{"id":1182,"date":"2014-01-23T13:31:06","date_gmt":"2014-01-23T12:31:06","guid":{"rendered":"http:\/\/www.pogotowie.bialystok.pl\/?page_id=1182"},"modified":"2024-03-11T15:00:54","modified_gmt":"2024-03-11T14:00:54","slug":"formularz-zgloszenia-udzialu-w-kursie","status":"publish","type":"page","link":"https:\/\/www.wspr.bialystok.pl\/?page_id=1182","title":{"rendered":"Formularz zg\u0142oszenia udzia\u0142u w kursie"},"content":{"rendered":"<div id=\"dslc-theme-content\"><div id=\"dslc-theme-content-inner\">\n\n\n<div class=\"forminator-ui forminator-custom-form forminator-custom-form-18688 forminator-design--material  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-18688\" data-uid=\"6ac9872c6751e\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-18688\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-18688 forminator-design--material  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"18688\"\n\t\t\t\t data-color-option=\"default\" data-design=\"material\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6ac9872c6751e\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-18688__field--select-1_6ac9872c6751e\" id=\"forminator-form-18688__field--select-1_6ac9872c6751e-label\" class=\"forminator-label\">Rodzaj kursu<\/label><select  id=\"forminator-form-18688__field--select-1_6ac9872c6751e\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-1\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-18688__field--select-1_6ac9872c6751e-label\"><option value=\"one\"  data-calculation=\"0\">Pierwsza Pomoc<\/option><option value=\"two\"  data-calculation=\"0\">Kwalifikowana Pierwsza Pomoc<\/option><option value=\"Recertyfikacja-KPP\"  data-calculation=\"0\">Recertyfikacja KPP<\/option><option value=\"Kurs-doskonal\u0105cy-dla-ratownik\u00f3w-medycznych\"  data-calculation=\"0\">Kurs doskonal\u0105cy dla ratownik\u00f3w medycznych<\/option><option value=\"Seminarium-8-godz.\"  data-calculation=\"0\">Seminarium 8 godz.<\/option><option value=\"Warsztat-praktyczny-8-godz.\"  data-calculation=\"0\">Warsztat praktyczny 8 godz.<\/option><option value=\"Kurs-przygotowuj\u0105cy-nauczycieli-do-prowadzenia-zaj\u0119\u0107-edukacyjnych-z-zakresu-pierwszej-pomocy\"  data-calculation=\"0\">Kurs przygotowuj\u0105cy nauczycieli do prowadzenia zaj\u0119\u0107 edukacyjnych z zakresu pierwszej pomocy<\/option><option value=\"Kurs-RKO-30-godz.\"  data-calculation=\"0\">Kurs RKO 30 godz.<\/option><option value=\"Wsparcie-psychologiczne\"  data-calculation=\"0\">Wsparcie psychologiczne<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6ac9872c6751e\" id=\"forminator-field-name-1_6ac9872c6751e-label\" class=\"forminator-label\">Imi\u0119 i Nazwisko <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"Na przyk\u0142ad: Jan Kowalski\" id=\"forminator-field-name-1_6ac9872c6751e\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6ac9872c6751e\" id=\"forminator-field-phone-1_6ac9872c6751e-label\" class=\"forminator-label\">Numer telefonu <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"Przyk\u0142ad: +48 300 400 500\" id=\"forminator-field-phone-1_6ac9872c6751e\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" data-national_mode=\"enabled\" data-country=\"pl\" data-validation=\"standard\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6ac9872c6751e\" id=\"forminator-field-email-1_6ac9872c6751e-label\" class=\"forminator-label\">Adres e-mail <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"Na przyk\u0142ad: jan@kowalski.com\" id=\"forminator-field-email-1_6ac9872c6751e\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-4\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-4_6ac9872c6751e\" id=\"forminator-field-name-4_6ac9872c6751e-label\" class=\"forminator-label\">Numer Prawa Wykonywania Zawodu<\/label><input type=\"text\" name=\"name-4\" value=\"\" placeholder=\"\" id=\"forminator-field-name-4_6ac9872c6751e\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-6ac9872c6751e-label\"><span id=\"forminator-radiogroup-radio-1-6ac9872c6751e-label\" class=\"forminator-label\">Faktura VAT <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-6ac9872c6751e\" class=\"forminator-radio\" title=\"TAK\"><input type=\"radio\" name=\"radio-1\" value=\"one\" id=\"forminator-field-radio-1-1-6ac9872c6751e\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">TAK<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-6ac9872c6751e\" class=\"forminator-radio\" title=\"NIE\"><input type=\"radio\" name=\"radio-1\" value=\"two\" id=\"forminator-field-radio-1-2-6ac9872c6751e\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">NIE<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6ac9872c6751e\" id=\"forminator-field-textarea-1_6ac9872c6751e-label\" class=\"forminator-label\">Dane do Faktury VAT<\/label><textarea name=\"textarea-1\" placeholder=\"Wype\u0142ni\u0107 w przypadku zaznaczenia opcji &quot;TAK&quot; w powy\u017cszym punkcie. W innym wypadku pozostawi\u0107 puste pole.