{"id":1057,"date":"2025-07-21T11:05:22","date_gmt":"2025-07-21T03:05:22","guid":{"rendered":"https:\/\/boms1.amitechco.solutions\/?page_id=1057"},"modified":"2025-07-22T16:29:08","modified_gmt":"2025-07-22T08:29:08","slug":"user-registration-form","status":"publish","type":"page","link":"https:\/\/juban-boms.lguapps.com\/south-poblacion\/index.php\/user-registration-form\/","title":{"rendered":"Resident Registration Form"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full wpforms-container-save-resume wpforms-block wpforms-block-6410f9d7-d6cf-4e52-8ab0-89e7c544f3ad wpforms-render-modern\" id=\"wpforms-1037\"><form id=\"wpforms-form-1037\" class=\"wpforms-validate wpforms-form\" data-formid=\"1037\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/south-poblacion\/index.php\/wp-json\/wp\/v2\/pages\/1057\" data-token=\"8cba23ff10fd505e03770244ae0e79d2\" data-token-time=\"1784864385\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-hidden\" id=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-1037-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-1037-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" aria-errormessage=\"wpforms-1037-field_1-error\" required><label for=\"wpforms-1037-field_1\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1037-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" aria-errormessage=\"wpforms-1037-field_1-last-error\" required><label for=\"wpforms-1037-field_1-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-1037-field_2-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-1037-field_2\">Username <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1037-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" aria-errormessage=\"wpforms-1037-field_2-error\" required><\/div>\t\t<div id=\"wpforms-1037-field_5-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"5\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-1037-field_5\" >Contact Username Address<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-1037-field_5\" class=\"wpforms-field-medium\" name=\"wpforms[fields][5]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-1037-field_3-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-1037-field_3\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1037-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1037-field_3-error\" required><\/div><div id=\"wpforms-1037-field_4-container\" class=\"wpforms-field wpforms-field-password\" data-field-type=\"password\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-1037-field_4\">Password <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"password\" id=\"wpforms-1037-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1037-field_4-error\" required><\/div><div id=\"wpforms-1037-field_6-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-1037-field_6\">Date of Birth <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1037-field_6\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][6][date]\" aria-errormessage=\"wpforms-1037-field_6-error\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-1037-field_7-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"7\"><fieldset><legend class=\"wpforms-field-label\">Gender <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1037-field_7\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1037-field_7_1\" name=\"wpforms[fields][7]\" value=\"Male\" aria-errormessage=\"wpforms-1037-field_7_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1037-field_7_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1037-field_7_2\" name=\"wpforms[fields][7]\" value=\"Female\" aria-errormessage=\"wpforms-1037-field_7_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1037-field_7_2\">Female<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1037-field_8-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"8\"><fieldset><legend class=\"wpforms-field-label\">Civil Status <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1037-field_8\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1037-field_8_1\" name=\"wpforms[fields][8]\" value=\"Single\" aria-errormessage=\"wpforms-1037-field_8_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1037-field_8_1\">Single<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1037-field_8_2\" name=\"wpforms[fields][8]\" value=\"Married\" aria-errormessage=\"wpforms-1037-field_8_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1037-field_8_2\">Married<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1037-field_8_3\" name=\"wpforms[fields][8]\" value=\"Widowed\" aria-errormessage=\"wpforms-1037-field_8_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1037-field_8_3\">Widowed<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1037-field_8_4\" name=\"wpforms[fields][8]\" value=\"Annulled\" aria-errormessage=\"wpforms-1037-field_8_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1037-field_8_4\">Annulled<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-1037-field_8_5\" name=\"wpforms[fields][8]\" value=\"Separated\" aria-errormessage=\"wpforms-1037-field_8_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1037-field_8_5\">Separated<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1037-field_9-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"9\"><fieldset><legend class=\"wpforms-field-label\">Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium wpforms-geolocation-map\"><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-1037-field_9\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][9][address1]\" data-autocomplete=\"1\" data-display-map=\"1\" aria-errormessage=\"wpforms-1037-field_9-error\" required><label for=\"wpforms-1037-field_9\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1037-field_9-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][9][city]\" value=\"Calapan\" placeholder=\"Calapan\" aria-errormessage=\"wpforms-1037-field_9-city-error\" required><label for=\"wpforms-1037-field_9-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1037-field_9-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][9][state]\" value=\"Oriental Mindoro\" placeholder=\"Oriental Mindoro\" aria-errormessage=\"wpforms-1037-field_9-state-error\" required><label for=\"wpforms-1037-field_9-state\" class=\"wpforms-field-sublabel after\">State \/ Province \/ Region<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-1037-field_10-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-1037-field_10\">Contact Number <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1037-field_10\" class=\"wpforms-field-large wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][10]\" aria-label=\"Contact Number\" aria-errormessage=\"wpforms-1037-field_10-error\" required><\/div><div id=\"wpforms-1037-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-1037-field_11\">Occupation <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1037-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" aria-errormessage=\"wpforms-1037-field_11-error\" required><\/div><div id=\"wpforms-1037-field_12-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"12\"><fieldset><legend class=\"wpforms-field-label\">Voter Status <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1037-field_12\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1037-field_12_1\" name=\"wpforms[fields][12]\" value=\"Yes\" aria-errormessage=\"wpforms-1037-field_12_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1037-field_12_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1037-field_12_2\" name=\"wpforms[fields][12]\" value=\"No\" aria-errormessage=\"wpforms-1037-field_12_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1037-field_12_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1037-field_13-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-1037-field_13\">Household ID (Household Number) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1037-field_13\" 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value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/juban-boms.lguapps.com\/south-poblacion\/index.php\/wp-json\/wp\/v2\/pages\/1057\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1037\" class=\"wpforms-submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><\/div><\/form><\/div>  <!-- .wpforms-container -->","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"_view_id":"","footnotes":""},"class_list":["post-1057","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/juban-boms.lguapps.com\/south-poblacion\/index.php\/wp-json\/wp\/v2\/pages\/1057","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/juban-boms.lguapps.com\/south-poblacion\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/juban-boms.lguapps.com\/south-poblacion\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/juban-boms.lguapps.com\/south-poblacion\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/juban-boms.lguapps.com\/south-poblacion\/index.php\/wp-json\/wp\/v2\/comments?post=1057"}],"version-history":[{"count":2,"href":"https:\/\/juban-boms.lguapps.com\/south-poblacion\/index.php\/wp-json\/wp\/v2\/pages\/1057\/revisions"}],"predecessor-version":[{"id":1082,"href":"https:\/\/juban-boms.lguapps.com\/south-poblacion\/index.php\/wp-json\/wp\/v2\/pages\/1057\/revisions\/1082"}],"wp:attachment":[{"href":"https:\/\/juban-boms.lguapps.com\/south-poblacion\/index.php\/wp-json\/wp\/v2\/media?parent=1057"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}