document.write("<div class=\"fsBody fsEmbed\">"+"\n");
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document.write("<form method=\"post\" accept-charset=\"UTF-8\" novalidate enctype=\"multipart/form-data\" action=\"https://sitejab.formstack.com/forms/index.php\" class=\"fsForm fsSingleColumn\" id=\"fsForm2905455\">"+"\n");
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document.write("<input type=\"hidden\" name=\"referrer\" id=\"referrer2905455\" value=\"https://protectldschildren.org/share-your-story/\" />"+"\n");
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document.write("<div id=\"saveAndResume\" style=\"display: none;\">Save and Resume Later</div>"+"\n");
document.write("<div id=\"saveResumeProcess\" style=\"display: none;\">Save and get link</div>"+"\n");
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document.write("<div id=\"dcmWithCode\" style=\"display:none;\">with code</div>"+"\n");
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document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsSpan100\" id=\"fsCell59469876\" aria-describedby=\"fsSupporting59469876\" lang=\"en\" fs-field-type=\"checkbox\" fs-field-validation-name=\"Name Privacy\">"+"\n");
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document.write("    "+"\n");
document.write("    "+"\n");
document.write("                                                                                                        <div id=\"fsSupporting59469876\" class=\"fsSupporting\">***Please view our privacy policy: <a href=\"http://protectldschildren.org/privacy-policy/\">http://protectldschildren.org/privacy-policy/</a></div>"+"\n");
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document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsSpan100\" id=\"fsCell59389361\" lang=\"en\" fs-field-type=\"checkbox\" fs-field-validation-name=\"Consequences Suffered (Check All That Apply)\">"+"\n");
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document.write("                            <legend id=\"fsLegend59389361\" class=\"fsLabel fsRequiredLabel fsLabelVertical\"><span>Consequences Suffered (Check All That Apply)<span class=\"fsRequiredMarker\">*</span></span></legend>"+"\n");
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document.write("                                                        <label class=\"fsOptionLabel vertical\" for=\"field59389361_3\"><input type=\"checkbox\" id=\"field59389361_3\" name=\"field59389361[]\" value=\"Adulthood self-loathing\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />Adulthood self-loathing</label>"+"\n");
document.write("                                                        <label class=\"fsOptionLabel vertical\" for=\"field59389361_4\"><input type=\"checkbox\" id=\"field59389361_4\" name=\"field59389361[]\" value=\"Normalizing children to sexual questions by adult men. (Grooming)\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />Normalizing children to sexual questions by adult men. (Grooming)</label>"+"\n");
document.write("                                                        <label class=\"fsOptionLabel vertical\" for=\"field59389361_5\"><input type=\"checkbox\" id=\"field59389361_5\" name=\"field59389361[]\" value=\"Sexual abuse. (Pedophilia)\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />Sexual abuse. (Pedophilia)</label>"+"\n");
document.write("                                                        <label class=\"fsOptionLabel vertical\" for=\"field59389361_6\"><input type=\"checkbox\" id=\"field59389361_6\" name=\"field59389361[]\" value=\"Impaired sexual relations after marriage.\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />Impaired sexual relations after marriage.</label>"+"\n");
document.write("                                                        <label class=\"fsOptionLabel vertical\" for=\"field59389361_7\"><input type=\"checkbox\" id=\"field59389361_7\" name=\"field59389361[]\" value=\"Years of recovery from childhood shaming. Often lasting decades.\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />Years of recovery from childhood shaming. Often lasting decades.</label>"+"\n");
document.write("                                                        <label class=\"fsOptionLabel vertical\" for=\"field59389361_8\"><input type=\"checkbox\" id=\"field59389361_8\" name=\"field59389361[]\" value=\"Suicide Ideation\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />Suicide Ideation</label>"+"\n");
document.write("                                                        <label class=\"fsOptionLabel vertical\" for=\"field59389361_9\"><input type=\"checkbox\" id=\"field59389361_9\" name=\"field59389361[]\" value=\"Attempted Suicide\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />Attempted Suicide</label>"+"\n");
document.write("                                                        <label class=\"fsOptionLabel vertical\" for=\"field59389361_10\"><input type=\"checkbox\" id=\"field59389361_10\" name=\"field59389361[]\" value=\"Suicide of a Loved One or Friend\" class=\"fsField fsRequired vertical\" aria-required=\"true\" />Suicide of a Loved One or Friend</label>"+"\n");
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document.write("            <div class=\"fsRowBody fsCell fsFieldCell fsFirst fsLast fsLabelVertical fsSpan100\" id=\"fsCell59326617\" aria-describedby=\"fsSupporting59326617\" lang=\"en\" fs-field-type=\"file\" fs-field-validation-name=\"Upload a Video\">"+"\n");
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document.write("           id=\"field59326617DeleteButton\""+"\n");
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document.write("           value=\"Remove File\""+"\n");
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document.write("    <span class=\"fsFileUploadName\" id=\"field59326617FileName\">No File Chosen</span>"+"\n");
document.write("    <div class=\"showMobile\">File uploads may not work on some mobile devices.</div>"+"\n");
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document.write("    "+"\n");
document.write("                                                                                                        <div id=\"fsSupporting59326617\" class=\"fsSupporting\">You can also make a video with your story and share it with us. By uploading, you are also granting us permission to use this video on our website.</div>"+"\n");
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