{"id":4420,"date":"2023-07-05T09:04:21","date_gmt":"2023-07-05T00:04:21","guid":{"rendered":"https:\/\/ks-wish.jp\/rei-us\/?page_id=4420"},"modified":"2023-09-14T13:07:48","modified_gmt":"2023-09-14T04:07:48","slug":"request-for-proxy-visit","status":"publish","type":"page","link":"https:\/\/ks-wish.jp\/rei-us\/request-for-proxy-visit\/","title":{"rendered":"Proxy visitation request form"},"content":{"rendered":"<p style=\"text-align: center;\"><span style=\"font-size: 24pt; font-family: 'book antiqua', palatino, serif;\"><b>Please fill out the form in person.<\/b><\/span><\/p>\n<div class=\"s_table\"><table style=\"border-collapse: collapse; width: 100%;\">\n<tbody>\n<tr>\n<td style=\"width: 100%;\"><span style=\"color: #ff0000; font-size: 12pt;\">The information on this form is the &#8221; <strong>information you will request for prayers at each shrine<\/strong> &#8221; when you make a proxy visit to the shrine. If it is difficult for you to fill out this form, please have a family member fill it out while listening to your wishes.<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n<p style=\"text-align: right;\"><a href=\"https:\/\/ks-wish.jp\/rei-us\/privacy-policy-2\/\">Please click here to view our privacy policy.<\/a><\/p>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f4860-o1\" lang=\"ja\" dir=\"ltr\" data-wpcf7-id=\"4860\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/rei-us\/wp-json\/wp\/v2\/pages\/4420#wpcf7-f4860-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"\u30b3\u30f3\u30bf\u30af\u30c8\u30d5\u30a9\u30fc\u30e0\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"4860\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"ja\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f4860-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<p><label>Please select the organization to which you would like to request a proxy visit <span class=\"red\">(required)<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-koumoku\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"menu-koumoku\"><option value=\"\">&#8212;\u4ee5\u4e0b\u304b\u3089\u9078\u629e\u3057\u3066\u304f\u3060\u3055\u3044&#8212;<\/option><option value=\"Tsuno Shrine\">Tsuno Shrine<\/option><\/select><\/span> <\/label>\n<\/p>\n<p>Please select your prayer (multiple selections allowed)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-element\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"your-element[]\" value=\"worship\" \/><span class=\"wpcf7-list-item-label\">worship<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-element[]\" value=\"Family safety\" \/><span class=\"wpcf7-list-item-label\">Family safety<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-element[]\" value=\"Prosperous business\" \/><span class=\"wpcf7-list-item-label\">Prosperous business<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-element[]\" value=\"Thank God for God&#039;s grace\" \/><span class=\"wpcf7-list-item-label\">Thank God for God&#039;s grace<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-element[]\" value=\"national security\" \/><span class=\"wpcf7-list-item-label\">national security<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-element[]\" value=\"troublesome\" \/><span class=\"wpcf7-list-item-label\">troublesome<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-element[]\" value=\"car cover\" \/><span class=\"wpcf7-list-item-label\">car cover<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-element[]\" value=\"health\" \/><span class=\"wpcf7-list-item-label\">health<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-element[]\" value=\"disease\" \/><span class=\"wpcf7-list-item-label\">disease<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-element[]\" value=\"good match\" \/><span class=\"wpcf7-list-item-label\">good match<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-element[]\" value=\"Easy delivery\" \/><span class=\"wpcf7-list-item-label\">Easy delivery<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-element[]\" value=\"Childhood\" \/><span class=\"wpcf7-list-item-label\">Childhood<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-element[]\" value=\"Entertainment\" \/><span class=\"wpcf7-list-item-label\">Entertainment<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"your-element[]\" value=\"Achievement of your wish\" \/><span class=\"wpcf7-list-item-label\">Achievement of your wish<\/span><\/span><\/span><\/span>\n<\/p>\n<h3>Please fill in the address to which you would like us to send your sacred items (your address)\n<\/h3>\n<p><label> Postal Code <span class=\"red\"> (required)<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-yuubin\"><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-yuubin\" \/><\/span> <\/label>\n<\/p>\n<p><label> Address <span class=\"red\"> (required)<\/span><br \/>\nPlease provide your full address, including the county seat, building name, and room number.<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-home\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\" value=\"\" type=\"text\" name=\"your-home\" \/><\/span> <\/label>\n<\/p>\n<h3>Please fill in your name, furigana, date of birth, and contact information\n<\/h3>\n<p><label> Your name <span class=\"red\"> (required)<\/span><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> Furigana of your name (Japanese only)<span class=\"red\"><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-kana\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-kana\" \/><\/span> <\/label>\n<\/p>\n<p><label> Date of birth (Western calendar year)<span class=\"red\"><\/span><br \/>\n[text your-nenrei placeholder\"] <\/label>\n<\/p>\n<p><label> E-mail address <span class=\"red\"> (required)<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"inquiry_mail\"><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=\"inquiry_mail\" \/><\/span> <\/label>\n<\/p>\n<p><label> Re-enter email address <span class=\"red\"> (confirmation)<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"inquiry_mail_confirm\"><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=\"inquiry_mail_confirm\" \/><\/span> <\/label>\n<\/p>\n<p><label> Contact phone number, cell phone acceptable <span class=\"red\"> (required)<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tel-no\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"tel-no\" \/><\/span><\/label>\n<\/p>\n<h3>Please enter your message here\n<\/h3>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-message\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"your-message\"><\/textarea><\/span>\n<\/p>\n<p>1. A message of completion of transmission is displayed at the bottom.<br \/>\n2. The same content will be automatically sent to the above e-mail address.Please use the domain \"ks-wish.jp\" in a state where it can be received.\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"send\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"K's Wish\uff0d\u958b\u904b\u5e2b \u79ae\u8863\uff0d\u4ee3\u7406\u53c2\u62dd\u306e\u4e88\u7d04\u30d5\u30a9\u30fc\u30e0\u3067\u3059\u3002","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-noside.php","meta":{"footnotes":""},"class_list":["post-4420","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/ks-wish.jp\/rei-us\/wp-json\/wp\/v2\/pages\/4420","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ks-wish.jp\/rei-us\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/ks-wish.jp\/rei-us\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/ks-wish.jp\/rei-us\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/ks-wish.jp\/rei-us\/wp-json\/wp\/v2\/comments?post=4420"}],"version-history":[{"count":14,"href":"https:\/\/ks-wish.jp\/rei-us\/wp-json\/wp\/v2\/pages\/4420\/revisions"}],"predecessor-version":[{"id":4914,"href":"https:\/\/ks-wish.jp\/rei-us\/wp-json\/wp\/v2\/pages\/4420\/revisions\/4914"}],"wp:attachment":[{"href":"https:\/\/ks-wish.jp\/rei-us\/wp-json\/wp\/v2\/media?parent=4420"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}