{"id":1251,"date":"2026-09-09T18:51:28","date_gmt":"2026-09-09T09:51:28","guid":{"rendered":"https:\/\/life2025.xbiz.jp\/ginpa-new\/?page_id=1251"},"modified":"2026-10-15T22:43:11","modified_gmt":"2026-10-15T13:43:11","slug":"allergy-form","status":"publish","type":"page","link":"https:\/\/life2025.xbiz.jp\/ginpa-new\/allergy-form\/","title":{"rendered":"\u98df\u7269\u30a2\u30ec\u30eb\u30ae\u30fc\u4e8b\u524d\u30d2\u30a2\u30ea\u30f3\u30b0\u30d5\u30a9\u30fc\u30e0"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1250-o1\" lang=\"ja\" dir=\"ltr\" data-wpcf7-id=\"1250\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/ginpa-new\/wp-json\/wp\/v2\/pages\/1251#wpcf7-f1250-o1\" method=\"post\" class=\"wpcf7-form init cf7mls-no-scroll cf7mls-auto-return-first-step cf7mls-no-moving-animation\" aria-label=\"\u30b3\u30f3\u30bf\u30af\u30c8\u30d5\u30a9\u30fc\u30e0\" novalidate=\"novalidate\" 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class=\"req\">\u5fc5\u9808<\/span>\n\t\t\t<\/p>\n\t\t<\/dt>\n\t\t<dd>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"anaphylaxis\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"anaphylaxis\" value=\"\u7d4c\u9a13\u6709\" \/><span class=\"wpcf7-list-item-label\">\u7d4c\u9a13\u6709<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"anaphylaxis\" value=\"\u7d4c\u9a13\u7121\" \/><span class=\"wpcf7-list-item-label\">\u7d4c\u9a13\u7121<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/dd>\n\t<\/dl>\n\t<div id=\"af-stop\" class=\"af-stop\" role=\"alert\" hidden>\n\t\t<p 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href=\"tel:0533571515\">0533-57-1515<\/a>\uff08\u53d7\u4ed8\u6642\u9593 9:00\u301c18:00\uff09\n\t\t<\/p>\n\t<\/div>\n\t<div id=\"af-rest\">\n\t\t<h3>\u3054\u5229\u7528\u65e5\u306b\u3064\u3044\u3066\n\t\t<\/h3>\n\t\t<dl class=\"cform\">\n\t\t\t<dt>\n\t\t\t\t<p>\u3054\u5165\u529b\u65e5<span class=\"req\">\u5fc5\u9808<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dt>\n\t\t\t<dd>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"entry-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"entry-date\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dd>\n\t\t\t<dt>\n\t\t\t\t<p>\u5f53\u65bd\u8a2d\u3054\u5229\u7528\u4e88\u5b9a\u65e5<span class=\"req\">\u5fc5\u9808<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dt>\n\t\t\t<dd>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"stay-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"stay-date\" \/><\/span><small class=\"af-note\" style=\"display:block;\">\u672c\u65e5\u304b\u30893\u65e5\u5f8c\u4ee5\u964d\u306e\u65e5\u4ed8\u3092\u304a\u9078\u3073\u304f\u3060\u3055\u3044\u3002<\/small>\n\t\t\t\t<\/p>\n\t\t\t<\/dd>\n\t\t<\/dl>\n\t\t<h3>\u30a2\u30ec\u30eb\u30ae\u30fc\u3092\u304a\u6301\u3061\u306e\u304a\u5ba2\u69d8\u306e\u60c5\u5831\n\t\t<\/h3>\n\t\t<dl class=\"cform\">\n\t\t\t<dt>\n\t\t\t\t<p>\u304a\u540d\u524d<span class=\"req\">\u5fc5\u9808<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dt>\n\t\t\t<dd>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"patient-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff1a\u9280\u6ce2 \u592a\u90ce\" value=\"\" type=\"text\" name=\"patient-name\" 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\u6b73\n\t\t\t\t<\/p>\n\t\t\t<\/dd>\n\t\t\t<dt>\n\t\t\t\t<p>\u6027\u5225<span class=\"req\">\u5fc5\u9808<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dt>\n\t\t\t<dd>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"patient-gender\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"patient-gender\" value=\"\u7537\u6027\" \/><span class=\"wpcf7-list-item-label\">\u7537\u6027<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"patient-gender\" value=\"\u5973\u6027\" \/><span class=\"wpcf7-list-item-label\">\u5973\u6027<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dd>\n\t\t<\/dl>\n\t\t<h3>\u3054\u81ea\u5b85\u306e\u8abf\u7406\u5668\u5177\u30fb\u98df\u6750\u306b\u3064\u3044\u3066\uff08\u4efb\u610f\uff09\n\t\t<\/h3>\n\t\t<dl class=\"cform\">\n\t\t\t<dt>\n\t\t\t\t<p>\u8a72\u5f53\u3059\u308b\u3082\u306e\u3092\u304a\u9078\u3073\u304f\u3060\u3055\u3044\n\t\t\t\t<\/p>\n\t\t\t<\/dt>\n\t\t\t<dd>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"home-kitchen\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"home-kitchen[]\" value=\"\u8abf\u7406\u5668\u5177\u306f\u5bb6\u65cf\u3068\u5225\u306b\u3057\u3066\u3044\u307e\u3059\" \/><span class=\"wpcf7-list-item-label\">\u8abf\u7406\u5668\u5177\u306f\u5bb6\u65cf\u3068\u5225\u306b\u3057\u3066\u3044\u307e\u3059<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"home-kitchen[]\" value=\"\u30a2\u30ec\u30eb\u30b2\u30f3\u98df\u6750\u306f\u81ea\u5b85\u306b\u7f6e\u3044\u3066\u3042\u308a\u307e\u305b\u3093\" \/><span class=\"wpcf7-list-item-label\">\u30a2\u30ec\u30eb\u30b2\u30f3\u98df\u6750\u306f\u81ea\u5b85\u306b\u7f6e\u3044\u3066\u3042\u308a\u307e\u305b\u3093<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dd>\n\t\t<\/dl>\n\t\t<h3>\u30a2\u30ec\u30eb\u30ae\u30fc\u5bfe\u5fdc\u306e\u5e0c\u671b\n\t\t<\/h3>\n\t\t<dl class=\"cform\">\n\t\t\t<dt>\n\t\t\t\t<p>\u9664\u53bb\u5e0c\u671b\u306e\u30a2\u30ec\u30eb\u30b2\u30f3<span class=\"req\">\u5fc5\u9808<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dt>\n\t\t\t<dd>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"allergens\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"allergens[]\" value=\"\u9d8f\u5375\" \/><span class=\"wpcf7-list-item-label\">\u9d8f\u5375<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"allergens[]\" value=\"\u725b\u4e73\" \/><span class=\"wpcf7-list-item-label\">\u725b\u4e73<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"allergens[]\" value=\"\u4e73\u88fd\u54c1\" \/><span class=\"wpcf7-list-item-label\">\u4e73\u88fd\u54c1<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"allergens[]\" value=\"\u5c0f\u9ea6\" \/><span class=\"wpcf7-list-item-label\">\u5c0f\u9ea6<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"allergens[]\" value=\"\u5927\u8c46\" \/><span class=\"wpcf7-list-item-label\">\u5927\u8c46<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"allergens[]\" value=\"\u3054\u307e\" \/><span class=\"wpcf7-list-item-label\">\u3054\u307e<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"allergens[]\" value=\"\u8c5a\" \/><span class=\"wpcf7-list-item-label\">\u8c5a<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"allergens[]\" value=\"\u725b\" \/><span