{"id":1855,"date":"2026-04-29T14:04:26","date_gmt":"2026-04-29T12:04:26","guid":{"rendered":"https:\/\/genomikadlapolski.pl\/?page_id=1855"},"modified":"2026-07-07T14:13:53","modified_gmt":"2026-07-07T12:13:53","slug":"kwestionariusz-uczestnika-badania","status":"publish","type":"page","link":"https:\/\/genomikadlapolski.pl\/en\/kwestionariusz-uczestnika-badania\/","title":{"rendered":"Kwestionariusz uczestnika badania"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1855\" class=\"elementor elementor-1855\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4952b62 e-flex e-con-boxed e-con e-parent\" data-id=\"4952b62\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-1e3de24 e-con-full e-flex e-con e-child\" data-id=\"1e3de24\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-189ce33 elementor-widget elementor-widget-heading\" data-id=\"189ce33\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Kwestionariusz Uczestnika Badania<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-929cfc8 elementor-widget__width-initial elementor-widget elementor-widget-text-editor\" data-id=\"929cfc8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Niniejszy kwestionariusz powsta\u0142 na potrzeby projektu \u201cGenomika dla Polski\u201d (G4PL). 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.jet-form-builder__desc{background-color: ;} .jet-sm-gb-92099755-dbb2-45c6-ba4a-35dfcdf2ab6d .jet-form-builder__desc{background-color: ;} .jet-sm-gb-9fc67d47-bb4d-4502-bd27-b2a8380845bc .jet-form-builder__desc{background-color: ;} .jet-sm-gb-01c00ba3-3b06-412f-a836-7b56c25f1742 .jet-form-builder__desc{background-color: ;} .jet-sm-gb-17dc286d-65bc-4ca0-8894-c8003ffba80c .jet-form-builder__desc{background-color: ;} .jet-sm-gb-17dc286d-65bc-4ca0-8894-c8003ffba80c .components-radio-control__option input:checked{background-color: #398ffc;} .jet-sm-gb-17dc286d-65bc-4ca0-8894-c8003ffba80c .jet-form-builder__field-wrap label.jet-form-builder__field-label :checked + span::before{background-color: #398ffc;} .jet-sm-gb-17dc286d-65bc-4ca0-8894-c8003ffba80c .jet-form-builder__field-wrap select{border-style:none;border-width:1px 1px 1px 1px;border-radius:1px 1px 1px 1px;border-color:#000000;} .jet-sm-gb-17dc286d-65bc-4ca0-8894-c8003ffba80c .jet-form-builder__field-wrap div.components-input-control__backdrop.components-input-control__backdrop.components-input-control__backdrop{border-style:none;border-width:1px 1px 1px 1px;border-radius:1px 1px 1px 1px;border-color:#000000;} <\/style><form  class=\"jet-form-builder layout-column submit-type-reload\" action=\"https:\/\/genomikadlapolski.pl\/en\/wp-json\/wp\/v2\/pages\/1855\/?t8G86M=qP02D03R84ci&amp;method=reload\" method=\"POST\" data-form-id=\"1825\" data-layout=\"column\" enctype=\"multipart\/form-data\" novalidate=\"null\" ssr_validation_method=\"rest\"><input type=\"hidden\" id=\"_wpnonce_1825\" name=\"_wpnonce\" value=\"f1b0bc1bc0\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/1855\" \/>\r\n<input type=\"hidden\" name=\"_jfb_current_render_states[]\" value=\"DEFAULT.STATE\" data-jfb-sync \/><input type=\"hidden\" class=\"jet-form-builder__field hidden-field\" name=\"_jet_engine_booking_form_id\" data-field-name=\"_jet_engine_booking_form_id\" value=\"1825\">\n<input type=\"hidden\" class=\"jet-form-builder__field hidden-field\" name=\"_jet_engine_refer\" data-field-name=\"_jet_engine_refer\" value=\"https:\/\/genomikadlapolski.pl\/en\/wp-json\/wp\/v2\/pages\/1855\/\">\n<input type=\"hidden\" class=\"jet-form-builder__field hidden-field\" name=\"__queried_post_id\" data-field-name=\"__queried_post_id\" value=\"1855\">\n<div class=\"jet-form-builder-page \" data-page=\"1\" data-page-offset=\"75\">\n<p class=\"has-text-align-center wp-block-paragraph\"><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Dane uczestnika<\/h3>\n\n\n\n<div style=\"height:8px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h4 class=\"wp-block-heading\">Wype\u0142nij pola formularza, aby przej\u015b\u0107 do ankiety<\/h4>\n\n\n\n<div style=\"height:32px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Dane osobowe<\/p>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-7387b849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-7387b849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-6e0a1d72-f292-43b7-bcae-b0cf5119de82 cb-qvr6gr7e\" data-block-id=\"jet-sm-gb-6e0a1d72-f292-43b7-bcae-b0cf5119de82\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Imi\u0119 <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Podaj swoje imi\u0119\" required=\"required\" name=\"imie\" id=\"imie\" type=\"text\" data-field-name=\"imie\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_0rH9akAi\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-64a9b4d0-5da2-4a84-9415-97d8b3775b45 cb-w66zq6l7\" data-block-id=\"jet-sm-gb-64a9b4d0-5da2-4a84-9415-97d8b3775b45\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">P\u0142e\u0107 przy urodzeniu <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"plec\" data-field-name=\"plec\" id=\"plec\" data-jfb-sync=\"null\">\n\t\t<option value=\"\"  selected>Twoja p\u0142e\u0107<\/option><option value=\"kobieta\" >kobieta<\/option><option value=\"me\u017cczyzna\" >m\u0119\u017cczyzna<\/option>\t<\/select>\n<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-57153b97-49bc-4acd-a72b-284beca23b79 cb-bjlbumid\" data-block-id=\"jet-sm-gb-57153b97-49bc-4acd-a72b-284beca23b79\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Nazwisko <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Podaj swoje nazwisko\" required=\"required\" name=\"nazwisko\" id=\"nazwisko\" type=\"text\" data-field-name=\"nazwisko\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_CdPxRFeH\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-64a9b4d0-5da2-4a84-9415-97d8b3775b45 cb-r5514d06\" data-block-id=\"jet-sm-gb-64a9b4d0-5da2-4a84-9415-97d8b3775b45\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Rok urodzenia <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz sw\u00f3j rok urodzenia\" required=\"required\" name=\"rok_urodzenia\" id=\"rok_urodzenia\" type=\"text\" data-field-name=\"rok_urodzenia\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_PqMzCDNn\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-7387b849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-01c00ba3-3b06-412f-a836-7b56c25f1742 cb-l4uhr8da\" data-block-id=\"jet-sm-gb-01c00ba3-3b06-412f-a836-7b56c25f1742\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Miejscowo\u015b\u0107 lub gmina urodzenia <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz miejscowo\u015b\u0107 lub gmin\u0119 urodzenia\" required=\"required\" name=\"miejscowosc_lub_gmina_urodzenia\" id=\"miejscowosc_lub_gmina_urodzenia\" type=\"text\" data-field-name=\"miejscowosc_lub_gmina_urodzenia\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_3vePRlm6\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-17dc286d-65bc-4ca0-8894-c8003ffba80c cb-roe4l4kh\" data-block-id=\"jet-sm-gb-17dc286d-65bc-4ca0-8894-c8003ffba80c\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Wojew\u00f3dztwo urodzenia <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"wojewodztwo\" data-field-name=\"wojewodztwo\" id=\"wojewodztwo\" data-jfb-sync=\"null\">\n\t\t<option value=\"\ufeffNieznane\" >\ufeffNieznane<\/option><option value=\"Dolno\u015bl\u0105skie\" >Dolno\u015bl\u0105skie<\/option><option value=\"Kujawsko-Pomorskie\" >Kujawsko-Pomorskie<\/option><option value=\"Lubelskie\" >Lubelskie<\/option><option value=\"Lubuskie\" >Lubuskie<\/option><option value=\"\u0141\u00f3dzkie\" >\u0141\u00f3dzkie<\/option><option value=\"Ma\u0142opolskie\" >Ma\u0142opolskie<\/option><option value=\"Mazowieckie\" >Mazowieckie<\/option><option value=\"Opolskie\" >Opolskie<\/option><option value=\"Podkarpackie\" >Podkarpackie<\/option><option value=\"Podlaskie\" >Podlaskie<\/option><option value=\"Pomorskie\" >Pomorskie<\/option><option value=\"\u015al\u0105skie\" >\u015al\u0105skie<\/option><option value=\"\u015awi\u0119tokrzyskie\" >\u015awi\u0119tokrzyskie<\/option><option value=\"Warmi\u0144sko-Mazurskie\" >Warmi\u0144sko-Mazurskie<\/option><option value=\"Wielkopolskie\" >Wielkopolskie<\/option><option value=\"Zachodniopomorskie\" >Zachodniopomorskie<\/option>\t<\/select>\n<\/div><div class=\"jet-form-builder__desc\"><small>Wpisz wojew\u00f3dztwo miejsca urodzenia<\/small><\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-7387b849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-64a9b4d0-5da2-4a84-9415-97d8b3775b45 cb-g4r12ytu\" data-block-id=\"jet-sm-gb-64a9b4d0-5da2-4a84-9415-97d8b3775b45\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Miejsce lub gmina zamieszkania <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz miejscowo\u015b\u0107 lub gmin\u0119 zamieszkania\" required=\"required\" name=\"miejsce_zamieszkania\" id=\"miejsce_zamieszkania\" type=\"text\" data-field-name=\"miejsce_zamieszkania\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_nxt7XCob\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-17dc286d-65bc-4ca0-8894-c8003ffba80c cb-cy5pw5py\" data-block-id=\"jet-sm-gb-17dc286d-65bc-4ca0-8894-c8003ffba80c\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Wojew\u00f3dztwo zamieszkania <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"wojewodztwo_copy\" data-field-name=\"wojewodztwo_copy\" id=\"wojewodztwo_copy\" data-jfb-sync=\"null\">\n\t\t<option value=\"\ufeffNieznane\" >\ufeffNieznane<\/option><option value=\"Dolno\u015bl\u0105skie\" >Dolno\u015bl\u0105skie<\/option><option value=\"Kujawsko-Pomorskie\" >Kujawsko-Pomorskie<\/option><option value=\"Lubelskie\" >Lubelskie<\/option><option value=\"Lubuskie\" >Lubuskie<\/option><option value=\"\u0141\u00f3dzkie\" >\u0141\u00f3dzkie<\/option><option value=\"Ma\u0142opolskie\" >Ma\u0142opolskie<\/option><option value=\"Mazowieckie\" >Mazowieckie<\/option><option value=\"Opolskie\" >Opolskie<\/option><option value=\"Podkarpackie\" >Podkarpackie<\/option><option value=\"Podlaskie\" >Podlaskie<\/option><option value=\"Pomorskie\" >Pomorskie<\/option><option value=\"\u015al\u0105skie\" >\u015al\u0105skie<\/option><option value=\"\u015awi\u0119tokrzyskie\" >\u015awi\u0119tokrzyskie<\/option><option value=\"Warmi\u0144sko-Mazurskie\" >Warmi\u0144sko-Mazurskie<\/option><option value=\"Wielkopolskie\" >Wielkopolskie<\/option><option value=\"Zachodniopomorskie\" >Zachodniopomorskie<\/option>\t<\/select>\n<\/div><div class=\"jet-form-builder__desc\"><small>Wpisz wojew\u00f3dztwo obecnego miejsca zamieszkania<\/small><\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-7387b849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\" jet-sm-gb-wrapper jet-sm-gb-bd448b93-63fc-45a7-ab07-a0af0dcf9197\" data-block-id=\"jet-sm-gb-bd448b93-63fc-45a7-ab07-a0af0dcf9197\" ><div  data-value=\"[{&quot;id&quot;:6800,&quot;conditions&quot;:[{&quot;__visible&quot;:true,&quot;value&quot;:&quot;&quot;}],&quot;to_set&quot;:&quot;&quot;}]\" class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Masa cia\u0142a <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" placeholder=\"Podaj swoj\u0105 mas\u0119 cia\u0142a w kg\" required=\"required\" min=\"0\" max=\"300\" name=\"masa_cia_a\" data-field-name=\"masa_cia_a\" id=\"masa_cia_a\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\" jet-sm-gb-wrapper jet-sm-gb-fb64beb2-5309-49e7-8e57-547737c63a8f\" data-block-id=\"jet-sm-gb-fb64beb2-5309-49e7-8e57-547737c63a8f\" ><div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Wysoko\u015b\u0107 cia\u0142a <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" placeholder=\"Podaj swoj\u0105 wysoko\u015b\u0107 cia\u0142a w cm\" required=\"required\" min=\"0\" max=\"300\" name=\"wysokosc_cia_a\" data-field-name=\"wysokosc_cia_a\" id=\"wysokosc_cia_a\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div><\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Dane kontaktowe<\/p>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-7387b849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-916a81a8-8f9b-41cc-b85d-cf04d058b3e1 cb-i261mneg\" data-block-id=\"jet-sm-gb-916a81a8-8f9b-41cc-b85d-cf04d058b3e1\" ><div  class=\"jet-form-builder-row field-type-phone-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Numer telefonu <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap phone-field-wrap separate-dial-code\">\n\t\n\t<input type=\"tel\" required=\"required\" name=\"numer_telefonu\" id=\"numer_telefonu\" data-field-name=\"numer_telefonu\" class=\"jet-form-builder__field phone-field\" data-jfb-sync=\"null\" autocomplete=\"tel\" data-default-country=\"auto\" data-save-format=\"e164\" data-validation-message-required=\"Required field is empty\" data-validation-message-invalid=\"Please enter a valid phone number\" data-separate-dial-code=\"1\">\n\n\t<input\n\t\ttype=\"tel\"\n\t\tname=\"numer_telefonu_intl\"\n\t\tdata-field-name=\"numer_telefonu_intl\"\n\t\tclass=\"jet-form-builder__field phone-field-intl  \"\n\t\tvalue=\"\"\n\t\tautocomplete=\"tel\"\n\t>\n\n\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-01addfda-298f-4bd2-9932-d76c70e2028b cb-nt1tzaxl\" data-block-id=\"jet-sm-gb-01addfda-298f-4bd2-9932-d76c70e2028b\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">E-mail <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz sw\u00f3j adres e-mail\" required=\"required\" name=\"e_mail\" id=\"e_mail\" type=\"text\" data-field-name=\"e_mail\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_pT0EBYgn\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n\n<div class=\"jet-form-builder__next-page-wrap\">\n\t\t\t\t\t<button class=\"jet-form-builder__next-page\" type=\"button\">Przejd\u017a do nast\u0119pnego kroku<\/button>\n\t<\/div>\n<\/div>\n<div class=\"jet-form-builder-page jet-form-builder-page--hidden\" data-page=\"2\" data-page-offset=\"75\">\n\n\n<h3 class=\"wp-block-heading\">Ankieta<\/h3>\n\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-01aea416-3f78-4d3e-9f00-36c8877989cc cb-al3ibvea\" data-block-id=\"jet-sm-gb-01aea416-3f78-4d3e-9f00-36c8877989cc\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">1. Jaki jest Pani\/Pana kraj urodzenia (wed\u0142ug aktualnych granic)? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"1_jaki_jest_pani_pana_kraj_urodzenia_wed_ug_aktualnych_granic\" data-field-name=\"1_jaki_jest_pani_pana_kraj_urodzenia_wed_ug_aktualnych_granic\" id=\"1_jaki_jest_pani_pana_kraj_urodzenia_wed_ug_aktualnych_granic\" data-jfb-sync=\"null\">\n\t\t<option value=\"\"  selected>Wybierz sw\u00f3j kraj urodzenia<\/option><option value=\"Polska\" >Polska<\/option><option value=\"Nieznany\" >Nieznany<\/option><option value=\"Afganistan\" >Afganistan<\/option><option value=\"Albania\" >Albania<\/option><option value=\"Algieria\" >Algieria<\/option><option value=\"Andora\" >Andora<\/option><option value=\"Angola\" >Angola<\/option><option value=\"Antigua i Barbuda\" >Antigua i Barbuda<\/option><option value=\"Arabia Saudyjska\" >Arabia Saudyjska<\/option><option value=\"Argentyna\" >Argentyna<\/option><option value=\"Armenia\" >Armenia<\/option><option value=\"Australia\" >Australia<\/option><option value=\"Austria\" >Austria<\/option><option value=\"Azerbejd\u017can\" >Azerbejd\u017can<\/option><option value=\"Bahamy\" >Bahamy<\/option><option value=\"Bahrajn\" >Bahrajn<\/option><option value=\"Bangladesz\" >Bangladesz<\/option><option value=\"Barbados\" >Barbados<\/option><option value=\"Belgia\" >Belgia<\/option><option value=\"Belize\" >Belize<\/option><option value=\"Benin\" >Benin<\/option><option value=\"Bhutan\" >Bhutan<\/option><option value=\"Bia\u0142oru\u015b\" >Bia\u0142oru\u015b<\/option><option value=\"Boliwia\" >Boliwia<\/option><option value=\"Bo\u015bnia i Hercegowina\" >Bo\u015bnia i Hercegowina<\/option><option value=\"Botswana\" >Botswana<\/option><option value=\"Brazylia\" >Brazylia<\/option><option value=\"Brunei\" >Brunei<\/option><option value=\"Bu\u0142garia\" >Bu\u0142garia<\/option><option value=\"Burkina Faso\" >Burkina Faso<\/option><option value=\"Burundi\" >Burundi<\/option><option value=\"Chile\" >Chile<\/option><option value=\"Chiny\" >Chiny<\/option><option value=\"Chorwacja\" >Chorwacja<\/option><option value=\"Cypr\" >Cypr<\/option><option value=\"Czad\" >Czad<\/option><option value=\"Czarnog\u00f3ra\" >Czarnog\u00f3ra<\/option><option value=\"Czechy\" >Czechy<\/option><option value=\"Dania\" >Dania<\/option><option value=\"Demokratyczna Republika Konga\" >Demokratyczna Republika Konga<\/option><option value=\"Dominika\" >Dominika<\/option><option value=\"Dominikana\" >Dominikana<\/option><option value=\"D\u017cibuti\" >D\u017cibuti<\/option><option value=\"Ekwador\" >Ekwador<\/option><option value=\"Egipt\" >Egipt<\/option><option value=\"Erytrea\" >Erytrea<\/option><option value=\"Estonia\" >Estonia<\/option><option value=\"Eswatini\" >Eswatini<\/option><option value=\"Etiopia\" >Etiopia<\/option><option value=\"Fid\u017ci\" >Fid\u017ci<\/option><option value=\"Filipiny\" >Filipiny<\/option><option value=\"Finlandia\" >Finlandia<\/option><option value=\"Francja\" >Francja<\/option><option value=\"Gabon\" >Gabon<\/option><option value=\"Gambia\" >Gambia<\/option><option value=\"Ghana\" >Ghana<\/option><option value=\"Grecja\" >Grecja<\/option><option value=\"Grenada\" >Grenada<\/option><option value=\"Gruzja\" >Gruzja<\/option><option value=\"Gwatemala\" >Gwatemala<\/option><option value=\"Gwinea\" >Gwinea<\/option><option value=\"Gwinea Bissau\" >Gwinea Bissau<\/option><option value=\"Gwinea R\u00f3wnikowa\" >Gwinea R\u00f3wnikowa<\/option><option value=\"Haiti\" >Haiti<\/option><option value=\"Hiszpania\" >Hiszpania<\/option><option value=\"Holandia\" >Holandia<\/option><option value=\"Honduras\" >Honduras<\/option><option value=\"Indie\" >Indie<\/option><option value=\"Indonezja\" >Indonezja<\/option><option value=\"Irak\" >Irak<\/option><option value=\"Iran\" >Iran<\/option><option value=\"Irlandia\" >Irlandia<\/option><option value=\"Islandia\" >Islandia<\/option><option value=\"Izrael\" >Izrael<\/option><option value=\"Jamajka\" >Jamajka<\/option><option value=\"Japonia\" >Japonia<\/option><option value=\"Jemen\" >Jemen<\/option><option value=\"Jordania\" >Jordania<\/option><option value=\"Kambod\u017ca\" >Kambod\u017ca<\/option><option value=\"Kamerun\" >Kamerun<\/option><option value=\"Kanada\" >Kanada<\/option><option value=\"Katar\" >Katar<\/option><option value=\"Kazachstan\" >Kazachstan<\/option><option value=\"Kenia\" >Kenia<\/option><option value=\"Kirgistan\" >Kirgistan<\/option><option value=\"Kiribati\" >Kiribati<\/option><option value=\"Kolumbia\" >Kolumbia<\/option><option value=\"Komory\" >Komory<\/option><option value=\"Kongo\" >Kongo<\/option><option value=\"Korea Po\u0142udniowa\" >Korea Po\u0142udniowa<\/option><option value=\"Korea P\u00f3\u0142nocna\" >Korea P\u00f3\u0142nocna<\/option><option value=\"Kostaryka\" >Kostaryka<\/option><option value=\"Kuba\" >Kuba<\/option><option value=\"Kuwejt\" >Kuwejt<\/option><option value=\"Laos\" >Laos<\/option><option value=\"Lesotho\" >Lesotho<\/option><option value=\"Liban\" >Liban<\/option><option value=\"Liberia\" >Liberia<\/option><option value=\"Libia\" >Libia<\/option><option value=\"Liechtenstein\" >Liechtenstein<\/option><option value=\"Litwa\" >Litwa<\/option><option value=\"Luksemburg\" >Luksemburg<\/option><option value=\"\u0141otwa\" >\u0141otwa<\/option><option value=\"Macedonia P\u00f3\u0142nocna\" >Macedonia P\u00f3\u0142nocna<\/option><option value=\"Madagaskar\" >Madagaskar<\/option><option value=\"Malawi\" >Malawi<\/option><option value=\"Malediwy\" >Malediwy<\/option><option value=\"Malezja\" >Malezja<\/option><option value=\"Mali\" >Mali<\/option><option value=\"Malta\" >Malta<\/option><option value=\"Maroko\" >Maroko<\/option><option value=\"Mauretania\" >Mauretania<\/option><option value=\"Mauritius\" >Mauritius<\/option><option value=\"Meksyk\" >Meksyk<\/option><option value=\"Mikronezja\" >Mikronezja<\/option><option value=\"Mjanma (Birma)\" >Mjanma (Birma)<\/option><option value=\"Mo\u0142dawia\" >Mo\u0142dawia<\/option><option value=\"Monako\" >Monako<\/option><option value=\"Mongolia\" >Mongolia<\/option><option value=\"Mozambik\" >Mozambik<\/option><option value=\"Namibia\" >Namibia<\/option><option value=\"Nauru\" >Nauru<\/option><option value=\"Nepal\" >Nepal<\/option><option value=\"Niemcy\" >Niemcy<\/option><option value=\"Niger\" >Niger<\/option><option value=\"Nigeria\" >Nigeria<\/option><option value=\"Nikaragua\" >Nikaragua<\/option><option value=\"Norwegia\" >Norwegia<\/option><option value=\"Nowa Zelandia\" >Nowa Zelandia<\/option><option value=\"Oman\" >Oman<\/option><option value=\"Pakistan\" >Pakistan<\/option><option value=\"Palau\" >Palau<\/option><option value=\"Panama\" >Panama<\/option><option value=\"Papua-Nowa Gwinea\" >Papua-Nowa Gwinea<\/option><option value=\"Paragwaj\" >Paragwaj<\/option><option value=\"Peru\" >Peru<\/option><option value=\"Portugalia\" >Portugalia<\/option><option value=\"Pa\u0144stwo Palestyna\" >Pa\u0144stwo Palestyna<\/option><option value=\"Republika Po\u0142udniowej Afryki\" >Republika Po\u0142udniowej Afryki<\/option><option value=\"Republika \u015arodkowoafryka\u0144ska\" >Republika \u015arodkowoafryka\u0144ska<\/option><option value=\"Republika Zielonego Przyl\u0105dka\" >Republika Zielonego Przyl\u0105dka<\/option><option value=\"Rosja\" >Rosja<\/option><option value=\"Rumunia\" >Rumunia<\/option><option value=\"Rwanda\" >Rwanda<\/option><option value=\"Saint Kitts i Nevis\" >Saint Kitts i Nevis<\/option><option value=\"Saint Lucia\" >Saint Lucia<\/option><option value=\"Saint Vincent i Grenadyny\" >Saint Vincent i Grenadyny<\/option><option value=\"Salwador\" >Salwador<\/option><option value=\"Samoa\" >Samoa<\/option><option value=\"San Marino\" >San Marino<\/option><option value=\"Senegal\" >Senegal<\/option><option value=\"Serbia\" >Serbia<\/option><option value=\"Seszele\" >Seszele<\/option><option value=\"Sierra Leone\" >Sierra Leone<\/option><option value=\"Singapur\" >Singapur<\/option><option value=\"S\u0142owacja\" >S\u0142owacja<\/option><option value=\"S\u0142owenia\" >S\u0142owenia<\/option><option value=\"Somalia\" >Somalia<\/option><option value=\"Sri Lanka\" >Sri Lanka<\/option><option value=\"Stany Zjednoczone\" >Stany Zjednoczone<\/option><option value=\"Sudan\" >Sudan<\/option><option value=\"Sudan Po\u0142udniowy\" >Sudan Po\u0142udniowy<\/option><option value=\"Surinam\" >Surinam<\/option><option value=\"Syria\" >Syria<\/option><option value=\"Szwajcaria\" >Szwajcaria<\/option><option value=\"Szwecja\" >Szwecja<\/option><option value=\"Tad\u017cykistan\" >Tad\u017cykistan<\/option><option value=\"Tajlandia\" >Tajlandia<\/option><option value=\"Tanzania\" >Tanzania<\/option><option value=\"Timor Wschodni\" >Timor Wschodni<\/option><option value=\"Togo\" >Togo<\/option><option value=\"Tonga\" >Tonga<\/option><option value=\"Trynidad i Tobago\" >Trynidad i Tobago<\/option><option value=\"Tunezja\" >Tunezja<\/option><option value=\"Turcja\" >Turcja<\/option><option value=\"Turkmenistan\" >Turkmenistan<\/option><option value=\"Tuvalu\" >Tuvalu<\/option><option value=\"Uganda\" >Uganda<\/option><option value=\"Ukraina\" >Ukraina<\/option><option value=\"Urugwaj\" >Urugwaj<\/option><option value=\"Uzbekistan\" >Uzbekistan<\/option><option value=\"Vanuatu\" >Vanuatu<\/option><option value=\"Watykan\" >Watykan<\/option><option value=\"Wenezuela\" >Wenezuela<\/option><option value=\"W\u0119gry\" >W\u0119gry<\/option><option value=\"Wielka Brytania\" >Wielka Brytania<\/option><option value=\"Wietnam\" >Wietnam<\/option><option value=\"W\u0142ochy\" >W\u0142ochy<\/option><option value=\"Wybrze\u017ce Ko\u015bci S\u0142oniowej\" >Wybrze\u017ce Ko\u015bci S\u0142oniowej<\/option><option value=\"Zambia\" >Zambia<\/option><option value=\"Zimbabwe\" >Zimbabwe<\/option><option value=\"Zjednoczone Emiraty Arabskie\" >Zjednoczone Emiraty Arabskie<\/option>\t<\/select>\n<\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-58fe77a7-87c4-4cf2-b5e9-15212b6bf1ab cb-bc66uf19\" data-block-id=\"jet-sm-gb-58fe77a7-87c4-4cf2-b5e9-15212b6bf1ab\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">2. Jakie jest Pani\/Pana obywatelstwo? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"2_jakie_jest_pani_pana_obywatelstwo\" value=\"wy\u0142\u0105cznie polskie\" data-field-name=\"2_jakie_jest_pani_pana_obywatelstwo\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>wy\u0142\u0105cznie polskie<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"2_jakie_jest_pani_pana_obywatelstwo\" value=\"polskie i inne\" data-field-name=\"2_jakie_jest_pani_pana_obywatelstwo\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>polskie i inne<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"2_jakie_jest_pani_pana_obywatelstwo\" value=\"wy\u0142\u0105cznie inne\" data-field-name=\"2_jakie_jest_pani_pana_obywatelstwo\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>wy\u0142\u0105cznie inne<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"2_jakie_jest_pani_pana_obywatelstwo\" value=\"bezpa\u0144stwowiec\" data-field-name=\"2_jakie_jest_pani_pana_obywatelstwo\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>bezpa\u0144stwowiec<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-ac653582-368e-4d81-a40e-0b59972c2dd1\" data-block-id=\"jet-sm-gb-ac653582-368e-4d81-a40e-0b59972c2dd1\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;polskie i inne&quot;,&quot;field&quot;:&quot;2_jakie_jest_pani_pana_obywatelstwo&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-32cd8e55-9ede-4f78-9df0-65b0c2039b33 cb-emaz12yg\" data-block-id=\"jet-sm-gb-32cd8e55-9ede-4f78-9df0-65b0c2039b33\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Prosz\u0119 wybra\u0107 nazw\u0119 kraju z listy <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"polskie_i_inne\" data-field-name=\"polskie_i_inne\" id=\"polskie_i_inne\" data-jfb-sync=\"null\">\n\t\t<option value=\"\"  selected>Wybierz z listy<\/option><option value=\"Polska\" >Polska<\/option><option value=\"Nieznany\" >Nieznany<\/option><option value=\"Afganistan\" >Afganistan<\/option><option value=\"Albania\" >Albania<\/option><option value=\"Algieria\" >Algieria<\/option><option value=\"Andora\" >Andora<\/option><option value=\"Angola\" >Angola<\/option><option value=\"Antigua i Barbuda\" >Antigua i Barbuda<\/option><option value=\"Arabia Saudyjska\" >Arabia Saudyjska<\/option><option value=\"Argentyna\" >Argentyna<\/option><option value=\"Armenia\" >Armenia<\/option><option value=\"Australia\" >Australia<\/option><option value=\"Austria\" >Austria<\/option><option value=\"Azerbejd\u017can\" >Azerbejd\u017can<\/option><option value=\"Bahamy\" >Bahamy<\/option><option value=\"Bahrajn\" >Bahrajn<\/option><option value=\"Bangladesz\" >Bangladesz<\/option><option value=\"Barbados\" >Barbados<\/option><option value=\"Belgia\" >Belgia<\/option><option value=\"Belize\" >Belize<\/option><option value=\"Benin\" >Benin<\/option><option value=\"Bhutan\" >Bhutan<\/option><option value=\"Bia\u0142oru\u015b\" >Bia\u0142oru\u015b<\/option><option value=\"Boliwia\" >Boliwia<\/option><option value=\"Bo\u015bnia i Hercegowina\" >Bo\u015bnia i Hercegowina<\/option><option value=\"Botswana\" >Botswana<\/option><option value=\"Brazylia\" >Brazylia<\/option><option value=\"Brunei\" >Brunei<\/option><option value=\"Bu\u0142garia\" >Bu\u0142garia<\/option><option value=\"Burkina Faso\" >Burkina Faso<\/option><option value=\"Burundi\" >Burundi<\/option><option value=\"Chile\" >Chile<\/option><option value=\"Chiny\" >Chiny<\/option><option value=\"Chorwacja\" >Chorwacja<\/option><option value=\"Cypr\" >Cypr<\/option><option value=\"Czad\" >Czad<\/option><option value=\"Czarnog\u00f3ra\" >Czarnog\u00f3ra<\/option><option value=\"Czechy\" >Czechy<\/option><option value=\"Dania\" >Dania<\/option><option value=\"Demokratyczna Republika Konga\" >Demokratyczna Republika Konga<\/option><option value=\"Dominika\" >Dominika<\/option><option value=\"Dominikana\" >Dominikana<\/option><option value=\"D\u017cibuti\" >D\u017cibuti<\/option><option value=\"Ekwador\" >Ekwador<\/option><option value=\"Egipt\" >Egipt<\/option><option value=\"Erytrea\" >Erytrea<\/option><option value=\"Estonia\" >Estonia<\/option><option value=\"Eswatini\" >Eswatini<\/option><option value=\"Etiopia\" >Etiopia<\/option><option value=\"Fid\u017ci\" >Fid\u017ci<\/option><option value=\"Filipiny\" >Filipiny<\/option><option value=\"Finlandia\" >Finlandia<\/option><option value=\"Francja\" >Francja<\/option><option value=\"Gabon\" >Gabon<\/option><option value=\"Gambia\" >Gambia<\/option><option value=\"Ghana\" >Ghana<\/option><option value=\"Grecja\" >Grecja<\/option><option value=\"Grenada\" >Grenada<\/option><option value=\"Gruzja\" >Gruzja<\/option><option value=\"Gwatemala\" >Gwatemala<\/option><option value=\"Gwinea\" >Gwinea<\/option><option value=\"Gwinea Bissau\" >Gwinea Bissau<\/option><option value=\"Gwinea R\u00f3wnikowa\" >Gwinea R\u00f3wnikowa<\/option><option value=\"Haiti\" >Haiti<\/option><option value=\"Hiszpania\" >Hiszpania<\/option><option value=\"Holandia\" >Holandia<\/option><option value=\"Honduras\" >Honduras<\/option><option value=\"Indie\" >Indie<\/option><option value=\"Indonezja\" >Indonezja<\/option><option value=\"Irak\" >Irak<\/option><option value=\"Iran\" >Iran<\/option><option value=\"Irlandia\" >Irlandia<\/option><option value=\"Islandia\" >Islandia<\/option><option value=\"Izrael\" >Izrael<\/option><option value=\"Jamajka\" >Jamajka<\/option><option value=\"Japonia\" >Japonia<\/option><option value=\"Jemen\" >Jemen<\/option><option value=\"Jordania\" >Jordania<\/option><option value=\"Kambod\u017ca\" >Kambod\u017ca<\/option><option value=\"Kamerun\" >Kamerun<\/option><option value=\"Kanada\" >Kanada<\/option><option value=\"Katar\" >Katar<\/option><option value=\"Kazachstan\" >Kazachstan<\/option><option value=\"Kenia\" >Kenia<\/option><option value=\"Kirgistan\" >Kirgistan<\/option><option value=\"Kiribati\" >Kiribati<\/option><option value=\"Kolumbia\" >Kolumbia<\/option><option value=\"Komory\" >Komory<\/option><option value=\"Kongo\" >Kongo<\/option><option value=\"Korea Po\u0142udniowa\" >Korea Po\u0142udniowa<\/option><option value=\"Korea P\u00f3\u0142nocna\" >Korea P\u00f3\u0142nocna<\/option><option value=\"Kostaryka\" >Kostaryka<\/option><option value=\"Kuba\" >Kuba<\/option><option value=\"Kuwejt\" >Kuwejt<\/option><option value=\"Laos\" >Laos<\/option><option value=\"Lesotho\" >Lesotho<\/option><option value=\"Liban\" >Liban<\/option><option value=\"Liberia\" >Liberia<\/option><option value=\"Libia\" >Libia<\/option><option value=\"Liechtenstein\" >Liechtenstein<\/option><option value=\"Litwa\" >Litwa<\/option><option value=\"Luksemburg\" >Luksemburg<\/option><option value=\"\u0141otwa\" >\u0141otwa<\/option><option value=\"Macedonia P\u00f3\u0142nocna\" >Macedonia P\u00f3\u0142nocna<\/option><option value=\"Madagaskar\" >Madagaskar<\/option><option value=\"Malawi\" >Malawi<\/option><option value=\"Malediwy\" >Malediwy<\/option><option value=\"Malezja\" >Malezja<\/option><option value=\"Mali\" >Mali<\/option><option value=\"Malta\" >Malta<\/option><option value=\"Maroko\" >Maroko<\/option><option value=\"Mauretania\" >Mauretania<\/option><option value=\"Mauritius\" >Mauritius<\/option><option value=\"Meksyk\" >Meksyk<\/option><option value=\"Mikronezja\" >Mikronezja<\/option><option value=\"Mjanma (Birma)\" >Mjanma (Birma)<\/option><option value=\"Mo\u0142dawia\" >Mo\u0142dawia<\/option><option value=\"Monako\" >Monako<\/option><option value=\"Mongolia\" >Mongolia<\/option><option value=\"Mozambik\" >Mozambik<\/option><option value=\"Namibia\" >Namibia<\/option><option value=\"Nauru\" >Nauru<\/option><option value=\"Nepal\" >Nepal<\/option><option value=\"Niemcy\" >Niemcy<\/option><option value=\"Niger\" >Niger<\/option><option value=\"Nigeria\" >Nigeria<\/option><option value=\"Nikaragua\" >Nikaragua<\/option><option value=\"Norwegia\" >Norwegia<\/option><option value=\"Nowa Zelandia\" >Nowa Zelandia<\/option><option value=\"Oman\" >Oman<\/option><option value=\"Pakistan\" >Pakistan<\/option><option value=\"Palau\" >Palau<\/option><option value=\"Panama\" >Panama<\/option><option value=\"Papua-Nowa Gwinea\" >Papua-Nowa Gwinea<\/option><option value=\"Paragwaj\" >Paragwaj<\/option><option value=\"Peru\" >Peru<\/option><option value=\"Portugalia\" >Portugalia<\/option><option value=\"Pa\u0144stwo Palestyna\" >Pa\u0144stwo Palestyna<\/option><option value=\"Republika Po\u0142udniowej Afryki\" >Republika Po\u0142udniowej Afryki<\/option><option value=\"Republika \u015arodkowoafryka\u0144ska\" >Republika \u015arodkowoafryka\u0144ska<\/option><option value=\"Republika Zielonego Przyl\u0105dka\" >Republika Zielonego Przyl\u0105dka<\/option><option value=\"Rosja\" >Rosja<\/option><option value=\"Rumunia\" >Rumunia<\/option><option value=\"Rwanda\" >Rwanda<\/option><option value=\"Saint Kitts i Nevis\" >Saint Kitts i Nevis<\/option><option value=\"Saint Lucia\" >Saint Lucia<\/option><option value=\"Saint Vincent i Grenadyny\" >Saint Vincent i Grenadyny<\/option><option value=\"Salwador\" >Salwador<\/option><option value=\"Samoa\" >Samoa<\/option><option value=\"San Marino\" >San Marino<\/option><option value=\"Senegal\" >Senegal<\/option><option value=\"Serbia\" >Serbia<\/option><option value=\"Seszele\" >Seszele<\/option><option value=\"Sierra Leone\" >Sierra Leone<\/option><option value=\"Singapur\" >Singapur<\/option><option value=\"S\u0142owacja\" >S\u0142owacja<\/option><option value=\"S\u0142owenia\" >S\u0142owenia<\/option><option value=\"Somalia\" >Somalia<\/option><option value=\"Sri Lanka\" >Sri Lanka<\/option><option value=\"Stany Zjednoczone\" >Stany Zjednoczone<\/option><option value=\"Sudan\" >Sudan<\/option><option value=\"Sudan Po\u0142udniowy\" >Sudan Po\u0142udniowy<\/option><option value=\"Surinam\" >Surinam<\/option><option value=\"Syria\" >Syria<\/option><option value=\"Szwajcaria\" >Szwajcaria<\/option><option value=\"Szwecja\" >Szwecja<\/option><option value=\"Tad\u017cykistan\" >Tad\u017cykistan<\/option><option value=\"Tajlandia\" >Tajlandia<\/option><option value=\"Tanzania\" >Tanzania<\/option><option value=\"Timor Wschodni\" >Timor Wschodni<\/option><option value=\"Togo\" >Togo<\/option><option value=\"Tonga\" >Tonga<\/option><option value=\"Trynidad i Tobago\" >Trynidad i Tobago<\/option><option value=\"Tunezja\" >Tunezja<\/option><option value=\"Turcja\" >Turcja<\/option><option value=\"Turkmenistan\" >Turkmenistan<\/option><option value=\"Tuvalu\" >Tuvalu<\/option><option value=\"Uganda\" >Uganda<\/option><option value=\"Ukraina\" >Ukraina<\/option><option value=\"Urugwaj\" >Urugwaj<\/option><option value=\"Uzbekistan\" >Uzbekistan<\/option><option value=\"Vanuatu\" >Vanuatu<\/option><option value=\"Watykan\" >Watykan<\/option><option value=\"Wenezuela\" >Wenezuela<\/option><option value=\"W\u0119gry\" >W\u0119gry<\/option><option value=\"Wielka Brytania\" >Wielka Brytania<\/option><option value=\"Wietnam\" >Wietnam<\/option><option value=\"W\u0142ochy\" >W\u0142ochy<\/option><option value=\"Wybrze\u017ce Ko\u015bci S\u0142oniowej\" >Wybrze\u017ce Ko\u015bci S\u0142oniowej<\/option><option value=\"Zambia\" >Zambia<\/option><option value=\"Zimbabwe\" >Zimbabwe<\/option><option value=\"Zjednoczone Emiraty Arabskie\" >Zjednoczone Emiraty Arabskie<\/option>\t<\/select>\n<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-aa63058e-e03d-4a01-877b-26d428d2d8a1\" data-block-id=\"jet-sm-gb-aa63058e-e03d-4a01-877b-26d428d2d8a1\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;wy\\u0142\\u0105cznie inne&quot;,&quot;field&quot;:&quot;2_jakie_jest_pani_pana_obywatelstwo&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-82e3de17-050b-4101-b24a-63cb12bbfcda