{"id":3162,"date":"2017-03-13T11:25:05","date_gmt":"2017-03-13T18:25:05","guid":{"rendered":"http:\/\/www.breining.edu\/?page_id=3162"},"modified":"2017-03-13T12:26:56","modified_gmt":"2017-03-13T19:26:56","slug":"dui-program-72-hour-reschedule-request","status":"publish","type":"page","link":"https:\/\/www.breining.edu\/index.php\/programsservices\/dui-schools\/dui-program-72-hour-reschedule-request\/","title":{"rendered":"DUI Program &#8211; 72-hour Reschedule Request"},"content":{"rendered":"<p class=\"Body\">You may submit this form to request a reschedule. This form must be submitted at least 72 hours prior to your scheduled activity. The fee for a reschedule is $10.00.<\/p>\n<p class=\"Body\">Submission of this form does not automatically result in approval of your request. We will email or call you to confirm the reschedule.<\/p>\n<form method=\"post\" enctype=\"multipart\/form-data\" id=\"vfbp-form-24\" class=\"vfbp-form\"><div style=\"display:none;\"><label for=\"vfbp-EMAIL-AN8fuQyoDLXem\">If you are human, leave this field blank.<\/label><input size=\"25\" autocomplete=\"off\" type=\"text\" name=\"vfbp-EMAIL-AN8fuQyoDLXem\" value=\"\" id=\"\"><\/div><input type=\"hidden\" name=\"_vfb-timestamp-24\" value=\"1775233493\" id=\"\"><input type=\"hidden\" name=\"_vfb-form-id\" value=\"24\" id=\"\"><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Section 1: Client Information<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField533\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField534\"><div class=\"vfb-form-group\"><label for=\"vfb-field-534\" class=\"vfb-control-label\">Full Name: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-534\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-534\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-email\" id=\"vfbField535\"><div class=\"vfb-form-group\"><label for=\"vfb-field-535\" class=\"vfb-control-label\">Email Address: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-535\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"email\" name=\"vfb-field-535\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-email\" id=\"vfbField536\"><div class=\"vfb-form-group\"><label for=\"vfb-field-536\" class=\"vfb-control-label\">Confirm Email Address: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-536\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"email\" name=\"vfb-field-536\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-phone\" id=\"vfbField537\"><div class=\"vfb-form-group\"><label for=\"vfb-field-537\" class=\"vfb-control-label\">Primary Phone Number <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-537\" class=\"vfb-form-control vfb-intl-phone\" placeholder=\"\" required=\"required\" type=\"tel\" name=\"vfb-field-537\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Section 2: Program Location<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField538\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField539\"><label for=\"vfb-field-539\" class=\"vfb-control-label\">Identify which Sacramento County Breining Institute DUI Program location you are attending: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-539-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-539\" required=\"required\" type=\"checkbox\" name=\"vfb-field-539[0]\" value=\"1\">NORTH COUNTY: 8894 Greenback Lane, Orangevale<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-539-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-539\" type=\"checkbox\" name=\"vfb-field-539[1]\" value=\"1\">FOLSOM: 2360 E. Bidwell Street, Suite 107, Folsom<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-539-2\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-539\" type=\"checkbox\" name=\"vfb-field-539[2]\" value=\"1\">MID-COUNTY: 2775 Cottage Way, Suite 25, Sacramento<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-539-3\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-539\" type=\"checkbox\" name=\"vfb-field-539[3]\" value=\"1\">SOUTH COUNTY: 3159 Dwight Road, Suite 100, Elk Grove<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Section 3: Credit Card and Payment Information<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField544\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-instructions\" id=\"vfbField545\"><div class=\"vfb-form-group\"><label for=\"vfb-field-545\" class=\"vfb-control-label\">You give permission to and authorize Breining Institute to charge the ten dollar ($10.00) 72-hour Reschedule Request Fee to the following credit card:<\/label><div class=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField546\"><label for=\"vfb-field-546\" class=\"vfb-control-label\">Credit Card: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-546-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-546\" value=\"VISA\">VISA<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-546-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-546\" value=\"MasterCard\">MasterCard<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-546-2\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-546\" value=\"Discover\">Discover<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-number\" id=\"vfbField547\"><div class=\"vfb-form-group\"><label for=\"vfb-field-547\" class=\"vfb-control-label\">Credit Card Number: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-547\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"number\" name=\"vfb-field-547\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField548\"><div class=\"vfb-form-group\"><label for=\"vfb-field-548\" class=\"vfb-control-label\">Full Name on Credit Card: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-548\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-548\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField549\"><div class=\"vfb-form-group\"><label for=\"vfb-field-549\" class=\"vfb-control-label\">Credit Card Expiration Date <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-549\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-549\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-captcha\" id=\"vfbField550\"><div class=\"vfb-form-group\"><label for=\"vfb-field-550\" class=\"vfb-control-label\">Captcha <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"g-recaptcha\" data-sitekey=\"6LdWgN0UAAAAAM_hb1SqmzT2DP4J1X289K2epOVA\"><\/div><input type=\"hidden\" name=\"_vfb_recaptcha_enabled\" value=\"1\" id=\"\"><div class=\"vfb-has-error\" id=\"vfb-recaptcha-error\"><span class=\"vfb-help-block\">reCAPTCHA is required.<\/span><\/div><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-submit\" id=\"vfbField551\"><button id=\"vfb-field-551\" class=\" btn btn-primary\" placeholder=\"\" type=\"submit\" name=\"_vfb-submit\">Submit<\/button><\/div><div class=\"vfb-clearfix\"><\/div><\/form>\n","protected":false},"excerpt":{"rendered":"<p>You may submit this form to request a reschedule. This form must be submitted at least 72 hours prior to your scheduled activity. The fee for a reschedule is $10.00. Submission of this form does not automatically result in approval of your request. We will email or call you to confirm the reschedule.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":528,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-3162","page","type-page","status-publish","czr-hentry"],"_links":{"self":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/3162","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/comments?post=3162"}],"version-history":[{"count":2,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/3162\/revisions"}],"predecessor-version":[{"id":3173,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/3162\/revisions\/3173"}],"up":[{"embeddable":true,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/528"}],"wp:attachment":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/media?parent=3162"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}