{"id":545,"date":"2018-07-19T11:45:08","date_gmt":"2018-07-19T11:45:08","guid":{"rendered":"https:\/\/www.auxiliavera.com\/?page_id=545"},"modified":"2026-02-17T14:10:51","modified_gmt":"2026-02-17T14:10:51","slug":"aplikuj","status":"publish","type":"page","link":"https:\/\/www.auxiliavera.com\/?page_id=545","title":{"rendered":"APLIKUJ"},"content":{"rendered":"\n<div class=\"wp-block-group has-black-color has-text-color has-background has-medium-font-size is-horizontal is-content-justification-center is-nowrap is-layout-flex wp-container-core-group-is-layout-1 wp-block-group-is-layout-flex\" style=\"background-color:#ecf4fd\">\n<div class=\"wp-block-contact-form-7-contact-form-selector\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f5643-o1\" lang=\"pl-PL\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F545#wpcf7-f5643-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formularz kontaktowy\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"5643\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.7.7\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"pl_PL\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f5643-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<p><label> Imi\u0119 i nazwisko<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" 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> Adres e-mail (opcjonalnie)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span> <\/label>\n<\/p>\n<p><label> Numer telefonu<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Numertelefonu\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-required wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"Numertelefonu\" \/><\/span><br \/>\n<label> Data urodzenia<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Dataurodzenia\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"Dataurodzenia\" \/><\/span><br \/>\n<label> Znajomo\u015b\u0107 j\u0119zyka niemieckiego:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Znajomojzykaniemieckiego\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"Znajomojzykaniemieckiego\" value=\"Brak\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Brak<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"Znajomojzykaniemieckiego\" value=\"Podstawowa\" \/><span class=\"wpcf7-list-item-label\">Podstawowa<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"Znajomojzykaniemieckiego\" value=\"Komunikatywna\" \/><span class=\"wpcf7-list-item-label\">Komunikatywna<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"Znajomojzykaniemieckiego\" value=\"Dobra\" \/><span class=\"wpcf7-list-item-label\">Dobra<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"Znajomojzykaniemieckiego\" value=\"P\u0142ynna\" \/><span class=\"wpcf7-list-item-label\">P\u0142ynna<\/span><\/label><\/span><\/span><\/span><br \/>\n<label> Do\u015bwiadczenie:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Dowiadczenie\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"Dowiadczenie[]\" value=\"Brak\" \/><span class=\"wpcf7-list-item-label\">Brak<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Dowiadczenie[]\" value=\"Parkinson\" \/><span class=\"wpcf7-list-item-label\">Parkinson<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Dowiadczenie[]\" value=\"Demencja\" \/><span class=\"wpcf7-list-item-label\">Demencja<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Dowiadczenie[]\" value=\"Transfer na w\u00f3zek\" \/><span class=\"wpcf7-list-item-label\">Transfer na w\u00f3zek<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Dowiadczenie[]\" value=\"Obs\u0142uga liftu\" \/><span class=\"wpcf7-list-item-label\">Obs\u0142uga liftu<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Dowiadczenie[]\" value=\"Osoba le\u017c\u0105ca\" \/><span class=\"wpcf7-list-item-label\">Osoba le\u017c\u0105ca<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Dowiadczenie[]\" value=\"Alzheimer\" \/><span class=\"wpcf7-list-item-label\">Alzheimer<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Dowiadczenie[]\" value=\"Cewnik\" \/><span class=\"wpcf7-list-item-label\">Cewnik<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Dowiadczenie[]\" value=\"Stomia\" \/><span class=\"wpcf7-list-item-label\">Stomia<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Dowiadczenie[]\" value=\"Sonda PEG\" \/><span class=\"wpcf7-list-item-label\">Sonda PEG<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Dowiadczenie[]\" value=\"Po\u0144czochy uciskowe\" \/><span class=\"wpcf7-list-item-label\">Po\u0144czochy uciskowe<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"Dowiadczenie[]\" value=\"Maska tlenowa\" \/><span class=\"wpcf7-list-item-label\">Maska tlenowa<\/span><\/label><\/span><\/span><\/span><br \/>\n<label> Inne: <span class=\"wpcf7-form-control-wrap\" data-name=\"Inne\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Inne\" \/><\/span><br \/>\n<label> Numer oferty (opcjonalnie): <span class=\"wpcf7-form-control-wrap\" data-name=\"Numeroferty\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Numeroferty\" \/><\/span><br \/>\n<label> Preferowana data wyjazdu:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Preferowanadatawyjazdu\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"Preferowanadatawyjazdu\" \/><\/span><br \/>\n<label> Dodatkowe pytania (opcjonalne): <span class=\"wpcf7-form-control-wrap\" data-name=\"Dodatkowepytania\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Dodatkowepytania\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Wyraaniezgody\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Wyraaniezgody\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">Wyra\u017cam zgod\u0119 na przetwarzanie moich danych w celach kontaktowych.<\/span><\/label><\/span><\/span><\/span><br \/>\n<input class=\"wpcf7-form-control has-spinner wpcf7-submit\" type=\"submit\" value=\"Wy\u015blij\" \/><\/label><\/label><\/label><\/label><\/label><\/label><\/label><\/label>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n<\/div>\n ","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-545","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.auxiliavera.com\/index.php?rest_route=\/wp\/v2\/pages\/545","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.auxiliavera.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.auxiliavera.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.auxiliavera.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.auxiliavera.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=545"}],"version-history":[{"count":42,"href":"https:\/\/www.auxiliavera.com\/index.php?rest_route=\/wp\/v2\/pages\/545\/revisions"}],"predecessor-version":[{"id":8291,"href":"https:\/\/www.auxiliavera.com\/index.php?rest_route=\/wp\/v2\/pages\/545\/revisions\/8291"}],"wp:attachment":[{"href":"https:\/\/www.auxiliavera.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=545"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}