cb-xw2henf7\" data-block-id=\"jet-sm-gb-82e3de17-050b-4101-b24a-63cb12bbfcda\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Prosz\u0119 wybra\u0107 nazw\u0119 kraju z listy <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"wylacznie_inne\" data-field-name=\"wylacznie_inne\" id=\"wylacznie_inne\" data-jfb-sync=\"null\">\n\t\t<option value=\"\"  selected>Wybierz z listy<\/option><option value=\"Polska\" >Polska<\/option><option value=\"Nieznany\" >Nieznany<\/option><option value=\"Afganistan\" >Afganistan<\/option><option value=\"Albania\" >Albania<\/option><option value=\"Algieria\" >Algieria<\/option><option value=\"Andora\" >Andora<\/option><option value=\"Angola\" >Angola<\/option><option value=\"Antigua i Barbuda\" >Antigua i Barbuda<\/option><option value=\"Arabia Saudyjska\" >Arabia Saudyjska<\/option><option value=\"Argentyna\" >Argentyna<\/option><option value=\"Armenia\" >Armenia<\/option><option value=\"Australia\" >Australia<\/option><option value=\"Austria\" >Austria<\/option><option value=\"Azerbejd\u017can\" >Azerbejd\u017can<\/option><option value=\"Bahamy\" >Bahamy<\/option><option value=\"Bahrajn\" >Bahrajn<\/option><option value=\"Bangladesz\" >Bangladesz<\/option><option value=\"Barbados\" >Barbados<\/option><option value=\"Belgia\" >Belgia<\/option><option value=\"Belize\" >Belize<\/option><option value=\"Benin\" >Benin<\/option><option value=\"Bhutan\" >Bhutan<\/option><option value=\"Bia\u0142oru\u015b\" >Bia\u0142oru\u015b<\/option><option value=\"Boliwia\" >Boliwia<\/option><option value=\"Bo\u015bnia i Hercegowina\" >Bo\u015bnia i Hercegowina<\/option><option value=\"Botswana\" >Botswana<\/option><option value=\"Brazylia\" >Brazylia<\/option><option value=\"Brunei\" >Brunei<\/option><option value=\"Bu\u0142garia\" >Bu\u0142garia<\/option><option value=\"Burkina Faso\" >Burkina Faso<\/option><option value=\"Burundi\" >Burundi<\/option><option value=\"Chile\" >Chile<\/option><option value=\"Chiny\" >Chiny<\/option><option value=\"Chorwacja\" >Chorwacja<\/option><option value=\"Cypr\" >Cypr<\/option><option value=\"Czad\" >Czad<\/option><option value=\"Czarnog\u00f3ra\" >Czarnog\u00f3ra<\/option><option value=\"Czechy\" >Czechy<\/option><option value=\"Dania\" >Dania<\/option><option value=\"Demokratyczna Republika Konga\" >Demokratyczna Republika Konga<\/option><option value=\"Dominika\" >Dominika<\/option><option value=\"Dominikana\" >Dominikana<\/option><option value=\"D\u017cibuti\" >D\u017cibuti<\/option><option value=\"Ekwador\" >Ekwador<\/option><option value=\"Egipt\" >Egipt<\/option><option value=\"Erytrea\" >Erytrea<\/option><option value=\"Estonia\" >Estonia<\/option><option value=\"Eswatini\" >Eswatini<\/option><option value=\"Etiopia\" >Etiopia<\/option><option value=\"Fid\u017ci\" >Fid\u017ci<\/option><option value=\"Filipiny\" >Filipiny<\/option><option value=\"Finlandia\" >Finlandia<\/option><option value=\"Francja\" >Francja<\/option><option value=\"Gabon\" >Gabon<\/option><option value=\"Gambia\" >Gambia<\/option><option value=\"Ghana\" >Ghana<\/option><option value=\"Grecja\" >Grecja<\/option><option value=\"Grenada\" >Grenada<\/option><option value=\"Gruzja\" >Gruzja<\/option><option value=\"Gwatemala\" >Gwatemala<\/option><option value=\"Gwinea\" >Gwinea<\/option><option value=\"Gwinea Bissau\" >Gwinea Bissau<\/option><option value=\"Gwinea R\u00f3wnikowa\" >Gwinea R\u00f3wnikowa<\/option><option value=\"Haiti\" >Haiti<\/option><option value=\"Hiszpania\" >Hiszpania<\/option><option value=\"Holandia\" >Holandia<\/option><option value=\"Honduras\" >Honduras<\/option><option value=\"Indie\" >Indie<\/option><option value=\"Indonezja\" >Indonezja<\/option><option value=\"Irak\" >Irak<\/option><option value=\"Iran\" >Iran<\/option><option value=\"Irlandia\" >Irlandia<\/option><option value=\"Islandia\" >Islandia<\/option><option value=\"Izrael\" >Izrael<\/option><option value=\"Jamajka\" >Jamajka<\/option><option value=\"Japonia\" >Japonia<\/option><option value=\"Jemen\" >Jemen<\/option><option value=\"Jordania\" >Jordania<\/option><option value=\"Kambod\u017ca\" >Kambod\u017ca<\/option><option value=\"Kamerun\" >Kamerun<\/option><option value=\"Kanada\" >Kanada<\/option><option value=\"Katar\" >Katar<\/option><option value=\"Kazachstan\" >Kazachstan<\/option><option value=\"Kenia\" >Kenia<\/option><option value=\"Kirgistan\" >Kirgistan<\/option><option value=\"Kiribati\" >Kiribati<\/option><option value=\"Kolumbia\" >Kolumbia<\/option><option value=\"Komory\" >Komory<\/option><option value=\"Kongo\" >Kongo<\/option><option value=\"Korea Po\u0142udniowa\" >Korea Po\u0142udniowa<\/option><option value=\"Korea P\u00f3\u0142nocna\" >Korea P\u00f3\u0142nocna<\/option><option value=\"Kostaryka\" >Kostaryka<\/option><option value=\"Kuba\" >Kuba<\/option><option value=\"Kuwejt\" >Kuwejt<\/option><option value=\"Laos\" >Laos<\/option><option value=\"Lesotho\" >Lesotho<\/option><option value=\"Liban\" >Liban<\/option><option value=\"Liberia\" >Liberia<\/option><option value=\"Libia\" >Libia<\/option><option value=\"Liechtenstein\" >Liechtenstein<\/option><option value=\"Litwa\" >Litwa<\/option><option value=\"Luksemburg\" >Luksemburg<\/option><option value=\"\u0141otwa\" >\u0141otwa<\/option><option value=\"Macedonia P\u00f3\u0142nocna\" >Macedonia P\u00f3\u0142nocna<\/option><option value=\"Madagaskar\" >Madagaskar<\/option><option value=\"Malawi\" >Malawi<\/option><option value=\"Malediwy\" >Malediwy<\/option><option value=\"Malezja\" >Malezja<\/option><option value=\"Mali\" >Mali<\/option><option value=\"Malta\" >Malta<\/option><option value=\"Maroko\" >Maroko<\/option><option value=\"Mauretania\" >Mauretania<\/option><option value=\"Mauritius\" >Mauritius<\/option><option value=\"Meksyk\" >Meksyk<\/option><option value=\"Mikronezja\" >Mikronezja<\/option><option value=\"Mjanma (Birma)\" >Mjanma (Birma)<\/option><option value=\"Mo\u0142dawia\" >Mo\u0142dawia<\/option><option value=\"Monako\" >Monako<\/option><option value=\"Mongolia\" >Mongolia<\/option><option value=\"Mozambik\" >Mozambik<\/option><option value=\"Namibia\" >Namibia<\/option><option value=\"Nauru\" >Nauru<\/option><option value=\"Nepal\" >Nepal<\/option><option value=\"Niemcy\" >Niemcy<\/option><option value=\"Niger\" >Niger<\/option><option value=\"Nigeria\" >Nigeria<\/option><option value=\"Nikaragua\" >Nikaragua<\/option><option value=\"Norwegia\" >Norwegia<\/option><option value=\"Nowa Zelandia\" >Nowa Zelandia<\/option><option value=\"Oman\" >Oman<\/option><option value=\"Pakistan\" >Pakistan<\/option><option value=\"Palau\" >Palau<\/option><option value=\"Panama\" >Panama<\/option><option value=\"Papua-Nowa Gwinea\" >Papua-Nowa Gwinea<\/option><option value=\"Paragwaj\" >Paragwaj<\/option><option value=\"Peru\" >Peru<\/option><option value=\"Portugalia\" >Portugalia<\/option><option value=\"Pa\u0144stwo Palestyna\" >Pa\u0144stwo Palestyna<\/option><option value=\"Republika Po\u0142udniowej Afryki\" >Republika Po\u0142udniowej Afryki<\/option><option value=\"Republika \u015arodkowoafryka\u0144ska\" >Republika \u015arodkowoafryka\u0144ska<\/option><option value=\"Republika Zielonego Przyl\u0105dka\" >Republika Zielonego Przyl\u0105dka<\/option><option value=\"Rosja\" >Rosja<\/option><option value=\"Rumunia\" >Rumunia<\/option><option value=\"Rwanda\" >Rwanda<\/option><option value=\"Saint Kitts i Nevis\" >Saint Kitts i Nevis<\/option><option value=\"Saint Lucia\" >Saint Lucia<\/option><option value=\"Saint Vincent i Grenadyny\" >Saint Vincent i Grenadyny<\/option><option value=\"Salwador\" >Salwador<\/option><option value=\"Samoa\" >Samoa<\/option><option value=\"San Marino\" >San Marino<\/option><option value=\"Senegal\" >Senegal<\/option><option value=\"Serbia\" >Serbia<\/option><option value=\"Seszele\" >Seszele<\/option><option value=\"Sierra Leone\" >Sierra Leone<\/option><option value=\"Singapur\" >Singapur<\/option><option value=\"S\u0142owacja\" >S\u0142owacja<\/option><option value=\"S\u0142owenia\" >S\u0142owenia<\/option><option value=\"Somalia\" >Somalia<\/option><option value=\"Sri Lanka\" >Sri Lanka<\/option><option value=\"Stany Zjednoczone\" >Stany Zjednoczone<\/option><option value=\"Sudan\" >Sudan<\/option><option value=\"Sudan Po\u0142udniowy\" >Sudan Po\u0142udniowy<\/option><option value=\"Surinam\" >Surinam<\/option><option value=\"Syria\" >Syria<\/option><option value=\"Szwajcaria\" >Szwajcaria<\/option><option value=\"Szwecja\" >Szwecja<\/option><option value=\"Tad\u017cykistan\" >Tad\u017cykistan<\/option><option value=\"Tajlandia\" >Tajlandia<\/option><option value=\"Tanzania\" >Tanzania<\/option><option value=\"Timor Wschodni\" >Timor Wschodni<\/option><option value=\"Togo\" >Togo<\/option><option value=\"Tonga\" >Tonga<\/option><option value=\"Trynidad i Tobago\" >Trynidad i Tobago<\/option><option value=\"Tunezja\" >Tunezja<\/option><option value=\"Turcja\" >Turcja<\/option><option value=\"Turkmenistan\" >Turkmenistan<\/option><option value=\"Tuvalu\" >Tuvalu<\/option><option value=\"Uganda\" >Uganda<\/option><option value=\"Ukraina\" >Ukraina<\/option><option value=\"Urugwaj\" >Urugwaj<\/option><option value=\"Uzbekistan\" >Uzbekistan<\/option><option value=\"Vanuatu\" >Vanuatu<\/option><option value=\"Watykan\" >Watykan<\/option><option value=\"Wenezuela\" >Wenezuela<\/option><option value=\"W\u0119gry\" >W\u0119gry<\/option><option value=\"Wielka Brytania\" >Wielka Brytania<\/option><option value=\"Wietnam\" >Wietnam<\/option><option value=\"W\u0142ochy\" >W\u0142ochy<\/option><option value=\"Wybrze\u017ce Ko\u015bci S\u0142oniowej\" >Wybrze\u017ce Ko\u015bci S\u0142oniowej<\/option><option value=\"Zambia\" >Zambia<\/option><option value=\"Zimbabwe\" >Zimbabwe<\/option><option value=\"Zjednoczone Emiraty Arabskie\" >Zjednoczone Emiraty Arabskie<\/option>\t<\/select>\n<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-0cdcd4ff-020d-4d7b-ab8e-74ee4e822a7d cb-v8koikgt\" data-block-id=\"jet-sm-gb-0cdcd4ff-020d-4d7b-ab8e-74ee4e822a7d\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">3. Jaka jest Pani\/Pana narodowo\u015b\u0107? (przez narodowo\u015b\u0107 nale\u017cy rozumie\u0107 przynale\u017cno\u015b\u0107 narodow\u0105 lub etniczn\u0105 - nie nale\u017cy jej myli\u0107 z obywatelstwem) <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"3_jaka_jest_pani_pana_narodowosc\" value=\"polska\" data-field-name=\"3_jaka_jest_pani_pana_narodowosc\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>polska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"3_jaka_jest_pani_pana_narodowosc\" value=\"bia\u0142oruska\" data-field-name=\"3_jaka_jest_pani_pana_narodowosc\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>bia\u0142oruska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"3_jaka_jest_pani_pana_narodowosc\" value=\"czeska\" data-field-name=\"3_jaka_jest_pani_pana_narodowosc\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>czeska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"3_jaka_jest_pani_pana_narodowosc\" value=\"karaimska\" data-field-name=\"3_jaka_jest_pani_pana_narodowosc\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>karaimska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"3_jaka_jest_pani_pana_narodowosc\" value=\"litewska\" data-field-name=\"3_jaka_jest_pani_pana_narodowosc\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>litewska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"3_jaka_jest_pani_pana_narodowosc\" value=\"\u0142emkowska\" data-field-name=\"3_jaka_jest_pani_pana_narodowosc\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>\u0142emkowska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"3_jaka_jest_pani_pana_narodowosc\" value=\"niemiecka\" data-field-name=\"3_jaka_jest_pani_pana_narodowosc\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>niemiecka<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"3_jaka_jest_pani_pana_narodowosc\" value=\"ormia\u0144ska\" data-field-name=\"3_jaka_jest_pani_pana_narodowosc\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>ormia\u0144ska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"3_jaka_jest_pani_pana_narodowosc\" value=\"romska\" data-field-name=\"3_jaka_jest_pani_pana_narodowosc\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>romska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"3_jaka_jest_pani_pana_narodowosc\" value=\"rosyjska\" data-field-name=\"3_jaka_jest_pani_pana_narodowosc\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>rosyjska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"3_jaka_jest_pani_pana_narodowosc\" value=\"s\u0142owacka\" data-field-name=\"3_jaka_jest_pani_pana_narodowosc\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>s\u0142owacka<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"3_jaka_jest_pani_pana_narodowosc\" value=\"tatarska\" data-field-name=\"3_jaka_jest_pani_pana_narodowosc\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tatarska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"3_jaka_jest_pani_pana_narodowosc\" value=\"ukrai\u0144ska\" data-field-name=\"3_jaka_jest_pani_pana_narodowosc\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>ukrai\u0144ska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"3_jaka_jest_pani_pana_narodowosc\" value=\"\u017cydowska\" data-field-name=\"3_jaka_jest_pani_pana_narodowosc\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>\u017cydowska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"3_jaka_jest_pani_pana_narodowosc\" value=\"inna\" data-field-name=\"3_jaka_jest_pani_pana_narodowosc\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>inna<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-791acb4c-13c8-4ef0-ac30-4dc7312a5526\" data-block-id=\"jet-sm-gb-791acb4c-13c8-4ef0-ac30-4dc7312a5526\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;inna&quot;,&quot;field&quot;:&quot;3_jaka_jest_pani_pana_narodowosc&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-f294e0f1-9bad-48ee-b00d-a3cf62d228b9 cb-c8fuz6bn\" data-block-id=\"jet-sm-gb-f294e0f1-9bad-48ee-b00d-a3cf62d228b9\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Poda\u0107 jaka? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz swoj\u0105 narodowo\u015b\u0107\" required=\"required\" name=\"narodowosc_inna\" id=\"narodowosc_inna\" type=\"text\" data-field-name=\"narodowosc_inna\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_azENJDfK\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-56fc46fb-83c6-476c-ad9b-56ddb651025f cb-o50c3c1n\" data-block-id=\"jet-sm-gb-56fc46fb-83c6-476c-ad9b-56ddb651025f\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">4. Czy odczuwa Pani\/Pan przynale\u017cno\u015b\u0107 tak\u017ce do innego narodu lub wsp\u00f3lnoty etnicznej? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"4_czy_odczuwa_pani_pan_przynaleznosc_takze_do_innego_narodu_lub__\" value=\"tak\" data-field-name=\"4_czy_odczuwa_pani_pan_przynaleznosc_takze_do_innego_narodu_lub__\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"4_czy_odczuwa_pani_pan_przynaleznosc_takze_do_innego_narodu_lub__\" value=\"nie\" data-field-name=\"4_czy_odczuwa_pani_pan_przynaleznosc_takze_do_innego_narodu_lub__\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>nie<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-cf4b7c7a-8caa-432e-abc3-7862de8d1684\" data-block-id=\"jet-sm-gb-cf4b7c7a-8caa-432e-abc3-7862de8d1684\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;tak&quot;,&quot;field&quot;:&quot;4_czy_odczuwa_pani_pan_przynaleznosc_takze_do_innego_narodu_lub__&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-a4540d05-61c5-436d-b7ee-b7db7e289d42 cb-u05zw5jy\" data-block-id=\"jet-sm-gb-a4540d05-61c5-436d-b7ee-b7db7e289d42\" ><div  class=\"jet-form-builder-row field-type-checkbox-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Prosz\u0119 wybra\u0107 odpowiedni\u0105 pozycj\u0119 na li\u015bcie lub wybra\u0107 kategori\u0119 \u201einna \u2013 wpisa\u0107 jaka\u201d oraz wpisa\u0107 w\u0142asne okre\u015blenie: <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"przynaleznosc_etniczna[]\" value=\"polska\" data-field-name=\"przynaleznosc_etniczna\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>polska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"przynaleznosc_etniczna[]\" value=\"bia\u0142oruska\" data-field-name=\"przynaleznosc_etniczna\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>bia\u0142oruska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"przynaleznosc_etniczna[]\" value=\"czeska\" data-field-name=\"przynaleznosc_etniczna\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>czeska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"przynaleznosc_etniczna[]\" value=\"karaimska\" data-field-name=\"przynaleznosc_etniczna\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>karaimska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"przynaleznosc_etniczna[]\" value=\"litewska\" data-field-name=\"przynaleznosc_etniczna\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>litewska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"przynaleznosc_etniczna[]\" value=\"\u0142emkowska\" data-field-name=\"przynaleznosc_etniczna\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>\u0142emkowska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"przynaleznosc_etniczna[]\" value=\"niemiecka\" data-field-name=\"przynaleznosc_etniczna\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>niemiecka<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"przynaleznosc_etniczna[]\" value=\"ormia\u0144ska\" data-field-name=\"przynaleznosc_etniczna\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>ormia\u0144ska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"przynaleznosc_etniczna[]\" value=\"romska\" data-field-name=\"przynaleznosc_etniczna\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>romska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"przynaleznosc_etniczna[]\" value=\"rosyjska\" data-field-name=\"przynaleznosc_etniczna\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>rosyjska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"przynaleznosc_etniczna[]\" value=\"s\u0142owacka\" data-field-name=\"przynaleznosc_etniczna\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>s\u0142owacka<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"przynaleznosc_etniczna[]\" value=\"tatarska\" data-field-name=\"przynaleznosc_etniczna\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>tatarska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"przynaleznosc_etniczna[]\" value=\"ukrai\u0144ska\" data-field-name=\"przynaleznosc_etniczna\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>ukrai\u0144ska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"przynaleznosc_etniczna[]\" value=\"\u017cydowska\" data-field-name=\"przynaleznosc_etniczna\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>\u017cydowska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"przynaleznosc_etniczna[]\" value=\"inna\" data-field-name=\"przynaleznosc_etniczna\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>inna <\/span><\/label><\/div><\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-6ab84d7d-5507-4280-b855-46ec7c9b9d4a\" data-block-id=\"jet-sm-gb-6ab84d7d-5507-4280-b855-46ec7c9b9d4a\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;contain&quot;,&quot;value&quot;:&quot;inna&quot;,&quot;field&quot;:&quot;przynaleznosc_etniczna&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-a751dd7c-1d17-43a6-ac5f-91aa148d8de3 cb-dfycelb0\" data-block-id=\"jet-sm-gb-a751dd7c-1d17-43a6-ac5f-91aa148d8de3\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Wpisa\u0107 jaka? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz swoj\u0105 przynale\u017cno\u015b\u0107 etniczn\u0105\" required=\"required\" name=\"przynaleznosc_etniczna_inna\" id=\"przynaleznosc_etniczna_inna\" type=\"text\" data-field-name=\"przynaleznosc_etniczna_inna\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_MJPApCN5\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-a8545aa9-7db2-4580-84e8-4d1e1c0dcd77 cb-zjxvdfpy\" data-block-id=\"jet-sm-gb-a8545aa9-7db2-4580-84e8-4d1e1c0dcd77\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">5. Jakimi j\u0119zykami zazwyczaj pos\u0142uguje si\u0119 Pani\/Pan w domu? (j\u0119zyk lub j\u0119zyki u\u017cywane w codziennych kontaktach domowych z osobami najbli\u017cszymi - nie nale\u017cy myli\u0107 ze znajomo\u015bci\u0105 j\u0119zyk\u00f3w obcych) <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"5_jakimi_jezykami_zazwyczaj_pos_uguje_sie_pani_pan_w_domu\" value=\"wy\u0142\u0105cznie polskim\" data-field-name=\"5_jakimi_jezykami_zazwyczaj_pos_uguje_sie_pani_pan_w_domu\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>wy\u0142\u0105cznie polskim<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"5_jakimi_jezykami_zazwyczaj_pos_uguje_sie_pani_pan_w_domu\" value=\"polskim i innym(i) ni\u017c polski\" data-field-name=\"5_jakimi_jezykami_zazwyczaj_pos_uguje_sie_pani_pan_w_domu\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>polskim i innym(i) ni\u017c polski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"5_jakimi_jezykami_zazwyczaj_pos_uguje_sie_pani_pan_w_domu\" value=\"wy\u0142\u0105cznie innym(i) ni\u017c polski\" data-field-name=\"5_jakimi_jezykami_zazwyczaj_pos_uguje_sie_pani_pan_w_domu\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>wy\u0142\u0105cznie innym(i) ni\u017c polski<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-bb8eb465-535c-4f11-98bd-3285d4902dc7\" data-block-id=\"jet-sm-gb-bb8eb465-535c-4f11-98bd-3285d4902dc7\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;polskim i innym(i) ni\\u017c polski&quot;,&quot;field&quot;:&quot;5_jakimi_jezykami_zazwyczaj_pos_uguje_sie_pani_pan_w_domu&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-a4994056-6542-4c24-8d58-6b5162ee558f cb-hqzylbg1\" data-block-id=\"jet-sm-gb-a4994056-6542-4c24-8d58-6b5162ee558f\" ><div  class=\"jet-form-builder-row field-type-checkbox-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Poda\u0107 jakim\/jakimi? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"polskim_i_innymi_niz_polski[]\" value=\"bia\u0142oruski\" data-field-name=\"polskim_i_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>bia\u0142oruski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"polskim_i_innymi_niz_polski[]\" value=\"czeski\" data-field-name=\"polskim_i_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>czeski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"polskim_i_innymi_niz_polski[]\" value=\"karaimski\" data-field-name=\"polskim_i_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>karaimski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"polskim_i_innymi_niz_polski[]\" value=\"litewski\" data-field-name=\"polskim_i_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>litewski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"polskim_i_innymi_niz_polski[]\" value=\"\u0142emkowski\" data-field-name=\"polskim_i_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>\u0142emkowski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"polskim_i_innymi_niz_polski[]\" value=\"niemiecki\" data-field-name=\"polskim_i_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>niemiecki<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"polskim_i_innymi_niz_polski[]\" value=\"ormia\u0144ski\" data-field-name=\"polskim_i_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>ormia\u0144ski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"polskim_i_innymi_niz_polski[]\" value=\"romski\" data-field-name=\"polskim_i_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>romski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"polskim_i_innymi_niz_polski[]\" value=\"rosyjski\" data-field-name=\"polskim_i_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>rosyjski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"polskim_i_innymi_niz_polski[]\" value=\"s\u0142owacki\" data-field-name=\"polskim_i_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>s\u0142owacki<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"polskim_i_innymi_niz_polski[]\" value=\"tatarski\" data-field-name=\"polskim_i_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>tatarski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"polskim_i_innymi_niz_polski[]\" value=\"ukrai\u0144ski\" data-field-name=\"polskim_i_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>ukrai\u0144ski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"polskim_i_innymi_niz_polski[]\" value=\"hebrajski\" data-field-name=\"polskim_i_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>hebrajski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"polskim_i_innymi_niz_polski[]\" value=\"jidysz\" data-field-name=\"polskim_i_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>jidysz<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"polskim_i_innymi_niz_polski[]\" value=\"inny\" data-field-name=\"polskim_i_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>inny<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-94923a40-6503-4918-8af2-111d7e9db4bc\" data-block-id=\"jet-sm-gb-94923a40-6503-4918-8af2-111d7e9db4bc\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;contain&quot;,&quot;value&quot;:&quot;inny&quot;,&quot;field&quot;:&quot;polskim_i_innymi_niz_polski&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-32536148-7ca8-4669-bb08-a1543d78571c cb-b6p4jb23\" data-block-id=\"jet-sm-gb-32536148-7ca8-4669-bb08-a1543d78571c\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Poda\u0107 jaki? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz sw\u00f3j j\u0119zyk\" required=\"required\" name=\"polskim_i_innymi_niz_polski_inny\" id=\"polskim_i_innymi_niz_polski_inny\" type=\"text\" data-field-name=\"polskim_i_innymi_niz_polski_inny\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_5ar0Zk63\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-26389aa7-45bb-4fa9-965a-766ca1fb8c34\" data-block-id=\"jet-sm-gb-26389aa7-45bb-4fa9-965a-766ca1fb8c34\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;wy\\u0142\\u0105cznie innym(i) ni\\u017c polski&quot;,&quot;field&quot;:&quot;5_jakimi_jezykami_zazwyczaj_pos_uguje_sie_pani_pan_w_domu&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-a4994056-6542-4c24-8d58-6b5162ee558f cb-ospxxu4k\" data-block-id=\"jet-sm-gb-a4994056-6542-4c24-8d58-6b5162ee558f\" ><div  class=\"jet-form-builder-row field-type-checkbox-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Poda\u0107 jakim\/jakimi? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"wylacznie_innymi_niz_polski[]\" value=\"bia\u0142oruski\" data-field-name=\"wylacznie_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>bia\u0142oruski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"wylacznie_innymi_niz_polski[]\" value=\"czeski\" data-field-name=\"wylacznie_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>czeski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"wylacznie_innymi_niz_polski[]\" value=\"karaimski\" data-field-name=\"wylacznie_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>karaimski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"wylacznie_innymi_niz_polski[]\" value=\"litewski\" data-field-name=\"wylacznie_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>litewski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"wylacznie_innymi_niz_polski[]\" value=\"\u0142emkowski\" data-field-name=\"wylacznie_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>\u0142emkowski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"wylacznie_innymi_niz_polski[]\" value=\"niemiecki\" data-field-name=\"wylacznie_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>niemiecki<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"wylacznie_innymi_niz_polski[]\" value=\"ormia\u0144ski\" data-field-name=\"wylacznie_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>ormia\u0144ski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"wylacznie_innymi_niz_polski[]\" value=\"romski\" data-field-name=\"wylacznie_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>romski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"wylacznie_innymi_niz_polski[]\" value=\"rosyjski\" data-field-name=\"wylacznie_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>rosyjski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"wylacznie_innymi_niz_polski[]\" value=\"s\u0142owacki\" data-field-name=\"wylacznie_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>s\u0142owacki<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"wylacznie_innymi_niz_polski[]\" value=\"tatarski\" data-field-name=\"wylacznie_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>tatarski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"wylacznie_innymi_niz_polski[]\" value=\"ukrai\u0144ski\" data-field-name=\"wylacznie_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>ukrai\u0144ski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"wylacznie_innymi_niz_polski[]\" value=\"hebrajski\" data-field-name=\"wylacznie_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>hebrajski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"wylacznie_innymi_niz_polski[]\" value=\"jidysz\" data-field-name=\"wylacznie_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>jidysz<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"wylacznie_innymi_niz_polski[]\" value=\"inny\" data-field-name=\"wylacznie_innymi_niz_polski\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>inny<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-8e424946-f1a7-4d69-95c4-23cd9c9ab139\" data-block-id=\"jet-sm-gb-8e424946-f1a7-4d69-95c4-23cd9c9ab139\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;contain&quot;,&quot;value&quot;:&quot;inny&quot;,&quot;field&quot;:&quot;wylacznie_innymi_niz_polski&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-258e32bd-ba1b-4878-9fb6-b9bb5b501f97 cb-k3xh4xy9\" data-block-id=\"jet-sm-gb-258e32bd-ba1b-4878-9fb6-b9bb5b501f97\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Poda\u0107 jakim\/i? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz sw\u00f3j j\u0119zyk\" required=\"required\" name=\"wylacznie_innymi_niz_polski_inny\" id=\"wylacznie_innymi_niz_polski_inny\" type=\"text\" data-field-name=\"wylacznie_innymi_niz_polski_inny\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_OPGMAKf5\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n<\/div><\/div>\n\n\n<h5 class=\"wp-block-heading\">6. Jakie jest miejsce urodzenia Pani\/Pana rodzic\u00f3w oraz dziadk\u00f3w?<\/h5>\n\n\n\n<p class=\"dopisek wp-block-paragraph\">Dla ka\u017cdego pola prosz\u0119 wybra\u0107 odpowiedni\u0105 pozycj\u0119 na li\u015bcie [s\u0142ownik kraj\u00f3w j.w.]<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Prosimy o podanie miejscowo\u015bci urodzenia ka\u017cdej osoby. Je\u015bli nie zna Pani\/Pan dok\u0142adnej miejscowo\u015bci, prosimy poda\u0107 najdok\u0142adniejsz\u0105 znan\u0105 informacj\u0119, np. wojew\u00f3dztwo lub kraj. Je\u015bli to mo\u017cliwe, do miejscowo\u015bci prosimy o dopisanie wojew\u00f3dztwa, poniewa\u017c nazwy miejscowo\u015bci mog\u0105 si\u0119 powtarza\u0107.<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Je\u017celi miejsce urodzenia danej osoby nie odzwierciedla miejsca pochodzenia rodziny (na przyk\u0142ad osoba urodzi\u0142a si\u0119 w szpitalu oddalonym od miejsca zamieszkania rodziny, podczas przesiedlenia, migracji lub w innych szczeg\u00f3lnych okoliczno\u015bciach), prosimy poda\u0107 miejscowo\u015b\u0107 lub region, w kt\u00f3rym ta osoba mieszka\u0142a we wczesnym dzieci\u0144stwie.