class=\"wpcf7-list-item-label\">\u725b<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"allergens[]\" value=\"\u9d8f\" \/><span class=\"wpcf7-list-item-label\">\u9d8f<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"allergens[]\" value=\"\u30a8\u30d3\" \/><span class=\"wpcf7-list-item-label\">\u30a8\u30d3<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"allergens[]\" value=\"\u30ab\u30cb\" \/><span class=\"wpcf7-list-item-label\">\u30ab\u30cb<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"allergens[]\" value=\"\u30a4\u30ab\" \/><span class=\"wpcf7-list-item-label\">\u30a4\u30ab<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"allergens[]\" value=\"\u30bf\u30b3\" \/><span class=\"wpcf7-list-item-label\">\u30bf\u30b3<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"allergens[]\" value=\"\u30db\u30bf\u30c6\" \/><span class=\"wpcf7-list-item-label\">\u30db\u30bf\u30c6<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"allergens[]\" value=\"\u843d\u82b1\u751f\" \/><span class=\"wpcf7-list-item-label\">\u843d\u82b1\u751f<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"allergens[]\" value=\"\u304f\u308b\u307f\" \/><span class=\"wpcf7-list-item-label\">\u304f\u308b\u307f<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"allergens[]\" value=\"\u30ab\u30b7\u30e5\u30fc\u30ca\u30c3\u30c4\" \/><span class=\"wpcf7-list-item-label\">\u30ab\u30b7\u30e5\u30fc\u30ca\u30c3\u30c4<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"allergens[]\" value=\"\u305d\u3070\" \/><span class=\"wpcf7-list-item-label\">\u305d\u3070<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"allergens[]\" value=\"\u9b5a\u8c9d\u985e\" \/><span class=\"wpcf7-list-item-label\">\u9b5a\u8c9d\u985e<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"allergens[]\" value=\"\u9b5a\u5375\" \/><span class=\"wpcf7-list-item-label\">\u9b5a\u5375<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"allergens[]\" value=\"\u305d\u306e\u4ed6\" \/><span class=\"wpcf7-list-item-label\">\u305d\u306e\u4ed6<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dd>\n\t\t<\/dl>\n\t\t<div id=\"af-levels\" hidden>\n\t\t\t<p class=\"af-levels-lead\">\u9078\u3093\u3060\u30a2\u30ec\u30eb\u30b2\u30f3\u306b\u3064\u3044\u3066\u3001<strong>\u73fe\u5728\u306e\u6442\u53d6\u30ec\u30d9\u30eb<\/strong>\u3092\u304a\u9078\u3073\u304f\u3060\u3055\u3044\u3002<small>\uff08\u300c\u3007\u3007\u306f\u53ef\u80fd\u300d\u306b\u30c1\u30a7\u30c3\u30af\u304c\u7121\u3044\u3082\u306e\u306f\u3001\u53ec\u3057\u4e0a\u304c\u308c\u306a\u3044\u3082\u306e\u3068\u3057\u3066\u627f\u308a\u307e\u3059\uff09<\/small>\n\t\t\t<\/p>\n\t\t\t<div class=\"af-level\" data-allergen=\"\u9d8f\u5375\" hidden>\n\t\t\t\t<p class=\"af-level-name\">\u9d8f\u5375<span class=\"req\">\u5fc5\u9808<\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"egg-level\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"egg-level[]\" value=\"\u5b8c\u5168\u9664\u53bb\" \/><span class=\"wpcf7-list-item-label\">\u5b8c\u5168\u9664\u53bb<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"egg-level[]\" value=\"\u52a0\u5de5\u54c1\u306f\u53ef\u80fd\" \/><span class=\"wpcf7-list-item-label\">\u52a0\u5de5\u54c1\u306f\u53ef\u80fd<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"egg-level[]\" value=\"\u3064\u306a\u304e\u306f\u53ef\u80fd\" \/><span class=\"wpcf7-list-item-label\">\u3064\u306a\u304e\u306f\u53ef\u80fd<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"egg-level[]\" value=\"\u751f\u5375\u4ee5\u5916\u306f\u98df\u3079\u3089\u308c\u308b\" \/><span class=\"wpcf7-list-item-label\">\u751f\u5375\u4ee5\u5916\u306f\u98df\u3079\u3089\u308c\u308b<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<div class=\"af-sub\" data-when=\"egg-level|\u52a0\u5de5\u54c1\u306f\u53ef\u80fd\" hidden>\n\t\t\t\t\t<p class=\"af-sub-name\">\u52a0\u5de5\u54c1\u3067\u98df\u3079\u3089\u308c\u308b\u98df\u54c1\u306b\u30c1\u30a7\u30c3\u30af\u3057\u3066\u304f\u3060\u3055\u3044\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"egg-processed\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"egg-processed[]\" value=\"\u304b\u307e\u307c\u3053\" \/><span class=\"wpcf7-list-item-label\">\u304b\u307e\u307c\u3053<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"egg-processed[]\" value=\"\u3061\u304f\u308f\" \/><span class=\"wpcf7-list-item-label\">\u3061\u304f\u308f<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"egg-processed[]\" value=\"\u30cf\u30e0\" \/><span class=\"wpcf7-list-item-label\">\u30cf\u30e0<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"egg-processed[]\" value=\"\u30bd\u30fc\u30bb\u30fc\u30b8\" \/><span class=\"wpcf7-list-item-label\">\u30bd\u30fc\u30bb\u30fc\u30b8<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"egg-processed[]\" value=\"\u30de\u30e8\u30cd\u30fc\u30ba\" \/><span class=\"wpcf7-list-item-label\">\u30de\u30e8\u30cd\u30fc\u30ba<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"egg-processed[]\" value=\"\u4e2d\u83ef\u3081\u3093\" \/><span class=\"wpcf7-list-item-label\">\u4e2d\u83ef\u3081\u3093<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"egg-processed[]\" value=\"\u5375\u713c\u304d\" \/><span class=\"wpcf7-list-item-label\">\u5375\u713c\u304d<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"egg-processed[]\" value=\"\u8336\u7897\u84b8\u3057\" \/><span class=\"wpcf7-list-item-label\">\u8336\u7897\u84b8\u3057<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"af-sub\" data-when=\"egg-level|\u3064\u306a\u304e\u306f\u53ef\u80fd\" hidden>\n\t\t\t\t\t<p class=\"af-sub-name\">\u3064\u306a\u304e\u3067\u98df\u3079\u3089\u308c\u308b\u98df\u54c1\u306b\u30c1\u30a7\u30c3\u30af\u3057\u3066\u304f\u3060\u3055\u3044\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"egg-binder\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"egg-binder[]\" value=\"\u30d5\u30e9\u30a4\" \/><span class=\"wpcf7-list-item-label\">\u30d5\u30e9\u30a4<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"egg-binder[]\" value=\"\u5929\u3077\u3089\" \/><span class=\"wpcf7-list-item-label\">\u5929\u3077\u3089<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"egg-binder[]\" value=\"\u30cf\u30f3\u30d0\u30fc\u30b0\" \/><span class=\"wpcf7-list-item-label\">\u30cf\u30f3\u30d0\u30fc\u30b0<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"egg-binder[]\" value=\"\u5510\u63da\u3052\" \/><span