{"id":2761,"date":"2021-12-21T11:52:34","date_gmt":"2021-12-21T17:52:34","guid":{"rendered":"http:\/\/www.kenoshamoose286.com\/?page_id=2761"},"modified":"2021-12-21T11:52:34","modified_gmt":"2021-12-21T17:52:34","slug":"reports-of-sickness-or-distress","status":"publish","type":"page","link":"https:\/\/www.kenoshamoose286.com\/NewMoose\/reports-of-sickness-or-distress\/","title":{"rendered":"Reports of Sickness or Distress"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f2760-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"2760\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/NewMoose\/wp-json\/wp\/v2\/pages\/2761#wpcf7-f2760-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"2760\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f2760-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<p><u><strong>NOTICE:<\/strong><\/u> It is the responsibility of the reporter to be sure that the person named (or the family in case of death) is in agreement to have the information posted.\n<\/p>\n<p><strong>SICK or DISTRESSED MEMBER INFORMATION<\/strong>\n<\/p>\n<p><label> Name of Member Sick or Deceased:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"sd-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"sd-name\" \/><\/span> <\/label>\n<\/p>\n<p>Is This a Member of the Lodge or Chapter?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-754\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-754\" value=\"Lodge\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Lodge<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-754\" value=\"Chapter\" \/><span class=\"wpcf7-list-item-label\">Chapter<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label> Name of Lodge or Chapter:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-54\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-54\" \/><\/span><\/label>\n<\/p>\n<p><label> Lodge or Chapter Number:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-55\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-55\" \/><\/span><\/label>\n<\/p>\n<p><label>Please Provide Details of Distress:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-260\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-260\"><\/textarea><\/span><\/label>\n<\/p>\n<p><strong>MEMBERS SHOULD SEND CARD TO:<\/strong>\n<\/p>\n<p><label> Address:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-388\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"textarea-388\"><\/textarea><\/span><\/label>\n<\/p>\n<p><strong>IF DEATH, PLEASE PROVIDE FUNERAL DETAILS<\/strong>\n<\/p>\n<p><u>NOTICE:<\/u> A Death Notice WILL NOT BE POSTER without complete information (Funeral Home, Visitation, funeral, etc). If you do not have this information, do not submit report until you have the information.\n<\/p>\n<p><label>Date of Passing: <span class=\"wpcf7-form-control-wrap\" data-name=\"date-134\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"dd\/mm\/yy\" type=\"date\" name=\"date-134\" \/><\/span><\/label>\n<\/p>\n<p><label> Date and Time of Visitation: <span class=\"wpcf7-form-control-wrap\" data-name=\"date-135\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"dd\/mm\/yy\" type=\"date\" name=\"date-135\" \/><\/span><\/label>\n<\/p>\n<p><label> Date and Time of Funeral: <span class=\"wpcf7-form-control-wrap\" data-name=\"date-136\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"dd\/mm\/yy\" type=\"date\" name=\"date-136\" \/><\/span><\/label>\n<\/p>\n<p><label>Funeral Home Information:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-389\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"textarea-389\"><\/textarea><\/span><\/label>\n<\/p>\n<p>Interested in a \"Breaking of the Circle\" ceremony?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-291\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-291\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-291\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><strong> YOUR CONTACT INFORMATION<\/strong>\n<\/p>\n<p><u>NOTE:<\/u> Notice will not be posted without your name and a valid email address.\n<\/p>\n<p><label>Your Name:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span><\/label>\n<\/p>\n<p><label>Your Phone and Address:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-390\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"textarea-390\"><\/textarea><\/span><\/label>\n<\/p>\n<p><label>Your Email Address:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span><\/label>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit Report of Sickness or Distress\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n[\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][\/vc_column][\/vc_row]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-2761","page","type-page","status-publish","czr-hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Reports of Sickness or Distress - Kenosha Moose Lodge<\/title>\n<meta name=\"description\" content=\"The Loyal Order of Moose is a fraternal and service organization founded in 1888, with nearly 1 million men in roughly 2,400 Lodges, in all 50 U.S. states and four Canadian provinces as well as Bermuda; along with its female auxiliary, Women of the Moose with more than 400,000 members in roughly 1,600 Chapters in the same areas and the Loyal Order of Moose in Britain these organizations make up the Moose International. 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