\" id=\"forminator-field-textarea-1_6ac9872c6751e\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-6ac9872c6751e-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-6ac9872c6751e-label\" class=\"forminator-label\">O\u015bwiadczenie o wyra\u017ceniu zgody na przetwarzanie danych osobowych. <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-1-1-6ac9872c6751e-label\" for=\"forminator-field-checkbox-1-1-6ac9872c6751e\" class=\"forminator-checkbox\" title=\"O\u015bwiadczam, \u017ce wyra\u017cam zgod\u0119 na gromadzenie i przetwarzanie moich danych osobowych przez SP ZOZ WSPR w Bia\u0142ymstoku w celach zwi\u0105zanych z realizacj\u0105 szkole\u0144, um\u00f3w i celach marketingowych (zgodnie z: Rozporz\u0105dzenie Parlamentu Europejskiego I Rady (UE) 2016\/679 z dnia 27 kwietnia 2016 r. w sprawie ochrony os\u00f3b fizycznych w zwi\u0105zku z przetwarzaniem danych osobowych i w sprawie swobodnego przep\u0142ywu takich danych oraz uchylenia dyrektywy 95\/46\/WE)\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-1-6ac9872c6751e\" aria-labelledby=\"forminator-field-checkbox-1-1-6ac9872c6751e-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">O\u015bwiadczam, \u017ce wyra\u017cam zgod\u0119 na gromadzenie i przetwarzanie moich danych osobowych przez SP ZOZ WSPR w Bia\u0142ymstoku w celach zwi\u0105zanych z realizacj\u0105 szkole\u0144, um\u00f3w i celach marketingowych (zgodnie z: Rozporz\u0105dzenie Parlamentu Europejskiego I Rady (UE) 2016\/679 z dnia 27 kwietnia 2016 r. w sprawie ochrony os\u00f3b fizycznych w zwi\u0105zku z przetwarzaniem danych osobowych i w sprawie swobodnego przep\u0142ywu takich danych oraz uchylenia dyrektywy 95\/46\/WE)<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"consent-1\" class=\"forminator-field-consent forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-consent-1_6ac9872c6751e\" id=\"forminator-field-consent-1_6ac9872c6751e-label\" class=\"forminator-label\">Regulamin Szkole\u0144 i Kurs\u00f3w <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-checkbox__wrapper\"><label id=\"forminator-field-consent-1_6ac9872c6751e__label\" class=\"forminator-checkbox forminator-consent\"><input type=\"checkbox\" name=\"consent-1\" id=\"forminator-field-consent-1_6ac9872c6751e\" value=\"checked\" aria-labelledby=\"forminator-field-consent-1_6ac9872c6751e-label\" aria-describedby=\"forminator-field-consent-1_6ac9872c6751e__description\" data-required=\"true\" aria-required=\"true\" \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><\/label><div id=\"forminator-field-consent-1_6ac9872c6751e__description\" class=\"forminator-checkbox__label forminator-consent__label\"><p>O\u015bwiadczam, \u017ce zapozna\u0142em\/am si\u0119 z <a href=\"https:\/\/www.wspr.bialystok.pl\/?page_id=18816\">Regulaminem Szkole\u0144 i Kurs\u00f3w<\/a>. Akceptuje wszystkie zawarte w nim warunki.<\/p><\/div><\/div><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\"><span>Wy\u015blij wiadomo\u015b\u0107<\/span><span aria-hidden=\"true\"><\/span><\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"5b5ac56d4a\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F1182\" \/><input type=\"hidden\" name=\"form_id\" value=\"18688\"><input type=\"hidden\" name=\"page_id\" value=\"1182\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/www.wspr.bialystok.pl\/?page_id=1182\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form>\n<\/div><\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":22,"featured_media":0,"parent":156,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1182","page","type-page","status-publish"],"_links":{"self":[{"href":"https:\/\/www.wspr.bialystok.pl\/index.php?rest_route=\/wp\/v2\/pages\/1182","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.wspr.bialystok.pl\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.wspr.bialystok.pl\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.wspr.bialystok.pl\/index.php?rest_route=\/wp\/v2\/users\/22"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wspr.bialystok.pl\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1182"}],"version-history":[{"count":5,"href":"https:\/\/www.wspr.bialystok.pl\/index.php?rest_route=\/wp\/v2\/pages\/1182\/revisions"}],"predecessor-version":[{"id":18701,"href":"https:\/\/www.wspr.bialystok.pl\/index.php?rest_route=\/wp\/v2\/pages\/1182\/revisions\/18701"}],"up":[{"embeddable":true,"href":"https:\/\/www.wspr.bialystok.pl\/index.php?rest_route=\/wp\/v2\/pages\/156"}],"wp:attachment":[{"href":"https:\/\/www.wspr.bialystok.pl\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1182"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}