<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Matka<\/p>\n\n\n\n<div class=\"wp-block-columns moja-flex is-layout-flex wp-container-core-columns-is-layout-7387b849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-59df02fd-a446-4f6c-b32b-568b03058d5c cb-tvtjkzve\" data-block-id=\"jet-sm-gb-59df02fd-a446-4f6c-b32b-568b03058d5c\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Miejscowo\u015b\u0107 lub gmina<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz nazw\u0119 miejscowo\u015bci\" name=\"miejscowosc_matka\" id=\"miejscowosc_matka\" type=\"text\" data-field-name=\"miejscowosc_matka\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_37rwUxKf\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc cb-iws5lmrm\" data-block-id=\"jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Wojew\u00f3dztwo<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" name=\"wojewodztwo_matka\" data-field-name=\"wojewodztwo_matka\" id=\"wojewodztwo_matka\" data-jfb-sync=\"null\">\n\t\t<option value=\"\"  selected>Lista wojew\u00f3dztw<\/option><option value=\"\ufeffNieznane\" >\ufeffNieznane<\/option><option value=\"Dolno\u015bl\u0105skie\" >Dolno\u015bl\u0105skie<\/option><option value=\"Kujawsko-Pomorskie\" >Kujawsko-Pomorskie<\/option><option value=\"Lubelskie\" >Lubelskie<\/option><option value=\"Lubuskie\" >Lubuskie<\/option><option value=\"\u0141\u00f3dzkie\" >\u0141\u00f3dzkie<\/option><option value=\"Ma\u0142opolskie\" >Ma\u0142opolskie<\/option><option value=\"Mazowieckie\" >Mazowieckie<\/option><option value=\"Opolskie\" >Opolskie<\/option><option value=\"Podkarpackie\" >Podkarpackie<\/option><option value=\"Podlaskie\" >Podlaskie<\/option><option value=\"Pomorskie\" >Pomorskie<\/option><option value=\"\u015al\u0105skie\" >\u015al\u0105skie<\/option><option value=\"\u015awi\u0119tokrzyskie\" >\u015awi\u0119tokrzyskie<\/option><option value=\"Warmi\u0144sko-Mazurskie\" >Warmi\u0144sko-Mazurskie<\/option><option value=\"Wielkopolskie\" >Wielkopolskie<\/option><option value=\"Zachodniopomorskie\" >Zachodniopomorskie<\/option>\t<\/select>\n<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc cb-lxxl3xne\" data-block-id=\"jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Pa\u0144stwo <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"panstwo_matka\" data-field-name=\"panstwo_matka\" id=\"panstwo_matka\" data-jfb-sync=\"null\">\n\t\t<option value=\"\"  selected>Lista pa\u0144stw<\/option><option value=\"Polska\" >Polska<\/option><option value=\"Nieznany\" >Nieznany<\/option><option value=\"Afganistan\" >Afganistan<\/option><option value=\"Albania\" >Albania<\/option><option value=\"Algieria\" >Algieria<\/option><option value=\"Andora\" >Andora<\/option><option value=\"Angola\" >Angola<\/option><option value=\"Antigua i Barbuda\" >Antigua i Barbuda<\/option><option value=\"Arabia Saudyjska\" >Arabia Saudyjska<\/option><option value=\"Argentyna\" >Argentyna<\/option><option value=\"Armenia\" >Armenia<\/option><option value=\"Australia\" >Australia<\/option><option value=\"Austria\" >Austria<\/option><option value=\"Azerbejd\u017can\" >Azerbejd\u017can<\/option><option value=\"Bahamy\" >Bahamy<\/option><option value=\"Bahrajn\" >Bahrajn<\/option><option value=\"Bangladesz\" >Bangladesz<\/option><option value=\"Barbados\" >Barbados<\/option><option value=\"Belgia\" >Belgia<\/option><option value=\"Belize\" >Belize<\/option><option value=\"Benin\" >Benin<\/option><option value=\"Bhutan\" >Bhutan<\/option><option value=\"Bia\u0142oru\u015b\" >Bia\u0142oru\u015b<\/option><option value=\"Boliwia\" >Boliwia<\/option><option value=\"Bo\u015bnia i Hercegowina\" >Bo\u015bnia i Hercegowina<\/option><option value=\"Botswana\" >Botswana<\/option><option value=\"Brazylia\" >Brazylia<\/option><option value=\"Brunei\" >Brunei<\/option><option value=\"Bu\u0142garia\" >Bu\u0142garia<\/option><option value=\"Burkina Faso\" >Burkina Faso<\/option><option value=\"Burundi\" >Burundi<\/option><option value=\"Chile\" >Chile<\/option><option value=\"Chiny\" >Chiny<\/option><option value=\"Chorwacja\" >Chorwacja<\/option><option value=\"Cypr\" >Cypr<\/option><option value=\"Czad\" >Czad<\/option><option value=\"Czarnog\u00f3ra\" >Czarnog\u00f3ra<\/option><option value=\"Czechy\" >Czechy<\/option><option value=\"Dania\" >Dania<\/option><option value=\"Demokratyczna Republika Konga\" >Demokratyczna Republika Konga<\/option><option value=\"Dominika\" >Dominika<\/option><option value=\"Dominikana\" >Dominikana<\/option><option value=\"D\u017cibuti\" >D\u017cibuti<\/option><option value=\"Ekwador\" >Ekwador<\/option><option value=\"Egipt\" >Egipt<\/option><option value=\"Erytrea\" >Erytrea<\/option><option value=\"Estonia\" >Estonia<\/option><option value=\"Eswatini\" >Eswatini<\/option><option value=\"Etiopia\" >Etiopia<\/option><option value=\"Fid\u017ci\" >Fid\u017ci<\/option><option value=\"Filipiny\" >Filipiny<\/option><option value=\"Finlandia\" >Finlandia<\/option><option value=\"Francja\" >Francja<\/option><option value=\"Gabon\" >Gabon<\/option><option value=\"Gambia\" >Gambia<\/option><option value=\"Ghana\" >Ghana<\/option><option value=\"Grecja\" >Grecja<\/option><option value=\"Grenada\" >Grenada<\/option><option value=\"Gruzja\" >Gruzja<\/option><option value=\"Gwatemala\" >Gwatemala<\/option><option value=\"Gwinea\" >Gwinea<\/option><option value=\"Gwinea Bissau\" >Gwinea Bissau<\/option><option value=\"Gwinea R\u00f3wnikowa\" >Gwinea R\u00f3wnikowa<\/option><option value=\"Haiti\" >Haiti<\/option><option value=\"Hiszpania\" >Hiszpania<\/option><option value=\"Holandia\" >Holandia<\/option><option value=\"Honduras\" >Honduras<\/option><option value=\"Indie\" >Indie<\/option><option value=\"Indonezja\" >Indonezja<\/option><option value=\"Irak\" >Irak<\/option><option value=\"Iran\" >Iran<\/option><option value=\"Irlandia\" >Irlandia<\/option><option value=\"Islandia\" >Islandia<\/option><option value=\"Izrael\" >Izrael<\/option><option value=\"Jamajka\" >Jamajka<\/option><option value=\"Japonia\" >Japonia<\/option><option value=\"Jemen\" >Jemen<\/option><option value=\"Jordania\" >Jordania<\/option><option value=\"Kambod\u017ca\" >Kambod\u017ca<\/option><option value=\"Kamerun\" >Kamerun<\/option><option value=\"Kanada\" >Kanada<\/option><option value=\"Katar\" >Katar<\/option><option value=\"Kazachstan\" >Kazachstan<\/option><option value=\"Kenia\" >Kenia<\/option><option value=\"Kirgistan\" >Kirgistan<\/option><option value=\"Kiribati\" >Kiribati<\/option><option value=\"Kolumbia\" >Kolumbia<\/option><option value=\"Komory\" >Komory<\/option><option value=\"Kongo\" >Kongo<\/option><option value=\"Korea Po\u0142udniowa\" >Korea Po\u0142udniowa<\/option><option value=\"Korea P\u00f3\u0142nocna\" >Korea P\u00f3\u0142nocna<\/option><option value=\"Kostaryka\" >Kostaryka<\/option><option value=\"Kuba\" >Kuba<\/option><option value=\"Kuwejt\" >Kuwejt<\/option><option value=\"Laos\" >Laos<\/option><option value=\"Lesotho\" >Lesotho<\/option><option value=\"Liban\" >Liban<\/option><option value=\"Liberia\" >Liberia<\/option><option value=\"Libia\" >Libia<\/option><option value=\"Liechtenstein\" >Liechtenstein<\/option><option value=\"Litwa\" >Litwa<\/option><option value=\"Luksemburg\" >Luksemburg<\/option><option value=\"\u0141otwa\" >\u0141otwa<\/option><option value=\"Macedonia P\u00f3\u0142nocna\" >Macedonia P\u00f3\u0142nocna<\/option><option value=\"Madagaskar\" >Madagaskar<\/option><option value=\"Malawi\" >Malawi<\/option><option value=\"Malediwy\" >Malediwy<\/option><option value=\"Malezja\" >Malezja<\/option><option value=\"Mali\" >Mali<\/option><option value=\"Malta\" >Malta<\/option><option value=\"Maroko\" >Maroko<\/option><option value=\"Mauretania\" >Mauretania<\/option><option value=\"Mauritius\" >Mauritius<\/option><option value=\"Meksyk\" >Meksyk<\/option><option value=\"Mikronezja\" >Mikronezja<\/option><option value=\"Mjanma (Birma)\" >Mjanma (Birma)<\/option><option value=\"Mo\u0142dawia\" >Mo\u0142dawia<\/option><option value=\"Monako\" >Monako<\/option><option value=\"Mongolia\" >Mongolia<\/option><option value=\"Mozambik\" >Mozambik<\/option><option value=\"Namibia\" >Namibia<\/option><option value=\"Nauru\" >Nauru<\/option><option value=\"Nepal\" >Nepal<\/option><option value=\"Niemcy\" >Niemcy<\/option><option value=\"Niger\" >Niger<\/option><option value=\"Nigeria\" >Nigeria<\/option><option value=\"Nikaragua\" >Nikaragua<\/option><option value=\"Norwegia\" >Norwegia<\/option><option value=\"Nowa Zelandia\" >Nowa Zelandia<\/option><option value=\"Oman\" >Oman<\/option><option value=\"Pakistan\" >Pakistan<\/option><option value=\"Palau\" >Palau<\/option><option value=\"Panama\" >Panama<\/option><option value=\"Papua-Nowa Gwinea\" >Papua-Nowa Gwinea<\/option><option value=\"Paragwaj\" >Paragwaj<\/option><option value=\"Peru\" >Peru<\/option><option value=\"Portugalia\" >Portugalia<\/option><option value=\"Pa\u0144stwo Palestyna\" >Pa\u0144stwo Palestyna<\/option><option value=\"Republika Po\u0142udniowej Afryki\" >Republika Po\u0142udniowej Afryki<\/option><option value=\"Republika \u015arodkowoafryka\u0144ska\" >Republika \u015arodkowoafryka\u0144ska<\/option><option value=\"Republika Zielonego Przyl\u0105dka\" >Republika Zielonego Przyl\u0105dka<\/option><option value=\"Rosja\" >Rosja<\/option><option value=\"Rumunia\" >Rumunia<\/option><option value=\"Rwanda\" >Rwanda<\/option><option value=\"Saint Kitts i Nevis\" >Saint Kitts i Nevis<\/option><option value=\"Saint Lucia\" >Saint Lucia<\/option><option value=\"Saint Vincent i Grenadyny\" >Saint Vincent i Grenadyny<\/option><option value=\"Salwador\" >Salwador<\/option><option value=\"Samoa\" >Samoa<\/option><option value=\"San Marino\" >San Marino<\/option><option value=\"Senegal\" >Senegal<\/option><option value=\"Serbia\" >Serbia<\/option><option value=\"Seszele\" >Seszele<\/option><option value=\"Sierra Leone\" >Sierra Leone<\/option><option value=\"Singapur\" >Singapur<\/option><option value=\"S\u0142owacja\" >S\u0142owacja<\/option><option value=\"S\u0142owenia\" >S\u0142owenia<\/option><option value=\"Somalia\" >Somalia<\/option><option value=\"Sri Lanka\" >Sri Lanka<\/option><option value=\"Stany Zjednoczone\" >Stany Zjednoczone<\/option><option value=\"Sudan\" >Sudan<\/option><option value=\"Sudan Po\u0142udniowy\" >Sudan Po\u0142udniowy<\/option><option value=\"Surinam\" >Surinam<\/option><option value=\"Syria\" >Syria<\/option><option value=\"Szwajcaria\" >Szwajcaria<\/option><option value=\"Szwecja\" >Szwecja<\/option><option value=\"Tad\u017cykistan\" >Tad\u017cykistan<\/option><option value=\"Tajlandia\" >Tajlandia<\/option><option value=\"Tanzania\" >Tanzania<\/option><option value=\"Timor Wschodni\" >Timor Wschodni<\/option><option value=\"Togo\" >Togo<\/option><option value=\"Tonga\" >Tonga<\/option><option value=\"Trynidad i Tobago\" >Trynidad i Tobago<\/option><option value=\"Tunezja\" >Tunezja<\/option><option value=\"Turcja\" >Turcja<\/option><option value=\"Turkmenistan\" >Turkmenistan<\/option><option value=\"Tuvalu\" >Tuvalu<\/option><option value=\"Uganda\" >Uganda<\/option><option value=\"Ukraina\" >Ukraina<\/option><option value=\"Urugwaj\" >Urugwaj<\/option><option value=\"Uzbekistan\" >Uzbekistan<\/option><option value=\"Vanuatu\" >Vanuatu<\/option><option value=\"Watykan\" >Watykan<\/option><option value=\"Wenezuela\" >Wenezuela<\/option><option value=\"W\u0119gry\" >W\u0119gry<\/option><option value=\"Wielka Brytania\" >Wielka Brytania<\/option><option value=\"Wietnam\" >Wietnam<\/option><option value=\"W\u0142ochy\" >W\u0142ochy<\/option><option value=\"Wybrze\u017ce Ko\u015bci S\u0142oniowej\" >Wybrze\u017ce Ko\u015bci S\u0142oniowej<\/option><option value=\"Zambia\" >Zambia<\/option><option value=\"Zimbabwe\" >Zimbabwe<\/option><option value=\"Zjednoczone Emiraty Arabskie\" >Zjednoczone Emiraty Arabskie<\/option>\t<\/select>\n<\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Babcia ze strony matki<\/p>\n\n\n\n<div class=\"wp-block-columns moja-flex has-custom-css is-layout-flex wp-container-core-columns-is-layout-7387b849 wp-block-columns-is-layout-flex wp-custom-css-ef50b3bf\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-59df02fd-a446-4f6c-b32b-568b03058d5c cb-l1xsa6fw\" data-block-id=\"jet-sm-gb-59df02fd-a446-4f6c-b32b-568b03058d5c\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Miejscowo\u015b\u0107 lub gmina<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz nazw\u0119 miejscowo\u015bci\" name=\"miejscowosc_babcia_ze_strony_matki\" id=\"miejscowosc_babcia_ze_strony_matki\" type=\"text\" data-field-name=\"miejscowosc_babcia_ze_strony_matki\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_or40BY5v\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc cb-qar04ku0\" data-block-id=\"jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Wojew\u00f3dztwo<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" name=\"wojewodztwo_babcia_ze_strony_matki\" data-field-name=\"wojewodztwo_babcia_ze_strony_matki\" id=\"wojewodztwo_babcia_ze_strony_matki\" data-jfb-sync=\"null\">\n\t\t<option value=\"\"  selected>Lista wojew\u00f3dztw<\/option><option value=\"\ufeffNieznane\" >\ufeffNieznane<\/option><option value=\"Dolno\u015bl\u0105skie\" >Dolno\u015bl\u0105skie<\/option><option value=\"Kujawsko-Pomorskie\" >Kujawsko-Pomorskie<\/option><option value=\"Lubelskie\" >Lubelskie<\/option><option value=\"Lubuskie\" >Lubuskie<\/option><option value=\"\u0141\u00f3dzkie\" >\u0141\u00f3dzkie<\/option><option value=\"Ma\u0142opolskie\" >Ma\u0142opolskie<\/option><option value=\"Mazowieckie\" >Mazowieckie<\/option><option value=\"Opolskie\" >Opolskie<\/option><option value=\"Podkarpackie\" >Podkarpackie<\/option><option value=\"Podlaskie\" >Podlaskie<\/option><option value=\"Pomorskie\" >Pomorskie<\/option><option value=\"\u015al\u0105skie\" >\u015al\u0105skie<\/option><option value=\"\u015awi\u0119tokrzyskie\" >\u015awi\u0119tokrzyskie<\/option><option value=\"Warmi\u0144sko-Mazurskie\" >Warmi\u0144sko-Mazurskie<\/option><option value=\"Wielkopolskie\" >Wielkopolskie<\/option><option value=\"Zachodniopomorskie\" >Zachodniopomorskie<\/option>\t<\/select>\n<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc cb-u90wbqfh\" data-block-id=\"jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Pa\u0144stwo <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"panstwo_babcia_ze_strony_matki\" data-field-name=\"panstwo_babcia_ze_strony_matki\" id=\"panstwo_babcia_ze_strony_matki\" data-jfb-sync=\"null\">\n\t\t<option value=\"\"  selected>Lista pa\u0144stw<\/option><option value=\"Polska\" >Polska<\/option><option value=\"Nieznany\" >Nieznany<\/option><option value=\"Afganistan\" >Afganistan<\/option><option value=\"Albania\" >Albania<\/option><option value=\"Algieria\" >Algieria<\/option><option value=\"Andora\" >Andora<\/option><option value=\"Angola\" >Angola<\/option><option value=\"Antigua i Barbuda\" >Antigua i Barbuda<\/option><option value=\"Arabia Saudyjska\" >Arabia Saudyjska<\/option><option value=\"Argentyna\" >Argentyna<\/option><option value=\"Armenia\" >Armenia<\/option><option value=\"Australia\" >Australia<\/option><option value=\"Austria\" >Austria<\/option><option value=\"Azerbejd\u017can\" >Azerbejd\u017can<\/option><option value=\"Bahamy\" >Bahamy<\/option><option value=\"Bahrajn\" >Bahrajn<\/option><option value=\"Bangladesz\" >Bangladesz<\/option><option value=\"Barbados\" >Barbados<\/option><option value=\"Belgia\" >Belgia<\/option><option value=\"Belize\" >Belize<\/option><option value=\"Benin\" >Benin<\/option><option value=\"Bhutan\" >Bhutan<\/option><option value=\"Bia\u0142oru\u015b\" >Bia\u0142oru\u015b<\/option><option value=\"Boliwia\" >Boliwia<\/option><option value=\"Bo\u015bnia i Hercegowina\" >Bo\u015bnia i Hercegowina<\/option><option value=\"Botswana\" >Botswana<\/option><option value=\"Brazylia\" >Brazylia<\/option><option value=\"Brunei\" >Brunei<\/option><option value=\"Bu\u0142garia\" >Bu\u0142garia<\/option><option value=\"Burkina Faso\" >Burkina Faso<\/option><option value=\"Burundi\" >Burundi<\/option><option value=\"Chile\" >Chile<\/option><option value=\"Chiny\" >Chiny<\/option><option value=\"Chorwacja\" >Chorwacja<\/option><option value=\"Cypr\" >Cypr<\/option><option value=\"Czad\" >Czad<\/option><option value=\"Czarnog\u00f3ra\" >Czarnog\u00f3ra<\/option><option value=\"Czechy\" >Czechy<\/option><option value=\"Dania\" >Dania<\/option><option value=\"Demokratyczna Republika Konga\" >Demokratyczna Republika Konga<\/option><option value=\"Dominika\" >Dominika<\/option><option value=\"Dominikana\" >Dominikana<\/option><option value=\"D\u017cibuti\" >D\u017cibuti<\/option><option value=\"Ekwador\" >Ekwador<\/option><option value=\"Egipt\" >Egipt<\/option><option value=\"Erytrea\" >Erytrea<\/option><option value=\"Estonia\" >Estonia<\/option><option value=\"Eswatini\" >Eswatini<\/option><option value=\"Etiopia\" >Etiopia<\/option><option value=\"Fid\u017ci\" >Fid\u017ci<\/option><option value=\"Filipiny\" >Filipiny<\/option><option value=\"Finlandia\" >Finlandia<\/option><option value=\"Francja\" >Francja<\/option><option value=\"Gabon\" >Gabon<\/option><option value=\"Gambia\" >Gambia<\/option><option value=\"Ghana\" >Ghana<\/option><option value=\"Grecja\" >Grecja<\/option><option value=\"Grenada\" >Grenada<\/option><option value=\"Gruzja\" >Gruzja<\/option><option value=\"Gwatemala\" >Gwatemala<\/option><option value=\"Gwinea\" >Gwinea<\/option><option value=\"Gwinea Bissau\" >Gwinea Bissau<\/option><option value=\"Gwinea R\u00f3wnikowa\" >Gwinea R\u00f3wnikowa<\/option><option value=\"Haiti\" >Haiti<\/option><option value=\"Hiszpania\" >Hiszpania<\/option><option value=\"Holandia\" >Holandia<\/option><option value=\"Honduras\" >Honduras<\/option><option value=\"Indie\" >Indie<\/option><option value=\"Indonezja\" >Indonezja<\/option><option value=\"Irak\" >Irak<\/option><option value=\"Iran\" >Iran<\/option><option value=\"Irlandia\" >Irlandia<\/option><option value=\"Islandia\" >Islandia<\/option><option value=\"Izrael\" >Izrael<\/option><option value=\"Jamajka\" >Jamajka<\/option><option value=\"Japonia\" >Japonia<\/option><option value=\"Jemen\" >Jemen<\/option><option value=\"Jordania\" >Jordania<\/option><option value=\"Kambod\u017ca\" >Kambod\u017ca<\/option><option value=\"Kamerun\" >Kamerun<\/option><option value=\"Kanada\" >Kanada<\/option><option value=\"Katar\" >Katar<\/option><option value=\"Kazachstan\" >Kazachstan<\/option><option value=\"Kenia\" >Kenia<\/option><option value=\"Kirgistan\" >Kirgistan<\/option><option value=\"Kiribati\" >Kiribati<\/option><option value=\"Kolumbia\" >Kolumbia<\/option><option value=\"Komory\" >Komory<\/option><option value=\"Kongo\" >Kongo<\/option><option value=\"Korea Po\u0142udniowa\" >Korea Po\u0142udniowa<\/option><option value=\"Korea P\u00f3\u0142nocna\" >Korea P\u00f3\u0142nocna<\/option><option value=\"Kostaryka\" >Kostaryka<\/option><option value=\"Kuba\" >Kuba<\/option><option value=\"Kuwejt\" >Kuwejt<\/option><option value=\"Laos\" >Laos<\/option><option value=\"Lesotho\" >Lesotho<\/option><option value=\"Liban\" >Liban<\/option><option value=\"Liberia\" >Liberia<\/option><option value=\"Libia\" >Libia<\/option><option value=\"Liechtenstein\" >Liechtenstein<\/option><option value=\"Litwa\" >Litwa<\/option><option value=\"Luksemburg\" >Luksemburg<\/option><option value=\"\u0141otwa\" >\u0141otwa<\/option><option value=\"Macedonia P\u00f3\u0142nocna\" >Macedonia P\u00f3\u0142nocna<\/option><option value=\"Madagaskar\" >Madagaskar<\/option><option value=\"Malawi\" >Malawi<\/option><option value=\"Malediwy\" >Malediwy<\/option><option value=\"Malezja\" >Malezja<\/option><option value=\"Mali\" >Mali<\/option><option value=\"Malta\" >Malta<\/option><option value=\"Maroko\" >Maroko<\/option><option value=\"Mauretania\" >Mauretania<\/option><option value=\"Mauritius\" >Mauritius<\/option><option value=\"Meksyk\" >Meksyk<\/option><option value=\"Mikronezja\" >Mikronezja<\/option><option value=\"Mjanma (Birma)\" >Mjanma (Birma)<\/option><option value=\"Mo\u0142dawia\" >Mo\u0142dawia<\/option><option value=\"Monako\" >Monako<\/option><option value=\"Mongolia\" >Mongolia<\/option><option value=\"Mozambik\" >Mozambik<\/option><option value=\"Namibia\" >Namibia<\/option><option value=\"Nauru\" >Nauru<\/option><option value=\"Nepal\" >Nepal<\/option><option value=\"Niemcy\" >Niemcy<\/option><option value=\"Niger\" >Niger<\/option><option value=\"Nigeria\" >Nigeria<\/option><option value=\"Nikaragua\" >Nikaragua<\/option><option value=\"Norwegia\" >Norwegia<\/option><option value=\"Nowa Zelandia\" >Nowa Zelandia<\/option><option value=\"Oman\" >Oman<\/option><option value=\"Pakistan\" >Pakistan<\/option><option value=\"Palau\" >Palau<\/option><option value=\"Panama\" >Panama<\/option><option value=\"Papua-Nowa Gwinea\" >Papua-Nowa Gwinea<\/option><option value=\"Paragwaj\" >Paragwaj<\/option><option value=\"Peru\" >Peru<\/option><option value=\"Portugalia\" >Portugalia<\/option><option value=\"Pa\u0144stwo Palestyna\" >Pa\u0144stwo Palestyna<\/option><option value=\"Republika Po\u0142udniowej Afryki\" >Republika Po\u0142udniowej Afryki<\/option><option value=\"Republika \u015arodkowoafryka\u0144ska\" >Republika \u015arodkowoafryka\u0144ska<\/option><option value=\"Republika Zielonego Przyl\u0105dka\" >Republika Zielonego Przyl\u0105dka<\/option><option value=\"Rosja\" >Rosja<\/option><option value=\"Rumunia\" >Rumunia<\/option><option value=\"Rwanda\" >Rwanda<\/option><option value=\"Saint Kitts i Nevis\" >Saint Kitts i Nevis<\/option><option value=\"Saint Lucia\" >Saint Lucia<\/option><option value=\"Saint Vincent i Grenadyny\" >Saint Vincent i Grenadyny<\/option><option value=\"Salwador\" >Salwador<\/option><option value=\"Samoa\" >Samoa<\/option><option value=\"San Marino\" >San Marino<\/option><option value=\"Senegal\" >Senegal<\/option><option value=\"Serbia\" >Serbia<\/option><option value=\"Seszele\" >Seszele<\/option><option value=\"Sierra Leone\" >Sierra Leone<\/option><option value=\"Singapur\" >Singapur<\/option><option value=\"S\u0142owacja\" >S\u0142owacja<\/option><option value=\"S\u0142owenia\" >S\u0142owenia<\/option><option value=\"Somalia\" >Somalia<\/option><option value=\"Sri Lanka\" >Sri Lanka<\/option><option value=\"Stany Zjednoczone\" >Stany Zjednoczone<\/option><option value=\"Sudan\" >Sudan<\/option><option value=\"Sudan Po\u0142udniowy\" >Sudan Po\u0142udniowy<\/option><option value=\"Surinam\" >Surinam<\/option><option value=\"Syria\" >Syria<\/option><option value=\"Szwajcaria\" >Szwajcaria<\/option><option value=\"Szwecja\" >Szwecja<\/option><option value=\"Tad\u017cykistan\" >Tad\u017cykistan<\/option><option value=\"Tajlandia\" >Tajlandia<\/option><option value=\"Tanzania\" >Tanzania<\/option><option value=\"Timor Wschodni\" >Timor Wschodni<\/option><option value=\"Togo\" >Togo<\/option><option value=\"Tonga\" >Tonga<\/option><option value=\"Trynidad i Tobago\" >Trynidad i Tobago<\/option><option value=\"Tunezja\" >Tunezja<\/option><option value=\"Turcja\" >Turcja<\/option><option value=\"Turkmenistan\" >Turkmenistan<\/option><option value=\"Tuvalu\" >Tuvalu<\/option><option value=\"Uganda\" >Uganda<\/option><option value=\"Ukraina\" >Ukraina<\/option><option value=\"Urugwaj\" >Urugwaj<\/option><option value=\"Uzbekistan\" >Uzbekistan<\/option><option value=\"Vanuatu\" >Vanuatu<\/option><option value=\"Watykan\" >Watykan<\/option><option value=\"Wenezuela\" >Wenezuela<\/option><option value=\"W\u0119gry\" >W\u0119gry<\/option><option value=\"Wielka Brytania\" >Wielka Brytania<\/option><option value=\"Wietnam\" >Wietnam<\/option><option value=\"W\u0142ochy\" >W\u0142ochy<\/option><option value=\"Wybrze\u017ce Ko\u015bci S\u0142oniowej\" >Wybrze\u017ce Ko\u015bci S\u0142oniowej<\/option><option value=\"Zambia\" >Zambia<\/option><option value=\"Zimbabwe\" >Zimbabwe<\/option><option value=\"Zjednoczone Emiraty Arabskie\" >Zjednoczone Emiraty Arabskie<\/option>\t<\/select>\n<\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Dziadek ze strony matki<\/p>\n\n\n\n<div class=\"wp-block-columns moja-flex is-layout-flex wp-container-core-columns-is-layout-7387b849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-59df02fd-a446-4f6c-b32b-568b03058d5c cb-k5bnspe5\" data-block-id=\"jet-sm-gb-59df02fd-a446-4f6c-b32b-568b03058d5c\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Miejscowo\u015b\u0107 lub gmina<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz nazw\u0119 miejscowo\u015bci\" name=\"miejscowosc_dziadek_ze_strony_matki\" id=\"miejscowosc_dziadek_ze_strony_matki\" type=\"text\" data-field-name=\"miejscowosc_dziadek_ze_strony_matki\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_lp3vrT0B\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc cb-tfav866p\" data-block-id=\"jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Wojew\u00f3dztwo<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" name=\"wojewodztwo_dziadek_ze_strony_matki\" data-field-name=\"wojewodztwo_dziadek_ze_strony_matki\" id=\"wojewodztwo_dziadek_ze_strony_matki\" data-jfb-sync=\"null\">\n\t\t<option value=\"\"  selected>Lista wojew\u00f3dztw<\/option><option value=\"\ufeffNieznane\" >\ufeffNieznane<\/option><option value=\"Dolno\u015bl\u0105skie\" >Dolno\u015bl\u0105skie<\/option><option value=\"Kujawsko-Pomorskie\" >Kujawsko-Pomorskie<\/option><option value=\"Lubelskie\" >Lubelskie<\/option><option value=\"Lubuskie\" >Lubuskie<\/option><option value=\"\u0141\u00f3dzkie\" >\u0141\u00f3dzkie<\/option><option value=\"Ma\u0142opolskie\" >Ma\u0142opolskie<\/option><option value=\"Mazowieckie\" >Mazowieckie<\/option><option value=\"Opolskie\" >Opolskie<\/option><option value=\"Podkarpackie\" >Podkarpackie<\/option><option value=\"Podlaskie\" >Podlaskie<\/option><option value=\"Pomorskie\" >Pomorskie<\/option><option value=\"\u015al\u0105skie\" >\u015al\u0105skie<\/option><option value=\"\u015awi\u0119tokrzyskie\" >\u015awi\u0119tokrzyskie<\/option><option value=\"Warmi\u0144sko-Mazurskie\" >Warmi\u0144sko-Mazurskie<\/option><option value=\"Wielkopolskie\" >Wielkopolskie<\/option><option value=\"Zachodniopomorskie\" >Zachodniopomorskie<\/option>\t<\/select>\n<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc cb-uvq1l3oe\" data-block-id=\"jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Pa\u0144stwo <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"panstwo_dziadek_ze_strony_matki\" data-field-name=\"panstwo_dziadek_ze_strony_matki\" id=\"panstwo_dziadek_ze_strony_matki\" data-jfb-sync=\"null\">\n\t\t<option value=\"\"  selected>Lista pa\u0144stw<\/option><option value=\"Polska\" >Polska<\/option><option value=\"Nieznany\" >Nieznany<\/option><option value=\"Afganistan\" >Afganistan<\/option><option value=\"Albania\" >Albania<\/option><option value=\"Algieria\" >Algieria<\/option><option value=\"Andora\" >Andora<\/option><option value=\"Angola\" >Angola<\/option><option value=\"Antigua i Barbuda\" >Antigua i Barbuda<\/option><option value=\"Arabia Saudyjska\" >Arabia Saudyjska<\/option><option value=\"Argentyna\" >Argentyna<\/option><option value=\"Armenia\" >Armenia<\/option><option value=\"Australia\" >Australia<\/option><option value=\"Austria\" >Austria<\/option><option value=\"Azerbejd\u017can\" >Azerbejd\u017can<\/option><option value=\"Bahamy\" >Bahamy<\/option><option value=\"Bahrajn\" >Bahrajn<\/option><option value=\"Bangladesz\" >Bangladesz<\/option><option value=\"Barbados\" >Barbados<\/option><option value=\"Belgia\" >Belgia<\/option><option value=\"Belize\" >Belize<\/option><option value=\"Benin\" >Benin<\/option><option value=\"Bhutan\" >Bhutan<\/option><option value=\"Bia\u0142oru\u015b\" >Bia\u0142oru\u015b<\/option><option value=\"Boliwia\" >Boliwia<\/option><option value=\"Bo\u015bnia i Hercegowina\" >Bo\u015bnia i Hercegowina<\/option><option value=\"Botswana\" >Botswana<\/option><option value=\"Brazylia\" >Brazylia<\/option><option value=\"Brunei\" >Brunei<\/option><option value=\"Bu\u0142garia\" >Bu\u0142garia<\/option><option value=\"Burkina Faso\" >Burkina Faso<\/option><option value=\"Burundi\" >Burundi<\/option><option value=\"Chile\" >Chile<\/option><option value=\"Chiny\" >Chiny<\/option><option value=\"Chorwacja\" >Chorwacja<\/option><option value=\"Cypr\" >Cypr<\/option><option value=\"Czad\" >Czad<\/option><option value=\"Czarnog\u00f3ra\" >Czarnog\u00f3ra<\/option><option value=\"Czechy\" >Czechy<\/option><option value=\"Dania\" >Dania<\/option><option value=\"Demokratyczna Republika Konga\" >Demokratyczna Republika Konga<\/option><option value=\"Dominika\" >Dominika<\/option><option value=\"Dominikana\" >Dominikana<\/option><option value=\"D\u017cibuti\" >D\u017cibuti<\/option><option value=\"Ekwador\" >Ekwador<\/option><option value=\"Egipt\" >Egipt<\/option><option value=\"Erytrea\" >Erytrea<\/option><option value=\"Estonia\" >Estonia<\/option><option value=\"Eswatini\" >Eswatini<\/option><option value=\"Etiopia\" >Etiopia<\/option><option value=\"Fid\u017ci\" >Fid\u017ci<\/option><option value=\"Filipiny\" >Filipiny<\/option><option value=\"Finlandia\" >Finlandia<\/option><option value=\"Francja\" >Francja<\/option><option value=\"Gabon\" >Gabon<\/option><option value=\"Gambia\" >Gambia<\/option><option value=\"Ghana\" >Ghana<\/option><option value=\"Grecja\" >Grecja<\/option><option value=\"Grenada\" >Grenada<\/option><option value=\"Gruzja\" >Gruzja<\/option><option value=\"Gwatemala\" >Gwatemala<\/option><option value=\"Gwinea\" >Gwinea<\/option><option value=\"Gwinea Bissau\" >Gwinea Bissau<\/option><option value=\"Gwinea R\u00f3wnikowa\" >Gwinea R\u00f3wnikowa<\/option><option value=\"Haiti\" >Haiti<\/option><option value=\"Hiszpania\" >Hiszpania<\/option><option value=\"Holandia\" >Holandia<\/option><option value=\"Honduras\" >Honduras<\/option><option value=\"Indie\" >Indie<\/option><option value=\"Indonezja\" >Indonezja<\/option><option value=\"Irak\" >Irak<\/option><option value=\"Iran\" >Iran<\/option><option value=\"Irlandia\" >Irlandia<\/option><option value=\"Islandia\" >Islandia<\/option><option value=\"Izrael\" >Izrael<\/option><option value=\"Jamajka\" >Jamajka<\/option><option value=\"Japonia\" >Japonia<\/option><option value=\"Jemen\" >Jemen<\/option><option value=\"Jordania\" >Jordania<\/option><option value=\"Kambod\u017ca\" >Kambod\u017ca<\/option><option value=\"Kamerun\" >Kamerun<\/option><option value=\"Kanada\" >Kanada<\/option><option value=\"Katar\" >Katar<\/option><option value=\"Kazachstan\" >Kazachstan<\/option><option value=\"Kenia\" >Kenia<\/option><option value=\"Kirgistan\" >Kirgistan<\/option><option value=\"Kiribati\" >Kiribati<\/option><option value=\"Kolumbia\" >Kolumbia<\/option><option value=\"Komory\" >Komory<\/option><option value=\"Kongo\" >Kongo<\/option><option value=\"Korea Po\u0142udniowa\" >Korea Po\u0142udniowa<\/option><option value=\"Korea P\u00f3\u0142nocna\" >Korea P\u00f3\u0142nocna<\/option><option value=\"Kostaryka\" >Kostaryka<\/option><option value=\"Kuba\" >Kuba<\/option><option value=\"Kuwejt\" >Kuwejt<\/option><option value=\"Laos\" >Laos<\/option><option value=\"Lesotho\" >Lesotho<\/option><option value=\"Liban\" >Liban<\/option><option value=\"Liberia\" >Liberia<\/option><option value=\"Libia\" >Libia<\/option><option value=\"Liechtenstein\" >Liechtenstein<\/option><option value=\"Litwa\" >Litwa<\/option><option value=\"Luksemburg\" >Luksemburg<\/option><option value=\"\u0141otwa\" >\u0141otwa<\/option><option value=\"Macedonia P\u00f3\u0142nocna\" >Macedonia P\u00f3\u0142nocna<\/option><option value=\"Madagaskar\" >Madagaskar<\/option><option value=\"Malawi\" >Malawi<\/option><option value=\"Malediwy\" >Malediwy<\/option><option value=\"Malezja\" >Malezja<\/option><option value=\"Mali\" >Mali<\/option><option value=\"Malta\" >Malta<\/option><option value=\"Maroko\" >Maroko<\/option><option value=\"Mauretania\" >Mauretania<\/option><option value=\"Mauritius\" >Mauritius<\/option><option value=\"Meksyk\" >Meksyk<\/option><option value=\"Mikronezja\" >Mikronezja<\/option><option value=\"Mjanma (Birma)\" >Mjanma (Birma)<\/option><option value=\"Mo\u0142dawia\" >Mo\u0142dawia<\/option><option value=\"Monako\" >Monako<\/option><option value=\"Mongolia\" >Mongolia<\/option><option value=\"Mozambik\" >Mozambik<\/option><option value=\"Namibia\" >Namibia<\/option><option value=\"Nauru\" >Nauru<\/option><option value=\"Nepal\" >Nepal<\/option><option value=\"Niemcy\" >Niemcy<\/option><option value=\"Niger\" >Niger<\/option><option value=\"Nigeria\" >Nigeria<\/option><option value=\"Nikaragua\" >Nikaragua<\/option><option value=\"Norwegia\" >Norwegia<\/option><option value=\"Nowa Zelandia\" >Nowa Zelandia<\/option><option value=\"Oman\" >Oman<\/option><option value=\"Pakistan\" >Pakistan<\/option><option value=\"Palau\" >Palau<\/option><option value=\"Panama\" >Panama<\/option><option value=\"Papua-Nowa Gwinea\" >Papua-Nowa Gwinea<\/option><option value=\"Paragwaj\" >Paragwaj<\/option><option value=\"Peru\" >Peru<\/option><option value=\"Portugalia\" >Portugalia<\/option><option value=\"Pa\u0144stwo Palestyna\" >Pa\u0144stwo Palestyna<\/option><option value=\"Republika Po\u0142udniowej Afryki\" >Republika Po\u0142udniowej Afryki<\/option><option value=\"Republika \u015arodkowoafryka\u0144ska\" >Republika \u015arodkowoafryka\u0144ska<\/option><option value=\"Republika Zielonego Przyl\u0105dka\" >Republika Zielonego Przyl\u0105dka<\/option><option value=\"Rosja\" >Rosja<\/option><option value=\"Rumunia\" >Rumunia<\/option><option value=\"Rwanda\" >Rwanda<\/option><option value=\"Saint Kitts i Nevis\" >Saint Kitts i Nevis<\/option><option value=\"Saint Lucia\" >Saint Lucia<\/option><option value=\"Saint Vincent i Grenadyny\" >Saint Vincent i Grenadyny<\/option><option value=\"Salwador\" >Salwador<\/option><option value=\"Samoa\" >Samoa<\/option><option value=\"San Marino\" >San Marino<\/option><option value=\"Senegal\" >Senegal<\/option><option value=\"Serbia\" >Serbia<\/option><option value=\"Seszele\" >Seszele<\/option><option value=\"Sierra Leone\" >Sierra Leone<\/option><option value=\"Singapur\" >Singapur<\/option><option value=\"S\u0142owacja\" >S\u0142owacja<\/option><option value=\"S\u0142owenia\" >S\u0142owenia<\/option><option value=\"Somalia\" >Somalia<\/option><option value=\"Sri Lanka\" >Sri Lanka<\/option><option value=\"Stany Zjednoczone\" >Stany Zjednoczone<\/option><option value=\"Sudan\" >Sudan<\/option><option value=\"Sudan Po\u0142udniowy\" >Sudan Po\u0142udniowy<\/option><option value=\"Surinam\" >Surinam<\/option><option value=\"Syria\" >Syria<\/option><option value=\"Szwajcaria\" >Szwajcaria<\/option><option value=\"Szwecja\" >Szwecja<\/option><option value=\"Tad\u017cykistan\" >Tad\u017cykistan<\/option><option value=\"Tajlandia\" >Tajlandia<\/option><option value=\"Tanzania\" >Tanzania<\/option><option value=\"Timor Wschodni\" >Timor Wschodni<\/option><option value=\"Togo\" >Togo<\/option><option value=\"Tonga\" >Tonga<\/option><option value=\"Trynidad i Tobago\" >Trynidad i Tobago<\/option><option value=\"Tunezja\" >Tunezja<\/option><option value=\"Turcja\" >Turcja<\/option><option value=\"Turkmenistan\" >Turkmenistan<\/option><option value=\"Tuvalu\" >Tuvalu<\/option><option value=\"Uganda\" >Uganda<\/option><option value=\"Ukraina\" >Ukraina<\/option><option value=\"Urugwaj\" >Urugwaj<\/option><option value=\"Uzbekistan\" >Uzbekistan<\/option><option value=\"Vanuatu\" >Vanuatu<\/option><option value=\"Watykan\" >Watykan<\/option><option value=\"Wenezuela\" >Wenezuela<\/option><option value=\"W\u0119gry\" >W\u0119gry<\/option><option value=\"Wielka Brytania\" >Wielka Brytania<\/option><option value=\"Wietnam\" >Wietnam<\/option><option value=\"W\u0142ochy\" >W\u0142ochy<\/option><option value=\"Wybrze\u017ce Ko\u015bci S\u0142oniowej\" >Wybrze\u017ce Ko\u015bci S\u0142oniowej<\/option><option value=\"Zambia\" >Zambia<\/option><option value=\"Zimbabwe\" >Zimbabwe<\/option><option value=\"Zjednoczone Emiraty Arabskie\" >Zjednoczone Emiraty Arabskie<\/option>\t<\/select>\n<\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Ojciec<\/p>\n\n\n\n<div class=\"wp-block-columns moja-flex is-layout-flex wp-container-core-columns-is-layout-7387b849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-59df02fd-a446-4f6c-b32b-568b03058d5c cb-q7lq7r3k\" data-block-id=\"jet-sm-gb-59df02fd-a446-4f6c-b32b-568b03058d5c\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Miejscowo\u015b\u0107 lub gmina<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz nazw\u0119 miejscowo\u015bci\" name=\"miejscowosc_ojciec\" id=\"miejscowosc_ojciec\" type=\"text\" data-field-name=\"miejscowosc_ojciec\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_PnDTrVcQ\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc cb-n57vqcvj\" data-block-id=\"jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Wojew\u00f3dztwo<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" name=\"wojewodztwo_ojciec\" data-field-name=\"wojewodztwo_ojciec\" id=\"wojewodztwo_ojciec\" data-jfb-sync=\"null\">\n\t\t<option value=\"\"  selected>Lista wojew\u00f3dztw<\/option><option value=\"\ufeffNieznane\" >\ufeffNieznane<\/option><option value=\"Dolno\u015bl\u0105skie\" >Dolno\u015bl\u0105skie<\/option><option value=\"Kujawsko-Pomorskie\" >Kujawsko-Pomorskie<\/option><option value=\"Lubelskie\" >Lubelskie<\/option><option value=\"Lubuskie\" >Lubuskie<\/option><option value=\"\u0141\u00f3dzkie\" >\u0141\u00f3dzkie<\/option><option value=\"Ma\u0142opolskie\" >Ma\u0142opolskie<\/option><option value=\"Mazowieckie\" >Mazowieckie<\/option><option value=\"Opolskie\" >Opolskie<\/option><option value=\"Podkarpackie\" >Podkarpackie<\/option><option value=\"Podlaskie\" >Podlaskie<\/option><option value=\"Pomorskie\" >Pomorskie<\/option><option value=\"\u015al\u0105skie\" >\u015al\u0105skie<\/option><option value=\"\u015awi\u0119tokrzyskie\" >\u015awi\u0119tokrzyskie<\/option><option value=\"Warmi\u0144sko-Mazurskie\" >Warmi\u0144sko-Mazurskie<\/option><option value=\"Wielkopolskie\" >Wielkopolskie<\/option><option value=\"Zachodniopomorskie\" >Zachodniopomorskie<\/option>\t<\/select>\n<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc cb-vhh5njg8\" data-block-id=\"jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Pa\u0144stwo <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"panstwo_ojciec\" data-field-name=\"panstwo_ojciec\" id=\"panstwo_ojciec\" data-jfb-sync=\"null\">\n\t\t<option value=\"\"  selected>Lista pa\u0144stw<\/option><option value=\"Polska\" >Polska<\/option><option value=\"Nieznany\" >Nieznany<\/option><option value=\"Afganistan\" >Afganistan<\/option><option value=\"Albania\" >Albania<\/option><option value=\"Algieria\" >Algieria<\/option><option value=\"Andora\" >Andora<\/option><option value=\"Angola\" >Angola<\/option><option value=\"Antigua i Barbuda\" >Antigua i Barbuda<\/option><option value=\"Arabia Saudyjska\" >Arabia Saudyjska<\/option><option value=\"Argentyna\" >Argentyna<\/option><option value=\"Armenia\" >Armenia<\/option><option value=\"Australia\" >Australia<\/option><option value=\"Austria\" >Austria<\/option><option value=\"Azerbejd\u017can\" >Azerbejd\u017can<\/option><option value=\"Bahamy\" >Bahamy<\/option><option value=\"Bahrajn\" >Bahrajn<\/option><option value=\"Bangladesz\" >Bangladesz<\/option><option value=\"Barbados\" >Barbados<\/option><option value=\"Belgia\" >Belgia<\/option><option value=\"Belize\" >Belize<\/option><option value=\"Benin\" >Benin<\/option><option value=\"Bhutan\" >Bhutan<\/option><option value=\"Bia\u0142oru\u015b\" >Bia\u0142oru\u015b<\/option><option value=\"Boliwia\" >Boliwia<\/option><option value=\"Bo\u015bnia i Hercegowina\" >Bo\u015bnia i Hercegowina<\/option><option value=\"Botswana\" >Botswana<\/option><option value=\"Brazylia\" >Brazylia<\/option><option value=\"Brunei\" >Brunei<\/option><option value=\"Bu\u0142garia\" >Bu\u0142garia<\/option><option value=\"Burkina Faso\" >Burkina Faso<\/option><option value=\"Burundi\" >Burundi<\/option><option value=\"Chile\" >Chile<\/option><option