995","order":9},{"objectType":"Field","objectDomain":"fields","editActive":false,"idAttribute":"id","type":"listcheckbox","label":"I Have Read and Agree to the Terms Above","key":"agree_to_terms_1785851646995","label_pos":"default","required":true,"container_class":"","element_class":"","admin_label":"","help_text":"","drawerDisabled":"","field_label":"I Have Read and Agree to the Terms Above","field_key":"agree_to_terms_1785851646995","options":[{"errors":[],"max_options":0,"label":"I have read and understood the consent statement above and I agree.","value":"I have read and understood the consent statement above and I agree.","calc":"","selected":0,"order":0,"manual_value":true}],"order":10},{"objectType":"Field","objectDomain":"fields","editActive":false,"idAttribute":"id","type":"textbox","label":"Type your full name as your signature.","key":"typed_signature_1785851647995","label_pos":"default","required":true,"default":"","placeholder":"","input_limit":"","input_limit_type":"characters","input_limit_msg":"Character(s) left","manual_key":false,"admin_label":"","help_text":"","mask":"","custom_mask":"","custom_name_attribute":"","personally_identifiable":"","value":"","container_class":"","element_class":"","drawerDisabled":"","field_label":"Type your full name as your signature.","field_key":"typed_signature_1785851647995","order":11},{"objectType":"Field","objectDomain":"fields","editActive":false,"idAttribute":"id","type":"hcaptcha","label":"Spam Check","key":"hcaptcha_1785851648995","label_pos":"hidden","required":false,"container_class":"","element_class":"","admin_label":"","site_key":"","secret_key":"","size":"normal","theme":"light","drawerDisabled":"","field_label":"Spam Check","field_key":"hcaptcha_1785851648995","order":12},{"objectType":"Field","objectDomain":"fields","editActive":false,"idAttribute":"id","type":"submit","label":"Submit Consent","processing_label":"Submitting...","container_class":"","element_class":"","key":"submit_1785851649995","admin_label":"","field_label":"Submit Consent","field_key":"submit_1785851649995","order":13}],"actions":[{"title":"","key":"","type":"successmessage","active":"1","created_at":"2026-08-04 00:00:00","label":"Success Message","objectType":"Action","objectDomain":"actions","editActive":"","message":"Thank you. Your consent has been recorded. A confirmation with your signed record has been sent to your email.","order":"1","to":"{wp:admin_email}","reply_to":"","email_subject":"Ninja Forms Submission","email_message":"{fields_table}","email_message_plain":"","from_name":"","from_address":"","email_format":"html","cc":"","bcc":"","success_msg":"Thank you. Your consent has been recorded. A confirmation with your signed record has been sent to your email."},{"title":"","key":"","type":"email","active":"1","created_at":"2026-08-04 00:00:00","label":"Admin Email","objectType":"Action","objectDomain":"actions","editActive":"","order":"2","to":"{wp:admin_email}","reply_to":"","email_subject":"New Consent Form Submission: {field:full_name_1785851637995}","email_message":"A new consent form has been submitted. The generated PDF record is attached for filing.
{fields_table}","email_message_plain":"","from_name":"","from_address":"","email_format":"html","cc":"","bcc":""},{"title":"","key":"","type":"save","active":"1","created_at":"2026-08-04 00:00:00","label":"Record Submission","objectType":"Action","objectDomain":"actions","editActive":"","order":"3","conditions":{"collapsed":false,"process":1,"connector":"all","when":[],"then":[],"else":[]},"to":"{wp:admin_email}","reply_to":"","email_subject":"Ninja Forms Submission","email_message":"{fields_table}","email_message_plain":"","from_name":"","from_address":"","email_format":"html","cc":"","bcc":"","success_msg":"Your form has been successfully submitted.","redirect_url":"","submitter_email":"email_1785851638995","fields-save-toggle":"save_all","exception_fields":[],"set_subs_to_expire":"0","subs_expire_time":"90"},{"title":"","key":"","type":"email","active":"1","created_at":"2026-08-04 00:00:00","label":"Email Confirmation","objectType":"Action","objectDomain":"actions","editActive":"","order":"4","to":"{field:email_1785851638995}","reply_to":"","email_subject":"Your Consent Form Submission","email_message":"Hi {field:full_name_1785851637995} , thank you. Your consent has been recorded.
Name on record: {field:full_name_1785851637995}
Date submitted: {field:date_of_consent_1785851640995}
A PDF copy of your completed consent form is attached to this email for your records.
","email_message_plain":"","from_name":"","from_address":"","email_format":"html","cc":"","bcc":""},{"title":"","key":"","type":"redirect","active":"0","created_at":"2026-08-04 00:00:00","label":"Redirect","objectType":"Action","objectDomain":"actions","editActive":"","order":"5","redirect_url":""},{"title":"","key":"","type":"pdfformsubmission","active":"1","created_at":"2026-08-04 00:00:00","label":"PDF Form Submission","objectType":"Action","objectDomain":"actions","editActive":"","order":"6","pdf_template":"default","pdf_filename":"Consent-Form-{field:full_name_1785851637995}","attach_pdf_to_email":"1","conditions":{"collapsed":false,"process":1,"connector":"all","when":[],"then":[],"else":[]}},{"title":"","key":"","type":"slack","active":"0","created_at":"2026-08-04 00:00:00","label":"Slack Notification","objectType":"Action","objectDomain":"actions","editActive":"","order":"7","slack_webhook_url":"","slack_channel":"","slack_message":"New consent form submitted by {field:full_name_1785851637995} on {field:date_of_consent_1785851640995} .","conditions":{"collapsed":false,"process":1,"connector":"all","when":[],"then":[],"else":[]}},{"title":"","key":"","type":"zapier","active":"0","created_at":"2026-08-04 00:00:00","label":"Zapier","objectType":"Action","objectDomain":"actions","editActive":"","order":"8","zapier_hook_url":"","conditions":{"collapsed":false,"process":1,"connector":"all","when":[],"then":[],"else":[]}},{"title":"","key":"","type":"webhooks","active":"0","created_at":"2026-08-04 00:00:00","label":"Webhook","objectType":"Action","objectDomain":"actions","editActive":"","order":"9","webhook_url":"","webhook_method":"POST","webhook_format":"json","conditions":{"collapsed":false,"process":1,"connector":"all","when":[],"then":[],"else":[]}}]}