class=\"wpcf7-list-item-label\">\u5510\u63da\u3052<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"egg-binder[]\" value=\"\u30af\u30c3\u30ad\u30fc\" \/><span class=\"wpcf7-list-item-label\">\u30af\u30c3\u30ad\u30fc<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"egg-binder[]\" value=\"\u30db\u30c3\u30c8\u30b1\u30fc\u30ad\" \/><span class=\"wpcf7-list-item-label\">\u30db\u30c3\u30c8\u30b1\u30fc\u30ad<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"af-level\" data-allergen=\"\u725b\u4e73|\u4e73\u88fd\u54c1\" hidden>\n\t\t\t\t<p class=\"af-level-name\">\u725b\u4e73\u30fb\u4e73\u88fd\u54c1<span class=\"req\">\u5fc5\u9808<\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"milk-level\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"milk-level[]\" value=\"\u5b8c\u5168\u9664\u53bb\" \/><span class=\"wpcf7-list-item-label\">\u5b8c\u5168\u9664\u53bb<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"milk-level[]\" value=\"\u52a0\u5de5\u54c1\u306f\u53ef\u80fd\" \/><span class=\"wpcf7-list-item-label\">\u52a0\u5de5\u54c1\u306f\u53ef\u80fd<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"milk-level[]\" value=\"\u4e73\u7cd6\u306f\u53ef\u80fd\" \/><span class=\"wpcf7-list-item-label\">\u4e73\u7cd6\u306f\u53ef\u80fd<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<div class=\"af-sub\" data-when=\"milk-level|\u52a0\u5de5\u54c1\u306f\u53ef\u80fd\" hidden>\n\t\t\t\t\t<p class=\"af-sub-name\">\u52a0\u5de5\u54c1\u3067\u98df\u3079\u3089\u308c\u308b\u98df\u54c1\u306b\u30c1\u30a7\u30c3\u30af\u3057\u3066\u304f\u3060\u3055\u3044\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"milk-processed\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"milk-processed[]\" value=\"\u725b\u4e73\" \/><span class=\"wpcf7-list-item-label\">\u725b\u4e73<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"milk-processed[]\" value=\"\u30d0\u30bf\u30fc\" \/><span class=\"wpcf7-list-item-label\">\u30d0\u30bf\u30fc<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"milk-processed[]\" value=\"\u751f\u30af\u30ea\u30fc\u30e0\" \/><span class=\"wpcf7-list-item-label\">\u751f\u30af\u30ea\u30fc\u30e0<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"milk-processed[]\" value=\"\u30e8\u30fc\u30b0\u30eb\u30c8\" \/><span class=\"wpcf7-list-item-label\">\u30e8\u30fc\u30b0\u30eb\u30c8<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"milk-processed[]\" value=\"\u30a2\u30a4\u30b9\u30af\u30ea\u30fc\u30e0\" \/><span class=\"wpcf7-list-item-label\">\u30a2\u30a4\u30b9\u30af\u30ea\u30fc\u30e0<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"milk-processed[]\" value=\"\u30c1\u30fc\u30ba\" \/><span class=\"wpcf7-list-item-label\">\u30c1\u30fc\u30ba<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"milk-processed[]\" value=\"\u30cf\u30e0\" \/><span class=\"wpcf7-list-item-label\">\u30cf\u30e0<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"milk-processed[]\" value=\"\u30bd\u30fc\u30bb\u30fc\u30b8\" \/><span class=\"wpcf7-list-item-label\">\u30bd\u30fc\u30bb\u30fc\u30b8<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"af-level\" data-allergen=\"\u5c0f\u9ea6\" hidden>\n\t\t\t\t<p class=\"af-level-name\">\u5c0f\u9ea6\n\t\t\t\t<\/p>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"wheat-level\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"wheat-level[]\" value=\"\u91a4\u6cb9\u306f\u53ef\u80fd\" \/><span class=\"wpcf7-list-item-label\">\u91a4\u6cb9\u306f\u53ef\u80fd<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"wheat-level[]\" value=\"\u5473\u564c\u306f\u53ef\u80fd\" \/><span class=\"wpcf7-list-item-label\">\u5473\u564c\u306f\u53ef\u80fd<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"wheat-level[]\" value=\"\u9162\u306f\u53ef\u80fd\" \/><span class=\"wpcf7-list-item-label\">\u9162\u306f\u53ef\u80fd<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"af-level\" data-allergen=\"\u5927\u8c46\" hidden>\n\t\t\t\t<p class=\"af-level-name\">\u5927\u8c46\n\t\t\t\t<\/p>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"soy-level\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"soy-level[]\" value=\"\u6cb9\u306f\u53ef\u80fd\" \/><span class=\"wpcf7-list-item-label\">\u6cb9\u306f\u53ef\u80fd<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"soy-level[]\" value=\"\u5473\u564c\u306f\u53ef\u80fd\" \/><span class=\"wpcf7-list-item-label\">\u5473\u564c\u306f\u53ef\u80fd<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"af-level\" data-allergen=\"\u3054\u307e\" hidden>\n\t\t\t\t<p class=\"af-level-name\">\u3054\u307e\n\t\t\t\t<\/p>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"sesame-level\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"sesame-level[]\" value=\"\u6cb9\u306f\u53ef\u80fd\" \/><span class=\"wpcf7-list-item-label\">\u6cb9\u306f\u53ef\u80fd<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"af-level\" data-allergen=\"\u8c5a|\u725b|\u9d8f\" hidden>\n\t\t\t\t<p class=\"af-level-name\">\u8c5a\u30fb\u725b\u30fb\u9d8f\n\t\t\t\t<\/p>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"meat-level\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"meat-level[]\" value=\"\u3060\u3057\u306f\u53ef\u80fd\" \/><span class=\"wpcf7-list-item-label\">\u3060\u3057\u306f\u53ef\u80fd<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"af-level\" data-allergen=\"\u30a8\u30d3|\u30ab\u30cb\" hidden>\n\t\t\t\t<p class=\"af-level-name\">\u30a8\u30d3\u30fb\u30ab\u30cb\n\t\t\t\t<\/p>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"shellfish-level\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"shellfish-level[]\" value=\"\u3060\u3057\u306f\u53ef\u80fd\" \/><span class=\"wpcf7-list-item-label\">\u3060\u3057\u306f\u53ef\u80fd<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"af-level\" data-allergen=\"\u30a4\u30ab|\u30bf\u30b3\" hidden>\n\t\t\t\t<p class=\"af-level-name\">\u30a4\u30ab\u30fb\u30bf\u30b3\n\t\t\t\t<\/p>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"squid-level\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"squid-level[]\" value=\"\u3060\u3057\u306f\u53ef\u80fd\" \/><span class=\"wpcf7-list-item-label\">\u3060\u3057\u306f\u53ef\u80fd<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"af-level\" data-allergen=\"\u30db\u30bf\u30c6\" hidden>\n\t\t\t\t<p class=\"af-level-name\">\u30db\u30bf\u30c6\n\t\t\t\t<\/p>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"scallop-level\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"scallop-level[]\" value=\"\u3060\u3057\u306f\u53ef\u80fd\" \/><span