value=\"Chiny\" >Chiny<\/option><option value=\"Chorwacja\" >Chorwacja<\/option><option value=\"Cypr\" >Cypr<\/option><option value=\"Czad\" >Czad<\/option><option value=\"Czarnog\u00f3ra\" >Czarnog\u00f3ra<\/option><option value=\"Czechy\" >Czechy<\/option><option value=\"Dania\" >Dania<\/option><option value=\"Demokratyczna Republika Konga\" >Demokratyczna Republika Konga<\/option><option value=\"Dominika\" >Dominika<\/option><option value=\"Dominikana\" >Dominikana<\/option><option value=\"D\u017cibuti\" >D\u017cibuti<\/option><option value=\"Ekwador\" >Ekwador<\/option><option value=\"Egipt\" >Egipt<\/option><option value=\"Erytrea\" >Erytrea<\/option><option value=\"Estonia\" >Estonia<\/option><option value=\"Eswatini\" >Eswatini<\/option><option value=\"Etiopia\" >Etiopia<\/option><option value=\"Fid\u017ci\" >Fid\u017ci<\/option><option value=\"Filipiny\" >Filipiny<\/option><option value=\"Finlandia\" >Finlandia<\/option><option value=\"Francja\" >Francja<\/option><option value=\"Gabon\" >Gabon<\/option><option value=\"Gambia\" >Gambia<\/option><option value=\"Ghana\" >Ghana<\/option><option value=\"Grecja\" >Grecja<\/option><option value=\"Grenada\" >Grenada<\/option><option value=\"Gruzja\" >Gruzja<\/option><option value=\"Gwatemala\" >Gwatemala<\/option><option value=\"Gwinea\" >Gwinea<\/option><option value=\"Gwinea Bissau\" >Gwinea Bissau<\/option><option value=\"Gwinea R\u00f3wnikowa\" >Gwinea R\u00f3wnikowa<\/option><option value=\"Haiti\" >Haiti<\/option><option value=\"Hiszpania\" >Hiszpania<\/option><option value=\"Holandia\" >Holandia<\/option><option value=\"Honduras\" >Honduras<\/option><option value=\"Indie\" >Indie<\/option><option value=\"Indonezja\" >Indonezja<\/option><option value=\"Irak\" >Irak<\/option><option value=\"Iran\" >Iran<\/option><option value=\"Irlandia\" >Irlandia<\/option><option value=\"Islandia\" >Islandia<\/option><option value=\"Izrael\" >Izrael<\/option><option value=\"Jamajka\" >Jamajka<\/option><option value=\"Japonia\" >Japonia<\/option><option value=\"Jemen\" >Jemen<\/option><option value=\"Jordania\" >Jordania<\/option><option value=\"Kambod\u017ca\" >Kambod\u017ca<\/option><option value=\"Kamerun\" >Kamerun<\/option><option value=\"Kanada\" >Kanada<\/option><option value=\"Katar\" >Katar<\/option><option value=\"Kazachstan\" >Kazachstan<\/option><option value=\"Kenia\" >Kenia<\/option><option value=\"Kirgistan\" >Kirgistan<\/option><option value=\"Kiribati\" >Kiribati<\/option><option value=\"Kolumbia\" >Kolumbia<\/option><option value=\"Komory\" >Komory<\/option><option value=\"Kongo\" >Kongo<\/option><option value=\"Korea Po\u0142udniowa\" >Korea Po\u0142udniowa<\/option><option value=\"Korea P\u00f3\u0142nocna\" >Korea P\u00f3\u0142nocna<\/option><option value=\"Kostaryka\" >Kostaryka<\/option><option value=\"Kuba\" >Kuba<\/option><option value=\"Kuwejt\" >Kuwejt<\/option><option value=\"Laos\" >Laos<\/option><option value=\"Lesotho\" >Lesotho<\/option><option value=\"Liban\" >Liban<\/option><option value=\"Liberia\" >Liberia<\/option><option value=\"Libia\" >Libia<\/option><option value=\"Liechtenstein\" >Liechtenstein<\/option><option value=\"Litwa\" >Litwa<\/option><option value=\"Luksemburg\" >Luksemburg<\/option><option value=\"\u0141otwa\" >\u0141otwa<\/option><option value=\"Macedonia P\u00f3\u0142nocna\" >Macedonia P\u00f3\u0142nocna<\/option><option value=\"Madagaskar\" >Madagaskar<\/option><option value=\"Malawi\" >Malawi<\/option><option value=\"Malediwy\" >Malediwy<\/option><option value=\"Malezja\" >Malezja<\/option><option value=\"Mali\" >Mali<\/option><option value=\"Malta\" >Malta<\/option><option value=\"Maroko\" >Maroko<\/option><option value=\"Mauretania\" >Mauretania<\/option><option value=\"Mauritius\" >Mauritius<\/option><option value=\"Meksyk\" >Meksyk<\/option><option value=\"Mikronezja\" >Mikronezja<\/option><option value=\"Mjanma (Birma)\" >Mjanma (Birma)<\/option><option value=\"Mo\u0142dawia\" >Mo\u0142dawia<\/option><option value=\"Monako\" >Monako<\/option><option value=\"Mongolia\" >Mongolia<\/option><option value=\"Mozambik\" >Mozambik<\/option><option value=\"Namibia\" >Namibia<\/option><option value=\"Nauru\" >Nauru<\/option><option value=\"Nepal\" >Nepal<\/option><option value=\"Niemcy\" >Niemcy<\/option><option value=\"Niger\" >Niger<\/option><option value=\"Nigeria\" >Nigeria<\/option><option value=\"Nikaragua\" >Nikaragua<\/option><option value=\"Norwegia\" >Norwegia<\/option><option value=\"Nowa Zelandia\" >Nowa Zelandia<\/option><option value=\"Oman\" >Oman<\/option><option value=\"Pakistan\" >Pakistan<\/option><option value=\"Palau\" >Palau<\/option><option value=\"Panama\" >Panama<\/option><option value=\"Papua-Nowa Gwinea\" >Papua-Nowa Gwinea<\/option><option value=\"Paragwaj\" >Paragwaj<\/option><option value=\"Peru\" >Peru<\/option><option value=\"Portugalia\" >Portugalia<\/option><option value=\"Pa\u0144stwo Palestyna\" >Pa\u0144stwo Palestyna<\/option><option value=\"Republika Po\u0142udniowej Afryki\" >Republika Po\u0142udniowej Afryki<\/option><option value=\"Republika \u015arodkowoafryka\u0144ska\" >Republika \u015arodkowoafryka\u0144ska<\/option><option value=\"Republika Zielonego Przyl\u0105dka\" >Republika Zielonego Przyl\u0105dka<\/option><option value=\"Rosja\" >Rosja<\/option><option value=\"Rumunia\" >Rumunia<\/option><option value=\"Rwanda\" >Rwanda<\/option><option value=\"Saint Kitts i Nevis\" >Saint Kitts i Nevis<\/option><option value=\"Saint Lucia\" >Saint Lucia<\/option><option value=\"Saint Vincent i Grenadyny\" >Saint Vincent i Grenadyny<\/option><option value=\"Salwador\" >Salwador<\/option><option value=\"Samoa\" >Samoa<\/option><option value=\"San Marino\" >San Marino<\/option><option value=\"Senegal\" >Senegal<\/option><option value=\"Serbia\" >Serbia<\/option><option value=\"Seszele\" >Seszele<\/option><option value=\"Sierra Leone\" >Sierra Leone<\/option><option value=\"Singapur\" >Singapur<\/option><option value=\"S\u0142owacja\" >S\u0142owacja<\/option><option value=\"S\u0142owenia\" >S\u0142owenia<\/option><option value=\"Somalia\" >Somalia<\/option><option value=\"Sri Lanka\" >Sri Lanka<\/option><option value=\"Stany Zjednoczone\" >Stany Zjednoczone<\/option><option value=\"Sudan\" >Sudan<\/option><option value=\"Sudan Po\u0142udniowy\" >Sudan Po\u0142udniowy<\/option><option value=\"Surinam\" >Surinam<\/option><option value=\"Syria\" >Syria<\/option><option value=\"Szwajcaria\" >Szwajcaria<\/option><option value=\"Szwecja\" >Szwecja<\/option><option value=\"Tad\u017cykistan\" >Tad\u017cykistan<\/option><option value=\"Tajlandia\" >Tajlandia<\/option><option value=\"Tanzania\" >Tanzania<\/option><option value=\"Timor Wschodni\" >Timor Wschodni<\/option><option value=\"Togo\" >Togo<\/option><option value=\"Tonga\" >Tonga<\/option><option value=\"Trynidad i Tobago\" >Trynidad i Tobago<\/option><option value=\"Tunezja\" >Tunezja<\/option><option value=\"Turcja\" >Turcja<\/option><option value=\"Turkmenistan\" >Turkmenistan<\/option><option value=\"Tuvalu\" >Tuvalu<\/option><option value=\"Uganda\" >Uganda<\/option><option value=\"Ukraina\" >Ukraina<\/option><option value=\"Urugwaj\" >Urugwaj<\/option><option value=\"Uzbekistan\" >Uzbekistan<\/option><option value=\"Vanuatu\" >Vanuatu<\/option><option value=\"Watykan\" >Watykan<\/option><option value=\"Wenezuela\" >Wenezuela<\/option><option value=\"W\u0119gry\" >W\u0119gry<\/option><option value=\"Wielka Brytania\" >Wielka Brytania<\/option><option value=\"Wietnam\" >Wietnam<\/option><option value=\"W\u0142ochy\" >W\u0142ochy<\/option><option value=\"Wybrze\u017ce Ko\u015bci S\u0142oniowej\" >Wybrze\u017ce Ko\u015bci S\u0142oniowej<\/option><option value=\"Zambia\" >Zambia<\/option><option value=\"Zimbabwe\" >Zimbabwe<\/option><option value=\"Zjednoczone Emiraty Arabskie\" >Zjednoczone Emiraty Arabskie<\/option>\t<\/select>\n<\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Babcia ze strony ojca<\/p>\n\n\n\n<div class=\"wp-block-columns moja-flex is-layout-flex wp-container-core-columns-is-layout-7387b849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-59df02fd-a446-4f6c-b32b-568b03058d5c cb-s4mp6n2p\" data-block-id=\"jet-sm-gb-59df02fd-a446-4f6c-b32b-568b03058d5c\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Miejscowo\u015b\u0107 lub gmina<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz nazw\u0119 miejscowo\u015bci\" name=\"miejscowosc_babcia_ze_strony_ojca\" id=\"miejscowosc_babcia_ze_strony_ojca\" type=\"text\" data-field-name=\"miejscowosc_babcia_ze_strony_ojca\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_ZPneU2Wy\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc cb-g4zdfk2w\" data-block-id=\"jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Wojew\u00f3dztwo<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" name=\"wojewodztwo_babcia_ze_strony_ojca\" data-field-name=\"wojewodztwo_babcia_ze_strony_ojca\" id=\"wojewodztwo_babcia_ze_strony_ojca\" data-jfb-sync=\"null\">\n\t\t<option value=\"\"  selected>Lista wojew\u00f3dztw<\/option><option value=\"\ufeffNieznane\" >\ufeffNieznane<\/option><option value=\"Dolno\u015bl\u0105skie\" >Dolno\u015bl\u0105skie<\/option><option value=\"Kujawsko-Pomorskie\" >Kujawsko-Pomorskie<\/option><option value=\"Lubelskie\" >Lubelskie<\/option><option value=\"Lubuskie\" >Lubuskie<\/option><option value=\"\u0141\u00f3dzkie\" >\u0141\u00f3dzkie<\/option><option value=\"Ma\u0142opolskie\" >Ma\u0142opolskie<\/option><option value=\"Mazowieckie\" >Mazowieckie<\/option><option value=\"Opolskie\" >Opolskie<\/option><option value=\"Podkarpackie\" >Podkarpackie<\/option><option value=\"Podlaskie\" >Podlaskie<\/option><option value=\"Pomorskie\" >Pomorskie<\/option><option value=\"\u015al\u0105skie\" >\u015al\u0105skie<\/option><option value=\"\u015awi\u0119tokrzyskie\" >\u015awi\u0119tokrzyskie<\/option><option value=\"Warmi\u0144sko-Mazurskie\" >Warmi\u0144sko-Mazurskie<\/option><option value=\"Wielkopolskie\" >Wielkopolskie<\/option><option value=\"Zachodniopomorskie\" >Zachodniopomorskie<\/option>\t<\/select>\n<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc cb-pu4psele\" data-block-id=\"jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Pa\u0144stwo <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"panstwo_babcia_ze_strony_ojca\" data-field-name=\"panstwo_babcia_ze_strony_ojca\" id=\"panstwo_babcia_ze_strony_ojca\" data-jfb-sync=\"null\">\n\t\t<option value=\"\"  selected>Lista pa\u0144stw<\/option><option value=\"Polska\" >Polska<\/option><option value=\"Nieznany\" >Nieznany<\/option><option value=\"Afganistan\" >Afganistan<\/option><option value=\"Albania\" >Albania<\/option><option value=\"Algieria\" >Algieria<\/option><option value=\"Andora\" >Andora<\/option><option value=\"Angola\" >Angola<\/option><option value=\"Antigua i Barbuda\" >Antigua i Barbuda<\/option><option value=\"Arabia Saudyjska\" >Arabia Saudyjska<\/option><option value=\"Argentyna\" >Argentyna<\/option><option value=\"Armenia\" >Armenia<\/option><option value=\"Australia\" >Australia<\/option><option value=\"Austria\" >Austria<\/option><option value=\"Azerbejd\u017can\" >Azerbejd\u017can<\/option><option value=\"Bahamy\" >Bahamy<\/option><option value=\"Bahrajn\" >Bahrajn<\/option><option value=\"Bangladesz\" >Bangladesz<\/option><option value=\"Barbados\" >Barbados<\/option><option value=\"Belgia\" >Belgia<\/option><option value=\"Belize\" >Belize<\/option><option value=\"Benin\" >Benin<\/option><option value=\"Bhutan\" >Bhutan<\/option><option value=\"Bia\u0142oru\u015b\" >Bia\u0142oru\u015b<\/option><option value=\"Boliwia\" >Boliwia<\/option><option value=\"Bo\u015bnia i Hercegowina\" >Bo\u015bnia i Hercegowina<\/option><option value=\"Botswana\" >Botswana<\/option><option value=\"Brazylia\" >Brazylia<\/option><option value=\"Brunei\" >Brunei<\/option><option value=\"Bu\u0142garia\" >Bu\u0142garia<\/option><option value=\"Burkina Faso\" >Burkina Faso<\/option><option value=\"Burundi\" >Burundi<\/option><option value=\"Chile\" >Chile<\/option><option value=\"Chiny\" >Chiny<\/option><option value=\"Chorwacja\" >Chorwacja<\/option><option value=\"Cypr\" >Cypr<\/option><option value=\"Czad\" >Czad<\/option><option value=\"Czarnog\u00f3ra\" >Czarnog\u00f3ra<\/option><option value=\"Czechy\" >Czechy<\/option><option value=\"Dania\" >Dania<\/option><option value=\"Demokratyczna Republika Konga\" >Demokratyczna Republika Konga<\/option><option value=\"Dominika\" >Dominika<\/option><option value=\"Dominikana\" >Dominikana<\/option><option value=\"D\u017cibuti\" >D\u017cibuti<\/option><option value=\"Ekwador\" >Ekwador<\/option><option value=\"Egipt\" >Egipt<\/option><option value=\"Erytrea\" >Erytrea<\/option><option value=\"Estonia\" >Estonia<\/option><option value=\"Eswatini\" >Eswatini<\/option><option value=\"Etiopia\" >Etiopia<\/option><option value=\"Fid\u017ci\" >Fid\u017ci<\/option><option value=\"Filipiny\" >Filipiny<\/option><option value=\"Finlandia\" >Finlandia<\/option><option value=\"Francja\" >Francja<\/option><option value=\"Gabon\" >Gabon<\/option><option value=\"Gambia\" >Gambia<\/option><option value=\"Ghana\" >Ghana<\/option><option value=\"Grecja\" >Grecja<\/option><option value=\"Grenada\" >Grenada<\/option><option value=\"Gruzja\" >Gruzja<\/option><option value=\"Gwatemala\" >Gwatemala<\/option><option value=\"Gwinea\" >Gwinea<\/option><option value=\"Gwinea Bissau\" >Gwinea Bissau<\/option><option value=\"Gwinea R\u00f3wnikowa\" >Gwinea R\u00f3wnikowa<\/option><option value=\"Haiti\" >Haiti<\/option><option value=\"Hiszpania\" >Hiszpania<\/option><option value=\"Holandia\" >Holandia<\/option><option value=\"Honduras\" >Honduras<\/option><option value=\"Indie\" >Indie<\/option><option value=\"Indonezja\" >Indonezja<\/option><option value=\"Irak\" >Irak<\/option><option value=\"Iran\" >Iran<\/option><option value=\"Irlandia\" >Irlandia<\/option><option value=\"Islandia\" >Islandia<\/option><option value=\"Izrael\" >Izrael<\/option><option value=\"Jamajka\" >Jamajka<\/option><option value=\"Japonia\" >Japonia<\/option><option value=\"Jemen\" >Jemen<\/option><option value=\"Jordania\" >Jordania<\/option><option value=\"Kambod\u017ca\" >Kambod\u017ca<\/option><option value=\"Kamerun\" >Kamerun<\/option><option value=\"Kanada\" >Kanada<\/option><option value=\"Katar\" >Katar<\/option><option value=\"Kazachstan\" >Kazachstan<\/option><option value=\"Kenia\" >Kenia<\/option><option value=\"Kirgistan\" >Kirgistan<\/option><option value=\"Kiribati\" >Kiribati<\/option><option value=\"Kolumbia\" >Kolumbia<\/option><option value=\"Komory\" >Komory<\/option><option value=\"Kongo\" >Kongo<\/option><option value=\"Korea Po\u0142udniowa\" >Korea Po\u0142udniowa<\/option><option value=\"Korea P\u00f3\u0142nocna\" >Korea P\u00f3\u0142nocna<\/option><option value=\"Kostaryka\" >Kostaryka<\/option><option value=\"Kuba\" >Kuba<\/option><option value=\"Kuwejt\" >Kuwejt<\/option><option value=\"Laos\" >Laos<\/option><option value=\"Lesotho\" >Lesotho<\/option><option value=\"Liban\" >Liban<\/option><option value=\"Liberia\" >Liberia<\/option><option value=\"Libia\" >Libia<\/option><option value=\"Liechtenstein\" >Liechtenstein<\/option><option value=\"Litwa\" >Litwa<\/option><option value=\"Luksemburg\" >Luksemburg<\/option><option value=\"\u0141otwa\" >\u0141otwa<\/option><option value=\"Macedonia P\u00f3\u0142nocna\" >Macedonia P\u00f3\u0142nocna<\/option><option value=\"Madagaskar\" >Madagaskar<\/option><option value=\"Malawi\" >Malawi<\/option><option value=\"Malediwy\" >Malediwy<\/option><option value=\"Malezja\" >Malezja<\/option><option value=\"Mali\" >Mali<\/option><option value=\"Malta\" >Malta<\/option><option value=\"Maroko\" >Maroko<\/option><option value=\"Mauretania\" >Mauretania<\/option><option value=\"Mauritius\" >Mauritius<\/option><option value=\"Meksyk\" >Meksyk<\/option><option value=\"Mikronezja\" >Mikronezja<\/option><option value=\"Mjanma (Birma)\" >Mjanma (Birma)<\/option><option value=\"Mo\u0142dawia\" >Mo\u0142dawia<\/option><option value=\"Monako\" >Monako<\/option><option value=\"Mongolia\" >Mongolia<\/option><option value=\"Mozambik\" >Mozambik<\/option><option value=\"Namibia\" >Namibia<\/option><option value=\"Nauru\" >Nauru<\/option><option value=\"Nepal\" >Nepal<\/option><option value=\"Niemcy\" >Niemcy<\/option><option value=\"Niger\" >Niger<\/option><option value=\"Nigeria\" >Nigeria<\/option><option value=\"Nikaragua\" >Nikaragua<\/option><option value=\"Norwegia\" >Norwegia<\/option><option value=\"Nowa Zelandia\" >Nowa Zelandia<\/option><option value=\"Oman\" >Oman<\/option><option value=\"Pakistan\" >Pakistan<\/option><option value=\"Palau\" >Palau<\/option><option value=\"Panama\" >Panama<\/option><option value=\"Papua-Nowa Gwinea\" >Papua-Nowa Gwinea<\/option><option value=\"Paragwaj\" >Paragwaj<\/option><option value=\"Peru\" >Peru<\/option><option value=\"Portugalia\" >Portugalia<\/option><option value=\"Pa\u0144stwo Palestyna\" >Pa\u0144stwo Palestyna<\/option><option value=\"Republika Po\u0142udniowej Afryki\" >Republika Po\u0142udniowej Afryki<\/option><option value=\"Republika \u015arodkowoafryka\u0144ska\" >Republika \u015arodkowoafryka\u0144ska<\/option><option value=\"Republika Zielonego Przyl\u0105dka\" >Republika Zielonego Przyl\u0105dka<\/option><option value=\"Rosja\" >Rosja<\/option><option value=\"Rumunia\" >Rumunia<\/option><option value=\"Rwanda\" >Rwanda<\/option><option value=\"Saint Kitts i Nevis\" >Saint Kitts i Nevis<\/option><option value=\"Saint Lucia\" >Saint Lucia<\/option><option value=\"Saint Vincent i Grenadyny\" >Saint Vincent i Grenadyny<\/option><option value=\"Salwador\" >Salwador<\/option><option value=\"Samoa\" >Samoa<\/option><option value=\"San Marino\" >San Marino<\/option><option value=\"Senegal\" >Senegal<\/option><option value=\"Serbia\" >Serbia<\/option><option value=\"Seszele\" >Seszele<\/option><option value=\"Sierra Leone\" >Sierra Leone<\/option><option value=\"Singapur\" >Singapur<\/option><option value=\"S\u0142owacja\" >S\u0142owacja<\/option><option value=\"S\u0142owenia\" >S\u0142owenia<\/option><option value=\"Somalia\" >Somalia<\/option><option value=\"Sri Lanka\" >Sri Lanka<\/option><option value=\"Stany Zjednoczone\" >Stany Zjednoczone<\/option><option value=\"Sudan\" >Sudan<\/option><option value=\"Sudan Po\u0142udniowy\" >Sudan Po\u0142udniowy<\/option><option value=\"Surinam\" >Surinam<\/option><option value=\"Syria\" >Syria<\/option><option value=\"Szwajcaria\" >Szwajcaria<\/option><option value=\"Szwecja\" >Szwecja<\/option><option value=\"Tad\u017cykistan\" >Tad\u017cykistan<\/option><option value=\"Tajlandia\" >Tajlandia<\/option><option value=\"Tanzania\" >Tanzania<\/option><option value=\"Timor Wschodni\" >Timor Wschodni<\/option><option value=\"Togo\" >Togo<\/option><option value=\"Tonga\" >Tonga<\/option><option value=\"Trynidad i Tobago\" >Trynidad i Tobago<\/option><option value=\"Tunezja\" >Tunezja<\/option><option value=\"Turcja\" >Turcja<\/option><option value=\"Turkmenistan\" >Turkmenistan<\/option><option value=\"Tuvalu\" >Tuvalu<\/option><option value=\"Uganda\" >Uganda<\/option><option value=\"Ukraina\" >Ukraina<\/option><option value=\"Urugwaj\" >Urugwaj<\/option><option value=\"Uzbekistan\" >Uzbekistan<\/option><option value=\"Vanuatu\" >Vanuatu<\/option><option value=\"Watykan\" >Watykan<\/option><option value=\"Wenezuela\" >Wenezuela<\/option><option value=\"W\u0119gry\" >W\u0119gry<\/option><option value=\"Wielka Brytania\" >Wielka Brytania<\/option><option value=\"Wietnam\" >Wietnam<\/option><option value=\"W\u0142ochy\" >W\u0142ochy<\/option><option value=\"Wybrze\u017ce Ko\u015bci S\u0142oniowej\" >Wybrze\u017ce Ko\u015bci S\u0142oniowej<\/option><option value=\"Zambia\" >Zambia<\/option><option value=\"Zimbabwe\" >Zimbabwe<\/option><option value=\"Zjednoczone Emiraty Arabskie\" >Zjednoczone Emiraty Arabskie<\/option>\t<\/select>\n<\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Dziadek ze strony ojca<\/p>\n\n\n\n<div class=\"wp-block-columns moja-flex is-layout-flex wp-container-core-columns-is-layout-7387b849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-59df02fd-a446-4f6c-b32b-568b03058d5c cb-mmku5h4t\" data-block-id=\"jet-sm-gb-59df02fd-a446-4f6c-b32b-568b03058d5c\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Miejscowo\u015b\u0107 lub gmina<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz nazw\u0119 miejscowo\u015bci\" name=\"miejscowosc_dziadek_ze_strony_ojca\" id=\"miejscowosc_dziadek_ze_strony_ojca\" type=\"text\" data-field-name=\"miejscowosc_dziadek_ze_strony_ojca\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_NTBLJV7v\">\n\t\t\t\t\t<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc cb-ocz572fy\" data-block-id=\"jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Wojew\u00f3dztwo<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" name=\"wojewodztwo_dziadek_ze_strony_ojca\" data-field-name=\"wojewodztwo_dziadek_ze_strony_ojca\" id=\"wojewodztwo_dziadek_ze_strony_ojca\" data-jfb-sync=\"null\">\n\t\t<option value=\"\"  selected>Lista wojew\u00f3dztw<\/option><option value=\"\ufeffNieznane\" >\ufeffNieznane<\/option><option value=\"Dolno\u015bl\u0105skie\" >Dolno\u015bl\u0105skie<\/option><option value=\"Kujawsko-Pomorskie\" >Kujawsko-Pomorskie<\/option><option value=\"Lubelskie\" >Lubelskie<\/option><option value=\"Lubuskie\" >Lubuskie<\/option><option value=\"\u0141\u00f3dzkie\" >\u0141\u00f3dzkie<\/option><option value=\"Ma\u0142opolskie\" >Ma\u0142opolskie<\/option><option value=\"Mazowieckie\" >Mazowieckie<\/option><option value=\"Opolskie\" >Opolskie<\/option><option value=\"Podkarpackie\" >Podkarpackie<\/option><option value=\"Podlaskie\" >Podlaskie<\/option><option value=\"Pomorskie\" >Pomorskie<\/option><option value=\"\u015al\u0105skie\" >\u015al\u0105skie<\/option><option value=\"\u015awi\u0119tokrzyskie\" >\u015awi\u0119tokrzyskie<\/option><option value=\"Warmi\u0144sko-Mazurskie\" >Warmi\u0144sko-Mazurskie<\/option><option value=\"Wielkopolskie\" >Wielkopolskie<\/option><option value=\"Zachodniopomorskie\" >Zachodniopomorskie<\/option>\t<\/select>\n<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc cb-thtzzekl\" data-block-id=\"jet-sm-gb-a5cdf05a-9198-47ed-bac5-06b9fc0d27cc\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Pa\u0144stwo <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"panstwo_dziadek_ze_strony_ojca\" data-field-name=\"panstwo_dziadek_ze_strony_ojca\" id=\"panstwo_dziadek_ze_strony_ojca\" data-jfb-sync=\"null\">\n\t\t<option value=\"\"  selected>Lista pa\u0144stw<\/option><option value=\"Polska\" >Polska<\/option><option value=\"Nieznany\" >Nieznany<\/option><option value=\"Afganistan\" >Afganistan<\/option><option value=\"Albania\" >Albania<\/option><option value=\"Algieria\" >Algieria<\/option><option value=\"Andora\" >Andora<\/option><option value=\"Angola\" >Angola<\/option><option value=\"Antigua i Barbuda\" >Antigua i Barbuda<\/option><option value=\"Arabia Saudyjska\" >Arabia Saudyjska<\/option><option value=\"Argentyna\" >Argentyna<\/option><option value=\"Armenia\" >Armenia<\/option><option value=\"Australia\" >Australia<\/option><option value=\"Austria\" >Austria<\/option><option value=\"Azerbejd\u017can\" >Azerbejd\u017can<\/option><option value=\"Bahamy\" >Bahamy<\/option><option value=\"Bahrajn\" >Bahrajn<\/option><option value=\"Bangladesz\" >Bangladesz<\/option><option value=\"Barbados\" >Barbados<\/option><option value=\"Belgia\" >Belgia<\/option><option value=\"Belize\" >Belize<\/option><option value=\"Benin\" >Benin<\/option><option value=\"Bhutan\" >Bhutan<\/option><option value=\"Bia\u0142oru\u015b\" >Bia\u0142oru\u015b<\/option><option value=\"Boliwia\" >Boliwia<\/option><option value=\"Bo\u015bnia i Hercegowina\" >Bo\u015bnia i Hercegowina<\/option><option value=\"Botswana\" >Botswana<\/option><option value=\"Brazylia\" >Brazylia<\/option><option value=\"Brunei\" >Brunei<\/option><option value=\"Bu\u0142garia\" >Bu\u0142garia<\/option><option value=\"Burkina Faso\" >Burkina Faso<\/option><option value=\"Burundi\" >Burundi<\/option><option value=\"Chile\" >Chile<\/option><option value=\"Chiny\" >Chiny<\/option><option value=\"Chorwacja\" >Chorwacja<\/option><option value=\"Cypr\" >Cypr<\/option><option value=\"Czad\" >Czad<\/option><option value=\"Czarnog\u00f3ra\" >Czarnog\u00f3ra<\/option><option value=\"Czechy\" >Czechy<\/option><option value=\"Dania\" >Dania<\/option><option value=\"Demokratyczna Republika Konga\" >Demokratyczna Republika Konga<\/option><option value=\"Dominika\" >Dominika<\/option><option value=\"Dominikana\" >Dominikana<\/option><option value=\"D\u017cibuti\" >D\u017cibuti<\/option><option value=\"Ekwador\" >Ekwador<\/option><option value=\"Egipt\" >Egipt<\/option><option value=\"Erytrea\" >Erytrea<\/option><option value=\"Estonia\" >Estonia<\/option><option value=\"Eswatini\" >Eswatini<\/option><option value=\"Etiopia\" >Etiopia<\/option><option value=\"Fid\u017ci\" >Fid\u017ci<\/option><option value=\"Filipiny\" >Filipiny<\/option><option value=\"Finlandia\" >Finlandia<\/option><option value=\"Francja\" >Francja<\/option><option value=\"Gabon\" >Gabon<\/option><option value=\"Gambia\" >Gambia<\/option><option value=\"Ghana\" >Ghana<\/option><option value=\"Grecja\" >Grecja<\/option><option value=\"Grenada\" >Grenada<\/option><option value=\"Gruzja\" >Gruzja<\/option><option value=\"Gwatemala\" >Gwatemala<\/option><option value=\"Gwinea\" >Gwinea<\/option><option value=\"Gwinea Bissau\" >Gwinea Bissau<\/option><option value=\"Gwinea R\u00f3wnikowa\" >Gwinea R\u00f3wnikowa<\/option><option value=\"Haiti\" >Haiti<\/option><option value=\"Hiszpania\" >Hiszpania<\/option><option value=\"Holandia\" >Holandia<\/option><option value=\"Honduras\" >Honduras<\/option><option value=\"Indie\" >Indie<\/option><option value=\"Indonezja\" >Indonezja<\/option><option value=\"Irak\" >Irak<\/option><option value=\"Iran\" >Iran<\/option><option value=\"Irlandia\" >Irlandia<\/option><option value=\"Islandia\" >Islandia<\/option><option value=\"Izrael\" >Izrael<\/option><option value=\"Jamajka\" >Jamajka<\/option><option value=\"Japonia\" >Japonia<\/option><option value=\"Jemen\" >Jemen<\/option><option value=\"Jordania\" >Jordania<\/option><option value=\"Kambod\u017ca\" >Kambod\u017ca<\/option><option value=\"Kamerun\" >Kamerun<\/option><option value=\"Kanada\" >Kanada<\/option><option value=\"Katar\" >Katar<\/option><option value=\"Kazachstan\" >Kazachstan<\/option><option value=\"Kenia\" >Kenia<\/option><option value=\"Kirgistan\" >Kirgistan<\/option><option value=\"Kiribati\" >Kiribati<\/option><option value=\"Kolumbia\" >Kolumbia<\/option><option value=\"Komory\" >Komory<\/option><option value=\"Kongo\" >Kongo<\/option><option value=\"Korea Po\u0142udniowa\" >Korea Po\u0142udniowa<\/option><option value=\"Korea P\u00f3\u0142nocna\" >Korea P\u00f3\u0142nocna<\/option><option value=\"Kostaryka\" >Kostaryka<\/option><option value=\"Kuba\" >Kuba<\/option><option value=\"Kuwejt\" >Kuwejt<\/option><option value=\"Laos\" >Laos<\/option><option value=\"Lesotho\" >Lesotho<\/option><option value=\"Liban\" >Liban<\/option><option value=\"Liberia\" >Liberia<\/option><option value=\"Libia\" >Libia<\/option><option value=\"Liechtenstein\" >Liechtenstein<\/option><option value=\"Litwa\" >Litwa<\/option><option value=\"Luksemburg\" >Luksemburg<\/option><option value=\"\u0141otwa\" >\u0141otwa<\/option><option value=\"Macedonia P\u00f3\u0142nocna\" >Macedonia P\u00f3\u0142nocna<\/option><option value=\"Madagaskar\" >Madagaskar<\/option><option value=\"Malawi\" >Malawi<\/option><option value=\"Malediwy\" >Malediwy<\/option><option value=\"Malezja\" >Malezja<\/option><option value=\"Mali\" >Mali<\/option><option value=\"Malta\" >Malta<\/option><option value=\"Maroko\" >Maroko<\/option><option value=\"Mauretania\" >Mauretania<\/option><option value=\"Mauritius\" >Mauritius<\/option><option value=\"Meksyk\" >Meksyk<\/option><option value=\"Mikronezja\" >Mikronezja<\/option><option value=\"Mjanma (Birma)\" >Mjanma (Birma)<\/option><option value=\"Mo\u0142dawia\" >Mo\u0142dawia<\/option><option value=\"Monako\" >Monako<\/option><option value=\"Mongolia\" >Mongolia<\/option><option value=\"Mozambik\" >Mozambik<\/option><option value=\"Namibia\" >Namibia<\/option><option value=\"Nauru\" >Nauru<\/option><option value=\"Nepal\" >Nepal<\/option><option value=\"Niemcy\" >Niemcy<\/option><option value=\"Niger\" >Niger<\/option><option value=\"Nigeria\" >Nigeria<\/option><option value=\"Nikaragua\" >Nikaragua<\/option><option value=\"Norwegia\" >Norwegia<\/option><option value=\"Nowa Zelandia\" >Nowa Zelandia<\/option><option value=\"Oman\" >Oman<\/option><option value=\"Pakistan\" >Pakistan<\/option><option value=\"Palau\" >Palau<\/option><option value=\"Panama\" >Panama<\/option><option value=\"Papua-Nowa Gwinea\" >Papua-Nowa Gwinea<\/option><option value=\"Paragwaj\" >Paragwaj<\/option><option value=\"Peru\" >Peru<\/option><option value=\"Portugalia\" >Portugalia<\/option><option value=\"Pa\u0144stwo Palestyna\" >Pa\u0144stwo Palestyna<\/option><option value=\"Republika Po\u0142udniowej Afryki\" >Republika Po\u0142udniowej Afryki<\/option><option value=\"Republika \u015arodkowoafryka\u0144ska\" >Republika \u015arodkowoafryka\u0144ska<\/option><option value=\"Republika Zielonego Przyl\u0105dka\" >Republika Zielonego Przyl\u0105dka<\/option><option value=\"Rosja\" >Rosja<\/option><option value=\"Rumunia\" >Rumunia<\/option><option value=\"Rwanda\" >Rwanda<\/option><option value=\"Saint Kitts i Nevis\" >Saint Kitts i Nevis<\/option><option value=\"Saint Lucia\" >Saint Lucia<\/option><option value=\"Saint Vincent i Grenadyny\" >Saint Vincent i Grenadyny<\/option><option value=\"Salwador\" >Salwador<\/option><option value=\"Samoa\" >Samoa<\/option><option value=\"San Marino\" >San Marino<\/option><option value=\"Senegal\" >Senegal<\/option><option value=\"Serbia\" >Serbia<\/option><option value=\"Seszele\" >Seszele<\/option><option value=\"Sierra Leone\" >Sierra Leone<\/option><option value=\"Singapur\" >Singapur<\/option><option value=\"S\u0142owacja\" >S\u0142owacja<\/option><option value=\"S\u0142owenia\" >S\u0142owenia<\/option><option value=\"Somalia\" >Somalia<\/option><option value=\"Sri Lanka\" >Sri Lanka<\/option><option value=\"Stany Zjednoczone\" >Stany Zjednoczone<\/option><option value=\"Sudan\" >Sudan<\/option><option value=\"Sudan Po\u0142udniowy\" >Sudan Po\u0142udniowy<\/option><option value=\"Surinam\" >Surinam<\/option><option value=\"Syria\" >Syria<\/option><option value=\"Szwajcaria\" >Szwajcaria<\/option><option value=\"Szwecja\" >Szwecja<\/option><option value=\"Tad\u017cykistan\" >Tad\u017cykistan<\/option><option value=\"Tajlandia\" >Tajlandia<\/option><option value=\"Tanzania\" >Tanzania<\/option><option value=\"Timor Wschodni\" >Timor Wschodni<\/option><option value=\"Togo\" >Togo<\/option><option value=\"Tonga\" >Tonga<\/option><option value=\"Trynidad i Tobago\" >Trynidad i Tobago<\/option><option value=\"Tunezja\" >Tunezja<\/option><option value=\"Turcja\" >Turcja<\/option><option value=\"Turkmenistan\" >Turkmenistan<\/option><option value=\"Tuvalu\" >Tuvalu<\/option><option value=\"Uganda\" >Uganda<\/option><option value=\"Ukraina\" >Ukraina<\/option><option value=\"Urugwaj\" >Urugwaj<\/option><option value=\"Uzbekistan\" >Uzbekistan<\/option><option value=\"Vanuatu\" >Vanuatu<\/option><option value=\"Watykan\" >Watykan<\/option><option value=\"Wenezuela\" >Wenezuela<\/option><option value=\"W\u0119gry\" >W\u0119gry<\/option><option value=\"Wielka Brytania\" >Wielka Brytania<\/option><option value=\"Wietnam\" >Wietnam<\/option><option value=\"W\u0142ochy\" >W\u0142ochy<\/option><option value=\"Wybrze\u017ce Ko\u015bci S\u0142oniowej\" >Wybrze\u017ce Ko\u015bci S\u0142oniowej<\/option><option value=\"Zambia\" >Zambia<\/option><option value=\"Zimbabwe\" >Zimbabwe<\/option><option value=\"Zjednoczone Emiraty Arabskie\" >Zjednoczone Emiraty Arabskie<\/option>\t<\/select>\n<\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n\n\n<h5 class=\"wp-block-heading\">7. Jaka jest\/by\u0142a narodowo\u015b\u0107 Pani\/Pana rodzic\u00f3w oraz dziadk\u00f3w?