<div class="forminator-ui forminator-custom-form forminator-custom-form-63524 forminator-design--default forminator_ajax" data-forminator-render="0" data-form="forminator-module-63524" data-uid="68b8101b756fd"><br/></div><form id="forminator-module-63524" class="forminator-ui forminator-custom-form forminator-custom-form-63524 forminator-design--default forminator_ajax" method="post" data-forminator-render="0" data-form-id="63524" data-design="default" data-color-option="default" data-grid="open" style="display: none;" data-uid="68b8101b756fd" ><div role="alert" aria-live="polite" class="forminator-response-message forminator-error" aria-hidden="true"></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_68b8101b756fd" id="forminator-field-name-1_68b8101b756fd-label" class="forminator-label">Full Name <span class="forminator-required">*</span></label><input type="text" name="name-1" value="" placeholder="E.g. John Jones" id="forminator-field-name-1_68b8101b756fd" class="forminator-input forminator-name--field" aria-required="true" /></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_68b8101b756fd" id="forminator-field-email-1_68b8101b756fd-label" class="forminator-label">Email Address <span class="forminator-required">*</span></label><input type="email" name="email-1" value="" placeholder="E.g. [email protected]" id="forminator-field-email-1_68b8101b756fd" class="forminator-input forminator-email--field" data-required="true" aria-required="true" /></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_68b8101b756fd" id="forminator-field-phone-1_68b8101b756fd-label" class="forminator-label">Phone Number</label><input type="text" name="phone-1" value="" placeholder="E.g. +1 3004005000" id="forminator-field-phone-1_68b8101b756fd" class="forminator-input forminator-field--phone" data-required="" aria-required="false" autocomplete="off" /></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_68b8101b756fd" id="forminator-field-textarea-1_68b8101b756fd-label" class="forminator-label">Message</label><textarea name="textarea-1" placeholder="Enter your message..." id="forminator-field-textarea-1_68b8101b756fd" class="forminator-textarea" rows="6" style="min-height:140px;" maxlength="180" ></textarea><span id="forminator-field-textarea-1_68b8101b756fd-description" class="forminator-description"><span data-limit="180" data-type="characters" data-editor="">0 / 180</span></span></div></div></div><div class="forminator-row"><div id="captcha-1" class="forminator-field-captcha forminator-col forminator-col-12 "><div class="forminator-captcha-left forminator-g-recaptcha recaptcha-invisible" data-theme="light" data-badge="bottomright" data-sitekey="6LfwHgAqAAAAAP7y9EbXOKrmpMlYAUGyMnY_tOWc" data-size="invisible"></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">Send Message</button></div></div></div><input type="hidden" id="forminator_nonce" name="forminator_nonce" value="90b084318f" /><input type="hidden" name="_wp_http_referer" value="/document/concussion-policy/" /><input type="hidden" name="form_id" value="63524"><input type="hidden" name="page_id" value="63124"><input type="hidden" name="form_type" value="default"><input type="hidden" name="current_url" value="https://us.7eliteacademy.com/document/concussion-policy/"><input type="hidden" name="render_id" value="0"><input type="hidden" name="action" value="forminator_submit_form_custom-forms"></form>