class=\"wpcf7-list-item-label\">\u3060\u3057\u306f\u53ef\u80fd<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"af-level\" data-allergen=\"\u9b5a\u8c9d\u985e|\u9b5a\u5375\" hidden>\n\t\t\t\t<p class=\"af-level-name\">\u9b5a\u8c9d\u985e\u30fb\u9b5a\u5375\n\t\t\t\t<\/p>\n\t\t\t\t<p class=\"af-sub-name\">\u666e\u6bb5\u9664\u53bb\u3057\u3066\u3044\u308b\u98df\u54c1<span class=\"req\">\u5fc5\u9808<\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"fish-avoid\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff1a\u9bd6\u3001\u9bf5\" value=\"\" type=\"text\" name=\"fish-avoid\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<p class=\"af-sub-name\">\u53c2\u8003\u307e\u3067\u306b\u3001\u98df\u3079\u3089\u308c\u308b\u9b5a\n\t\t\t\t<\/p>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"fish-ok\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff1a\u9baa\u3001\u9bad\" value=\"\" type=\"text\" name=\"fish-ok\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"af-level\" data-allergen=\"\u305d\u306e\u4ed6\" hidden>\n\t\t\t\t<p class=\"af-level-name\">\u305d\u306e\u4ed6\n\t\t\t\t<\/p>\n\t\t\t\t<p class=\"af-sub-name\">\u666e\u6bb5\u9664\u53bb\u3057\u3066\u3044\u308b\u98df\u54c1<span class=\"req\">\u5fc5\u9808<\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"other-avoid\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff1a\u30df\u30f3\u30c8\" value=\"\" type=\"text\" name=\"other-avoid\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<dl class=\"cform\">\n\t\t\t<dt>\n\t\t\t\t<p>\u65e5\u5e38\u6442\u53d6\u3057\u3066\u3044\u308b\u98df\u6750\u30fb\u8abf\u5473\u6599\u3001\u307e\u305f\u306f\u3054\u8981\u671b<small>\u5c0f\u9ea6\u30fb\u5927\u8c46\u304c\u542b\u307e\u308c\u308b\u8abf\u5473\u6599\u306e\u4f7f\u7528\u304c\u3067\u304d\u306a\u3044\u65b9\u3001\u9b5a\u8c9d\u985e\u30fb\u9b5a\u5375\u30fb\u8089\u30a2\u30ec\u30eb\u30ae\u30fc\u306e\u65b9\u306f\u5fc5\u305a\u3054\u8a18\u5165\u304f\u3060\u3055\u3044<\/small>\n\t\t\t\t<\/p>\n\t\t\t<\/dt>\n\t\t\t<dd>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"dietary-notes\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff1a\u91a4\u6cb9\u306e\u4ee3\u308f\u308a\u306b\u3007\u3007\u3092\u4f7f\u7528\u3057\u3066\u3044\u307e\u3059\u3001\u306a\u3069\" name=\"dietary-notes\"><\/textarea><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dd>\n\t\t<\/dl>\n\t\t<h3>\u9023\u7d61\u306e\u53d6\u308c\u308b\u304a\u5ba2\u69d8\u306e\u60c5\u5831\n\t\t<\/h3>\n\t\t<p class=\"af-note\">\u62c5\u5f53\u8005\u304b\u3089\u30e1\u30cb\u30e5\u30fc\u7b49\u306b\u95a2\u3057\u3066\u9023\u7d61\u3092\u3055\u305b\u3066\u3044\u305f\u3060\u304d\u307e\u3059\u306e\u3067\u3001\u9023\u7d61\u5148\u3092\u3054\u5165\u529b\u304f\u3060\u3055\u3044\u3002\n\t\t<\/p>\n\t\t<dl class=\"cform\">\n\t\t\t<dt>\n\t\t\t\t<p>\u304a\u540d\u524d<span class=\"req\">\u5fc5\u9808<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dt>\n\t\t\t<dd>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"contact-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff1a\u9280\u6ce2 \u82b1\u5b50\" value=\"\" type=\"text\" name=\"contact-name\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dd>\n\t\t\t<dt>\n\t\t\t\t<p>\u304a\u540d\u524d\u30d5\u30ea\u30ac\u30ca\n\t\t\t\t<\/p>\n\t\t\t<\/dt>\n\t\t\t<dd>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"contact-kana\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff1a\u30ae\u30f3\u30d1 \u30cf\u30ca\u30b3\" value=\"\" type=\"text\" name=\"contact-kana\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dd>\n\t\t\t<dt>\n\t\t\t\t<p>\u96fb\u8a71\u756a\u53f7<span class=\"req\">\u5fc5\u9808<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dt>\n\t\t\t<dd>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"contact-tel\"><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\" placeholder=\"\u4f8b\uff1a0533-57-1515\" value=\"\" type=\"tel\" name=\"contact-tel\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dd>\n\t\t\t<dt>\n\t\t\t\t<p>\u30e1\u30fc\u30eb\u30a2\u30c9\u30ec\u30b9<span class=\"req\">\u5fc5\u9808<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dt>\n\t\t\t<dd>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"contact-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\" placeholder=\"\u4f8b\uff1ainfo@example.com\" value=\"\" type=\"email\" name=\"contact-email\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dd>\n\t\t\t<dt>\n\t\t\t\t<p>\u30e1\u30fc\u30eb\u30a2\u30c9\u30ec\u30b9\u78ba\u8a8d\u7528<small>\u624b\u52d5\u3067\u3054\u5165\u529b\u304f\u3060\u3055\u3044<\/small><span class=\"req\">\u5fc5\u9808<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dt>\n\t\t\t<dd>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"contact-email-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\" placeholder=\"\u78ba\u8a8d\u306e\u305f\u3081\u518d\u5ea6\u3054\u5165\u529b\u304f\u3060\u3055\u3044\" value=\"\" type=\"email\" name=\"contact-email-confirm\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dd>\n\t\t<\/dl>\n\t\t<h3>\u3054\u4e88\u7d04\u4ee3\u8868\u8005\u69d8\u306e\u60c5\u5831\n\t\t<\/h3>\n\t\t<dl class=\"cform\">\n\t\t\t<dt>\n\t\t\t\t<p>\u3054\u4e88\u7d04\u4ee3\u8868\u8005\u69d8\u306f\u300c\u9023\u7d61\u306e\u53d6\u308c\u308b\u304a\u5ba2\u69d8\u300d\u3068\u540c\u4e00\u3067\u3059\u304b\uff1f<span class=\"req\">\u5fc5\u9808<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dt>\n\t\t\t<dd>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"rep-same\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"rep-same\" value=\"\u540c\u4e00\" \/><span class=\"wpcf7-list-item-label\">\u540c\u4e00<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"rep-same\" value=\"\u540c\u4e00\u3067\u306f\u306a\u3044\" \/><span class=\"wpcf7-list-item-label\">\u540c\u4e00\u3067\u306f\u306a\u3044<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dd>\n\t\t<\/dl>\n\t\t<dl class=\"cform\" id=\"af-rep\" hidden>\n\t\t\t<dt>\n\t\t\t\t<p>\u3054\u4e88\u7d04\u4ee3\u8868\u8005\u69d8\u306e\u304a\u540d\u524d<span class=\"req\">\u5fc5\u9808<\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dt>\n\t\t\t<dd>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"rep-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff1a\u9280\u6ce2 \u4e00\u90ce\" value=\"\" type=\"text\" name=\"rep-name\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dd>\n\t\t\t<dt>\n\t\t\t\t<p>\u3054\u4e88\u7d04\u4ee3\u8868\u8005\u69d8\u306e\u30d5\u30ea\u30ac\u30ca\n\t\t\t\t<\/p>\n\t\t\t<\/dt>\n\t\t\t<dd>\n\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"rep-kana\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"\u4f8b\uff1a\u30ae\u30f3\u30d1 \u30a4\u30c1\u30ed\u30a6\" value=\"\" type=\"text\" name=\"rep-kana\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/dd>\n\t\t<\/dl>\n\t<input class=\"wpcf7-form-control wpcf7-hidden\" value=\"\" type=\"hidden\" name=\"levels-summary\" \/>\n\t\t<p class=\"cform-privacy\"><span class=\"wpcf7-form-control-wrap\" data-name=\"privacy-agree\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"privacy-agree\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">\u500b\u4eba\u60c5\u5831\u4fdd\u8b77\u65b9\u91dd\u306b\u540c\u610f\u3059\u308b<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t\t<p id=\"cf7-email-mismatch\" class=\"cf7-error-msg\" style=\"display:none;color:#b3261e;text-align:center;\">\u30e1\u30fc\u30eb\u30a2\u30c9\u30ec\u30b9\u304c\u4e00\u81f4\u3057\u307e\u305b\u3093\u3002\u3054\u78ba\u8a8d\u304f\u3060\u3055\u3044\u3002\n\t\t<\/p>\n\t\t<p id=\"af-error\" class=\"cf7-error-msg\" style=\"display:none;color:#b3261e;text-align:center;\">\n\t\t<\/p>\n\t\t<p class=\"cform-submit\"><button type=\"button\" id=\"cf7-to-confirm-btn\" class=\"wpcf7-form-control\">\u78ba\u8a8d\u753b\u9762\u3078<\/button>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div id=\"cf7-step-confirm\" class=\"af\" style=\"display:none;\">\n\t<p class=\"af-lead\">\u5165\u529b\u5185\u5bb9\u3092\u3054\u78ba\u8a8d\u306e\u3046\u3048\u3001\u300c\u9001\u4fe1\u3059\u308b\u300d\u3092\u62bc\u3057\u3066\u304f\u3060\u3055\u3044\u3002\n\t<\/p>\n\t<dl class=\"cform cform-review\" id=\"af-review\">\n\t<\/dl>\n\t<p class=\"cform-submit\"><button type=\"button\" id=\"cf7-back-btn\" class=\"wpcf7-form-control cf7-back-btn\">\u623b\u308b<\/button><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"\u9001\u4fe1\u3059\u308b\" \/>\n\t<\/p>\n<\/div>\n<style>\nbody.page-id-1251 .af { max-width: 880px; margin: 0 auto; font-size: 1.7rem; line-height: 1.75; }\nbody.page-id-1251 .af .af-lead { font-size: 1.7rem; margin: 0 0 8px; }\nbody.page-id-1251 .af .af-points { margin: 0 0 14px; padding-left: 1.2em; font-size: 1.55rem; line-height: 1.7; }\nbody.page-id-1251 .af .af-points li { list-style: disc; margin: 2px 0; }\nbody.page-id-1251 .af-policy { border: 1px solid #dcd3c4; background: #f7f3ec; border-radius: 10px; padding: 14px 18px; font-size: 1.5rem; line-height: 1.75; }\nbody.page-id-1251 .af-policy p { margin: 0 0 8px; }\nbody.page-id-1251 .af-policy p:last-child { margin-bottom: 0; }\nbody.page-id-1251 .af-policy-title { font-weight: 700; font-size: 1.7rem; color: #1c2b38; }\nbody.page-id-1251 .af-policy-strong { font-weight: 700; color: #8f2e1e; }\nbody.page-id-1251 .af h3 { font-size: 2rem; margin: 30px 0 4px; padding-bottom: 6px; border-bottom: 1px solid #dcd3c4; }\nbody.page-id-1251 .af .af-note { font-size: 1.55rem; margin: 6px 0 0; }\nbody.page-id-1251 .af .cform { max-width: none; margin: 0; }\nbody.page-id-1251 .af .cform dt { font-size: 1.7rem; margin-top: 16px; }\nbody.page-id-1251 .af .cform dt small { display: block; font-size: 1.35rem; line-height: 1.5; }\nbody.page-id-1251 .af .cform dt .req, body.page-id-1251 .af .req { margin-left: 0.5em; font-size: 1.15rem; vertical-align: 2px; }\nbody.page-id-1251 .af .cform dd { margin: 6px 0 0; }\nbody.page-id-1251 .af .wpcf7-radio, body.page-id-1251 .af .wpcf7-checkbox { display: flex; flex-wrap: wrap; gap: 4px 0; font-size: 1.65rem; }\nbody.page-id-1251 .af .wpcf7-list-item { margin: 0 1.2em 0.3em 0 !important; }\nbody.page-id-1251 .af .wpcf7-list-item label { cursor: pointer; }\nbody.page-id-1251 .af input[type=\"checkbox\"], body.page-id-1251 .af input[type=\"radio\"] { width: 1.15em; height: 1.15em; vertical-align: -2px; margin-right: 4px; }\nbody.page-id-1251 .af input[type=\"text\"], body.page-id-1251 .af input[type=\"email\"], body.page-id-1251 .af input[type=\"tel\"], body.page-id-1251 .af input[type=\"date\"], body.page-id-1251 .af input[type=\"number\"], body.page-id-1251 .af textarea { font-size: 1.7rem; padding: 9px 12px; }\nbody.page-id-1251 .af input[type=\"date\"] { max-width: 15em; }\nbody.page-id-1251 .af input[type=\"number\"] { width: 6em; }\nbody.page-id-1251 .af textarea { min-height: 100px; }\nbody.page-id-1251 .af-stop { margin: 16px 0 0; border: 2px solid #b3261e; background: #fdf0ee; border-radius: 10px; padding: 14px 18px; font-size: 1.65rem; line-height: 1.75; }\nbody.page-id-1251 .af-stop p { margin: 0 0 6px; }\nbody.page-id-1251 .af-stop-title { font-weight: 700; color: #b3261e; }\nbody.page-id-1251 .af-stop-tel { font-weight: 700; font-size: 1.8rem; margin-bottom: 0 !important; }\nbody.page-id-1251 #af-levels { margin-top: 14px; }\nbody.page-id-1251 .af-levels-lead { font-size: 1.6rem; margin: 0 0 6px; }\nbody.page-id-1251 .af-levels-lead small { display: block; font-size: 1.35rem; color: #8a7c62; }\nbody.page-id-1251 .af-level { border: 1px solid #dcd3c4; border-radius: 10px; background: #fffdf8; padding: 10px 16px 6px; margin: 8px 0; }\nbody.page-id-1251 .af-level-name { font-weight: 700; font-size: 1.75rem; margin: 0 0 4px; color: #1c2b38; }\nbody.page-id-1251 .af-sub { margin: 4px 0 6px; padding: 6px 12px; border-left: 3px solid #dcd3c4; }\nbody.page-id-1251 .af-sub-name { font-size: 1.45rem; color: #5b5142; margin: 4px 0 2px; }\nbody.page-id-1251 .af-level input[type=\"text\"] { margin-bottom: 6px; }\nbody.page-id-1251\n[hidden] { display: none !important; }\nbody.page-id-1251 .af .af-nowrap { display: inline-flex; flex-wrap: nowrap; white-space: nowrap; }\nbody.page-id-1251 #contents .af p, body.page-id-1251 #contents .af li { font-size: 1.6rem !important; line-height: 1.75 !important; }\nbody.page-id-1251 #contents .af-policy p { font-size: 1.5rem !important; margin: 0 0 6px; }\nbody.page-id-1251 #contents .af-policy .af-policy-title, body.page-id-1251 #contents .af .af-level-name { font-size: 1.75rem !important; }\nbody.page-id-1251 #contents .af .af-sub-name, body.page-id-1251 #contents .af .af-note { font-size: 1.45rem !important; }\nbody.page-id-1251 #contents .af-stop p { font-size: 1.65rem !important; }\nbody.page-id-1251 #contents .af-stop .af-stop-tel { font-size: 1.8rem !important; }\nbody.page-id-1251 .af-policy-more summary { cursor: pointer; color: #8f4a2e; font-weight: 600; font-size: 1.5rem; margin-top: 4px; }\nbody.page-id-1251 .af-policy-more[open] summary { margin-bottom: 6px; }\nbody.page-id-1251 #contents .af li p, body.page-id-1251 #contents .af dd > p { margin: 0 !important; }\nbody.page-id-1251 .af .wpcf7-list-item label { line-height: 1.5; display: inline-block; padding: 2px 0; }\nbody.page-id-1251 .af .af-lead .req, body.page-id-1251 .af .af-level-name .req, body.page-id-1251 .af .af-sub-name .req { display: inline-block; background: #b2603c; color: #fff; border-radius: 4px; padding: 1px 8px; font-size: 1.15rem; line-height: 1.6; font-weight: 600; }\nbody.page-id-1251 .cform-privacy { margin-top: 24px; }\nbody.page-id-1251 #cf7-step-confirm .cform-review dt { font-size: 1.45rem; color: #5b5142; margin-top: 10px; }\nbody.page-id-1251 #cf7-step-confirm .cform-review dd { margin: 2px 0 0; padding: 0 0 8px; border-bottom: 1px dashed #ccc; min-height: 1.4em; white-space: pre-wrap; font-size: 1.65rem; }\np.cform-submit { display: flex; justify-content: center; align-items: center; gap: 16px; flex-wrap: wrap; }\n.wpcf7-response-output:empty { display: none !important; }\n@media (min-width: 768px) {\n body.page-id-1251 .af .cform { display: grid; grid-template-columns: 17em 1fr; column-gap: 24px; align-items: start; }\n body.page-id-1251 .af .cform dt { margin-top: 18px; }\n body.page-id-1251 .af .cform dd { margin-top: 16px; }\n body.page-id-1251 #cf7-step-confirm .cform-review { grid-template-columns: 17em 1fr; }\n body.page-id-1251 #cf7-step-confirm .cform-review dt, body.page-id-1251 #cf7-step-confirm .cform-review dd { margin-top: 0; padding-top: 8px; border-bottom: 1px dashed #ccc; }\n}\n<\/style><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n\n\n\n<script>\n\/* \u98df\u7269\u30a2\u30ec\u30eb\u30ae\u30fc\u4e8b\u524d\u30d2\u30a2\u30ea\u30f3\u30b0\u30d5\u30a9\u30fc\u30e0\uff08CF7 #1250\uff09\u306e\u753b\u9762\u5236\u5fa1\u3002\u6b63\u672c: sites\/_packages\/chatbot-lite\/ginpaso\/allergy-form\/page.html\n   \u6ce8\u610f: \u3053\u306e\u30d6\u30ed\u30c3\u30af\u306e\u4e2d\u3067\u306f\u8ad6\u7406\u7a4d\u306e\u6f14\u7b97\u5b50\u3092\u4f7f\u308f\u306a\u3044\uff08WordPress \u306e wptexturize \u304c\u5b9f\u4f53\u53c2\u7167\u306b\u5909\u3048\u3066\u69cb\u6587\u30a8\u30e9\u30fc\u306b\u306a\u308b\u3002\u4e09\u9805\u6f14\u7b97\u5b50\u3067\u66f8\u304f\uff09 *\/\n(function(){\n function init(){\n  var form = document.querySelector(\".wpcf7-form\");\n  if (!form) return;\n  var inputStep = document.getElementById(\"cf7-step-input\");\n  var confirmStep = document.getElementById(\"cf7-step-confirm\");\n  var toConfirmBtn = document.getElementById(\"cf7-to-confirm-btn\");\n  var backBtn = document.getElementById(\"cf7-back-btn\");\n  var mismatchMsg = document.getElementById(\"cf7-email-mismatch\");\n  var errorMsg = document.getElementById(\"af-error\");\n  var stopBox = document.getElementById(\"af-stop\");\n  var rest = document.getElementById(\"af-rest\");\n  var levelsBox = document.getElementById(\"af-levels\");\n  var repBox = document.getElementById(\"af-rep\");\n  if (!inputStep || !confirmStep || !toConfirmBtn) return;\n\n  function q(sel){ return form.querySelector(sel); }\n  function all(sel){ return Array.prototype.slice.call(form.querySelectorAll(sel)); }\n  function field(name){ return all('[name=\"' + name + '[]\"], [name=\"' + name + '\"]'); }\n  function checkedValues(name){ return field(name).filter(function(el){ return el.checked; }).map(function(el){ return el.value; }); }\n  function radioValue(name){ var v = checkedValues(name); return v.length ? v[0] : \"\"; }\n  function textOf(name){ var el = q('[name=\"' + name + '\"]'); return el ? el.value.trim() : \"\"; }\n  function isHidden(el){ return el.closest(\"[hidden]\") ? true : false; }\n  function clearInside(box){\n   Array.prototype.forEach.call(box.querySelectorAll(\"input, textarea\"), function(el){\n    if (el.type === \"checkbox\" || el.type === \"radio\") { el.checked = false; } else { el.value = \"\"; }\n   });\n  }\n\n  \/\/ \u3054\u5165\u529b\u65e5\u306b\u4eca\u65e5\u3092\u5165\u308c\u308b\n  var entryDate = q('[name=\"entry-date\"]');\n  if (entryDate ? !entryDate.value : false) {\n   var d = new Date();\n   entryDate.value = d.getFullYear() + \"-\" + (\"0\" + (d.getMonth() + 1)).slice(-2) + \"-\" + (\"0\" + d.getDate()).slice(-2);\n  }\n\n  \/\/ \u3054\u5229\u7528\u4e88\u5b9a\u65e5\u306f3\u65e5\u5f8c\u304b\u3089\uff08\u5f53\u65e5\u30682\u65e5\u4ee5\u5185\u306f\u9078\u3079\u306a\u3044\u30022026-10-04 \u30db\u30c6\u30eb\u4f9d\u983c\uff09\n  function ymd(dt){ return dt.getFullYear() + \"-\" + (\"0\" + (dt.getMonth() + 1)).slice(-2) + \"-\" + (\"0\" + dt.getDate()).slice(-2); }\n  var stayMin = new Date(); stayMin.setDate(stayMin.getDate() + 3);\n  var stayMinStr = ymd(stayMin);\n  var stayDate = q('[name=\"stay-date\"]');\n  if (stayDate) stayDate.setAttribute(\"min\", stayMinStr);\n\n  \/\/ \u78ba\u8a8d\u7528\u30e1\u30fc\u30eb\u30a2\u30c9\u30ec\u30b9\u306f\u8cbc\u308a\u4ed8\u3051\u4e0d\u53ef\n  var emailField = q('[name=\"contact-email\"]');\n  var emailConfirmField = q('[name=\"contact-email-confirm\"]');\n  if (emailConfirmField) {\n   emailConfirmField.addEventListener(\"paste\", function(e){ e.preventDefault(); });\n   emailConfirmField.addEventListener(\"drop\", function(e){ e.preventDefault(); });\n  }\n\n  \/\/ \u30a8\u30d4\u30da\u30f3\u3042\u308a\u30fb\u30a2\u30ca\u30d5\u30a3\u30e9\u30ad\u30b7\u30fc\u7d4c\u9a13\u6709\u306a\u3089\u3001\u304a\u65ad\u308a\u306e\u6848\u5185\u3092\u51fa\u3057\u3066\u4ee5\u964d\u3092\u5165\u529b\u3067\u304d\u306a\u304f\u3059\u308b\n  function isStopped(){\n   return radioValue(\"epipen\") === \"\u306f\u3044\u3001\u6301\u3063\u3066\u3044\u307e\u3059\" || radioValue(\"anaphylaxis\") === \"\u7d4c\u9a13\u6709\";\n  }\n  function updateStop(){\n   var stop = isStopped();\n   if (stopBox) stopBox.hidden = !stop;\n   if (rest) rest.hidden = stop;\n  }\n\n  \/\/ \u9078\u3093\u3060\u30a2\u30ec\u30eb\u30b2\u30f3\u306e\u6442\u53d6\u30ec\u30d9\u30eb\u6b04\u3060\u3051\u51fa\u3059\uff08\u96a0\u3057\u305f\u6b04\u306f\u9078\u629e\u3092\u6d88\u3059\uff09\n  function updateLevels(){\n   var chosen = checkedValues(\"allergens\");\n   var any = false;\n   all(\".af-level\").forEach(function(box){\n    var keys = (box.getAttribute(\"data-allergen\") || \"\").split(\"|\");\n    var show = keys.some(function(k){ return chosen.indexOf(k) > -1; });\n    if (!show) { if (!box.hidden) clearInside(box); }\n    box.hidden = !show;\n    if (show) any = true;\n   });\n   if (levelsBox) levelsBox.hidden = !any;\n   updateSubs();\n  }\n  function updateSubs(){\n   all(\".af-sub\").forEach(function(box){\n    var w = (box.getAttribute(\"data-when\") || \"\").split(\"|\");\n    var show = checkedValues(w[0]).indexOf(w[1]) > -1;\n    if (!show) { if (!box.hidden) clearInside(box); }\n    box.hidden = !show;\n   });\n  }\n  \/\/ \u300c\u5b8c\u5168\u9664\u53bb\u300d\u306f\u4ed6\u306e\u9078\u629e\u3068\u540c\u6642\u306b\u9078\u3079\u306a\u3044\n  function exclusive(name){\n   field(name).forEach(function(el){\n    el.addEventListener(\"change\", function(){\n     if (!el.checked) return;\n     field(name).forEach(function(o){\n      if (o === el) return;\n      if (el.value === \"\u5b8c\u5168\u9664\u53bb\" || o.value === \"\u5b8c\u5168\u9664\u53bb\") o.checked = false;\n     });\n     updateSubs();\n    });\n   });\n  }\n  exclusive(\"egg-level\");\n  exclusive(\"milk-level\");\n\n  \/\/ \u3054\u4e88\u7d04\u4ee3\u8868\u8005\u304c\u300c\u540c\u4e00\u3067\u306f\u306a\u3044\u300d\u3068\u304d\u3060\u3051\u4ee3\u8868\u8005\u540d\u3092\u51fa\u3059\n  function updateRep(){\n   if (!repBox) return;\n   var show = radioValue(\"rep-same\") === \"\u540c\u4e00\u3067\u306f\u306a\u3044\";\n   if (!show) { if (!repBox.hidden) clearInside(repBox); }\n   repBox.hidden = !show;\n  }\n\n  form.addEventListener(\"change\", function(e){\n   var n = e.target ? (e.target.name || \"\") : \"\";\n   if (n === \"epipen\" || n === \"anaphylaxis\") updateStop();\n   if (n === \"allergens[]\") updateLevels();\n   if (n.indexOf(\"-level\") > -1) updateSubs();\n   if (n === \"rep-same\") updateRep();\n  });\n  \/\/ \u8c5a\u30fb\u725b\u30fb\u9d8f\u306e\u30c1\u30a7\u30c3\u30af\u304c\u753b\u9762\u5e45\u306e\u6298\u308a\u8fd4\u3057\u3067\u5225\u306e\u884c\u306b\u5206\u304b\u308c\u306a\u3044\u3088\u3046\u30011\u3064\u306e\u304b\u305f\u307e\u308a\u306b\u3059\u308b\n  (function(){\n   var items = [\"\u8c5a\", \"\u725b\", \"\u9d8f\"].map(function(v){\n    var el = field(\"allergens\").filter(function(i){ return i.value === v; })[0];\n    return el ? el.closest(\".wpcf7-list-item\") : null;\n   });\n   if (!items[0] || !items[1] || !items[2]) return;\n   var g = document.createElement(\"span\");\n   g.className = \"af-nowrap\";\n   items[0].parentNode.insertBefore(g, items[0]);\n   items.forEach(function(it){ g.appendChild(it); });\n  })();\n  updateStop(); updateLevels(); updateRep();\n\n  function fail(msg, el){\n   if (errorMsg) { errorMsg.textContent = msg; errorMsg.style.display = \"\"; }\n   if (el) {\n    el.scrollIntoView({ block: \"center\", behavior: \"smooth\" });\n    if (el.focus) el.focus();\n   }\n   return false;\n  }\n\n  function validate(){\n   if (isStopped()) return false;\n   var required = form.querySelectorAll(\".wpcf7-validates-as-required\");\n   for (var i = 0; i < required.length; i++) {\n    var el = required[i];\n    if (isHidden(el)) continue;\n    \/\/ \u30e9\u30b8\u30aa\u30fb\u30c1\u30a7\u30c3\u30af\u30dc\u30c3\u30af\u30b9\u306f\u3001\u5fc5\u9808\u306e\u5370\u304c\u5165\u529b\u6b04\u3067\u306f\u306a\u304f\u5916\u5074\u306e span \u306b\u4ed8\u304f\n    if (el.tagName === \"SPAN\") {\n     if (el.classList.contains(\"wpcf7-acceptance\")) continue;\n     if (!el.querySelector(\"input:checked\")) return fail(\"\u672a\u5165\u529b\u306e\u5fc5\u9808\u9805\u76ee\u304c\u3042\u308a\u307e\u3059\u3002\", el.querySelector(\"input\") || el);\n     continue;\n    }\n    if ([\"INPUT\",\"TEXTAREA\",\"SELECT\"].indexOf(el.tagName) === -1) continue;\n    if (el.type === \"radio\" || el.type === \"checkbox\") {\n     if (!field(el.name.replace(\/\\[\\]$\/, \"\")).some(function(o){ return o.checked; })) return fail(\"\u672a\u5165\u529b\u306e\u5fc5\u9808\u9805\u76ee\u304c\u3042\u308a\u307e\u3059\u3002\", el);\n    } else if (!el.value || !el.value.trim()) {\n     return fail(\"\u672a\u5165\u529b\u306e\u5fc5\u9808\u9805\u76ee\u304c\u3042\u308a\u307e\u3059\u3002\", el);\n    }\n   }\n   if (stayDate ? (stayDate.value ? stayDate.value < stayMinStr : false) : false) {\n    return fail(\"\u5f53\u65bd\u8a2d\u3054\u5229\u7528\u4e88\u5b9a\u65e5\u306f\u3001\u672c\u65e5\u304b\u30893\u65e5\u5f8c\u4ee5\u964d\u306e\u65e5\u4ed8\u3092\u304a\u9078\u3073\u304f\u3060\u3055\u3044\uff082\u65e5\u4ee5\u5185\u306e\u3054\u5229\u7528\u306f\u304a\u53d7\u3051\u3067\u304d\u307e\u305b\u3093\uff09\u3002\", stayDate);\n   }\n   var boxes = all(\".af-level\");\n   for (var b = 0; b < boxes.length; b++) {\n    var box = boxes[b];\n    if (box.hidden) continue;\n    var name = box.querySelector(\".af-level-name\").childNodes[0].textContent.trim();\n    var key = box.getAttribute(\"data-allergen\");\n    if (key === \"\u9d8f\u5375\" || key === \"\u725b\u4e73|\u4e73\u88fd\u54c1\") {\n     if (!box.querySelector('input[type=\"checkbox\"]:checked')) return fail(\"\u3010\" + name + \"\u3011\u306e\u73fe\u5728\u306e\u6442\u53d6\u30ec\u30d9\u30eb\u3092\u304a\u9078\u3073\u304f\u3060\u3055\u3044\u3002\", box);\n    }\n    if (key === \"\u9b5a\u8c9d\u985e|\u9b5a\u5375\" || key === \"\u305d\u306e\u4ed6\") {\n     var t = box.querySelector('input[type=\"text\"]');\n     if (!t.value.trim()) return fail(\"\u3010\" + name + \"\u3011\u306e\u666e\u6bb5\u9664\u53bb\u3057\u3066\u3044\u308b\u98df\u54c1\u3092\u3054\u5165\u529b\u304f\u3060\u3055\u3044\u3002\", t);\n    }\n   }\n   if (repBox ? !repBox.hidden : false) {\n    if (!textOf(\"rep-name\")) return fail(\"\u3054\u4e88\u7d04\u4ee3\u8868\u8005\u69d8\u306e\u304a\u540d\u524d\u3092\u3054\u5165\u529b\u304f\u3060\u3055\u3044\u3002\", q('[name=\"rep-name\"]'));\n   }\n   var privacy = q('[name=\"privacy-agree\"]');\n   if (privacy ? !privacy.checked : false) return fail(\"\u500b\u4eba\u60c5\u5831\u4fdd\u8b77\u65b9\u91dd\u3078\u306e\u540c\u610f\u306b\u30c1\u30a7\u30c3\u30af\u3057\u3066\u304f\u3060\u3055\u3044\u3002\", privacy);\n   return true;\n  }\n\n  \/\/ \u78ba\u8a8d\u753b\u9762\n  function rows(){\n   var list = [\n    [\"\u30a8\u30d4\u30da\u30f3\u306e\u643a\u5e2f\", radioValue(\"epipen\")],\n    [\"\u30a2\u30ca\u30d5\u30a3\u30e9\u30ad\u30b7\u30fc\u306e\u3054\u7d4c\u9a13\", radioValue(\"anaphylaxis\")],\n    [\"\u3054\u5165\u529b\u65e5\", textOf(\"entry-date\")],\n    [\"\u5f53\u65bd\u8a2d\u3054\u5229\u7528\u4e88\u5b9a\u65e5\", textOf(\"stay-date\")],\n    [\"\u304a\u540d\u524d\uff08\u30a2\u30ec\u30eb\u30ae\u30fc\u3092\u304a\u6301\u3061\u306e\u304a\u5ba2\u69d8\uff09\", textOf(\"patient-name\") + (textOf(\"patient-kana\") ? \"\uff08\" + textOf(\"patient-kana\") + \"\uff09\" : \"\")],\n    [\"\u5e74\u9f62\u30fb\u6027\u5225\", textOf(\"patient-age\") + \" \u6b73 \uff0f \" + radioValue(\"patient-gender\")],\n    [\"\u3054\u81ea\u5b85\u306e\u8abf\u7406\u5668\u5177\u30fb\u98df\u6750\", checkedValues(\"home-kitchen\").join(\"\u3001\") || \"\uff08\u306a\u3057\uff09\"],\n    [\"\u9664\u53bb\u5e0c\u671b\u306e\u30a2\u30ec\u30eb\u30b2\u30f3\", checkedValues(\"allergens\").join(\"\u3001\")]\n   ];\n   var levelRows = [\n    [\"\u9d8f\u5375\", \"egg-level\"], [\"\u9d8f\u5375\uff1a\u52a0\u5de5\u54c1\u3067\u98df\u3079\u3089\u308c\u308b\u98df\u54c1\", \"egg-processed\"], [\"\u9d8f\u5375\uff1a\u3064\u306a\u304e\u3067\u98df\u3079\u3089\u308c\u308b\u98df\u54c1\", \"egg-binder\"],\n    [\"\u725b\u4e73\u30fb\u4e73\u88fd\u54c1\", \"milk-level\"], [\"\u725b\u4e73\u30fb\u4e73\u88fd\u54c1\uff1a\u52a0\u5de5\u54c1\u3067\u98df\u3079\u3089\u308c\u308b\u98df\u54c1\", \"milk-processed\"],\n    [\"\u5c0f\u9ea6\", \"wheat-level\"], [\"\u5927\u8c46\", \"soy-level\"], [\"\u3054\u307e\", \"sesame-level\"], [\"\u8c5a\u30fb\u725b\u30fb\u9d8f\", \"meat-level\"],\n    [\"\u30a8\u30d3\u30fb\u30ab\u30cb\", \"shellfish-level\"], [\"\u30a4\u30ab\u30fb\u30bf\u30b3\", \"squid-level\"], [\"\u30db\u30bf\u30c6\", \"scallop-level\"]\n   ];\n   levelRows.forEach(function(r){\n    var el = field(r[1])[0];\n    if (!el) return;\n    if (isHidden(el)) return;\n    list.push([\"\u3010\" + r[0] + \"\u3011\", checkedValues(r[1]).join(\"\u3001\") || \"\uff08\u3059\u3079\u3066\u4e0d\u53ef\uff09\"]);\n   });\n   if (!isHidden(q('[name=\"fish-avoid\"]'))) {\n    list.push([\"\u3010\u9b5a\u8c9d\u985e\u30fb\u9b5a\u5375\u3011\u666e\u6bb5\u9664\u53bb\u3057\u3066\u3044\u308b\u98df\u54c1\", textOf(\"fish-avoid\")]);\n    list.push([\"\u3010\u9b5a\u8c9d\u985e\u30fb\u9b5a\u5375\u3011\u53c2\u8003\uff1a\u98df\u3079\u3089\u308c\u308b\u9b5a\", textOf(\"fish-ok\") || \"\uff08\u672a\u5165\u529b\uff09\"]);\n   }\n   if (!isHidden(q('[name=\"other-avoid\"]'))) list.push([\"\u3010\u305d\u306e\u4ed6\u3011\u666e\u6bb5\u9664\u53bb\u3057\u3066\u3044\u308b\u98df\u54c1\", textOf(\"other-avoid\")]);\n   list.push([\"\u65e5\u5e38\u6442\u53d6\u3057\u3066\u3044\u308b\u98df\u6750\u30fb\u3054\u8981\u671b\", textOf(\"dietary-notes\") || \"\uff08\u672a\u5165\u529b\uff09\"]);\n   list.push([\"\u304a\u540d\u524d\uff08\u9023\u7d61\u5148\uff09\", textOf(\"contact-name\") + (textOf(\"contact-kana\") ? \"\uff08\" + textOf(\"contact-kana\") + \"\uff09\" : \"\")]);\n   list.push([\"\u96fb\u8a71\u756a\u53f7\", textOf(\"contact-tel\")]);\n   list.push([\"\u30e1\u30fc\u30eb\u30a2\u30c9\u30ec\u30b9\", textOf(\"contact-email\")]);\n   list.push([\"\u3054\u4e88\u7d04\u4ee3\u8868\u8005\u69d8\", radioValue(\"rep-same\")]);\n   if (repBox ? !repBox.hidden : false) list.push([\"\u3054\u4e88\u7d04\u4ee3\u8868\u8005\u69d8\u306e\u304a\u540d\u524d\", textOf(\"rep-name\") + (textOf(\"rep-kana\") ? \"\uff08\" + textOf(\"rep-kana\") + \"\uff09\" : \"\")]);\n   return list;\n  }\n  function fillReview(){\n   var dl = document.getElementById(\"af-review\");\n   if (!dl) return;\n   dl.innerHTML = \"\";\n   rows().forEach(function(r){\n    var dt = document.createElement(\"dt\"); dt.textContent = r[0];\n    var dd = document.createElement(\"dd\"); dd.textContent = r[1] || \"\uff08\u672a\u5165\u529b\uff09\";\n    dl.appendChild(dt); dl.appendChild(dd);\n   });\n  }\n\n  toConfirmBtn.addEventListener(\"click\", function(){\n   if (mismatchMsg) mismatchMsg.style.display = \"none\";\n   if (errorMsg) errorMsg.style.display = \"none\";\n   if (!validate()) return;\n   if (emailField ? (emailConfirmField ? emailField.value.trim() !== emailConfirmField.value.trim() : false) : false) {\n    if (mismatchMsg) mismatchMsg.style.display = \"\";\n    emailConfirmField.focus();\n    return;\n   }\n   fillReview();\n   \/\/ \u901a\u77e5\u30e1\u30fc\u30eb\u7528: \u6442\u53d6\u30ec\u30d9\u30eb\u30921\u3064\u306e\u6b04\u306b\u307e\u3068\u3081\u308b\uff08\u7a7a\u306e\u9805\u76ee\u306f CF7 \u304c\u30e1\u30fc\u30eb\u304b\u3089\u884c\u3054\u3068\u7701\u304f\u305f\u3081\u300c\u3059\u3079\u3066\u4e0d\u53ef\u300d\u3082\u6587\u5b57\u3067\u9001\u308b\uff09\n   var summary = q('[name=\"levels-summary\"]');\n   if (summary) summary.value = rows().filter(function(r){ return r[0].charAt(0) === \"\u3010\"; }).map(function(r){ return r[0] + \" \" + r[1]; }).join(\"\\n\");\n   inputStep.style.display = \"none\";\n   confirmStep.style.display = \"\";\n   window.scrollTo({ top: confirmStep.getBoundingClientRect().top + window.pageYOffset - 80, behavior: \"smooth\" });\n  });\n\n  if (backBtn) {\n   backBtn.addEventListener(\"click\", function(){\n    confirmStep.style.display = \"none\";\n    inputStep.style.display = \"\";\n    window.scrollTo({ top: inputStep.getBoundingClientRect().top + window.pageYOffset - 80, behavior: \"smooth\" });\n   });\n  }\n }\n if (document.readyState === \"loading\") {\n  document.addEventListener(\"DOMContentLoaded\", init);\n } else {\n  init();\n }\n})();\n<\/script>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":6,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_ginpaso_en_url":"","_ginpaso_ja_url":"","footnotes":""},"class_list":["post-1251","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/life2025.xbiz.jp\/ginpa-new\/wp-json\/wp\/v2\/pages\/1251","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/life2025.xbiz.jp\/ginpa-new\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/life2025.xbiz.jp\/ginpa-new\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/life2025.xbiz.jp\/ginpa-new\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/life2025.xbiz.jp\/ginpa-new\/wp-json\/wp\/v2\/comments?post=1251"}],"version-history":[{"count":8,"href":"https:\/\/life2025.xbiz.jp\/ginpa-new\/wp-json\/wp\/v2\/pages\/1251\/revisions"}],"predecessor-version":[{"id":1609,"href":"https:\/\/life2025.xbiz.jp\/ginpa-new\/wp-json\/wp\/v2\/pages\/1251\/revisions\/1609"}],"wp:attachment":[{"href":"https:\/\/life2025.xbiz.jp\/ginpa-new\/wp-json\/wp\/v2\/media?parent=1251"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}