<\/h5>\n\n\n\n<p class=\"dopisek wp-block-paragraph\">(Przez narodowo\u015b\u0107 nale\u017cy rozumie\u0107 przynale\u017cno\u015b\u0107 narodow\u0105 lub etniczn\u0105 - nie nale\u017cy jej myli\u0107 z obywatelstwem)<\/p>\n\n\n\n<p class=\"dopisek wp-block-paragraph\">Dla ka\u017cdego pola prosz\u0119 zaznaczy\u0107 wszystkie odpowiednie pozycje na rozwijanej li\u015bcie lub wybra\u0107 kategori\u0119 \u201einna \u2013 wpisa\u0107 jaka\u201d oraz wpisa\u0107 w\u0142asne okre\u015blenie [s\u0142ownik etnonim\u00f3w j.w]<\/p>\n\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-7387b849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-7387b849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-ba736447-2e12-4bfe-ba62-24e09a9c28a5 cb-mrgqp6dt\" data-block-id=\"jet-sm-gb-ba736447-2e12-4bfe-ba62-24e09a9c28a5\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Babcia od strony matki <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"7_mama_matki\" data-field-name=\"7_mama_matki\" id=\"7_mama_matki\" data-jfb-sync=\"null\">\n\t\t<option value=\"\"  selected>Wybierz z listy<\/option><option value=\"Polacy\" >Polacy<\/option><option value=\"Nieznana\" >Nieznana<\/option><option value=\"Aborygeni australijscy\" >Aborygeni australijscy<\/option><option value=\"Ajmarowie\" >Ajmarowie<\/option><option value=\"Akanowie\" >Akanowie<\/option><option value=\"Aleuci\" >Aleuci<\/option><option value=\"Amharowie\" >Amharowie<\/option><option value=\"Anglicy\" >Anglicy<\/option><option value=\"Apacze\" >Apacze<\/option><option value=\"Arabowie\" >Arabowie<\/option><option value=\"Aszanti\" >Aszanti<\/option><option value=\"Awarowie\" >Awarowie<\/option><option value=\"Azerowie\" >Azerowie<\/option><option value=\"Aztekowie\" >Aztekowie<\/option><option value=\"Baskowie\" >Baskowie<\/option><option value=\"Berberowie\" >Berberowie<\/option><option value=\"Bia\u0142orusini\" >Bia\u0142orusini<\/option><option value=\"Bo\u015bniacy\" >Bo\u015bniacy<\/option><option value=\"Breto\u0144czycy\" >Breto\u0144czycy<\/option><option value=\"Bu\u0142garzy\" >Bu\u0142garzy<\/option><option value=\"Buriaci\" >Buriaci<\/option><option value=\"Buszmeni\" >Buszmeni<\/option><option value=\"Celtowie\" >Celtowie<\/option><option value=\"Chi\u0144czycy Han\" >Chi\u0144czycy Han<\/option><option value=\"Chorwaci\" >Chorwaci<\/option><option value=\"Czesi\" >Czesi<\/option><option value=\"Czeczeni\" >Czeczeni<\/option><option value=\"Czirokezi\" >Czirokezi<\/option><option value=\"Dagesta\u0144czycy\" >Dagesta\u0144czycy<\/option><option value=\"Dakowie\" >Dakowie<\/option><option value=\"Du\u0144czycy\" >Du\u0144czycy<\/option><option value=\"Eskimosi (Inuici)\" >Eskimosi (Inuici)<\/option><option value=\"Esto\u0144czycy\" >Esto\u0144czycy<\/option><option value=\"Fid\u017cyjczycy\" >Fid\u017cyjczycy<\/option><option value=\"Finowie\" >Finowie<\/option><option value=\"Flamandowie\" >Flamandowie<\/option><option value=\"Francuzi\" >Francuzi<\/option><option value=\"Fryzowie\" >Fryzowie<\/option><option value=\"Fulanie\" >Fulanie<\/option><option value=\"Galowie\" >Galowie<\/option><option value=\"Germanie\" >Germanie<\/option><option value=\"G\u00f3rale\" >G\u00f3rale<\/option><option value=\"Gotowie\" >Gotowie<\/option><option value=\"Grecy\" >Grecy<\/option><option value=\"Gruzini\" >Gruzini<\/option><option value=\"Guarani\" >Guarani<\/option><option value=\"Hausa\" >Hausa<\/option><option value=\"Hazarowie\" >Hazarowie<\/option><option value=\"Hindusi\" >Hindusi<\/option><option value=\"Hiszpanie\" >Hiszpanie<\/option><option value=\"Hmongerzy\" >Hmongerzy<\/option><option value=\"Hunowie\" >Hunowie<\/option><option value=\"Huronowie\" >Huronowie<\/option><option value=\"Hutu\" >Hutu<\/option><option value=\"Ibowie\" >Ibowie<\/option><option value=\"Ingusze\" >Ingusze<\/option><option value=\"Inkowie\" >Inkowie<\/option><option value=\"Irokezi\" >Irokezi<\/option><option value=\"Irlandczycy\" >Irlandczycy<\/option><option value=\"Islandczycy\" >Islandczycy<\/option><option value=\"Japo\u0144czycy\" >Japo\u0144czycy<\/option><option value=\"Jorubowie\" >Jorubowie<\/option><option value=\"Kabylowie\" >Kabylowie<\/option><option value=\"Ka\u0142mucy\" >Ka\u0142mucy<\/option><option value=\"Katalo\u0144czycy\" >Katalo\u0144czycy<\/option><option value=\"Kaszubi\" >Kaszubi<\/option><option value=\"Kazachowie\" >Kazachowie<\/option><option value=\"Keczua\" >Keczua<\/option><option value=\"Khmerzy\" >Khmerzy<\/option><option value=\"Khoikhoi\" >Khoikhoi<\/option><option value=\"Kirgizi\" >Kirgizi<\/option><option value=\"Koptowie\" >Koptowie<\/option><option value=\"Korea\u0144czycy\" >Korea\u0144czycy<\/option><option value=\"Kurdowie\" >Kurdowie<\/option><option value=\"Kurpie\" >Kurpie<\/option><option value=\"Laota\u0144czycy\" >Laota\u0144czycy<\/option><option value=\"Litwini\" >Litwini<\/option><option value=\"Longobardowie\" >Longobardowie<\/option><option value=\"\u0141emkowie\" >\u0141emkowie<\/option><option value=\"\u0141otysze\" >\u0141otysze<\/option><option value=\"Macedo\u0144czycy\" >Macedo\u0144czycy<\/option><option value=\"Majowie\" >Majowie<\/option><option value=\"Malgasze\" >Malgasze<\/option><option value=\"Mand\u017curowie\" >Mand\u017curowie<\/option><option value=\"Mapucze\" >Mapucze<\/option><option value=\"Maorysi\" >Maorysi<\/option><option value=\"Masajowie\" >Masajowie<\/option><option value=\"Mazurzy\" >Mazurzy<\/option><option value=\"Melanezyjczycy\" >Melanezyjczycy<\/option><option value=\"Metysi\" >Metysi<\/option><option value=\"Mikronezyjczycy\" >Mikronezyjczycy<\/option><option value=\"Mohawkowie\" >Mohawkowie<\/option><option value=\"Mo\u0142dawianie\" >Mo\u0142dawianie<\/option><option value=\"Mongo\u0142owie\" >Mongo\u0142owie<\/option><option value=\"Nawahowie\" >Nawahowie<\/option><option value=\"Nepalczycy\" >Nepalczycy<\/option><option value=\"Niemcy\" >Niemcy<\/option><option value=\"Normanowie\" >Normanowie<\/option><option value=\"Norwegowie\" >Norwegowie<\/option><option value=\"Nubijczycy\" >Nubijczycy<\/option><option value=\"Od\u017cibwejowie\" >Od\u017cibwejowie<\/option><option value=\"Osetyjczycy\" >Osetyjczycy<\/option><option value=\"Oromo\" >Oromo<\/option><option value=\"Ormianie\" >Ormianie<\/option><option value=\"Papuasi\" >Papuasi<\/option><option value=\"Partowie\" >Partowie<\/option><option value=\"Pasztuni\" >Pasztuni<\/option><option value=\"Persowie\" >Persowie<\/option><option value=\"Pieczyngowie\" >Pieczyngowie<\/option><option value=\"Pigmeje\" >Pigmeje<\/option><option value=\"Podhalanie\" >Podhalanie<\/option><option value=\"Polinezyjczycy\" >Polinezyjczycy<\/option><option value=\"Pomorzanie\" >Pomorzanie<\/option><option value=\"Portugalczycy\" >Portugalczycy<\/option><option value=\"Pueblo\" >Pueblo<\/option><option value=\"Rosjanie\" >Rosjanie<\/option><option value=\"Rumuni\" >Rumuni<\/option><option value=\"Rusini\" >Rusini<\/option><option value=\"S\u00e1mi (Lapo\u0144czycy)\" >S\u00e1mi (Lapo\u0144czycy)<\/option><option value=\"Samoa\u0144czycy\" >Samoa\u0144czycy<\/option><option value=\"Sarmaci\" >Sarmaci<\/option><option value=\"Scytowie\" >Scytowie<\/option><option value=\"Seminole\" >Seminole<\/option><option value=\"Serbowie\" >Serbowie<\/option><option value=\"Sioux\" >Sioux<\/option><option value=\"Somalijczycy\" >Somalijczycy<\/option><option value=\"Suahili\" >Suahili<\/option><option value=\"Szkoci\" >Szkoci<\/option><option value=\"\u015al\u0105zacy\" >\u015al\u0105zacy<\/option><option value=\"S\u0142owacy\" >S\u0142owacy<\/option><option value=\"S\u0142owianie\" >S\u0142owianie<\/option><option value=\"S\u0142owe\u0144cy\" >S\u0142owe\u0144cy<\/option><option value=\"Szwajcarzy\" >Szwajcarzy<\/option><option value=\"Szwedzi\" >Szwedzi<\/option><option value=\"Tad\u017cycy\" >Tad\u017cycy<\/option><option value=\"Tajowie\" >Tajowie<\/option><option value=\"Tatarzy\" >Tatarzy<\/option><option value=\"Tatarzy syberyjscy\" >Tatarzy syberyjscy<\/option><option value=\"Tigrinia\" >Tigrinia<\/option><option value=\"Tonga\u0144czycy\" >Tonga\u0144czycy<\/option><option value=\"Turcy\" >Turcy<\/option><option value=\"Turkmeni\" >Turkmeni<\/option><option value=\"Tutsi\" >Tutsi<\/option><option value=\"Tybeta\u0144czycy\" >Tybeta\u0144czycy<\/option><option value=\"Ujgurzy\" >Ujgurzy<\/option><option value=\"Ukrai\u0144cy\" >Ukrai\u0144cy<\/option><option value=\"Uzbecy\" >Uzbecy<\/option><option value=\"Walijczycy\" >Walijczycy<\/option><option value=\"Wandalowie\" >Wandalowie<\/option><option value=\"Waregowie\" >Waregowie<\/option><option value=\"Wilniucy\" >Wilniucy<\/option><option value=\"Wietnamczycy\" >Wietnamczycy<\/option><option value=\"Wizygoci\" >Wizygoci<\/option><option value=\"W\u0142osi\" >W\u0142osi<\/option><option value=\"Wolofowie\" >Wolofowie<\/option><option value=\"Yakuci\" >Yakuci<\/option><option value=\"Yanomami\" >Yanomami<\/option><option value=\"Zag\u00f3rzanie\" >Zag\u00f3rzanie<\/option><option value=\"Zulusowie\" >Zulusowie<\/option><option value=\"\u017bydzi\" >\u017bydzi<\/option>\t<\/select>\n<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-ba736447-2e12-4bfe-ba62-24e09a9c28a5 cb-m9ad6ooa\" data-block-id=\"jet-sm-gb-ba736447-2e12-4bfe-ba62-24e09a9c28a5\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Dziadek od strony matki <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"7_ojciec_matki\" data-field-name=\"7_ojciec_matki\" id=\"7_ojciec_matki\" data-jfb-sync=\"null\">\n\t\t<option value=\"\"  selected>Wybierz z listy<\/option><option value=\"Polacy\" >Polacy<\/option><option value=\"Nieznana\" >Nieznana<\/option><option value=\"Aborygeni australijscy\" >Aborygeni australijscy<\/option><option value=\"Ajmarowie\" >Ajmarowie<\/option><option value=\"Akanowie\" >Akanowie<\/option><option value=\"Aleuci\" >Aleuci<\/option><option value=\"Amharowie\" >Amharowie<\/option><option value=\"Anglicy\" >Anglicy<\/option><option value=\"Apacze\" >Apacze<\/option><option value=\"Arabowie\" >Arabowie<\/option><option value=\"Aszanti\" >Aszanti<\/option><option value=\"Awarowie\" >Awarowie<\/option><option value=\"Azerowie\" >Azerowie<\/option><option value=\"Aztekowie\" >Aztekowie<\/option><option value=\"Baskowie\" >Baskowie<\/option><option value=\"Berberowie\" >Berberowie<\/option><option value=\"Bia\u0142orusini\" >Bia\u0142orusini<\/option><option value=\"Bo\u015bniacy\" >Bo\u015bniacy<\/option><option value=\"Breto\u0144czycy\" >Breto\u0144czycy<\/option><option value=\"Bu\u0142garzy\" >Bu\u0142garzy<\/option><option value=\"Buriaci\" >Buriaci<\/option><option value=\"Buszmeni\" >Buszmeni<\/option><option value=\"Celtowie\" >Celtowie<\/option><option value=\"Chi\u0144czycy Han\" >Chi\u0144czycy Han<\/option><option value=\"Chorwaci\" >Chorwaci<\/option><option value=\"Czesi\" >Czesi<\/option><option value=\"Czeczeni\" >Czeczeni<\/option><option value=\"Czirokezi\" >Czirokezi<\/option><option value=\"Dagesta\u0144czycy\" >Dagesta\u0144czycy<\/option><option value=\"Dakowie\" >Dakowie<\/option><option value=\"Du\u0144czycy\" >Du\u0144czycy<\/option><option value=\"Eskimosi (Inuici)\" >Eskimosi (Inuici)<\/option><option value=\"Esto\u0144czycy\" >Esto\u0144czycy<\/option><option value=\"Fid\u017cyjczycy\" >Fid\u017cyjczycy<\/option><option value=\"Finowie\" >Finowie<\/option><option value=\"Flamandowie\" >Flamandowie<\/option><option value=\"Francuzi\" >Francuzi<\/option><option value=\"Fryzowie\" >Fryzowie<\/option><option value=\"Fulanie\" >Fulanie<\/option><option value=\"Galowie\" >Galowie<\/option><option value=\"Germanie\" >Germanie<\/option><option value=\"G\u00f3rale\" >G\u00f3rale<\/option><option value=\"Gotowie\" >Gotowie<\/option><option value=\"Grecy\" >Grecy<\/option><option value=\"Gruzini\" >Gruzini<\/option><option value=\"Guarani\" >Guarani<\/option><option value=\"Hausa\" >Hausa<\/option><option value=\"Hazarowie\" >Hazarowie<\/option><option value=\"Hindusi\" >Hindusi<\/option><option value=\"Hiszpanie\" >Hiszpanie<\/option><option value=\"Hmongerzy\" >Hmongerzy<\/option><option value=\"Hunowie\" >Hunowie<\/option><option value=\"Huronowie\" >Huronowie<\/option><option value=\"Hutu\" >Hutu<\/option><option value=\"Ibowie\" >Ibowie<\/option><option value=\"Ingusze\" >Ingusze<\/option><option value=\"Inkowie\" >Inkowie<\/option><option value=\"Irokezi\" >Irokezi<\/option><option value=\"Irlandczycy\" >Irlandczycy<\/option><option value=\"Islandczycy\" >Islandczycy<\/option><option value=\"Japo\u0144czycy\" >Japo\u0144czycy<\/option><option value=\"Jorubowie\" >Jorubowie<\/option><option value=\"Kabylowie\" >Kabylowie<\/option><option value=\"Ka\u0142mucy\" >Ka\u0142mucy<\/option><option value=\"Katalo\u0144czycy\" >Katalo\u0144czycy<\/option><option value=\"Kaszubi\" >Kaszubi<\/option><option value=\"Kazachowie\" >Kazachowie<\/option><option value=\"Keczua\" >Keczua<\/option><option value=\"Khmerzy\" >Khmerzy<\/option><option value=\"Khoikhoi\" >Khoikhoi<\/option><option value=\"Kirgizi\" >Kirgizi<\/option><option value=\"Koptowie\" >Koptowie<\/option><option value=\"Korea\u0144czycy\" >Korea\u0144czycy<\/option><option value=\"Kurdowie\" >Kurdowie<\/option><option value=\"Kurpie\" >Kurpie<\/option><option value=\"Laota\u0144czycy\" >Laota\u0144czycy<\/option><option value=\"Litwini\" >Litwini<\/option><option value=\"Longobardowie\" >Longobardowie<\/option><option value=\"\u0141emkowie\" >\u0141emkowie<\/option><option value=\"\u0141otysze\" >\u0141otysze<\/option><option value=\"Macedo\u0144czycy\" >Macedo\u0144czycy<\/option><option value=\"Majowie\" >Majowie<\/option><option value=\"Malgasze\" >Malgasze<\/option><option value=\"Mand\u017curowie\" >Mand\u017curowie<\/option><option value=\"Mapucze\" >Mapucze<\/option><option value=\"Maorysi\" >Maorysi<\/option><option value=\"Masajowie\" >Masajowie<\/option><option value=\"Mazurzy\" >Mazurzy<\/option><option value=\"Melanezyjczycy\" >Melanezyjczycy<\/option><option value=\"Metysi\" >Metysi<\/option><option value=\"Mikronezyjczycy\" >Mikronezyjczycy<\/option><option value=\"Mohawkowie\" >Mohawkowie<\/option><option value=\"Mo\u0142dawianie\" >Mo\u0142dawianie<\/option><option value=\"Mongo\u0142owie\" >Mongo\u0142owie<\/option><option value=\"Nawahowie\" >Nawahowie<\/option><option value=\"Nepalczycy\" >Nepalczycy<\/option><option value=\"Niemcy\" >Niemcy<\/option><option value=\"Normanowie\" >Normanowie<\/option><option value=\"Norwegowie\" >Norwegowie<\/option><option value=\"Nubijczycy\" >Nubijczycy<\/option><option value=\"Od\u017cibwejowie\" >Od\u017cibwejowie<\/option><option value=\"Osetyjczycy\" >Osetyjczycy<\/option><option value=\"Oromo\" >Oromo<\/option><option value=\"Ormianie\" >Ormianie<\/option><option value=\"Papuasi\" >Papuasi<\/option><option value=\"Partowie\" >Partowie<\/option><option value=\"Pasztuni\" >Pasztuni<\/option><option value=\"Persowie\" >Persowie<\/option><option value=\"Pieczyngowie\" >Pieczyngowie<\/option><option value=\"Pigmeje\" >Pigmeje<\/option><option value=\"Podhalanie\" >Podhalanie<\/option><option value=\"Polinezyjczycy\" >Polinezyjczycy<\/option><option value=\"Pomorzanie\" >Pomorzanie<\/option><option value=\"Portugalczycy\" >Portugalczycy<\/option><option value=\"Pueblo\" >Pueblo<\/option><option value=\"Rosjanie\" >Rosjanie<\/option><option value=\"Rumuni\" >Rumuni<\/option><option value=\"Rusini\" >Rusini<\/option><option value=\"S\u00e1mi (Lapo\u0144czycy)\" >S\u00e1mi (Lapo\u0144czycy)<\/option><option value=\"Samoa\u0144czycy\" >Samoa\u0144czycy<\/option><option value=\"Sarmaci\" >Sarmaci<\/option><option value=\"Scytowie\" >Scytowie<\/option><option value=\"Seminole\" >Seminole<\/option><option value=\"Serbowie\" >Serbowie<\/option><option value=\"Sioux\" >Sioux<\/option><option value=\"Somalijczycy\" >Somalijczycy<\/option><option value=\"Suahili\" >Suahili<\/option><option value=\"Szkoci\" >Szkoci<\/option><option value=\"\u015al\u0105zacy\" >\u015al\u0105zacy<\/option><option value=\"S\u0142owacy\" >S\u0142owacy<\/option><option value=\"S\u0142owianie\" >S\u0142owianie<\/option><option value=\"S\u0142owe\u0144cy\" >S\u0142owe\u0144cy<\/option><option value=\"Szwajcarzy\" >Szwajcarzy<\/option><option value=\"Szwedzi\" >Szwedzi<\/option><option value=\"Tad\u017cycy\" >Tad\u017cycy<\/option><option value=\"Tajowie\" >Tajowie<\/option><option value=\"Tatarzy\" >Tatarzy<\/option><option value=\"Tatarzy syberyjscy\" >Tatarzy syberyjscy<\/option><option value=\"Tigrinia\" >Tigrinia<\/option><option value=\"Tonga\u0144czycy\" >Tonga\u0144czycy<\/option><option value=\"Turcy\" >Turcy<\/option><option value=\"Turkmeni\" >Turkmeni<\/option><option value=\"Tutsi\" >Tutsi<\/option><option value=\"Tybeta\u0144czycy\" >Tybeta\u0144czycy<\/option><option value=\"Ujgurzy\" >Ujgurzy<\/option><option value=\"Ukrai\u0144cy\" >Ukrai\u0144cy<\/option><option value=\"Uzbecy\" >Uzbecy<\/option><option value=\"Walijczycy\" >Walijczycy<\/option><option value=\"Wandalowie\" >Wandalowie<\/option><option value=\"Waregowie\" >Waregowie<\/option><option value=\"Wilniucy\" >Wilniucy<\/option><option value=\"Wietnamczycy\" >Wietnamczycy<\/option><option value=\"Wizygoci\" >Wizygoci<\/option><option value=\"W\u0142osi\" >W\u0142osi<\/option><option value=\"Wolofowie\" >Wolofowie<\/option><option value=\"Yakuci\" >Yakuci<\/option><option value=\"Yanomami\" >Yanomami<\/option><option value=\"Zag\u00f3rzanie\" >Zag\u00f3rzanie<\/option><option value=\"Zulusowie\" >Zulusowie<\/option><option value=\"\u017bydzi\" >\u017bydzi<\/option>\t<\/select>\n<\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-ba736447-2e12-4bfe-ba62-24e09a9c28a5 cb-mmfqhymp\" data-block-id=\"jet-sm-gb-ba736447-2e12-4bfe-ba62-24e09a9c28a5\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Matka <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"7_matka\" data-field-name=\"7_matka\" id=\"7_matka\" data-jfb-sync=\"null\">\n\t\t<option value=\"\"  selected>Wybierz z listy<\/option><option value=\"Polacy\" >Polacy<\/option><option value=\"Nieznana\" >Nieznana<\/option><option value=\"Aborygeni australijscy\" >Aborygeni australijscy<\/option><option value=\"Ajmarowie\" >Ajmarowie<\/option><option value=\"Akanowie\" >Akanowie<\/option><option value=\"Aleuci\" >Aleuci<\/option><option value=\"Amharowie\" >Amharowie<\/option><option value=\"Anglicy\" >Anglicy<\/option><option value=\"Apacze\" >Apacze<\/option><option value=\"Arabowie\" >Arabowie<\/option><option value=\"Aszanti\" >Aszanti<\/option><option value=\"Awarowie\" >Awarowie<\/option><option value=\"Azerowie\" >Azerowie<\/option><option value=\"Aztekowie\" >Aztekowie<\/option><option value=\"Baskowie\" >Baskowie<\/option><option value=\"Berberowie\" >Berberowie<\/option><option value=\"Bia\u0142orusini\" >Bia\u0142orusini<\/option><option value=\"Bo\u015bniacy\" >Bo\u015bniacy<\/option><option value=\"Breto\u0144czycy\" >Breto\u0144czycy<\/option><option value=\"Bu\u0142garzy\" >Bu\u0142garzy<\/option><option value=\"Buriaci\" >Buriaci<\/option><option value=\"Buszmeni\" >Buszmeni<\/option><option value=\"Celtowie\" >Celtowie<\/option><option value=\"Chi\u0144czycy Han\" >Chi\u0144czycy Han<\/option><option value=\"Chorwaci\" >Chorwaci<\/option><option value=\"Czesi\" >Czesi<\/option><option value=\"Czeczeni\" >Czeczeni<\/option><option value=\"Czirokezi\" >Czirokezi<\/option><option value=\"Dagesta\u0144czycy\" >Dagesta\u0144czycy<\/option><option value=\"Dakowie\" >Dakowie<\/option><option value=\"Du\u0144czycy\" >Du\u0144czycy<\/option><option value=\"Eskimosi (Inuici)\" >Eskimosi (Inuici)<\/option><option value=\"Esto\u0144czycy\" >Esto\u0144czycy<\/option><option value=\"Fid\u017cyjczycy\" >Fid\u017cyjczycy<\/option><option value=\"Finowie\" >Finowie<\/option><option value=\"Flamandowie\" >Flamandowie<\/option><option value=\"Francuzi\" >Francuzi<\/option><option value=\"Fryzowie\" >Fryzowie<\/option><option value=\"Fulanie\" >Fulanie<\/option><option value=\"Galowie\" >Galowie<\/option><option value=\"Germanie\" >Germanie<\/option><option value=\"G\u00f3rale\" >G\u00f3rale<\/option><option value=\"Gotowie\" >Gotowie<\/option><option value=\"Grecy\" >Grecy<\/option><option value=\"Gruzini\" >Gruzini<\/option><option value=\"Guarani\" >Guarani<\/option><option value=\"Hausa\" >Hausa<\/option><option value=\"Hazarowie\" >Hazarowie<\/option><option value=\"Hindusi\" >Hindusi<\/option><option value=\"Hiszpanie\" >Hiszpanie<\/option><option value=\"Hmongerzy\" >Hmongerzy<\/option><option value=\"Hunowie\" >Hunowie<\/option><option value=\"Huronowie\" >Huronowie<\/option><option value=\"Hutu\" >Hutu<\/option><option value=\"Ibowie\" >Ibowie<\/option><option value=\"Ingusze\" >Ingusze<\/option><option value=\"Inkowie\" >Inkowie<\/option><option value=\"Irokezi\" >Irokezi<\/option><option value=\"Irlandczycy\" >Irlandczycy<\/option><option value=\"Islandczycy\" >Islandczycy<\/option><option value=\"Japo\u0144czycy\" >Japo\u0144czycy<\/option><option value=\"Jorubowie\" >Jorubowie<\/option><option value=\"Kabylowie\" >Kabylowie<\/option><option value=\"Ka\u0142mucy\" >Ka\u0142mucy<\/option><option value=\"Katalo\u0144czycy\" >Katalo\u0144czycy<\/option><option value=\"Kaszubi\" >Kaszubi<\/option><option value=\"Kazachowie\" >Kazachowie<\/option><option value=\"Keczua\" >Keczua<\/option><option value=\"Khmerzy\" >Khmerzy<\/option><option value=\"Khoikhoi\" >Khoikhoi<\/option><option value=\"Kirgizi\" >Kirgizi<\/option><option value=\"Koptowie\" >Koptowie<\/option><option value=\"Korea\u0144czycy\" >Korea\u0144czycy<\/option><option value=\"Kurdowie\" >Kurdowie<\/option><option value=\"Kurpie\" >Kurpie<\/option><option value=\"Laota\u0144czycy\" >Laota\u0144czycy<\/option><option value=\"Litwini\" >Litwini<\/option><option value=\"Longobardowie\" >Longobardowie<\/option><option value=\"\u0141emkowie\" >\u0141emkowie<\/option><option value=\"\u0141otysze\" >\u0141otysze<\/option><option value=\"Macedo\u0144czycy\" >Macedo\u0144czycy<\/option><option value=\"Majowie\" >Majowie<\/option><option value=\"Malgasze\" >Malgasze<\/option><option value=\"Mand\u017curowie\" >Mand\u017curowie<\/option><option value=\"Mapucze\" >Mapucze<\/option><option value=\"Maorysi\" >Maorysi<\/option><option value=\"Masajowie\" >Masajowie<\/option><option value=\"Mazurzy\" >Mazurzy<\/option><option value=\"Melanezyjczycy\" >Melanezyjczycy<\/option><option value=\"Metysi\" >Metysi<\/option><option value=\"Mikronezyjczycy\" >Mikronezyjczycy<\/option><option value=\"Mohawkowie\" >Mohawkowie<\/option><option value=\"Mo\u0142dawianie\" >Mo\u0142dawianie<\/option><option value=\"Mongo\u0142owie\" >Mongo\u0142owie<\/option><option value=\"Nawahowie\" >Nawahowie<\/option><option value=\"Nepalczycy\" >Nepalczycy<\/option><option value=\"Niemcy\" >Niemcy<\/option><option value=\"Normanowie\" >Normanowie<\/option><option value=\"Norwegowie\" >Norwegowie<\/option><option value=\"Nubijczycy\" >Nubijczycy<\/option><option value=\"Od\u017cibwejowie\" >Od\u017cibwejowie<\/option><option value=\"Osetyjczycy\" >Osetyjczycy<\/option><option value=\"Oromo\" >Oromo<\/option><option value=\"Ormianie\" >Ormianie<\/option><option value=\"Papuasi\" >Papuasi<\/option><option value=\"Partowie\" >Partowie<\/option><option value=\"Pasztuni\" >Pasztuni<\/option><option value=\"Persowie\" >Persowie<\/option><option value=\"Pieczyngowie\" >Pieczyngowie<\/option><option value=\"Pigmeje\" >Pigmeje<\/option><option value=\"Podhalanie\" >Podhalanie<\/option><option value=\"Polinezyjczycy\" >Polinezyjczycy<\/option><option value=\"Pomorzanie\" >Pomorzanie<\/option><option value=\"Portugalczycy\" >Portugalczycy<\/option><option value=\"Pueblo\" >Pueblo<\/option><option value=\"Rosjanie\" >Rosjanie<\/option><option value=\"Rumuni\" >Rumuni<\/option><option value=\"Rusini\" >Rusini<\/option><option value=\"S\u00e1mi (Lapo\u0144czycy)\" >S\u00e1mi (Lapo\u0144czycy)<\/option><option value=\"Samoa\u0144czycy\" >Samoa\u0144czycy<\/option><option value=\"Sarmaci\" >Sarmaci<\/option><option value=\"Scytowie\" >Scytowie<\/option><option value=\"Seminole\" >Seminole<\/option><option value=\"Serbowie\" >Serbowie<\/option><option value=\"Sioux\" >Sioux<\/option><option value=\"Somalijczycy\" >Somalijczycy<\/option><option value=\"Suahili\" >Suahili<\/option><option value=\"Szkoci\" >Szkoci<\/option><option value=\"\u015al\u0105zacy\" >\u015al\u0105zacy<\/option><option value=\"S\u0142owacy\" >S\u0142owacy<\/option><option value=\"S\u0142owianie\" >S\u0142owianie<\/option><option value=\"S\u0142owe\u0144cy\" >S\u0142owe\u0144cy<\/option><option value=\"Szwajcarzy\" >Szwajcarzy<\/option><option value=\"Szwedzi\" >Szwedzi<\/option><option value=\"Tad\u017cycy\" >Tad\u017cycy<\/option><option value=\"Tajowie\" >Tajowie<\/option><option value=\"Tatarzy\" >Tatarzy<\/option><option value=\"Tatarzy syberyjscy\" >Tatarzy syberyjscy<\/option><option value=\"Tigrinia\" >Tigrinia<\/option><option value=\"Tonga\u0144czycy\" >Tonga\u0144czycy<\/option><option value=\"Turcy\" >Turcy<\/option><option value=\"Turkmeni\" >Turkmeni<\/option><option value=\"Tutsi\" >Tutsi<\/option><option value=\"Tybeta\u0144czycy\" >Tybeta\u0144czycy<\/option><option value=\"Ujgurzy\" >Ujgurzy<\/option><option value=\"Ukrai\u0144cy\" >Ukrai\u0144cy<\/option><option value=\"Uzbecy\" >Uzbecy<\/option><option value=\"Walijczycy\" >Walijczycy<\/option><option value=\"Wandalowie\" >Wandalowie<\/option><option value=\"Waregowie\" >Waregowie<\/option><option value=\"Wilniucy\" >Wilniucy<\/option><option value=\"Wietnamczycy\" >Wietnamczycy<\/option><option value=\"Wizygoci\" >Wizygoci<\/option><option value=\"W\u0142osi\" >W\u0142osi<\/option><option value=\"Wolofowie\" >Wolofowie<\/option><option value=\"Yakuci\" >Yakuci<\/option><option value=\"Yanomami\" >Yanomami<\/option><option value=\"Zag\u00f3rzanie\" >Zag\u00f3rzanie<\/option><option value=\"Zulusowie\" >Zulusowie<\/option><option value=\"\u017bydzi\" >\u017bydzi<\/option>\t<\/select>\n<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-7387b849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-1eec7b4b-6c06-424b-abb2-fb22e303ad83 cb-whfyioz1\" data-block-id=\"jet-sm-gb-1eec7b4b-6c06-424b-abb2-fb22e303ad83\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Babcia od strony ojca <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"7_mama_ojca\" data-field-name=\"7_mama_ojca\" id=\"7_mama_ojca\" data-jfb-sync=\"null\">\n\t\t<option value=\"\"  selected>Wybierz z listy<\/option><option value=\"Polacy\" >Polacy<\/option><option value=\"Nieznana\" >Nieznana<\/option><option value=\"Aborygeni australijscy\" >Aborygeni australijscy<\/option><option value=\"Ajmarowie\" >Ajmarowie<\/option><option value=\"Akanowie\" >Akanowie<\/option><option value=\"Aleuci\" >Aleuci<\/option><option value=\"Amharowie\" >Amharowie<\/option><option value=\"Anglicy\" >Anglicy<\/option><option value=\"Apacze\" >Apacze<\/option><option value=\"Arabowie\" >Arabowie<\/option><option value=\"Aszanti\" >Aszanti<\/option><option value=\"Awarowie\" >Awarowie<\/option><option value=\"Azerowie\" >Azerowie<\/option><option value=\"Aztekowie\" >Aztekowie<\/option><option value=\"Baskowie\" >Baskowie<\/option><option value=\"Berberowie\" >Berberowie<\/option><option value=\"Bia\u0142orusini\" >Bia\u0142orusini<\/option><option value=\"Bo\u015bniacy\" >Bo\u015bniacy<\/option><option value=\"Breto\u0144czycy\" >Breto\u0144czycy<\/option><option value=\"Bu\u0142garzy\" >Bu\u0142garzy<\/option><option value=\"Buriaci\" >Buriaci<\/option><option value=\"Buszmeni\" >Buszmeni<\/option><option value=\"Celtowie\" >Celtowie<\/option><option value=\"Chi\u0144czycy Han\" >Chi\u0144czycy Han<\/option><option value=\"Chorwaci\" >Chorwaci<\/option><option value=\"Czesi\" >Czesi<\/option><option value=\"Czeczeni\" >Czeczeni<\/option><option value=\"Czirokezi\" >Czirokezi<\/option><option value=\"Dagesta\u0144czycy\" >Dagesta\u0144czycy<\/option><option value=\"Dakowie\" >Dakowie<\/option><option value=\"Du\u0144czycy\" >Du\u0144czycy<\/option><option value=\"Eskimosi (Inuici)\" >Eskimosi (Inuici)<\/option><option value=\"Esto\u0144czycy\" >Esto\u0144czycy<\/option><option value=\"Fid\u017cyjczycy\" >Fid\u017cyjczycy<\/option><option value=\"Finowie\" >Finowie<\/option><option value=\"Flamandowie\" >Flamandowie<\/option><option value=\"Francuzi\" >Francuzi<\/option><option value=\"Fryzowie\" >Fryzowie<\/option><option value=\"Fulanie\" >Fulanie<\/option><option value=\"Galowie\" >Galowie<\/option><option value=\"Germanie\" >Germanie<\/option><option value=\"G\u00f3rale\" >G\u00f3rale<\/option><option value=\"Gotowie\" >Gotowie<\/option><option value=\"Grecy\" >Grecy<\/option><option value=\"Gruzini\" >Gruzini<\/option><option value=\"Guarani\" >Guarani<\/option><option value=\"Hausa\" >Hausa<\/option><option value=\"Hazarowie\" >Hazarowie<\/option><option value=\"Hindusi\" >Hindusi<\/option><option value=\"Hiszpanie\" >Hiszpanie<\/option><option value=\"Hmongerzy\" >Hmongerzy<\/option><option value=\"Hunowie\" >Hunowie<\/option><option value=\"Huronowie\" >Huronowie<\/option><option value=\"Hutu\" >Hutu<\/option><option value=\"Ibowie\" >Ibowie<\/option><option value=\"Ingusze\" >Ingusze<\/option><option value=\"Inkowie\" >Inkowie<\/option><option value=\"Irokezi\" >Irokezi<\/option><option value=\"Irlandczycy\" >Irlandczycy<\/option><option value=\"Islandczycy\" >Islandczycy<\/option><option value=\"Japo\u0144czycy\" >Japo\u0144czycy<\/option><option value=\"Jorubowie\" >Jorubowie<\/option><option value=\"Kabylowie\" >Kabylowie<\/option><option value=\"Ka\u0142mucy\" >Ka\u0142mucy<\/option><option value=\"Katalo\u0144czycy\" >Katalo\u0144czycy<\/option><option value=\"Kaszubi\" >Kaszubi<\/option><option value=\"Kazachowie\" >Kazachowie<\/option><option value=\"Keczua\" >Keczua<\/option><option value=\"Khmerzy\" >Khmerzy<\/option><option value=\"Khoikhoi\" >Khoikhoi<\/option><option value=\"Kirgizi\" >Kirgizi<\/option><option value=\"Koptowie\" >Koptowie<\/option><option value=\"Korea\u0144czycy\" >Korea\u0144czycy<\/option><option value=\"Kurdowie\" >Kurdowie<\/option><option value=\"Kurpie\" >Kurpie<\/option><option value=\"Laota\u0144czycy\" >Laota\u0144czycy<\/option><option value=\"Litwini\" >Litwini<\/option><option value=\"Longobardowie\" >Longobardowie<\/option><option value=\"\u0141emkowie\" >\u0141emkowie<\/option><option value=\"\u0141otysze\" >\u0141otysze<\/option><option value=\"Macedo\u0144czycy\" >Macedo\u0144czycy<\/option><option value=\"Majowie\" >Majowie<\/option><option value=\"Malgasze\" >Malgasze<\/option><option value=\"Mand\u017curowie\" >Mand\u017curowie<\/option><option value=\"Mapucze\" >Mapucze<\/option><option value=\"Maorysi\" >Maorysi<\/option><option value=\"Masajowie\" >Masajowie<\/option><option value=\"Mazurzy\" >Mazurzy<\/option><option value=\"Melanezyjczycy\" >Melanezyjczycy<\/option><option value=\"Metysi\" >Metysi<\/option><option value=\"Mikronezyjczycy\" >Mikronezyjczycy<\/option><option value=\"Mohawkowie\" >Mohawkowie<\/option><option value=\"Mo\u0142dawianie\" >Mo\u0142dawianie<\/option><option value=\"Mongo\u0142owie\" >Mongo\u0142owie<\/option><option value=\"Nawahowie\" >Nawahowie<\/option><option value=\"Nepalczycy\" >Nepalczycy<\/option><option value=\"Niemcy\" >Niemcy<\/option><option value=\"Normanowie\" >Normanowie<\/option><option value=\"Norwegowie\" >Norwegowie<\/option><option value=\"Nubijczycy\" >Nubijczycy<\/option><option value=\"Od\u017cibwejowie\" >Od\u017cibwejowie<\/option><option value=\"Osetyjczycy\" >Osetyjczycy<\/option><option value=\"Oromo\" >Oromo<\/option><option value=\"Ormianie\" >Ormianie<\/option><option value=\"Papuasi\" >Papuasi<\/option><option value=\"Partowie\" >Partowie<\/option><option value=\"Pasztuni\" >Pasztuni<\/option><option value=\"Persowie\" >Persowie<\/option><option value=\"Pieczyngowie\" >Pieczyngowie<\/option><option value=\"Pigmeje\" >Pigmeje<\/option><option value=\"Podhalanie\" >Podhalanie<\/option><option value=\"Polinezyjczycy\" >Polinezyjczycy<\/option><option value=\"Pomorzanie\" >Pomorzanie<\/option><option value=\"Portugalczycy\" >Portugalczycy<\/option><option value=\"Pueblo\" >Pueblo<\/option><option value=\"Rosjanie\" >Rosjanie<\/option><option value=\"Rumuni\" >Rumuni<\/option><option value=\"Rusini\" >Rusini<\/option><option value=\"S\u00e1mi (Lapo\u0144czycy)\" >S\u00e1mi (Lapo\u0144czycy)<\/option><option value=\"Samoa\u0144czycy\" >Samoa\u0144czycy<\/option><option value=\"Sarmaci\" >Sarmaci<\/option><option value=\"Scytowie\" >Scytowie<\/option><option value=\"Seminole\" >Seminole<\/option><option value=\"Serbowie\" >Serbowie<\/option><option value=\"Sioux\" >Sioux<\/option><option value=\"Somalijczycy\" >Somalijczycy<\/option><option value=\"Suahili\" >Suahili<\/option><option value=\"Szkoci\" >Szkoci<\/option><option value=\"\u015al\u0105zacy\" >\u015al\u0105zacy<\/option><option value=\"S\u0142owacy\" >S\u0142owacy<\/option><option value=\"S\u0142owianie\" >S\u0142owianie<\/option><option value=\"S\u0142owe\u0144cy\" >S\u0142owe\u0144cy<\/option><option value=\"Szwajcarzy\" >Szwajcarzy<\/option><option value=\"Szwedzi\" >Szwedzi<\/option><option value=\"Tad\u017cycy\" >Tad\u017cycy<\/option><option value=\"Tajowie\" >Tajowie<\/option><option value=\"Tatarzy\" >Tatarzy<\/option><option value=\"Tatarzy syberyjscy\" >Tatarzy syberyjscy<\/option><option value=\"Tigrinia\" >Tigrinia<\/option><option value=\"Tonga\u0144czycy\" >Tonga\u0144czycy<\/option><option value=\"Turcy\" >Turcy<\/option><option value=\"Turkmeni\" >Turkmeni<\/option><option value=\"Tutsi\" >Tutsi<\/option><option value=\"Tybeta\u0144czycy\" >Tybeta\u0144czycy<\/option><option value=\"Ujgurzy\" >Ujgurzy<\/option><option value=\"Ukrai\u0144cy\" >Ukrai\u0144cy<\/option><option value=\"Uzbecy\" >Uzbecy<\/option><option value=\"Walijczycy\" >Walijczycy<\/option><option value=\"Wandalowie\" >Wandalowie<\/option><option value=\"Waregowie\" >Waregowie<\/option><option value=\"Wilniucy\" >Wilniucy<\/option><option value=\"Wietnamczycy\" >Wietnamczycy<\/option><option value=\"Wizygoci\" >Wizygoci<\/option><option value=\"W\u0142osi\" >W\u0142osi<\/option><option value=\"Wolofowie\" >Wolofowie<\/option><option value=\"Yakuci\" >Yakuci<\/option><option value=\"Yanomami\" >Yanomami<\/option><option value=\"Zag\u00f3rzanie\" >Zag\u00f3rzanie<\/option><option value=\"Zulusowie\" >Zulusowie<\/option><option value=\"\u017bydzi\" >\u017bydzi<\/option>\t<\/select>\n<\/div>\n<\/div><\/div><\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-1eec7b4b-6c06-424b-abb2-fb22e303ad83 cb-kjw341uj\" data-block-id=\"jet-sm-gb-1eec7b4b-6c06-424b-abb2-fb22e303ad83\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Dziadek od strony ojca <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"7_ojciec_ojca\" data-field-name=\"7_ojciec_ojca\" id=\"7_ojciec_ojca\" data-jfb-sync=\"null\">\n\t\t<option value=\"\"  selected>Wybierz z listy<\/option><option value=\"Polacy\" >Polacy<\/option><option value=\"Nieznana\" >Nieznana<\/option><option value=\"Aborygeni australijscy\" >Aborygeni australijscy<\/option><option value=\"Ajmarowie\" >Ajmarowie<\/option><option value=\"Akanowie\" >Akanowie<\/option><option value=\"Aleuci\" >Aleuci<\/option><option value=\"Amharowie\" >Amharowie<\/option><option value=\"Anglicy\" >Anglicy<\/option><option value=\"Apacze\" >Apacze<\/option><option value=\"Arabowie\" >Arabowie<\/option><option value=\"Aszanti\" >Aszanti<\/option><option value=\"Awarowie\" >Awarowie<\/option><option value=\"Azerowie\" >Azerowie<\/option><option value=\"Aztekowie\" >Aztekowie<\/option><option value=\"Baskowie\" >Baskowie<\/option><option value=\"Berberowie\" >Berberowie<\/option><option value=\"Bia\u0142orusini\" >Bia\u0142orusini<\/option><option value=\"Bo\u015bniacy\" >Bo\u015bniacy<\/option><option value=\"Breto\u0144czycy\" >Breto\u0144czycy<\/option><option value=\"Bu\u0142garzy\" >Bu\u0142garzy<\/option><option value=\"Buriaci\" >Buriaci<\/option><option value=\"Buszmeni\" >Buszmeni<\/option><option value=\"Celtowie\" >Celtowie<\/option><option value=\"Chi\u0144czycy Han\" >Chi\u0144czycy Han<\/option><option value=\"Chorwaci\" >Chorwaci<\/option><option value=\"Czesi\" >Czesi<\/option><option value=\"Czeczeni\" >Czeczeni<\/option><option value=\"Czirokezi\" >Czirokezi<\/option><option value=\"Dagesta\u0144czycy\" >Dagesta\u0144czycy<\/option><option value=\"Dakowie\" >Dakowie<\/option><option value=\"Du\u0144czycy\" >Du\u0144czycy<\/option><option value=\"Eskimosi (Inuici)\" >Eskimosi (Inuici)<\/option><option value=\"Esto\u0144czycy\" >Esto\u0144czycy<\/option><option value=\"Fid\u017cyjczycy\" >Fid\u017cyjczycy<\/option><option value=\"Finowie\" >Finowie<\/option><option value=\"Flamandowie\" >Flamandowie<\/option><option value=\"Francuzi\" >Francuzi<\/option><option value=\"Fryzowie\" >Fryzowie<\/option><option value=\"Fulanie\" >Fulanie<\/option><option value=\"Galowie\" >Galowie<\/option><option value=\"Germanie\" >Germanie<\/option><option value=\"G\u00f3rale\" >G\u00f3rale<\/option><option value=\"Gotowie\" >Gotowie<\/option><option value=\"Grecy\" >Grecy<\/option><option value=\"Gruzini\" >Gruzini<\/option><option value=\"Guarani\" >Guarani<\/option><option value=\"Hausa\" >Hausa<\/option><option value=\"Hazarowie\" >Hazarowie<\/option><option value=\"Hindusi\" >Hindusi<\/option><option value=\"Hiszpanie\" >Hiszpanie<\/option><option value=\"Hmongerzy\" >Hmongerzy<\/option><option value=\"Hunowie\" >Hunowie<\/option><option value=\"Huronowie\" >Huronowie<\/option><option value=\"Hutu\" >Hutu<\/option><option value=\"Ibowie\" >Ibowie<\/option><option value=\"Ingusze\" >Ingusze<\/option><option value=\"Inkowie\" >Inkowie<\/option><option value=\"Irokezi\" >Irokezi<\/option><option value=\"Irlandczycy\" >Irlandczycy<\/option><option value=\"Islandczycy\" >Islandczycy<\/option><option value=\"Japo\u0144czycy\" >Japo\u0144czycy<\/option><option value=\"Jorubowie\" >Jorubowie<\/option><option value=\"Kabylowie\" >Kabylowie<\/option><option value=\"Ka\u0142mucy\" >Ka\u0142mucy<\/option><option value=\"Katalo\u0144czycy\" >Katalo\u0144czycy<\/option><option value=\"Kaszubi\" >Kaszubi<\/option><option value=\"Kazachowie\" >Kazachowie<\/option><option value=\"Keczua\" >Keczua<\/option><option value=\"Khmerzy\" >Khmerzy<\/option><option value=\"Khoikhoi\" >Khoikhoi<\/option><option value=\"Kirgizi\" >Kirgizi<\/option><option value=\"Koptowie\" >Koptowie<\/option><option value=\"Korea\u0144czycy\" >Korea\u0144czycy<\/option><option value=\"Kurdowie\" >Kurdowie<\/option><option value=\"Kurpie\" >Kurpie<\/option><option value=\"Laota\u0144czycy\" >Laota\u0144czycy<\/option><option value=\"Litwini\" >Litwini<\/option><option value=\"Longobardowie\" >Longobardowie<\/option><option value=\"\u0141emkowie\" >\u0141emkowie<\/option><option value=\"\u0141otysze\" >\u0141otysze<\/option><option value=\"Macedo\u0144czycy\" >Macedo\u0144czycy<\/option><option value=\"Majowie\" >Majowie<\/option><option value=\"Malgasze\" >Malgasze<\/option><option value=\"Mand\u017curowie\" >Mand\u017curowie<\/option><option value=\"Mapucze\" >Mapucze<\/option><option value=\"Maorysi\" >Maorysi<\/option><option value=\"Masajowie\" >Masajowie<\/option><option value=\"Mazurzy\" >Mazurzy<\/option><option value=\"Melanezyjczycy\" >Melanezyjczycy<\/option><option value=\"Metysi\" >Metysi<\/option><option value=\"Mikronezyjczycy\" >Mikronezyjczycy<\/option><option value=\"Mohawkowie\" >Mohawkowie<\/option><option value=\"Mo\u0142dawianie\" >Mo\u0142dawianie<\/option><option value=\"Mongo\u0142owie\" >Mongo\u0142owie<\/option><option value=\"Nawahowie\" >Nawahowie<\/option><option value=\"Nepalczycy\" >Nepalczycy<\/option><option value=\"Niemcy\" >Niemcy<\/option><option value=\"Normanowie\" >Normanowie<\/option><option value=\"Norwegowie\" >Norwegowie<\/option><option value=\"Nubijczycy\" >Nubijczycy<\/option><option value=\"Od\u017cibwejowie\" >Od\u017cibwejowie<\/option><option value=\"Osetyjczycy\" >Osetyjczycy<\/option><option value=\"Oromo\" >Oromo<\/option><option value=\"Ormianie\" >Ormianie<\/option><option value=\"Papuasi\" >Papuasi<\/option><option value=\"Partowie\" >Partowie<\/option><option value=\"Pasztuni\" >Pasztuni<\/option><option value=\"Persowie\" >Persowie<\/option><option value=\"Pieczyngowie\" >Pieczyngowie<\/option><option value=\"Pigmeje\" >Pigmeje<\/option><option value=\"Podhalanie\" >Podhalanie<\/option><option value=\"Polinezyjczycy\" >Polinezyjczycy<\/option><option value=\"Pomorzanie\" >Pomorzanie<\/option><option value=\"Portugalczycy\" >Portugalczycy<\/option><option value=\"Pueblo\" >Pueblo<\/option><option value=\"Rosjanie\" >Rosjanie<\/option><option value=\"Rumuni\" >Rumuni<\/option><option value=\"Rusini\" >Rusini<\/option><option value=\"S\u00e1mi (Lapo\u0144czycy)\" >S\u00e1mi (Lapo\u0144czycy)<\/option><option value=\"Samoa\u0144czycy\" >Samoa\u0144czycy<\/option><option value=\"Sarmaci\" >Sarmaci<\/option><option value=\"Scytowie\" >Scytowie<\/option><option value=\"Seminole\" >Seminole<\/option><option value=\"Serbowie\" >Serbowie<\/option><option value=\"Sioux\" >Sioux<\/option><option value=\"Somalijczycy\" >Somalijczycy<\/option><option value=\"Suahili\" >Suahili<\/option><option value=\"Szkoci\" >Szkoci<\/option><option value=\"\u015al\u0105zacy\" >\u015al\u0105zacy<\/option><option value=\"S\u0142owacy\" >S\u0142owacy<\/option><option value=\"S\u0142owianie\" >S\u0142owianie<\/option><option value=\"S\u0142owe\u0144cy\" >S\u0142owe\u0144cy<\/option><option value=\"Szwajcarzy\" >Szwajcarzy<\/option><option value=\"Szwedzi\" >Szwedzi<\/option><option value=\"Tad\u017cycy\" >Tad\u017cycy<\/option><option value=\"Tajowie\" >Tajowie<\/option><option value=\"Tatarzy\" >Tatarzy<\/option><option value=\"Tatarzy syberyjscy\" >Tatarzy syberyjscy<\/option><option value=\"Tigrinia\" >Tigrinia<\/option><option value=\"Tonga\u0144czycy\" >Tonga\u0144czycy<\/option><option value=\"Turcy\" >Turcy<\/option><option value=\"Turkmeni\" >Turkmeni<\/option><option value=\"Tutsi\" >Tutsi<\/option><option value=\"Tybeta\u0144czycy\" >Tybeta\u0144czycy<\/option><option value=\"Ujgurzy\" >Ujgurzy<\/option><option value=\"Ukrai\u0144cy\" >Ukrai\u0144cy<\/option><option value=\"Uzbecy\" >Uzbecy<\/option><option value=\"Walijczycy\" >Walijczycy<\/option><option value=\"Wandalowie\" >Wandalowie<\/option><option value=\"Waregowie\" >Waregowie<\/option><option value=\"Wilniucy\" >Wilniucy<\/option><option value=\"Wietnamczycy\" >Wietnamczycy<\/option><option value=\"Wizygoci\" >Wizygoci<\/option><option value=\"W\u0142osi\" >W\u0142osi<\/option><option value=\"Wolofowie\" >Wolofowie<\/option><option value=\"Yakuci\" >Yakuci<\/option><option value=\"Yanomami\" >Yanomami<\/option><option value=\"Zag\u00f3rzanie\" >Zag\u00f3rzanie<\/option><option value=\"Zulusowie\" >Zulusowie<\/option><option value=\"\u017bydzi\" >\u017bydzi<\/option>\t<\/select>\n<\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-1eec7b4b-6c06-424b-abb2-fb22e303ad83 cb-kqzla50t\" data-block-id=\"jet-sm-gb-1eec7b4b-6c06-424b-abb2-fb22e303ad83\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Ojciec <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"7_ojciec\" data-field-name=\"7_ojciec\" id=\"7_ojciec\" data-jfb-sync=\"null\">\n\t\t<option value=\"\"  selected>Wybierz z listy<\/option><option value=\"Polacy\" >Polacy<\/option><option value=\"Nieznana\" >Nieznana<\/option><option value=\"Aborygeni australijscy\" >Aborygeni australijscy<\/option><option value=\"Ajmarowie\" >Ajmarowie<\/option><option value=\"Akanowie\" >Akanowie<\/option><option value=\"Aleuci\" >Aleuci<\/option><option value=\"Amharowie\" >Amharowie<\/option><option value=\"Anglicy\" >Anglicy<\/option><option value=\"Apacze\" >Apacze<\/option><option value=\"Arabowie\" >Arabowie<\/option><option value=\"Aszanti\" >Aszanti<\/option><option value=\"Awarowie\" >Awarowie<\/option><option value=\"Azerowie\" >Azerowie<\/option><option value=\"Aztekowie\" >Aztekowie<\/option><option value=\"Baskowie\" >Baskowie<\/option><option value=\"Berberowie\" >Berberowie<\/option><option value=\"Bia\u0142orusini\" >Bia\u0142orusini<\/option><option value=\"Bo\u015bniacy\" >Bo\u015bniacy<\/option><option value=\"Breto\u0144czycy\" >Breto\u0144czycy<\/option><option value=\"Bu\u0142garzy\" >Bu\u0142garzy<\/option><option value=\"Buriaci\" >Buriaci<\/option><option value=\"Buszmeni\" >Buszmeni<\/option><option value=\"Celtowie\" >Celtowie<\/option><option value=\"Chi\u0144czycy Han\" >Chi\u0144czycy Han<\/option><option value=\"Chorwaci\" >Chorwaci<\/option><option value=\"Czesi\" >Czesi<\/option><option value=\"Czeczeni\" >Czeczeni<\/option><option value=\"Czirokezi\" >Czirokezi<\/option><option value=\"Dagesta\u0144czycy\" >Dagesta\u0144czycy<\/option><option value=\"Dakowie\" >Dakowie<\/option><option value=\"Du\u0144czycy\" >Du\u0144czycy<\/option><option value=\"Eskimosi (Inuici)\" >Eskimosi (Inuici)<\/option><option value=\"Esto\u0144czycy\" >Esto\u0144czycy<\/option><option value=\"Fid\u017cyjczycy\" >Fid\u017cyjczycy<\/option><option value=\"Finowie\" >Finowie<\/option><option value=\"Flamandowie\" >Flamandowie<\/option><option value=\"Francuzi\" >Francuzi<\/option><option value=\"Fryzowie\" >Fryzowie<\/option><option value=\"Fulanie\" >Fulanie<\/option><option value=\"Galowie\" >Galowie<\/option><option value=\"Germanie\" >Germanie<\/option><option value=\"G\u00f3rale\" >G\u00f3rale<\/option><option value=\"Gotowie\" >Gotowie<\/option><option value=\"Grecy\" >Grecy<\/option><option value=\"Gruzini\" >Gruzini<\/option><option value=\"Guarani\" >Guarani<\/option><option value=\"Hausa\" >Hausa<\/option><option value=\"Hazarowie\" >Hazarowie<\/option><option value=\"Hindusi\" >Hindusi<\/option><option value=\"Hiszpanie\" >Hiszpanie<\/option><option value=\"Hmongerzy\" >Hmongerzy<\/option><option value=\"Hunowie\" >Hunowie<\/option><option value=\"Huronowie\" >Huronowie<\/option><option value=\"Hutu\" >Hutu<\/option><option value=\"Ibowie\" >Ibowie<\/option><option value=\"Ingusze\" >Ingusze<\/option><option value=\"Inkowie\" >Inkowie<\/option><option value=\"Irokezi\" >Irokezi<\/option><option value=\"Irlandczycy\" >Irlandczycy<\/option><option value=\"Islandczycy\" >Islandczycy<\/option><option value=\"Japo\u0144czycy\" >Japo\u0144czycy<\/option><option value=\"Jorubowie\" >Jorubowie<\/option><option value=\"Kabylowie\" >Kabylowie<\/option><option value=\"Ka\u0142mucy\" >Ka\u0142mucy<\/option><option value=\"Katalo\u0144czycy\" >Katalo\u0144czycy<\/option><option value=\"Kaszubi\" >Kaszubi<\/option><option value=\"Kazachowie\" >Kazachowie<\/option><option value=\"Keczua\" >Keczua<\/option><option value=\"Khmerzy\" >Khmerzy<\/option><option value=\"Khoikhoi\" >Khoikhoi<\/option><option value=\"Kirgizi\" >Kirgizi<\/option><option value=\"Koptowie\" >Koptowie<\/option><option value=\"Korea\u0144czycy\" >Korea\u0144czycy<\/option><option value=\"Kurdowie\" >Kurdowie<\/option><option value=\"Kurpie\" >Kurpie<\/option><option value=\"Laota\u0144czycy\" >Laota\u0144czycy<\/option><option value=\"Litwini\" >Litwini<\/option><option value=\"Longobardowie\" >Longobardowie<\/option><option value=\"\u0141emkowie\" >\u0141emkowie<\/option><option value=\"\u0141otysze\" >\u0141otysze<\/option><option value=\"Macedo\u0144czycy\" >Macedo\u0144czycy<\/option><option value=\"Majowie\" >Majowie<\/option><option value=\"Malgasze\" >Malgasze<\/option><option value=\"Mand\u017curowie\" >Mand\u017curowie<\/option><option value=\"Mapucze\" >Mapucze<\/option><option value=\"Maorysi\" >Maorysi<\/option><option value=\"Masajowie\" >Masajowie<\/option><option value=\"Mazurzy\" >Mazurzy<\/option><option value=\"Melanezyjczycy\" >Melanezyjczycy<\/option><option value=\"Metysi\" >Metysi<\/option><option value=\"Mikronezyjczycy\" >Mikronezyjczycy<\/option><option value=\"Mohawkowie\" >Mohawkowie<\/option><option value=\"Mo\u0142dawianie\" >Mo\u0142dawianie<\/option><option value=\"Mongo\u0142owie\" >Mongo\u0142owie<\/option><option value=\"Nawahowie\" >Nawahowie<\/option><option value=\"Nepalczycy\" >Nepalczycy<\/option><option value=\"Niemcy\" >Niemcy<\/option><option value=\"Normanowie\" >Normanowie<\/option><option value=\"Norwegowie\" >Norwegowie<\/option><option value=\"Nubijczycy\" >Nubijczycy<\/option><option value=\"Od\u017cibwejowie\" >Od\u017cibwejowie<\/option><option value=\"Osetyjczycy\" >Osetyjczycy<\/option><option value=\"Oromo\" >Oromo<\/option><option value=\"Ormianie\" >Ormianie<\/option><option value=\"Papuasi\" >Papuasi<\/option><option value=\"Partowie\" >Partowie<\/option><option value=\"Pasztuni\" >Pasztuni<\/option><option value=\"Persowie\" >Persowie<\/option><option value=\"Pieczyngowie\" >Pieczyngowie<\/option><option value=\"Pigmeje\" >Pigmeje<\/option><option value=\"Podhalanie\" >Podhalanie<\/option><option value=\"Polinezyjczycy\" >Polinezyjczycy<\/option><option value=\"Pomorzanie\" >Pomorzanie<\/option><option value=\"Portugalczycy\" >Portugalczycy<\/option><option value=\"Pueblo\" >Pueblo<\/option><option value=\"Rosjanie\" >Rosjanie<\/option><option value=\"Rumuni\" >Rumuni<\/option><option value=\"Rusini\" >Rusini<\/option><option value=\"S\u00e1mi (Lapo\u0144czycy)\" >S\u00e1mi (Lapo\u0144czycy)<\/option><option value=\"Samoa\u0144czycy\" >Samoa\u0144czycy<\/option><option value=\"Sarmaci\" >Sarmaci<\/option><option value=\"Scytowie\" >Scytowie<\/option><option value=\"Seminole\" >Seminole<\/option><option value=\"Serbowie\" >Serbowie<\/option><option value=\"Sioux\" >Sioux<\/option><option value=\"Somalijczycy\" >Somalijczycy<\/option><option value=\"Suahili\" >Suahili<\/option><option value=\"Szkoci\" >Szkoci<\/option><option value=\"\u015al\u0105zacy\" >\u015al\u0105zacy<\/option><option value=\"S\u0142owacy\" >S\u0142owacy<\/option><option value=\"S\u0142owianie\" >S\u0142owianie<\/option><option value=\"S\u0142owe\u0144cy\" >S\u0142owe\u0144cy<\/option><option value=\"Szwajcarzy\" >Szwajcarzy<\/option><option value=\"Szwedzi\" >Szwedzi<\/option><option value=\"Tad\u017cycy\" >Tad\u017cycy<\/option><option value=\"Tajowie\" >Tajowie<\/option><option value=\"Tatarzy\" >Tatarzy<\/option><option value=\"Tatarzy syberyjscy\" >Tatarzy syberyjscy<\/option><option value=\"Tigrinia\" >Tigrinia<\/option><option value=\"Tonga\u0144czycy\" >Tonga\u0144czycy<\/option><option value=\"Turcy\" >Turcy<\/option><option value=\"Turkmeni\" >Turkmeni<\/option><option value=\"Tutsi\" >Tutsi<\/option><option value=\"Tybeta\u0144czycy\" >Tybeta\u0144czycy<\/option><option value=\"Ujgurzy\" >Ujgurzy<\/option><option value=\"Ukrai\u0144cy\" >Ukrai\u0144cy<\/option><option value=\"Uzbecy\" >Uzbecy<\/option><option value=\"Walijczycy\" >Walijczycy<\/option><option value=\"Wandalowie\" >Wandalowie<\/option><option value=\"Waregowie\" >Waregowie<\/option><option value=\"Wilniucy\" >Wilniucy<\/option><option value=\"Wietnamczycy\" >Wietnamczycy<\/option><option value=\"Wizygoci\" >Wizygoci<\/option><option value=\"W\u0142osi\" >W\u0142osi<\/option><option value=\"Wolofowie\" >Wolofowie<\/option><option value=\"Yakuci\" >Yakuci<\/option><option value=\"Yanomami\" >Yanomami<\/option><option value=\"Zag\u00f3rzanie\" >Zag\u00f3rzanie<\/option><option value=\"Zulusowie\" >Zulusowie<\/option><option value=\"\u017bydzi\" >\u017bydzi<\/option>\t<\/select>\n<\/div>\n<\/div><\/div><\/div>\n<\/div>\n\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-2b36996e-cf9b-401e-a68c-9c743679c3d3 cb-g3bsuryc\" data-block-id=\"jet-sm-gb-2b36996e-cf9b-401e-a68c-9c743679c3d3\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Ja <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"7_ja\" data-field-name=\"7_ja\" id=\"7_ja\" data-jfb-sync=\"null\">\n\t\t<option value=\"\"  selected>Wybierz z listy<\/option><option value=\"Polacy\" >Polacy<\/option><option value=\"Nieznana\" >Nieznana<\/option><option value=\"Aborygeni australijscy\" >Aborygeni australijscy<\/option><option value=\"Ajmarowie\" >Ajmarowie<\/option><option value=\"Akanowie\" >Akanowie<\/option><option value=\"Aleuci\" >Aleuci<\/option><option value=\"Amharowie\" >Amharowie<\/option><option value=\"Anglicy\" >Anglicy<\/option><option value=\"Apacze\" >Apacze<\/option><option value=\"Arabowie\" >Arabowie<\/option><option value=\"Aszanti\" >Aszanti<\/option><option value=\"Awarowie\" >Awarowie<\/option><option value=\"Azerowie\" >Azerowie<\/option><option value=\"Aztekowie\" >Aztekowie<\/option><option value=\"Baskowie\" >Baskowie<\/option><option value=\"Berberowie\" >Berberowie<\/option><option value=\"Bia\u0142orusini\" >Bia\u0142orusini<\/option><option value=\"Bo\u015bniacy\" >Bo\u015bniacy<\/option><option value=\"Breto\u0144czycy\" >Breto\u0144czycy<\/option><option value=\"Bu\u0142garzy\" >Bu\u0142garzy<\/option><option value=\"Buriaci\" >Buriaci<\/option><option value=\"Buszmeni\" >Buszmeni<\/option><option value=\"Celtowie\" >Celtowie<\/option><option value=\"Chi\u0144czycy Han\" >Chi\u0144czycy Han<\/option><option value=\"Chorwaci\" >Chorwaci<\/option><option value=\"Czesi\" >Czesi<\/option><option value=\"Czeczeni\" >Czeczeni<\/option><option value=\"Czirokezi\" >Czirokezi<\/option><option value=\"Dagesta\u0144czycy\" >Dagesta\u0144czycy<\/option><option value=\"Dakowie\" >Dakowie<\/option><option value=\"Du\u0144czycy\" >Du\u0144czycy<\/option><option value=\"Eskimosi (Inuici)\" >Eskimosi (Inuici)<\/option><option value=\"Esto\u0144czycy\" >Esto\u0144czycy<\/option><option value=\"Fid\u017cyjczycy\" >Fid\u017cyjczycy<\/option><option value=\"Finowie\" >Finowie<\/option><option value=\"Flamandowie\" >Flamandowie<\/option><option value=\"Francuzi\" >Francuzi<\/option><option value=\"Fryzowie\" >Fryzowie<\/option><option value=\"Fulanie\" >Fulanie<\/option><option value=\"Galowie\" >Galowie<\/option><option value=\"Germanie\" >Germanie<\/option><option value=\"G\u00f3rale\" >G\u00f3rale<\/option><option value=\"Gotowie\" >Gotowie<\/option><option value=\"Grecy\" >Grecy<\/option><option value=\"Gruzini\" >Gruzini<\/option><option value=\"Guarani\" >Guarani<\/option><option value=\"Hausa\" >Hausa<\/option><option value=\"Hazarowie\" >Hazarowie<\/option><option value=\"Hindusi\" >Hindusi<\/option><option value=\"Hiszpanie\" >Hiszpanie<\/option><option value=\"Hmongerzy\" >Hmongerzy<\/option><option value=\"Hunowie\" >Hunowie<\/option><option value=\"Huronowie\" >Huronowie<\/option><option value=\"Hutu\" >Hutu<\/option><option value=\"Ibowie\" >Ibowie<\/option><option value=\"Ingusze\" >Ingusze<\/option><option value=\"Inkowie\" >Inkowie<\/option><option value=\"Irokezi\" >Irokezi<\/option><option value=\"Irlandczycy\" >Irlandczycy<\/option><option value=\"Islandczycy\" >Islandczycy<\/option><option value=\"Japo\u0144czycy\" >Japo\u0144czycy<\/option><option value=\"Jorubowie\" >Jorubowie<\/option><option value=\"Kabylowie\" >Kabylowie<\/option><option value=\"Ka\u0142mucy\" >Ka\u0142mucy<\/option><option value=\"Katalo\u0144czycy\" >Katalo\u0144czycy<\/option><option value=\"Kaszubi\" >Kaszubi<\/option><option value=\"Kazachowie\" >Kazachowie<\/option><option value=\"Keczua\" >Keczua<\/option><option value=\"Khmerzy\" >Khmerzy<\/option><option value=\"Khoikhoi\" >Khoikhoi<\/option><option value=\"Kirgizi\" >Kirgizi<\/option><option value=\"Koptowie\" >Koptowie<\/option><option value=\"Korea\u0144czycy\" >Korea\u0144czycy<\/option><option value=\"Kurdowie\" >Kurdowie<\/option><option value=\"Kurpie\" >Kurpie<\/option><option value=\"Laota\u0144czycy\" >Laota\u0144czycy<\/option><option value=\"Litwini\" >Litwini<\/option><option value=\"Longobardowie\" >Longobardowie<\/option><option value=\"\u0141emkowie\" >\u0141emkowie<\/option><option value=\"\u0141otysze\" >\u0141otysze<\/option><option value=\"Macedo\u0144czycy\" >Macedo\u0144czycy<\/option><option value=\"Majowie\" >Majowie<\/option><option value=\"Malgasze\" >Malgasze<\/option><option value=\"Mand\u017curowie\" >Mand\u017curowie<\/option><option value=\"Mapucze\" >Mapucze<\/option><option value=\"Maorysi\" >Maorysi<\/option><option value=\"Masajowie\" >Masajowie<\/option><option value=\"Mazurzy\" >Mazurzy<\/option><option value=\"Melanezyjczycy\" >Melanezyjczycy<\/option><option value=\"Metysi\" >Metysi<\/option><option value=\"Mikronezyjczycy\" >Mikronezyjczycy<\/option><option value=\"Mohawkowie\" >Mohawkowie<\/option><option value=\"Mo\u0142dawianie\" >Mo\u0142dawianie<\/option><option value=\"Mongo\u0142owie\" >Mongo\u0142owie<\/option><option value=\"Nawahowie\" >Nawahowie<\/option><option value=\"Nepalczycy\" >Nepalczycy<\/option><option value=\"Niemcy\" >Niemcy<\/option><option value=\"Normanowie\" >Normanowie<\/option><option value=\"Norwegowie\" >Norwegowie<\/option><option value=\"Nubijczycy\" >Nubijczycy<\/option><option value=\"Od\u017cibwejowie\" >Od\u017cibwejowie<\/option><option value=\"Osetyjczycy\" >Osetyjczycy<\/option><option value=\"Oromo\" >Oromo<\/option><option value=\"Ormianie\" >Ormianie<\/option><option value=\"Papuasi\" >Papuasi<\/option><option value=\"Partowie\" >Partowie<\/option><option value=\"Pasztuni\" >Pasztuni<\/option><option value=\"Persowie\" >Persowie<\/option><option value=\"Pieczyngowie\" >Pieczyngowie<\/option><option value=\"Pigmeje\" >Pigmeje<\/option><option value=\"Podhalanie\" >Podhalanie<\/option><option value=\"Polinezyjczycy\" >Polinezyjczycy<\/option><option value=\"Pomorzanie\" >Pomorzanie<\/option><option value=\"Portugalczycy\" >Portugalczycy<\/option><option value=\"Pueblo\" >Pueblo<\/option><option value=\"Rosjanie\" >Rosjanie<\/option><option value=\"Rumuni\" >Rumuni<\/option><option value=\"Rusini\" >Rusini<\/option><option value=\"S\u00e1mi (Lapo\u0144czycy)\" >S\u00e1mi (Lapo\u0144czycy)<\/option><option value=\"Samoa\u0144czycy\" >Samoa\u0144czycy<\/option><option value=\"Sarmaci\" >Sarmaci<\/option><option value=\"Scytowie\" >Scytowie<\/option><option value=\"Seminole\" >Seminole<\/option><option value=\"Serbowie\" >Serbowie<\/option><option value=\"Sioux\" >Sioux<\/option><option value=\"Somalijczycy\" >Somalijczycy<\/option><option value=\"Suahili\" >Suahili<\/option><option value=\"Szkoci\" >Szkoci<\/option><option value=\"\u015al\u0105zacy\" >\u015al\u0105zacy<\/option><option value=\"S\u0142owacy\" >S\u0142owacy<\/option><option value=\"S\u0142owianie\" >S\u0142owianie<\/option><option value=\"S\u0142owe\u0144cy\" >S\u0142owe\u0144cy<\/option><option value=\"Szwajcarzy\" >Szwajcarzy<\/option><option value=\"Szwedzi\" >Szwedzi<\/option><option value=\"Tad\u017cycy\" >Tad\u017cycy<\/option><option value=\"Tajowie\" >Tajowie<\/option><option value=\"Tatarzy\" >Tatarzy<\/option><option value=\"Tatarzy syberyjscy\" >Tatarzy syberyjscy<\/option><option value=\"Tigrinia\" >Tigrinia<\/option><option value=\"Tonga\u0144czycy\" >Tonga\u0144czycy<\/option><option value=\"Turcy\" >Turcy<\/option><option value=\"Turkmeni\" >Turkmeni<\/option><option value=\"Tutsi\" >Tutsi<\/option><option value=\"Tybeta\u0144czycy\" >Tybeta\u0144czycy<\/option><option value=\"Ujgurzy\" >Ujgurzy<\/option><option value=\"Ukrai\u0144cy\" >Ukrai\u0144cy<\/option><option value=\"Uzbecy\" >Uzbecy<\/option><option value=\"Walijczycy\" >Walijczycy<\/option><option value=\"Wandalowie\" >Wandalowie<\/option><option value=\"Waregowie\" >Waregowie<\/option><option value=\"Wilniucy\" >Wilniucy<\/option><option value=\"Wietnamczycy\" >Wietnamczycy<\/option><option value=\"Wizygoci\" >Wizygoci<\/option><option value=\"W\u0142osi\" >W\u0142osi<\/option><option value=\"Wolofowie\" >Wolofowie<\/option><option value=\"Yakuci\" >Yakuci<\/option><option value=\"Yanomami\" >Yanomami<\/option><option value=\"Zag\u00f3rzanie\" >Zag\u00f3rzanie<\/option><option value=\"Zulusowie\" >Zulusowie<\/option><option value=\"\u017bydzi\" >\u017bydzi<\/option>\t<\/select>\n<\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-e5ae98f3-7ac8-4d4e-89ca-323ba930ea47 cb-em36ihoc\" data-block-id=\"jet-sm-gb-e5ae98f3-7ac8-4d4e-89ca-323ba930ea47\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">8. Jakie jest Pana\/Pani miejsce zamieszkania? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"8_jakie_jest_pana_pani_miejsce_zamieszkania\" value=\"wie\u015b\" data-field-name=\"8_jakie_jest_pana_pani_miejsce_zamieszkania\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>wie\u015b<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"8_jakie_jest_pana_pani_miejsce_zamieszkania\" value=\"miasto do 20 tys. mieszka\u0144c\u00f3w\" data-field-name=\"8_jakie_jest_pana_pani_miejsce_zamieszkania\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>miasto do 20 tys. mieszka\u0144c\u00f3w<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"8_jakie_jest_pana_pani_miejsce_zamieszkania\" value=\"miasto 20-50 tys.mieszka\u0144c\u00f3w\" data-field-name=\"8_jakie_jest_pana_pani_miejsce_zamieszkania\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>miasto 20-50 tys.mieszka\u0144c\u00f3w<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"8_jakie_jest_pana_pani_miejsce_zamieszkania\" value=\"miasto 50-200 tys.mieszka\u0144c\u00f3w\" data-field-name=\"8_jakie_jest_pana_pani_miejsce_zamieszkania\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>miasto 50-200 tys.mieszka\u0144c\u00f3w<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"8_jakie_jest_pana_pani_miejsce_zamieszkania\" value=\"miasto 200-500 tys.mieszka\u0144c\u00f3w\" data-field-name=\"8_jakie_jest_pana_pani_miejsce_zamieszkania\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>miasto 200-500 tys.mieszka\u0144c\u00f3w<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"8_jakie_jest_pana_pani_miejsce_zamieszkania\" value=\"miasto powy\u017cej 500 tys. mieszka\u0144c\u00f3w\" data-field-name=\"8_jakie_jest_pana_pani_miejsce_zamieszkania\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>miasto powy\u017cej 500 tys. mieszka\u0144c\u00f3w<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-4fde2c09-d93a-4660-ba19-840c82616179 cb-zmvmggbm\" data-block-id=\"jet-sm-gb-4fde2c09-d93a-4660-ba19-840c82616179\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">9. Jakie ma Pan\/Pani wykszta\u0142cenie?  <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"9_jakie_ma_pan_pani_wykszta_cenie\" value=\"podstawowe\" data-field-name=\"9_jakie_ma_pan_pani_wykszta_cenie\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>podstawowe<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"9_jakie_ma_pan_pani_wykszta_cenie\" value=\" zawodowe\" data-field-name=\"9_jakie_ma_pan_pani_wykszta_cenie\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span> zawodowe<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"9_jakie_ma_pan_pani_wykszta_cenie\" value=\" gimnazjalne\" data-field-name=\"9_jakie_ma_pan_pani_wykszta_cenie\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span> gimnazjalne<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"9_jakie_ma_pan_pani_wykszta_cenie\" value=\" \u015brednie \" data-field-name=\"9_jakie_ma_pan_pani_wykszta_cenie\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span> \u015brednie <\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"9_jakie_ma_pan_pani_wykszta_cenie\" value=\"wy\u017csze\" data-field-name=\"9_jakie_ma_pan_pani_wykszta_cenie\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>wy\u017csze<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"9_jakie_ma_pan_pani_wykszta_cenie\" value=\"jeszcze si\u0119 ucz\u0119 (w przypadku dzieci)\" data-field-name=\"9_jakie_ma_pan_pani_wykszta_cenie\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>jeszcze si\u0119 ucz\u0119 (w przypadku dzieci)<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"9_jakie_ma_pan_pani_wykszta_cenie\" value=\"nie dotyczy (w przypadku os\u00f3b nie obj\u0119tych obowi\u0105zkiem szkolnym)\" data-field-name=\"9_jakie_ma_pan_pani_wykszta_cenie\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>nie dotyczy (w przypadku os\u00f3b nie obj\u0119tych obowi\u0105zkiem szkolnym)<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-6ec0ce4e-9b47-426e-a6ca-9dad1c978552 cb-f4bs8eb7\" data-block-id=\"jet-sm-gb-6ec0ce4e-9b47-426e-a6ca-9dad1c978552\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">10. Jaka jest Pana\/Pani sytuacja materialna? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"10_jaka_jest_pana_pani_sytuacja_materialna\" value=\"bardzo dobra\" data-field-name=\"10_jaka_jest_pana_pani_sytuacja_materialna\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>bardzo dobra<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"10_jaka_jest_pana_pani_sytuacja_materialna\" value=\"dobra\" data-field-name=\"10_jaka_jest_pana_pani_sytuacja_materialna\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>dobra<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"10_jaka_jest_pana_pani_sytuacja_materialna\" value=\"przeci\u0119tna\" data-field-name=\"10_jaka_jest_pana_pani_sytuacja_materialna\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>przeci\u0119tna<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"10_jaka_jest_pana_pani_sytuacja_materialna\" value=\"z\u0142a\" data-field-name=\"10_jaka_jest_pana_pani_sytuacja_materialna\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>z\u0142a<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"10_jaka_jest_pana_pani_sytuacja_materialna\" value=\"bardzo z\u0142a\" data-field-name=\"10_jaka_jest_pana_pani_sytuacja_materialna\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>bardzo z\u0142a<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-form-builder__next-page-wrap\">\n\t\t<button type=\"button\" class=\"jet-form-builder__prev-page\" data-to-page=\"1\">Wr\u00f3\u0107 do poprzedniego kroku<\/button>\t\t\t<button class=\"jet-form-builder__next-page\" type=\"button\">Przejd\u017a do nast\u0119pnego kroku<\/button>\n\t<\/div>\n<\/div>\n<div class=\"jet-form-builder-page jet-form-builder-page--hidden\" data-page=\"3\" data-page-offset=\"75\">\n\n\n<h3 class=\"wp-block-heading\">Dane fenotypowe<\/h3>\n\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-a39e03f5-09c0-423c-8133-9801763e05ac cb-jxx9jbuk\" data-block-id=\"jet-sm-gb-a39e03f5-09c0-423c-8133-9801763e05ac\" ><div  data-value=\"[{&quot;id&quot;:6051,&quot;conditions&quot;:[{&quot;__visible&quot;:true,&quot;value&quot;:&quot;&quot;}],&quot;to_set&quot;:&quot;&quot;}]\" class=\"jet-form-builder-row field-type-checkbox-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">11. Naturalny kolor oczu (prosz\u0119 wybra\u0107 maksymalnie dwa kolory dominuj\u0105ce): <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"11_naturalny_kolor_oczu_mozna_wybrac_maksymalnie_dwa_kolory_dominujace[]\" value=\"zielony\" data-field-name=\"11_naturalny_kolor_oczu_mozna_wybrac_maksymalnie_dwa_kolory_dominujace\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>zielony<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"11_naturalny_kolor_oczu_mozna_wybrac_maksymalnie_dwa_kolory_dominujace[]\" value=\"niebieski\" data-field-name=\"11_naturalny_kolor_oczu_mozna_wybrac_maksymalnie_dwa_kolory_dominujace\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>niebieski<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"11_naturalny_kolor_oczu_mozna_wybrac_maksymalnie_dwa_kolory_dominujace[]\" value=\"br\u0105zowy\" data-field-name=\"11_naturalny_kolor_oczu_mozna_wybrac_maksymalnie_dwa_kolory_dominujace\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>br\u0105zowy<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"11_naturalny_kolor_oczu_mozna_wybrac_maksymalnie_dwa_kolory_dominujace[]\" value=\"szary\" data-field-name=\"11_naturalny_kolor_oczu_mozna_wybrac_maksymalnie_dwa_kolory_dominujace\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>szary<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-fab51b72-b2d8-4b0e-9008-35990e54c193 cb-k99qyciv\" data-block-id=\"jet-sm-gb-fab51b72-b2d8-4b0e-9008-35990e54c193\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">12. Naturalny kolor w\u0142os\u00f3w:  <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"12_naturalny_kolor_w_osow\" value=\"czarny\" data-field-name=\"12_naturalny_kolor_w_osow\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>czarny<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"12_naturalny_kolor_w_osow\" value=\"ciemnobr\u0105zowy\" data-field-name=\"12_naturalny_kolor_w_osow\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>ciemnobr\u0105zowy<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"12_naturalny_kolor_w_osow\" value=\"jasnobr\u0105zowy\" data-field-name=\"12_naturalny_kolor_w_osow\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>jasnobr\u0105zowy<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"12_naturalny_kolor_w_osow\" value=\"rudy\" data-field-name=\"12_naturalny_kolor_w_osow\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>rudy<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"12_naturalny_kolor_w_osow\" value=\"ciemny blond\" data-field-name=\"12_naturalny_kolor_w_osow\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>ciemny blond<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"12_naturalny_kolor_w_osow\" value=\"jasny blond\" data-field-name=\"12_naturalny_kolor_w_osow\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>jasny blond<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-9b034e65-bed9-4008-b3c4-5f53b211ff2b cb-fyg1gg4e\" data-block-id=\"jet-sm-gb-9b034e65-bed9-4008-b3c4-5f53b211ff2b\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">13. Naturalny typ w\u0142os\u00f3w: <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"13_naturalny_typ_w_osow\" value=\"proste\" data-field-name=\"13_naturalny_typ_w_osow\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>proste<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"13_naturalny_typ_w_osow\" value=\" falowane\" data-field-name=\"13_naturalny_typ_w_osow\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span> falowane<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"13_naturalny_typ_w_osow\" value=\"kr\u0119cone\" data-field-name=\"13_naturalny_typ_w_osow\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>kr\u0119cone<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-86e313d7-134e-426c-ad61-00e3c3d1dd4e cb-zxu06ink\" data-block-id=\"jet-sm-gb-86e313d7-134e-426c-ad61-00e3c3d1dd4e\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">14. Naturalny kolor karnacji: <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"14_naturalny_kolor_karnacji\" value=\"bardzo jasna (r\u00f3\u017cowo-bia\u0142a, bia\u0142a)\" data-field-name=\"14_naturalny_kolor_karnacji\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>bardzo jasna (r\u00f3\u017cowo-bia\u0142a, bia\u0142a)<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"14_naturalny_kolor_karnacji\" value=\"jasna (p\u0142owa)\" data-field-name=\"14_naturalny_kolor_karnacji\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>jasna (p\u0142owa)<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"14_naturalny_kolor_karnacji\" value=\"oliwkowa\" data-field-name=\"14_naturalny_kolor_karnacji\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>oliwkowa<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"14_naturalny_kolor_karnacji\" value=\"\u015bniada\" data-field-name=\"14_naturalny_kolor_karnacji\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>\u015bniada<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"14_naturalny_kolor_karnacji\" value=\" \u017c\u00f3\u0142ta\" data-field-name=\"14_naturalny_kolor_karnacji\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span> \u017c\u00f3\u0142ta<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"14_naturalny_kolor_karnacji\" value=\"ciemna\" data-field-name=\"14_naturalny_kolor_karnacji\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>ciemna<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-f6d0e560-8113-409e-8cc5-559f5875fc4c cb-g3gihkzn\" data-block-id=\"jet-sm-gb-f6d0e560-8113-409e-8cc5-559f5875fc4c\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">15. Naturalna budowa cia\u0142a: <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"15_naturalna_budowa_cia_a\" value=\"drobno-ko\u015bcista\" data-field-name=\"15_naturalna_budowa_cia_a\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>drobno-ko\u015bcista<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"15_naturalna_budowa_cia_a\" value=\" grubo-ko\u015bcista\" data-field-name=\"15_naturalna_budowa_cia_a\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span> grubo-ko\u015bcista<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"15_naturalna_budowa_cia_a\" value=\"nie wiem\" data-field-name=\"15_naturalna_budowa_cia_a\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>nie wiem<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-8d8e26ca-1a20-4dd5-8a12-9754f9774b4a cb-o25juzfv\" data-block-id=\"jet-sm-gb-8d8e26ca-1a20-4dd5-8a12-9754f9774b4a\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">16. Naturalna sylwetka cia\u0142a: <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"16_naturalna_sylwetka_cia_a\" value=\" chuda\" data-field-name=\"16_naturalna_sylwetka_cia_a\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span> chuda<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"16_naturalna_sylwetka_cia_a\" value=\"przeci\u0119tna\" data-field-name=\"16_naturalna_sylwetka_cia_a\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>przeci\u0119tna<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"16_naturalna_sylwetka_cia_a\" value=\"z nadwag\u0105\" data-field-name=\"16_naturalna_sylwetka_cia_a\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>z nadwag\u0105<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-f8570063-d605-41d3-9458-e8e76c2e8084 cb-nbzhr99v\" data-block-id=\"jet-sm-gb-f8570063-d605-41d3-9458-e8e76c2e8084\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">17. Kszta\u0142t p\u0142atka ucha: <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"17_kszta_t_p_atka_ucha\" value=\"p\u0142atek wolny (nieprzylegaj\u0105cy do twarzy)\" data-field-name=\"17_kszta_t_p_atka_ucha\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>p\u0142atek wolny (nieprzylegaj\u0105cy do twarzy)<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"17_kszta_t_p_atka_ucha\" value=\"p\u0142atek przyro\u015bni\u0119ty (przylegaj\u0105cy do twarzy)\" data-field-name=\"17_kszta_t_p_atka_ucha\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>p\u0142atek przyro\u015bni\u0119ty (przylegaj\u0105cy do twarzy)<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n\n<figure class=\"wp-block-image is-resized has-custom-border is-style-default\"><img fetchpriority=\"high\" decoding=\"async\" width=\"1024\" height=\"681\" src=\"https:\/\/genomikadlapolski.pl\/wp-content\/uploads\/2026\/04\/c914c6bc69b2d793359083713b4310cec5c55d64-1024x681.png\" alt=\"\" class=\"wp-image-3036\" style=\"border-top-left-radius:24px;border-top-right-radius:24px;border-bottom-left-radius:24px;border-bottom-right-radius:24px;aspect-ratio:1.503709810387469;width:391px;height:auto\" srcset=\"https:\/\/genomikadlapolski.pl\/wp-content\/uploads\/2026\/04\/c914c6bc69b2d793359083713b4310cec5c55d64-1024x681.png 1024w, https:\/\/genomikadlapolski.pl\/wp-content\/uploads\/2026\/04\/c914c6bc69b2d793359083713b4310cec5c55d64-300x199.png 300w, https:\/\/genomikadlapolski.pl\/wp-content\/uploads\/2026\/04\/c914c6bc69b2d793359083713b4310cec5c55d64-768x511.png 768w, https:\/\/genomikadlapolski.pl\/wp-content\/uploads\/2026\/04\/c914c6bc69b2d793359083713b4310cec5c55d64-1536x1021.png 1536w, https:\/\/genomikadlapolski.pl\/wp-content\/uploads\/2026\/04\/c914c6bc69b2d793359083713b4310cec5c55d64-2048x1362.png 2048w, https:\/\/genomikadlapolski.pl\/wp-content\/uploads\/2026\/04\/c914c6bc69b2d793359083713b4310cec5c55d64-18x12.png 18w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-f2f81ea4-9ca1-43df-bb7f-b13b2b7e79a7 cb-dvdkkknp\" data-block-id=\"jet-sm-gb-f2f81ea4-9ca1-43df-bb7f-b13b2b7e79a7\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">18. Czy jest Pani\/Pan: <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"18_czy_jest_pani_pan\" value=\"lewor\u0119czna\/lewor\u0119czny\" data-field-name=\"18_czy_jest_pani_pan\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>lewor\u0119czna\/lewor\u0119czny<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"18_czy_jest_pani_pan\" value=\"prawor\u0119czna\/prawor\u0119czny\" data-field-name=\"18_czy_jest_pani_pan\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>prawor\u0119czna\/prawor\u0119czny<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"18_czy_jest_pani_pan\" value=\"obur\u0119czna\/obur\u0119czny\" data-field-name=\"18_czy_jest_pani_pan\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>obur\u0119czna\/obur\u0119czny<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-form-builder__next-page-wrap\">\n\t\t<button type=\"button\" class=\"jet-form-builder__prev-page\" data-to-page=\"2\">Wr\u00f3\u0107 do poprzedniego kroku<\/button>\t\t\t<button class=\"jet-form-builder__next-page\" type=\"button\">Przejd\u017a do nast\u0119pnego kroku<\/button>\n\t<\/div>\n<\/div>\n<div class=\"jet-form-builder-page jet-form-builder-page--hidden\" data-page=\"4\" data-page-offset=\"75\">\n\n\n<h3 class=\"wp-block-heading\">Dane na temat pracy i aktywno\u015bci fizycznej<\/h3>\n\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-4cd43d80-3075-4347-b24c-a7bf5158eea3 cb-uegdlusx\" data-block-id=\"jet-sm-gb-4cd43d80-3075-4347-b24c-a7bf5158eea3\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">19. Rodzaj wykonywanej pracy:  <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"19_rodzaj_wykonywanej_pracy\" value=\"g\u0142\u00f3wnie fizyczna\" data-field-name=\"19_rodzaj_wykonywanej_pracy\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>g\u0142\u00f3wnie fizyczna<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"19_rodzaj_wykonywanej_pracy\" value=\"g\u0142\u00f3wnie umys\u0142owa\" data-field-name=\"19_rodzaj_wykonywanej_pracy\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>g\u0142\u00f3wnie umys\u0142owa<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"19_rodzaj_wykonywanej_pracy\" value=\"mniej wi\u0119cej po r\u00f3wno fizyczna i umys\u0142owa\" data-field-name=\"19_rodzaj_wykonywanej_pracy\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>mniej wi\u0119cej po r\u00f3wno fizyczna i umys\u0142owa<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"19_rodzaj_wykonywanej_pracy\" value=\"nie dotyczy\" data-field-name=\"19_rodzaj_wykonywanej_pracy\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>nie dotyczy<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-77ceb82e-e04f-4c03-b803-f42208276012 cb-xnbda76b\" data-block-id=\"jet-sm-gb-77ceb82e-e04f-4c03-b803-f42208276012\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">20. Praca na \u015bwie\u017cym powietrzu:  <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"20_praca_na_swiezym_powietrzu\" value=\"tak\" data-field-name=\"20_praca_na_swiezym_powietrzu\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"20_praca_na_swiezym_powietrzu\" value=\"nie\" data-field-name=\"20_praca_na_swiezym_powietrzu\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>nie<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"20_praca_na_swiezym_powietrzu\" value=\"nie dotyczy\" data-field-name=\"20_praca_na_swiezym_powietrzu\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>nie dotyczy<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-7dfa92a1-6c73-4113-9263-383645eeb0e3 cb-v7vvgol1\" data-block-id=\"jet-sm-gb-7dfa92a1-6c73-4113-9263-383645eeb0e3\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">21. Jak zazwyczaj przemieszcza si\u0119 Pani\/Pan na co dzie\u0144? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"21_jak_zazwyczaj_przemieszcza_sie_pani_pan_na_co_dzien\" value=\"pieszo\" data-field-name=\"21_jak_zazwyczaj_przemieszcza_sie_pani_pan_na_co_dzien\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>pieszo<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"21_jak_zazwyczaj_przemieszcza_sie_pani_pan_na_co_dzien\" value=\"rowerem\/na rolkach\" data-field-name=\"21_jak_zazwyczaj_przemieszcza_sie_pani_pan_na_co_dzien\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>rowerem\/na rolkach<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"21_jak_zazwyczaj_przemieszcza_sie_pani_pan_na_co_dzien\" value=\"komunikacj\u0105 zbiorow\u0105\" data-field-name=\"21_jak_zazwyczaj_przemieszcza_sie_pani_pan_na_co_dzien\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>komunikacj\u0105 zbiorow\u0105<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"21_jak_zazwyczaj_przemieszcza_sie_pani_pan_na_co_dzien\" value=\"samochodem\" data-field-name=\"21_jak_zazwyczaj_przemieszcza_sie_pani_pan_na_co_dzien\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>samochodem<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"21_jak_zazwyczaj_przemieszcza_sie_pani_pan_na_co_dzien\" value=\"inaczej\" data-field-name=\"21_jak_zazwyczaj_przemieszcza_sie_pani_pan_na_co_dzien\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>inaczej<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-b4640f0c-4efa-4543-81f4-2c81305d653b\" data-block-id=\"jet-sm-gb-b4640f0c-4efa-4543-81f4-2c81305d653b\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;inaczej&quot;,&quot;field&quot;:&quot;21_jak_zazwyczaj_przemieszcza_sie_pani_pan_na_co_dzien&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-454f0392-3d80-4af9-9a1d-18185b492963 cb-o2k9hlih\" data-block-id=\"jet-sm-gb-454f0392-3d80-4af9-9a1d-18185b492963\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Jak? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz spos\u00f3b w jaki przemieszczasz si\u0119 na codzie\u0144\" required=\"required\" name=\"rodzaj_przemieszczania_inaczej\" id=\"rodzaj_przemieszczania_inaczej\" type=\"text\" data-field-name=\"rodzaj_przemieszczania_inaczej\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_KhEpd6Nb\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-0fc58bf5-73da-4d7a-928c-fe8b6b8ab3c0 cb-ktxh3aky\" data-block-id=\"jet-sm-gb-0fc58bf5-73da-4d7a-928c-fe8b6b8ab3c0\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">22. Czy prowadzi Pani\/Pan regularny tryb \u017cycia? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"22_czy_prowadzi_pani_pan_regularny_tryb_zycia\" value=\"tak\" data-field-name=\"22_czy_prowadzi_pani_pan_regularny_tryb_zycia\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"22_czy_prowadzi_pani_pan_regularny_tryb_zycia\" value=\"nie\" data-field-name=\"22_czy_prowadzi_pani_pan_regularny_tryb_zycia\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>nie<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-5b0c331e-6fa0-4828-b7e5-b8f6f19c1643 cb-mypcxhs2\" data-block-id=\"jet-sm-gb-5b0c331e-6fa0-4828-b7e5-b8f6f19c1643\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">23. Ile zwykle godzin Pani\/Pan \u015bpi? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"23_ile_zwykle_godzin_pani_pan_spi\" value=\"mniej ni\u017c 5h\" data-field-name=\"23_ile_zwykle_godzin_pani_pan_spi\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>mniej ni\u017c 5h<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"23_ile_zwykle_godzin_pani_pan_spi\" value=\"5-6h\" data-field-name=\"23_ile_zwykle_godzin_pani_pan_spi\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>5-6h<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"23_ile_zwykle_godzin_pani_pan_spi\" value=\"6-7h\" data-field-name=\"23_ile_zwykle_godzin_pani_pan_spi\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>6-7h<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"23_ile_zwykle_godzin_pani_pan_spi\" value=\"7-8h\" data-field-name=\"23_ile_zwykle_godzin_pani_pan_spi\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>7-8h<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"23_ile_zwykle_godzin_pani_pan_spi\" value=\"wi\u0119cej ni\u017c 8h\" data-field-name=\"23_ile_zwykle_godzin_pani_pan_spi\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>wi\u0119cej ni\u017c 8h<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-efe1a5d2-7a24-47f5-b100-f3af644fbae8 cb-fm919lt5\" data-block-id=\"jet-sm-gb-efe1a5d2-7a24-47f5-b100-f3af644fbae8\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">24. Czy uprawia Pani\/Pan sport? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"24_czy_uprawia_pani_pan_sport\" value=\"tak, regularnie\" data-field-name=\"24_czy_uprawia_pani_pan_sport\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak, regularnie<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"24_czy_uprawia_pani_pan_sport\" value=\"tak, nieregularnie\" data-field-name=\"24_czy_uprawia_pani_pan_sport\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak, nieregularnie<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"24_czy_uprawia_pani_pan_sport\" value=\"nie\" data-field-name=\"24_czy_uprawia_pani_pan_sport\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>nie<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-form-builder__next-page-wrap\">\n\t\t<button type=\"button\" class=\"jet-form-builder__prev-page\" data-to-page=\"3\">Wr\u00f3\u0107 do poprzedniego kroku<\/button>\t\t\t<button class=\"jet-form-builder__next-page\" type=\"button\">Przejd\u017a do nast\u0119pnego kroku<\/button>\n\t<\/div>\n<\/div>\n<div class=\"jet-form-builder-page jet-form-builder-page--hidden\" data-page=\"5\" data-page-offset=\"75\">\n\n\n<h3 class=\"wp-block-heading\">Dane na temat stylu \u017cycia<\/h3>\n\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-1af16737-bc88-4111-baf7-e943789770a6 cb-u0zw1dvb\" data-block-id=\"jet-sm-gb-1af16737-bc88-4111-baf7-e943789770a6\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">25. Czy pali lub pali\u0142a\/pali\u0142 Pani\/Pan wyroby tytoniowe?  <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"25_czy_pali_lub_pali_a_pali_pani_pan_wyroby_tytoniowe\" value=\"nigdy nie pali\u0142am\/pali\u0142em\" data-field-name=\"25_czy_pali_lub_pali_a_pali_pani_pan_wyroby_tytoniowe\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>nigdy nie pali\u0142am\/pali\u0142em<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"25_czy_pali_lub_pali_a_pali_pani_pan_wyroby_tytoniowe\" value=\"pali\u0142am\/pali\u0142em, ale rzuci\u0142am\/rzuci\u0142em\" data-field-name=\"25_czy_pali_lub_pali_a_pali_pani_pan_wyroby_tytoniowe\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>pali\u0142am\/pali\u0142em, ale rzuci\u0142am\/rzuci\u0142em<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"25_czy_pali_lub_pali_a_pali_pani_pan_wyroby_tytoniowe\" value=\"pal\u0119 \" data-field-name=\"25_czy_pali_lub_pali_a_pali_pani_pan_wyroby_tytoniowe\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>pal\u0119 <\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-92ce847b-60f3-40c8-bca7-2684b899e6ad\" data-block-id=\"jet-sm-gb-92ce847b-60f3-40c8-bca7-2684b899e6ad\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;contain&quot;,&quot;value&quot;:&quot;rzuci\\u0142am\\\/rzuci\\u0142em&quot;,&quot;field&quot;:&quot;25_czy_pali_lub_pali_a_pali_pani_pan_wyroby_tytoniowe&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-c5ec9d66-5b00-4623-a77f-0db97482d96d cb-ezfrxev3\" data-block-id=\"jet-sm-gb-c5ec9d66-5b00-4623-a77f-0db97482d96d\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Je\u015bli tak, to ile lat temu? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz liczb\u0119 lat\" required=\"required\" name=\"palilam_palilem_ale_rzucilam_rzucilem\" id=\"palilam_palilem_ale_rzucilam_rzucilem\" type=\"text\" data-field-name=\"palilam_palilem_ale_rzucilam_rzucilem\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_utLYJMmD\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-b300a3a2-ece9-4fe3-95ac-a8b2239f2235\" data-block-id=\"jet-sm-gb-b300a3a2-ece9-4fe3-95ac-a8b2239f2235\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;nigdy nie pali\\u0142am\\\/pali\\u0142em&quot;,&quot;field&quot;:&quot;25_czy_pali_lub_pali_a_pali_pani_pan_wyroby_tytoniowe&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"hide\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-26891105-eaa4-479b-a512-9ba6385a98ed cb-axublw1p\" data-block-id=\"jet-sm-gb-26891105-eaa4-479b-a512-9ba6385a98ed\" ><div  class=\"jet-form-builder-row field-type-checkbox-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">26. Jakie wyroby tytoniowe Pani\/Pan pali lub pali\u0142a\/pali\u0142? (mo\u017cliwo\u015b\u0107 wyboru wi\u0119cej ni\u017c jednej odpowiedzi) <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"rodzaje_wyrobow_tytoniowych[]\" value=\"papierosy zwyk\u0142e\" data-field-name=\"rodzaje_wyrobow_tytoniowych\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>papierosy zwyk\u0142e<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"rodzaje_wyrobow_tytoniowych[]\" value=\"papierosy elektroniczne\" data-field-name=\"rodzaje_wyrobow_tytoniowych\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>papierosy elektroniczne<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"rodzaje_wyrobow_tytoniowych[]\" value=\" cygara\" data-field-name=\"rodzaje_wyrobow_tytoniowych\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span> cygara<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"rodzaje_wyrobow_tytoniowych[]\" value=\" fajk\u0119\" data-field-name=\"rodzaje_wyrobow_tytoniowych\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span> fajk\u0119<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-568af9be-73ee-4a0a-b2fd-feb7bd915b62 cb-yruahdyt\" data-block-id=\"jet-sm-gb-568af9be-73ee-4a0a-b2fd-feb7bd915b62\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">27. Ile wyrob\u00f3w tytoniowych dziennie Pani\/Pan pali lub pali\u0142a\/pali\u0142? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"27_ile_wyrobow_tytoniowych_dzienniepani_pan_pali_lub_pali_a_pali\" value=\"liczba\" data-field-name=\"27_ile_wyrobow_tytoniowych_dzienniepani_pan_pali_lub_pali_a_pali\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>liczba<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"27_ile_wyrobow_tytoniowych_dzienniepani_pan_pali_lub_pali_a_pali\" value=\"nie dotyczy\" data-field-name=\"27_ile_wyrobow_tytoniowych_dzienniepani_pan_pali_lub_pali_a_pali\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>nie dotyczy<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-1c7a0246-3383-4f0b-8095-292d9dc4120a\" data-block-id=\"jet-sm-gb-1c7a0246-3383-4f0b-8095-292d9dc4120a\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;liczba&quot;,&quot;field&quot;:&quot;27_ile_wyrobow_tytoniowych_dzienniepani_pan_pali_lub_pali_a_pali&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-2088897b-3121-4c60-9f12-7c2dc1be6555 cb-yd2znvgm\" data-block-id=\"jet-sm-gb-2088897b-3121-4c60-9f12-7c2dc1be6555\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Ile? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz liczb\u0119\" required=\"required\" name=\"ile_wyrobow_tytoniowych\" id=\"ile_wyrobow_tytoniowych\" type=\"text\" data-field-name=\"ile_wyrobow_tytoniowych\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_aUnA3NFB\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-2b4a22a9-ab86-46b0-8f90-fe486a186e87 cb-ejm8tak1\" data-block-id=\"jet-sm-gb-2b4a22a9-ab86-46b0-8f90-fe486a186e87\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">28. Czy spo\u017cywa Pani\/Pan alkohol? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"28_czy_spozywa_pani_pan_alkohol\" value=\"tak\" data-field-name=\"28_czy_spozywa_pani_pan_alkohol\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"28_czy_spozywa_pani_pan_alkohol\" value=\"nie\" data-field-name=\"28_czy_spozywa_pani_pan_alkohol\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>nie<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-2bb3eeb2-d480-4efd-92ea-7e3f7b637dc0\" data-block-id=\"jet-sm-gb-2bb3eeb2-d480-4efd-92ea-7e3f7b637dc0\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;nie&quot;,&quot;field&quot;:&quot;28_czy_spozywa_pani_pan_alkohol&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"hide\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-c995eea6-56cc-46c7-b03c-dc1068671327 cb-ninysoc0\" data-block-id=\"jet-sm-gb-c995eea6-56cc-46c7-b03c-dc1068671327\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">29. Jaki alkohol najcz\u0119\u015bciej Pani\/Pan spo\u017cywa? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"29_jaki_alkohol_najczesciej_pani_pan_spozywa\" value=\"w\u00f3dka\/ alkohol wysokoprocentowy\" data-field-name=\"29_jaki_alkohol_najczesciej_pani_pan_spozywa\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>w\u00f3dka\/ alkohol wysokoprocentowy<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"29_jaki_alkohol_najczesciej_pani_pan_spozywa\" value=\"wino\" data-field-name=\"29_jaki_alkohol_najczesciej_pani_pan_spozywa\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>wino<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"29_jaki_alkohol_najczesciej_pani_pan_spozywa\" value=\"piwo\" data-field-name=\"29_jaki_alkohol_najczesciej_pani_pan_spozywa\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>piwo<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"29_jaki_alkohol_najczesciej_pani_pan_spozywa\" value=\"inny\" data-field-name=\"29_jaki_alkohol_najczesciej_pani_pan_spozywa\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>inny<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"29_jaki_alkohol_najczesciej_pani_pan_spozywa\" value=\"nie dotyczy\" data-field-name=\"29_jaki_alkohol_najczesciej_pani_pan_spozywa\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>nie dotyczy<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-017608d1-fc0c-46db-bec0-5e5b51d52182 cb-j77q8hlx\" data-block-id=\"jet-sm-gb-017608d1-fc0c-46db-bec0-5e5b51d52182\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">30. Jak cz\u0119sto spo\u017cywa Pani\/Pan alkohol? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"30_jak_czesto_spozywa_pani_pan_alkohol\" value=\"rzadziej ni\u017c raz na dwa tygodnie\" data-field-name=\"30_jak_czesto_spozywa_pani_pan_alkohol\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>rzadziej ni\u017c raz na dwa tygodnie<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"30_jak_czesto_spozywa_pani_pan_alkohol\" value=\"cz\u0119\u015bciej ni\u017c raz na dwa tygodnie\" data-field-name=\"30_jak_czesto_spozywa_pani_pan_alkohol\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>cz\u0119\u015bciej ni\u017c raz na dwa tygodnie<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"30_jak_czesto_spozywa_pani_pan_alkohol\" value=\"nie dotyczy\" data-field-name=\"30_jak_czesto_spozywa_pani_pan_alkohol\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>nie dotyczy<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-form-builder__next-page-wrap\">\n\t\t<button type=\"button\" class=\"jet-form-builder__prev-page\" data-to-page=\"4\">Wr\u00f3\u0107 do poprzedniego kroku<\/button>\t\t\t<button class=\"jet-form-builder__next-page\" type=\"button\">Przejd\u017a do nast\u0119pnego kroku<\/button>\n\t<\/div>\n<\/div>\n<div class=\"jet-form-builder-page jet-form-builder-page--hidden\" data-page=\"6\" data-page-offset=\"75\">\n\n\n<h3 class=\"wp-block-heading\">Dane na temat stanu zdrowia, chor\u00f3b i interwencji chirurgicznych<\/h3>\n\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-b3ba8eec-d03c-424c-8c56-642edc923ca0 cb-t9ul1a68\" data-block-id=\"jet-sm-gb-b3ba8eec-d03c-424c-8c56-642edc923ca0\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">31. Czy ma Pani\/Pan biologiczne dziecko? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"31_czy_ma_pani_pan_biologiczne_dziecko\" value=\"tak\" data-field-name=\"31_czy_ma_pani_pan_biologiczne_dziecko\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"31_czy_ma_pani_pan_biologiczne_dziecko\" value=\"nie\" data-field-name=\"31_czy_ma_pani_pan_biologiczne_dziecko\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>nie<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-d90db812-ef94-4702-984f-2f04e536d438 cb-iav9x0jj\" data-block-id=\"jet-sm-gb-d90db812-ef94-4702-984f-2f04e536d438\" ><div  class=\"jet-form-builder-row field-type-checkbox-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">32. Czy urodzi\u0142a Pani dziecko? (dotyczy wy\u0142\u0105cznie kobiet) <\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"32_czy_urodzi_a_pani_dziecko_dotyczy_wy_acznie_kobiet[]\" value=\"tak\" data-field-name=\"32_czy_urodzi_a_pani_dziecko_dotyczy_wy_acznie_kobiet\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>tak<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"32_czy_urodzi_a_pani_dziecko_dotyczy_wy_acznie_kobiet[]\" value=\"nie\" data-field-name=\"32_czy_urodzi_a_pani_dziecko_dotyczy_wy_acznie_kobiet\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>nie<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-4110bc25-33d5-4862-bb72-835414f88a62 cb-ckftvmc7\" data-block-id=\"jet-sm-gb-4110bc25-33d5-4862-bb72-835414f88a62\" ><div  class=\"jet-form-builder-row field-type-checkbox-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">33. Czy Pani miesi\u0105czkuje? (dotyczy wy\u0142\u0105cznie kobiet)<\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"33_czy_pani_miesiaczkuje_dotyczy_wy_acznie_kobiet[]\" value=\"tak, regularnie\" data-field-name=\"33_czy_pani_miesiaczkuje_dotyczy_wy_acznie_kobiet\" data-keep-commas=\"1\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>tak, regularnie<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"33_czy_pani_miesiaczkuje_dotyczy_wy_acznie_kobiet[]\" value=\"tak, nieregularnie\" data-field-name=\"33_czy_pani_miesiaczkuje_dotyczy_wy_acznie_kobiet\" data-keep-commas=\"1\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>tak, nieregularnie<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"33_czy_pani_miesiaczkuje_dotyczy_wy_acznie_kobiet[]\" value=\"nie miesi\u0105czkuj\u0119\" data-field-name=\"33_czy_pani_miesiaczkuje_dotyczy_wy_acznie_kobiet\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>nie miesi\u0105czkuj\u0119<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-88643658-ab22-4826-a927-ba07f67eb786 cb-ni2yd5mt\" data-block-id=\"jet-sm-gb-88643658-ab22-4826-a927-ba07f67eb786\" ><div  class=\"jet-form-builder-row field-type-checkbox-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">34. Czy ma Pani\/Pan wad\u0119 wzroku? (mo\u017cliwo\u015b\u0107 wyboru wi\u0119cej ni\u017c jednej odpowiedzi) <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"34_czy_ma_pani_pan_wade_wzroku[]\" value=\"jestem kr\u00f3tkowidzem (minusy)\" data-field-name=\"34_czy_ma_pani_pan_wade_wzroku\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>jestem kr\u00f3tkowidzem (minusy)<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"34_czy_ma_pani_pan_wade_wzroku[]\" value=\"jestem dalekowidzem (plusy)\" data-field-name=\"34_czy_ma_pani_pan_wade_wzroku\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>jestem dalekowidzem (plusy)<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"34_czy_ma_pani_pan_wade_wzroku[]\" value=\"mam astygmatyzm\" data-field-name=\"34_czy_ma_pani_pan_wade_wzroku\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>mam astygmatyzm<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"34_czy_ma_pani_pan_wade_wzroku[]\" value=\"cierpi\u0119 na daltonizm\" data-field-name=\"34_czy_ma_pani_pan_wade_wzroku\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>cierpi\u0119 na daltonizm<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"34_czy_ma_pani_pan_wade_wzroku[]\" value=\"nie mam wady wzroku\" data-field-name=\"34_czy_ma_pani_pan_wade_wzroku\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>nie mam wady wzroku<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-c2c8688d-6277-4a26-81c1-d408cbd5f61c cb-bflya6ti\" data-block-id=\"jet-sm-gb-c2c8688d-6277-4a26-81c1-d408cbd5f61c\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">35. Czy cierpi lub w przesz\u0142o\u015bci cierpia\u0142a\/cierpia\u0142 Pani\/Pan na chorob\u0119 przewlek\u0142\u0105? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"35_czy_cierpi_lub_w_przesz_osci_cierpia_a_cierpia_pani_pan_na__\" value=\"tak\" data-field-name=\"35_czy_cierpi_lub_w_przesz_osci_cierpia_a_cierpia_pani_pan_na__\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"35_czy_cierpi_lub_w_przesz_osci_cierpia_a_cierpia_pani_pan_na__\" value=\"nie\" data-field-name=\"35_czy_cierpi_lub_w_przesz_osci_cierpia_a_cierpia_pani_pan_na__\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>nie<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-af214c29-26b6-48bf-99e8-e49807a96821\" data-block-id=\"jet-sm-gb-af214c29-26b6-48bf-99e8-e49807a96821\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;tak&quot;,&quot;field&quot;:&quot;35_czy_cierpi_lub_w_przesz_osci_cierpia_a_cierpia_pani_pan_na__&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-9037076f-cace-41c1-bd19-84600bf9a507 cb-o6o2pby0\" data-block-id=\"jet-sm-gb-9037076f-cace-41c1-bd19-84600bf9a507\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Jak\u0105? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz nazw\u0119 choroby\" required=\"required\" name=\"nazwa_choroby_przewleklej\" id=\"nazwa_choroby_przewleklej\" type=\"text\" data-field-name=\"nazwa_choroby_przewleklej\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_F21MDdGJ\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-3a58488d-7345-4db9-9d92-b5d6e988a3b1 cb-qqk9krbt\" data-block-id=\"jet-sm-gb-3a58488d-7345-4db9-9d92-b5d6e988a3b1\" ><div  class=\"jet-form-builder-row field-type-checkbox-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">36. Czy cierpi Pani\/Pan na alergie? Je\u015bli tak, prosz\u0119 doprecyzowa\u0107 (mo\u017cliwo\u015b\u0107 wyboru wi\u0119cej ni\u017c jednej odpowiedzi). <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"36_czy_cierpi_pani_pan_na_alergie_jesli_tak_prosze_doprecyzowac__[]\" value=\"pokarmowe\" data-field-name=\"36_czy_cierpi_pani_pan_na_alergie_jesli_tak_prosze_doprecyzowac__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>pokarmowe<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"36_czy_cierpi_pani_pan_na_alergie_jesli_tak_prosze_doprecyzowac__[]\" value=\"wziewne\" data-field-name=\"36_czy_cierpi_pani_pan_na_alergie_jesli_tak_prosze_doprecyzowac__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>wziewne<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"36_czy_cierpi_pani_pan_na_alergie_jesli_tak_prosze_doprecyzowac__[]\" value=\"kontaktowe\" data-field-name=\"36_czy_cierpi_pani_pan_na_alergie_jesli_tak_prosze_doprecyzowac__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>kontaktowe<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"36_czy_cierpi_pani_pan_na_alergie_jesli_tak_prosze_doprecyzowac__[]\" value=\"iniekcyjne\" data-field-name=\"36_czy_cierpi_pani_pan_na_alergie_jesli_tak_prosze_doprecyzowac__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>iniekcyjne<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"36_czy_cierpi_pani_pan_na_alergie_jesli_tak_prosze_doprecyzowac__[]\" value=\"nie stwierdzono alergii\" data-field-name=\"36_czy_cierpi_pani_pan_na_alergie_jesli_tak_prosze_doprecyzowac__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>nie stwierdzono alergii<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-286ac0fc-2225-47d0-a6b2-a7ee38763108\" data-block-id=\"jet-sm-gb-286ac0fc-2225-47d0-a6b2-a7ee38763108\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;contain&quot;,&quot;value&quot;:&quot;pokarmowe&quot;,&quot;field&quot;:&quot;36_czy_cierpi_pani_pan_na_alergie_jesli_tak_prosze_doprecyzowac__&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-880ce010-57bf-4e84-a7ba-f8167decadf1 cb-b5wzg8un\" data-block-id=\"jet-sm-gb-880ce010-57bf-4e84-a7ba-f8167decadf1\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Jakie alergie pokarmowe? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz nazwy alergii pokarmowych\" required=\"required\" name=\"jakie_alergie_pokarmowe\" id=\"jakie_alergie_pokarmowe\" type=\"text\" data-field-name=\"jakie_alergie_pokarmowe\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_HQI2ZiMX\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-286ac0fc-2225-47d0-a6b2-a7ee38763108\" data-block-id=\"jet-sm-gb-286ac0fc-2225-47d0-a6b2-a7ee38763108\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;contain&quot;,&quot;value&quot;:&quot;wziewne&quot;,&quot;field&quot;:&quot;36_czy_cierpi_pani_pan_na_alergie_jesli_tak_prosze_doprecyzowac__&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-880ce010-57bf-4e84-a7ba-f8167decadf1 cb-jx5cl0bh\" data-block-id=\"jet-sm-gb-880ce010-57bf-4e84-a7ba-f8167decadf1\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Jakie alergie wziewne? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz nazwy alergii wziewnych\" required=\"required\" name=\"jakie_alergie_wziewne\" id=\"jakie_alergie_wziewne\" type=\"text\" data-field-name=\"jakie_alergie_wziewne\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_Moqmb1g7\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-286ac0fc-2225-47d0-a6b2-a7ee38763108\" data-block-id=\"jet-sm-gb-286ac0fc-2225-47d0-a6b2-a7ee38763108\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;contain&quot;,&quot;value&quot;:&quot;kontaktowe&quot;,&quot;field&quot;:&quot;36_czy_cierpi_pani_pan_na_alergie_jesli_tak_prosze_doprecyzowac__&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-880ce010-57bf-4e84-a7ba-f8167decadf1 cb-qh8lrsbt\" data-block-id=\"jet-sm-gb-880ce010-57bf-4e84-a7ba-f8167decadf1\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Jakie alergie kontaktowe? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz nazwy alergii kontaktowych\" required=\"required\" name=\"jakie_alergie_kontaktowe\" id=\"jakie_alergie_kontaktowe\" type=\"text\" data-field-name=\"jakie_alergie_kontaktowe\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_N3mtG4c6\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-286ac0fc-2225-47d0-a6b2-a7ee38763108\" data-block-id=\"jet-sm-gb-286ac0fc-2225-47d0-a6b2-a7ee38763108\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;contain&quot;,&quot;value&quot;:&quot;iniekcyjne&quot;,&quot;field&quot;:&quot;36_czy_cierpi_pani_pan_na_alergie_jesli_tak_prosze_doprecyzowac__&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-880ce010-57bf-4e84-a7ba-f8167decadf1 cb-hjro0ll1\" data-block-id=\"jet-sm-gb-880ce010-57bf-4e84-a7ba-f8167decadf1\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Jakie alergie iniekcyjne? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz nazwy alergii iniekcyjnych\" required=\"required\" name=\"jakie_alergie_iniekcyjne\" id=\"jakie_alergie_iniekcyjne\" type=\"text\" data-field-name=\"jakie_alergie_iniekcyjne\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_8SKELO1g\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-98929238-480f-4e41-95ae-3fe056d3eed3 cb-vt6tjste\" data-block-id=\"jet-sm-gb-98929238-480f-4e41-95ae-3fe056d3eed3\" ><div  data-value=\"[{&quot;id&quot;:6537,&quot;conditions&quot;:[{&quot;__visible&quot;:true,&quot;value&quot;:&quot;&quot;}],&quot;to_set&quot;:&quot;&quot;}]\" class=\"jet-form-builder-row field-type-checkbox-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">37. Czy choruje Pani\/Pan lub chorowa\u0142a\/chorowa\u0142 Pani\/Pan w przesz\u0142o\u015bci na kt\u00f3r\u0105\u015b z nast\u0119puj\u0105cych chor\u00f3b? (mo\u017cliwo\u015b\u0107 wyboru wi\u0119cej ni\u017c jednej odpowiedzi)<\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__[]\" value=\"choroby serca\" data-field-name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>choroby serca<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__[]\" value=\"mia\u017cd\u017cyca t\u0119tnic\" data-field-name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>mia\u017cd\u017cyca t\u0119tnic<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__[]\" value=\"t\u0119tniak aorty\" data-field-name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>t\u0119tniak aorty<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__[]\" value=\"zawa\u0142 serca\" data-field-name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>zawa\u0142 serca<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__[]\" value=\"cukrzyca\" data-field-name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>cukrzyca<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__[]\" value=\"nowotwory z\u0142o\u015bliwe\" data-field-name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>nowotwory z\u0142o\u015bliwe<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__[]\" value=\"udar m\u00f3zgu\" data-field-name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>udar m\u00f3zgu<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__[]\" value=\"stwardnienie rozsiane\" data-field-name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>stwardnienie rozsiane<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__[]\" value=\"choroba Huntingtona\" data-field-name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>choroba Huntingtona<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__[]\" value=\"choroba Alzheimera\" data-field-name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>choroba Alzheimera<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__[]\" value=\"choroba Parkinsona\" data-field-name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>choroba Parkinsona<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__[]\" value=\"zwyrodnienie torbielowate nerek\" data-field-name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>zwyrodnienie torbielowate nerek<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__[]\" value=\"polipowato\u015b\u0107 jelita grubego \" data-field-name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>polipowato\u015b\u0107 jelita grubego <\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__[]\" value=\"inne choroby wrodzone lub dziedziczne\" data-field-name=\"37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>inne choroby wrodzone lub dziedziczne<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-34356312-c458-4edb-90ba-a8b582ac4332\" data-block-id=\"jet-sm-gb-34356312-c458-4edb-90ba-a8b582ac4332\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;contain&quot;,&quot;value&quot;:&quot;nowotwory z\\u0142o\\u015bliwe&quot;,&quot;field&quot;:&quot;37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-b1f9729e-35fb-4ece-98e3-ccf2da80b92e cb-usanx3oi\" data-block-id=\"jet-sm-gb-b1f9729e-35fb-4ece-98e3-ccf2da80b92e\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Je\u015bli tak, to jakie? (nowotwory z\u0142o\u015bliwe) <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz nazwy nowotwor\u00f3w z\u0142o\u015bliwych\" required=\"required\" name=\"jesli_tak_to_jakie_nowotwory_zlosliwe\" id=\"jesli_tak_to_jakie_nowotwory_zlosliwe\" type=\"text\" data-field-name=\"jesli_tak_to_jakie_nowotwory_zlosliwe\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_ejDkJs6q\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-34356312-c458-4edb-90ba-a8b582ac4332\" data-block-id=\"jet-sm-gb-34356312-c458-4edb-90ba-a8b582ac4332\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;contain&quot;,&quot;value&quot;:&quot;inne choroby wrodzone lub dziedziczne&quot;,&quot;field&quot;:&quot;37_czy_choruje_pani_pan_lub_chorowa_a_chorowa_pani_pan_w_przesz__&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-b1f9729e-35fb-4ece-98e3-ccf2da80b92e cb-nublagaz\" data-block-id=\"jet-sm-gb-b1f9729e-35fb-4ece-98e3-ccf2da80b92e\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Je\u015bli tak, to jakie? (inne choroby wrodzone lub dziedziczne) <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz nazwy chor\u00f3b wrodzonych lub dziedzicznych\" required=\"required\" name=\"jesli_tak_to_jakie_inne_choroby_wrodzone_lub_dziedziczne\" id=\"jesli_tak_to_jakie_inne_choroby_wrodzone_lub_dziedziczne\" type=\"text\" data-field-name=\"jesli_tak_to_jakie_inne_choroby_wrodzone_lub_dziedziczne\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_T5wP87Ih\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-98929238-480f-4e41-95ae-3fe056d3eed3 cb-j92kpuey\" data-block-id=\"jet-sm-gb-98929238-480f-4e41-95ae-3fe056d3eed3\" ><div  class=\"jet-form-builder-row field-type-checkbox-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">38. Czy kto\u015b z najbli\u017cszej rodziny (rodzice, rodze\u0144stwo, dzieci) cierpi\/cierpia\u0142 z powodu cierpi\/cierpia\u0142 z powodu nast\u0119puj\u0105cych chor\u00f3b? (mo\u017cliwo\u015b\u0107 wyboru wi\u0119cej ni\u017c jednej odpowiedzi)<\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__[]\" value=\"choroby serca\" data-field-name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>choroby serca<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__[]\" value=\"mia\u017cd\u017cyca t\u0119tnic\" data-field-name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>mia\u017cd\u017cyca t\u0119tnic<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__[]\" value=\"t\u0119tniak aorty\" data-field-name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>t\u0119tniak aorty<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__[]\" value=\"zawa\u0142 serca\" data-field-name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>zawa\u0142 serca<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__[]\" value=\"cukrzyca\" data-field-name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>cukrzyca<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__[]\" value=\"nowotwory z\u0142o\u015bliwe\" data-field-name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>nowotwory z\u0142o\u015bliwe<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__[]\" value=\"udar m\u00f3zgu\" data-field-name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>udar m\u00f3zgu<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__[]\" value=\"stwardnienie rozsiane\" data-field-name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>stwardnienie rozsiane<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__[]\" value=\"choroba Huntingtona\" data-field-name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>choroba Huntingtona<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__[]\" value=\"choroba Alzheimera\" data-field-name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>choroba Alzheimera<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__[]\" value=\"choroba Parkinsona\" data-field-name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>choroba Parkinsona<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__[]\" value=\"zwyrodnienie torbielowate nerek\" data-field-name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>zwyrodnienie torbielowate nerek<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__[]\" value=\"polipowato\u015b\u0107 jelita grubego \" data-field-name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>polipowato\u015b\u0107 jelita grubego <\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__[]\" value=\"inne choroby wrodzone lub dziedziczne\" data-field-name=\"38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>inne choroby wrodzone lub dziedziczne<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-d1921813-fa3d-48e0-a8cf-6afc580ed974\" data-block-id=\"jet-sm-gb-d1921813-fa3d-48e0-a8cf-6afc580ed974\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;contain&quot;,&quot;value&quot;:&quot;nowotwory z\\u0142o\\u015bliwe&quot;,&quot;field&quot;:&quot;38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-6aa86076-4a62-4bfa-95c2-0e74254101b4 cb-rdrg2vtm\" data-block-id=\"jet-sm-gb-6aa86076-4a62-4bfa-95c2-0e74254101b4\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Je\u015bli tak, to jakie? (nowotwory z\u0142o\u015bliwe) <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz nazwy nowotwor\u00f3w z\u0142o\u015bliwych\" required=\"required\" name=\"38_jesli_tak_to_jakie_nowotwory_zlosliwe\" id=\"38_jesli_tak_to_jakie_nowotwory_zlosliwe\" type=\"text\" data-field-name=\"38_jesli_tak_to_jakie_nowotwory_zlosliwe\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_QFzkDmy7\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-d1921813-fa3d-48e0-a8cf-6afc580ed974\" data-block-id=\"jet-sm-gb-d1921813-fa3d-48e0-a8cf-6afc580ed974\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;contain&quot;,&quot;value&quot;:&quot;inne choroby wrodzone lub dziedziczne&quot;,&quot;field&quot;:&quot;38_czy_ktos_z_najblizszej_rodziny_rodzice_rodzenstwo_cierpi_cierpia__&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-6aa86076-4a62-4bfa-95c2-0e74254101b4 cb-qfcu8hc8\" data-block-id=\"jet-sm-gb-6aa86076-4a62-4bfa-95c2-0e74254101b4\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Je\u015bli tak, to jakie? (inne choroby wrodzone lub dziedziczne) <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Wpisz nazwy chor\u00f3b wrodzonych lub dziedzicznych\" required=\"required\" name=\"38_jesli_tak_to_jakie_inne_choroby_wrodzone_lyb_dziedziczne\" id=\"38_jesli_tak_to_jakie_inne_choroby_wrodzone_lyb_dziedziczne\" type=\"text\" data-field-name=\"38_jesli_tak_to_jakie_inne_choroby_wrodzone_lyb_dziedziczne\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_Et1an97B\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-cc5f1a5d-1658-463f-9f12-bd656989b562 cb-qdwobfla\" data-block-id=\"jet-sm-gb-cc5f1a5d-1658-463f-9f12-bd656989b562\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">39. Czy mia\u0142a\/mia\u0142 Pani\/Pan kiedykolwiek wykonywane zabiegi chirurgiczne? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"39_czy_mia_a_mia_pani_pan_kiedykolwiek_wykonywane_zabiegi_chirurgiczne\" value=\"tak\" data-field-name=\"39_czy_mia_a_mia_pani_pan_kiedykolwiek_wykonywane_zabiegi_chirurgiczne\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"39_czy_mia_a_mia_pani_pan_kiedykolwiek_wykonywane_zabiegi_chirurgiczne\" value=\"nie\" data-field-name=\"39_czy_mia_a_mia_pani_pan_kiedykolwiek_wykonywane_zabiegi_chirurgiczne\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>nie<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-42f7cbfc-487c-4367-87b5-d7359b589de8\" data-block-id=\"jet-sm-gb-42f7cbfc-487c-4367-87b5-d7359b589de8\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;tak&quot;,&quot;field&quot;:&quot;39_czy_mia_a_mia_pani_pan_kiedykolwiek_wykonywane_zabiegi_chirurgiczne&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-d16da1bf-5493-4685-b3f6-eda27863c61f cb-itfxqm88\" data-block-id=\"jet-sm-gb-d16da1bf-5493-4685-b3f6-eda27863c61f\" ><div  class=\"jet-form-builder-row field-type-textarea-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Jakie: <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<textarea class=\"jet-form-builder__field textarea-field\" placeholder=\"Podaj swoje zabiegi chirurgiczne\" required=\"required\" name=\"zabiegi_chirurgiczne\" data-field-name=\"zabiegi_chirurgiczne\" id=\"zabiegi_chirurgiczne\" data-jfb-sync=\"null\"><\/textarea>\n\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-form-builder__next-page-wrap\">\n\t\t<button type=\"button\" class=\"jet-form-builder__prev-page\" data-to-page=\"5\">Wr\u00f3\u0107 do poprzedniego kroku<\/button>\t\t\t<button class=\"jet-form-builder__next-page\" type=\"button\">Przejd\u017a do nast\u0119pnego kroku<\/button>\n\t<\/div>\n<\/div>\n<div class=\"jet-form-builder-page jet-form-builder-page--hidden\" data-page=\"7\" data-page-offset=\"75\">\n\n\n<h3 class=\"wp-block-heading\">Dane na temat stosowanej diety<\/h3>\n\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-3aac2eb6-a210-4f4c-b1c8-1444c4b9993c cb-mvqme002\" data-block-id=\"jet-sm-gb-3aac2eb6-a210-4f4c-b1c8-1444c4b9993c\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">40. Jak okre\u015bla Pani\/Pan swoj\u0105 diet\u0119?  <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"40_jak_okresla_pani_pan_swoja_diete\" value=\" ma\u0142o zr\u00f3\u017cnicowana\" data-field-name=\"40_jak_okresla_pani_pan_swoja_diete\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span> ma\u0142o zr\u00f3\u017cnicowana<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"40_jak_okresla_pani_pan_swoja_diete\" value=\"zr\u00f3\u017cnicowana \" data-field-name=\"40_jak_okresla_pani_pan_swoja_diete\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>zr\u00f3\u017cnicowana <\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-7239e847-98b4-4375-a69d-61d99424b676 cb-yq8ot741\" data-block-id=\"jet-sm-gb-7239e847-98b4-4375-a69d-61d99424b676\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">41. Jakie ilo\u015bci pokarm\u00f3w zwykle Pani\/Pan spo\u017cywa? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"br_br_41_jakie_ilosci_pokarmow_zwykle_pani_pan_spozywa_br_br\" value=\"nie dojadam\" data-field-name=\"br_br_41_jakie_ilosci_pokarmow_zwykle_pani_pan_spozywa_br_br\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>nie dojadam<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"br_br_41_jakie_ilosci_pokarmow_zwykle_pani_pan_spozywa_br_br\" value=\"jem w sam raz\" data-field-name=\"br_br_41_jakie_ilosci_pokarmow_zwykle_pani_pan_spozywa_br_br\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>jem w sam raz<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"br_br_41_jakie_ilosci_pokarmow_zwykle_pani_pan_spozywa_br_br\" value=\"przejadam si\u0119\" data-field-name=\"br_br_41_jakie_ilosci_pokarmow_zwykle_pani_pan_spozywa_br_br\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>przejadam si\u0119<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-6e9e4862-e074-401a-85d5-1c4d01bb3968 cb-dyzsf40s\" data-block-id=\"jet-sm-gb-6e9e4862-e074-401a-85d5-1c4d01bb3968\" ><div  class=\"jet-form-builder-row field-type-checkbox-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">42. Czy wykluczy\u0142a\/wykluczy\u0142 Pani\/Pan kt\u00f3ry\u015b z poni\u017cszych sk\u0142adnik\u00f3w ze swojej diety? (mo\u017cliwo\u015b\u0107 wyboru wi\u0119cej ni\u017c jednej odpowiedzi)<\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"42_czy_wykluczy_a_wykluczy_pani_pan_ktorys_z_ponizszych_sk_adnikow__[]\" value=\"cukier\" data-field-name=\"42_czy_wykluczy_a_wykluczy_pani_pan_ktorys_z_ponizszych_sk_adnikow__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>cukier<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"42_czy_wykluczy_a_wykluczy_pani_pan_ktorys_z_ponizszych_sk_adnikow__[]\" value=\"s\u00f3l\" data-field-name=\"42_czy_wykluczy_a_wykluczy_pani_pan_ktorys_z_ponizszych_sk_adnikow__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>s\u00f3l<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"42_czy_wykluczy_a_wykluczy_pani_pan_ktorys_z_ponizszych_sk_adnikow__[]\" value=\"gluten\" data-field-name=\"42_czy_wykluczy_a_wykluczy_pani_pan_ktorys_z_ponizszych_sk_adnikow__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>gluten<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"42_czy_wykluczy_a_wykluczy_pani_pan_ktorys_z_ponizszych_sk_adnikow__[]\" value=\" nabia\u0142\" data-field-name=\"42_czy_wykluczy_a_wykluczy_pani_pan_ktorys_z_ponizszych_sk_adnikow__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span> nabia\u0142<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"42_czy_wykluczy_a_wykluczy_pani_pan_ktorys_z_ponizszych_sk_adnikow__[]\" value=\"mi\u0119so\" data-field-name=\"42_czy_wykluczy_a_wykluczy_pani_pan_ktorys_z_ponizszych_sk_adnikow__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>mi\u0119so<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"42_czy_wykluczy_a_wykluczy_pani_pan_ktorys_z_ponizszych_sk_adnikow__[]\" value=\"inne\" data-field-name=\"42_czy_wykluczy_a_wykluczy_pani_pan_ktorys_z_ponizszych_sk_adnikow__\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>inne<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-92099755-dbb2-45c6-ba4a-35dfcdf2ab6d\" data-block-id=\"jet-sm-gb-92099755-dbb2-45c6-ba4a-35dfcdf2ab6d\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;contain&quot;,&quot;value&quot;:&quot;inne&quot;,&quot;field&quot;:&quot;42_czy_wykluczy_a_wykluczy_pani_pan_ktorys_z_ponizszych_sk_adnikow__&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-9fc67d47-bb4d-4502-bd27-b2a8380845bc cb-xlb4tkkt\" data-block-id=\"jet-sm-gb-9fc67d47-bb4d-4502-bd27-b2a8380845bc\" ><div  class=\"jet-form-builder-row field-type-textarea-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Jakie?<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<textarea class=\"jet-form-builder__field textarea-field\" name=\"42_jakie\" data-field-name=\"42_jakie\" id=\"42_jakie\" data-jfb-sync=\"null\"><\/textarea>\n\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-8bbe3306-4889-4025-8036-c5c55cb01c08 cb-bcsl6ahr\" data-block-id=\"jet-sm-gb-8bbe3306-4889-4025-8036-c5c55cb01c08\" ><div  class=\"jet-form-builder-row field-type-checkbox-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">43. Czy jest Pani\/Pan na specjalnej diecie? (mo\u017cliwo\u015b\u0107 wyboru wi\u0119cej ni\u017c jednej odpowiedzi)<\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"43_czy_jest_pani_pan_na_specjalnej_diecie[]\" value=\"wegetaria\u0144ska \" data-field-name=\"43_czy_jest_pani_pan_na_specjalnej_diecie\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>wegetaria\u0144ska <\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"43_czy_jest_pani_pan_na_specjalnej_diecie[]\" value=\"wega\u0144ska\" data-field-name=\"43_czy_jest_pani_pan_na_specjalnej_diecie\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>wega\u0144ska<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"43_czy_jest_pani_pan_na_specjalnej_diecie[]\" value=\"odchudzaj\u0105ca\" data-field-name=\"43_czy_jest_pani_pan_na_specjalnej_diecie\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>odchudzaj\u0105ca<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"43_czy_jest_pani_pan_na_specjalnej_diecie[]\" value=\"niskot\u0142uszczowa\" data-field-name=\"43_czy_jest_pani_pan_na_specjalnej_diecie\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>niskot\u0142uszczowa<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"43_czy_jest_pani_pan_na_specjalnej_diecie[]\" value=\"niskow\u0119glowodanowa\" data-field-name=\"43_czy_jest_pani_pan_na_specjalnej_diecie\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>niskow\u0119glowodanowa<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"43_czy_jest_pani_pan_na_specjalnej_diecie[]\" value=\"inna\" data-field-name=\"43_czy_jest_pani_pan_na_specjalnej_diecie\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" data-default-val=\"[&quot;&quot;]\"><span>inna<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-4310ac26-cefd-416d-9763-e8d90537ea49\" data-block-id=\"jet-sm-gb-4310ac26-cefd-416d-9763-e8d90537ea49\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;contain&quot;,&quot;value&quot;:&quot;inna&quot;,&quot;field&quot;:&quot;43_czy_jest_pani_pan_na_specjalnej_diecie&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-91f4d456-63bb-4d58-bc6a-67dab85d706f cb-ub3j58m7\" data-block-id=\"jet-sm-gb-91f4d456-63bb-4d58-bc6a-67dab85d706f\" ><div  class=\"jet-form-builder-row field-type-textarea-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Jaka: <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<textarea class=\"jet-form-builder__field textarea-field\" placeholder=\"Podaj nazw\u0119 swojej diety\" required=\"required\" name=\"43_inna\" data-field-name=\"43_inna\" id=\"43_inna\" data-jfb-sync=\"null\"><\/textarea>\n\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-9ba0c994-24b5-4cab-a2c1-14260d6e4c22 cb-a147lke5\" data-block-id=\"jet-sm-gb-9ba0c994-24b5-4cab-a2c1-14260d6e4c22\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">44. Czy \u017cywi si\u0119 Pani\/Pan poza domem?  <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"44_czy_zywi_sie_pani_pan_poza_domem\" value=\"tak, codziennie \" data-field-name=\"44_czy_zywi_sie_pani_pan_poza_domem\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak, codziennie<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"44_czy_zywi_sie_pani_pan_poza_domem\" value=\"5-6 razy w tygodniu\" data-field-name=\"44_czy_zywi_sie_pani_pan_poza_domem\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>5-6 razy w tygodniu<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"44_czy_zywi_sie_pani_pan_poza_domem\" value=\"3-4 razy w tygodniu\" data-field-name=\"44_czy_zywi_sie_pani_pan_poza_domem\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>3-4 razy w tygodniu<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"44_czy_zywi_sie_pani_pan_poza_domem\" value=\"1-2 razy w tygodniu\" data-field-name=\"44_czy_zywi_sie_pani_pan_poza_domem\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>1-2 razy w tygodniu<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"44_czy_zywi_sie_pani_pan_poza_domem\" value=\"1-2 razy w miesi\u0105cu lub rzadziej \" data-field-name=\"44_czy_zywi_sie_pani_pan_poza_domem\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>1-2 razy w miesi\u0105cu lub rzadziej <\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"44_czy_zywi_sie_pani_pan_poza_domem\" value=\"rzadko\" data-field-name=\"44_czy_zywi_sie_pani_pan_poza_domem\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>rzadko<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"44_czy_zywi_sie_pani_pan_poza_domem\" value=\"wcale\" data-field-name=\"44_czy_zywi_sie_pani_pan_poza_domem\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>wcale<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-c185abe0-82db-407f-80a4-26f9bb7cbdad cb-irhqe46l\" data-block-id=\"jet-sm-gb-c185abe0-82db-407f-80a4-26f9bb7cbdad\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">45. Jaki t\u0142uszcz Pani\/Pan stosuje?  <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"45_jaki_t_uszcz_pani_pan_stosuje\" value=\"g\u0142\u00f3wnie ro\u015blinny\" data-field-name=\"45_jaki_t_uszcz_pani_pan_stosuje\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>g\u0142\u00f3wnie ro\u015blinny<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"45_jaki_t_uszcz_pani_pan_stosuje\" value=\"g\u0142\u00f3wnie zwierz\u0119cy\" data-field-name=\"45_jaki_t_uszcz_pani_pan_stosuje\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>g\u0142\u00f3wnie zwierz\u0119cy<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"45_jaki_t_uszcz_pani_pan_stosuje\" value=\"mniej wi\u0119cej po r\u00f3wno ro\u015blinny i zwierz\u0119cy\" data-field-name=\"45_jaki_t_uszcz_pani_pan_stosuje\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>mniej wi\u0119cej po r\u00f3wno ro\u015blinny i zwierz\u0119cy<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-a8b2f436-062b-4c8c-a5a1-06c5afbaf398 cb-rpq03e1b\" data-block-id=\"jet-sm-gb-a8b2f436-062b-4c8c-a5a1-06c5afbaf398\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">46. Jaki rodzaj pieczywa Pani\/Pan zwykle spo\u017cywa?  <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"46_jaki_rodzaj_pieczywa_pani_pan_zwykle_spozywa\" value=\"g\u0142\u00f3wnie jasne (pszenne)\" data-field-name=\"46_jaki_rodzaj_pieczywa_pani_pan_zwykle_spozywa\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>g\u0142\u00f3wnie jasne (pszenne)<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"46_jaki_rodzaj_pieczywa_pani_pan_zwykle_spozywa\" value=\"g\u0142\u00f3wnie ciemne (\u017cytnie)\" data-field-name=\"46_jaki_rodzaj_pieczywa_pani_pan_zwykle_spozywa\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>g\u0142\u00f3wnie ciemne (\u017cytnie)<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"46_jaki_rodzaj_pieczywa_pani_pan_zwykle_spozywa\" value=\"mniej wi\u0119cej po r\u00f3wno jasne i ciemne\" data-field-name=\"46_jaki_rodzaj_pieczywa_pani_pan_zwykle_spozywa\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>mniej wi\u0119cej po r\u00f3wno jasne i ciemne<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"46_jaki_rodzaj_pieczywa_pani_pan_zwykle_spozywa\" value=\"\u017cadne \" data-field-name=\"46_jaki_rodzaj_pieczywa_pani_pan_zwykle_spozywa\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>\u017cadne <\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-393437b5-9ebd-467a-af8f-1bafbc26a536 cb-d3kfvqky\" data-block-id=\"jet-sm-gb-393437b5-9ebd-467a-af8f-1bafbc26a536\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">47. Ile p\u0142yn\u00f3w dziennie Pani\/Pan przyjmuje?  <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"47_ile_p_ynow_dziennie_pani_pan_przyjmuje\" value=\"mniej ni\u017c 0,5l\" data-field-name=\"47_ile_p_ynow_dziennie_pani_pan_przyjmuje\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>mniej ni\u017c 0,5l<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"47_ile_p_ynow_dziennie_pani_pan_przyjmuje\" value=\"0,5-1l\" data-field-name=\"47_ile_p_ynow_dziennie_pani_pan_przyjmuje\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>0,5-1l<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"47_ile_p_ynow_dziennie_pani_pan_przyjmuje\" value=\"1-1,5l\" data-field-name=\"47_ile_p_ynow_dziennie_pani_pan_przyjmuje\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>1-1,5l<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"47_ile_p_ynow_dziennie_pani_pan_przyjmuje\" value=\"1,5-2l\" data-field-name=\"47_ile_p_ynow_dziennie_pani_pan_przyjmuje\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>1,5-2l<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"47_ile_p_ynow_dziennie_pani_pan_przyjmuje\" value=\"wi\u0119cej ni\u017c &gt;2l\" data-field-name=\"47_ile_p_ynow_dziennie_pani_pan_przyjmuje\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>wi\u0119cej ni\u017c &gt;2l<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-a60616e0-7f08-4d96-8bda-c2b5a6180087 cb-mz19dp6x\" data-block-id=\"jet-sm-gb-a60616e0-7f08-4d96-8bda-c2b5a6180087\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">48. Czy pije Pani\/Pan s\u0142odkie napoje gazowane?  <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"48_czy_pije_pani_pan_s_odkie_napoje_gazowane\" value=\"nie pij\u0119\" data-field-name=\"48_czy_pije_pani_pan_s_odkie_napoje_gazowane\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>nie pij\u0119<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"48_czy_pije_pani_pan_s_odkie_napoje_gazowane\" value=\"tak, codziennie\" data-field-name=\"48_czy_pije_pani_pan_s_odkie_napoje_gazowane\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak, codziennie<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"48_czy_pije_pani_pan_s_odkie_napoje_gazowane\" value=\"tak, 5-6 razy w tygodniu\" data-field-name=\"48_czy_pije_pani_pan_s_odkie_napoje_gazowane\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak, 5-6 razy w tygodniu<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"48_czy_pije_pani_pan_s_odkie_napoje_gazowane\" value=\"tak, 3-4 razy w tygodniu\" data-field-name=\"48_czy_pije_pani_pan_s_odkie_napoje_gazowane\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak, 3-4 razy w tygodniu<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"48_czy_pije_pani_pan_s_odkie_napoje_gazowane\" value=\"tak, 1-2 razy w tygodniu\" data-field-name=\"48_czy_pije_pani_pan_s_odkie_napoje_gazowane\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak, 1-2 razy w tygodniu<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"48_czy_pije_pani_pan_s_odkie_napoje_gazowane\" value=\"tak, 1-2 razy w miesi\u0105cu lub rzadziej\" data-field-name=\"48_czy_pije_pani_pan_s_odkie_napoje_gazowane\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak, 1-2 razy w miesi\u0105cu lub rzadziej<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-c5117410-6551-4583-8a5d-248d58ebb446 cb-hs3umv93\" data-block-id=\"jet-sm-gb-c5117410-6551-4583-8a5d-248d58ebb446\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">49. Czy s\u0142odzi Pani\/Pan napoje? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"49_czy_s_odzi_pani_pan_napoje\" value=\"tak, zwykle u\u017cywam du\u017co cukru\" data-field-name=\"49_czy_s_odzi_pani_pan_napoje\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak, zwykle u\u017cywam du\u017co cukru<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"49_czy_s_odzi_pani_pan_napoje\" value=\"tak, zwykle s\u0142odz\u0119 umiarkowanie\" data-field-name=\"49_czy_s_odzi_pani_pan_napoje\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak, zwykle s\u0142odz\u0119 umiarkowanie<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"49_czy_s_odzi_pani_pan_napoje\" value=\"rzadko s\u0142odz\u0119\" data-field-name=\"49_czy_s_odzi_pani_pan_napoje\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>rzadko s\u0142odz\u0119<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"49_czy_s_odzi_pani_pan_napoje\" value=\"w og\u00f3le nie s\u0142odz\u0119\" data-field-name=\"49_czy_s_odzi_pani_pan_napoje\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>w og\u00f3le nie s\u0142odz\u0119<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-01856d3d-72c5-419b-9d97-b8fd704ab75c cb-kbo8o6j0\" data-block-id=\"jet-sm-gb-01856d3d-72c5-419b-9d97-b8fd704ab75c\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">50. Czy je Pani\/Pan przek\u0105ski s\u0142odkie?  <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"50_czy_je_pani_pan_przekaski_s_odkie\" value=\"nie jem\" data-field-name=\"50_czy_je_pani_pan_przekaski_s_odkie\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>nie jem<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"50_czy_je_pani_pan_przekaski_s_odkie\" value=\"tak, codziennie\" data-field-name=\"50_czy_je_pani_pan_przekaski_s_odkie\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak, codziennie<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"50_czy_je_pani_pan_przekaski_s_odkie\" value=\"tak, 5-6 razy w tygodniu\" data-field-name=\"50_czy_je_pani_pan_przekaski_s_odkie\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak, 5-6 razy w tygodniu<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"50_czy_je_pani_pan_przekaski_s_odkie\" value=\"tak, 3-4 razy w tygodniu\" data-field-name=\"50_czy_je_pani_pan_przekaski_s_odkie\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak, 3-4 razy w tygodniu<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"50_czy_je_pani_pan_przekaski_s_odkie\" value=\"tak, 1-2 razy w tygodniu\" data-field-name=\"50_czy_je_pani_pan_przekaski_s_odkie\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak, 1-2 razy w tygodniu<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"50_czy_je_pani_pan_przekaski_s_odkie\" value=\"tak, 1-2 razy w miesi\u0105cu lub rzadziej\" data-field-name=\"50_czy_je_pani_pan_przekaski_s_odkie\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak, 1-2 razy w miesi\u0105cu lub rzadziej<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-61904e9e-2958-48c6-bc2a-34a957c69904 cb-zl5yboxb\" data-block-id=\"jet-sm-gb-61904e9e-2958-48c6-bc2a-34a957c69904\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">51. Czy je Pani\/Pan przek\u0105ski s\u0142one?  <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"51_czy_je_pani_pan_przekaski_s_one\" value=\"nie jem\" data-field-name=\"51_czy_je_pani_pan_przekaski_s_one\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>nie jem<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"51_czy_je_pani_pan_przekaski_s_one\" value=\"tak, codziennie\" data-field-name=\"51_czy_je_pani_pan_przekaski_s_one\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak, codziennie<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"51_czy_je_pani_pan_przekaski_s_one\" value=\"tak, 5-6 razy w tygodniu\" data-field-name=\"51_czy_je_pani_pan_przekaski_s_one\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak, 5-6 razy w tygodniu<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"51_czy_je_pani_pan_przekaski_s_one\" value=\"tak, 3-4 razy w tygodniu\" data-field-name=\"51_czy_je_pani_pan_przekaski_s_one\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak, 3-4 razy w tygodniu<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"51_czy_je_pani_pan_przekaski_s_one\" value=\"tak, 1-2 razy w tygodniu\" data-field-name=\"51_czy_je_pani_pan_przekaski_s_one\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak, 1-2 razy w tygodniu<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"51_czy_je_pani_pan_przekaski_s_one\" value=\"tak, 1-2 razy w miesi\u0105cu lub rzadziej\" data-field-name=\"51_czy_je_pani_pan_przekaski_s_one\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak, 1-2 razy w miesi\u0105cu lub rzadziej<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-8452c60c-0ce5-4f60-96f3-65d33ae4c30a cb-gy6l1ybf\" data-block-id=\"jet-sm-gb-8452c60c-0ce5-4f60-96f3-65d33ae4c30a\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">52. Czy soli Pani\/Pan potrawy?  <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"52_czy_soli_pani_pan_potrawy\" value=\"tak, zwykle stosuj\u0119 du\u017co soli\" data-field-name=\"52_czy_soli_pani_pan_potrawy\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak, zwykle stosuj\u0119 du\u017co soli<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"52_czy_soli_pani_pan_potrawy\" value=\"tak, zwykle stosuj\u0119 umiarkowane ilo\u015bci soli\" data-field-name=\"52_czy_soli_pani_pan_potrawy\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak, zwykle stosuj\u0119 umiarkowane ilo\u015bci soli<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"52_czy_soli_pani_pan_potrawy\" value=\"rzadko sol\u0119\" data-field-name=\"52_czy_soli_pani_pan_potrawy\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>rzadko sol\u0119<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"52_czy_soli_pani_pan_potrawy\" value=\"w og\u00f3le nie sol\u0119 \" data-field-name=\"52_czy_soli_pani_pan_potrawy\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>w og\u00f3le nie sol\u0119 <\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-7f3b91cf-f80d-4296-ab01-8516a3013a3a cb-bqjez0bq\" data-block-id=\"jet-sm-gb-7f3b91cf-f80d-4296-ab01-8516a3013a3a\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">53. Czy przyjmuje Pani\/Pan leki? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"53_czy_przyjmuje_pani_pan_leki\" value=\"tak\" data-field-name=\"53_czy_przyjmuje_pani_pan_leki\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"53_czy_przyjmuje_pani_pan_leki\" value=\"nie\" data-field-name=\"53_czy_przyjmuje_pani_pan_leki\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>nie<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-9968f614-3347-4f7d-9176-f1884db85b02\" data-block-id=\"jet-sm-gb-9968f614-3347-4f7d-9176-f1884db85b02\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;tak&quot;,&quot;field&quot;:&quot;53_czy_przyjmuje_pani_pan_leki&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-9213ff58-81d5-4ec4-8caa-4ec65ee7f9cc cb-m8c1nbsy\" data-block-id=\"jet-sm-gb-9213ff58-81d5-4ec4-8caa-4ec65ee7f9cc\" ><div  class=\"jet-form-builder-row field-type-textarea-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Je\u015bli tak, to jakie... <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<textarea class=\"jet-form-builder__field textarea-field\" placeholder=\"Podaj nazwy lek\u00f3w\" required=\"required\" name=\"leki\" data-field-name=\"leki\" id=\"leki\" data-jfb-sync=\"null\"><\/textarea>\n\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-6e186679-102a-490c-9236-3e4c128479bc cb-l4321ywv\" data-block-id=\"jet-sm-gb-6e186679-102a-490c-9236-3e4c128479bc\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">54. Czy stosuje Pani\/Pan suplementy diety? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"54_czy_stosuje_pani_pan_suplementy_diety\" value=\"tak\" data-field-name=\"54_czy_stosuje_pani_pan_suplementy_diety\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"54_czy_stosuje_pani_pan_suplementy_diety\" value=\"nie\" data-field-name=\"54_czy_stosuje_pani_pan_suplementy_diety\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>nie<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-aa1eb446-7e63-4c3a-933e-407e48627f58\" data-block-id=\"jet-sm-gb-aa1eb446-7e63-4c3a-933e-407e48627f58\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;tak&quot;,&quot;field&quot;:&quot;54_czy_stosuje_pani_pan_suplementy_diety&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-df7d8431-6613-4bba-8573-923adc922f95 cb-hnj1sgk2\" data-block-id=\"jet-sm-gb-df7d8431-6613-4bba-8573-923adc922f95\" ><div  class=\"jet-form-builder-row field-type-textarea-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Je\u015bli tak, to jakie... <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<textarea class=\"jet-form-builder__field textarea-field\" placeholder=\"Podaj nazwy suplement\u00f3w diety\" required=\"required\" name=\"suplementy_diety\" data-field-name=\"suplementy_diety\" id=\"suplementy_diety\" data-jfb-sync=\"null\"><\/textarea>\n\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-c38cc084-77e5-4c70-ab70-fe6d1412d508 cb-om7ro3x3\" data-block-id=\"jet-sm-gb-c38cc084-77e5-4c70-ab70-fe6d1412d508\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">55. Czy s\u0105 jeszcze jakie\u015b inne istotne informacje, kt\u00f3re Pani\/Pana dotycz\u0105, a kt\u00f3re chcia\u0142aby\/chcia\u0142by nam Pani\/Pan przekaza\u0107? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"55_czy_sa_jeszcze_jakies_inne_istotne_informacje_ktore_pani_pana__\" value=\"tak\" data-field-name=\"55_czy_sa_jeszcze_jakies_inne_istotne_informacje_ktore_pani_pana__\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>tak<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"55_czy_sa_jeszcze_jakies_inne_istotne_informacje_ktore_pani_pana__\" value=\"nie\" data-field-name=\"55_czy_sa_jeszcze_jakies_inne_istotne_informacje_ktore_pani_pana__\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>nie<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-a093b5b3-cc0e-439c-a5c1-05cb98551176\" data-block-id=\"jet-sm-gb-a093b5b3-cc0e-439c-a5c1-05cb98551176\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;tak&quot;,&quot;field&quot;:&quot;55_czy_sa_jeszcze_jakies_inne_istotne_informacje_ktore_pani_pana__&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-eddce20c-3be9-4bf1-aee3-538c7a0749b5 cb-qirt6p1a\" data-block-id=\"jet-sm-gb-eddce20c-3be9-4bf1-aee3-538c7a0749b5\" ><div  class=\"jet-form-builder-row field-type-textarea-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Je\u015bli tak, to jakie...  <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<textarea class=\"jet-form-builder__field textarea-field\" placeholder=\"Podaj dodatkowe informacje\" required=\"required\" name=\"dodatkowe_informacje\" data-field-name=\"dodatkowe_informacje\" id=\"dodatkowe_informacje\" data-jfb-sync=\"null\"><\/textarea>\n\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-be05cd21-505c-4d0d-a719-fbf9d89e215a cb-ioeskbrl\" data-block-id=\"jet-sm-gb-be05cd21-505c-4d0d-a719-fbf9d89e215a\" ><div  class=\"jet-form-builder-row field-type-checkbox-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Zgoda na przetwarzanie danych osobowych <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"zgoda_na_przetwarzanie_danych_osobowych\" value=\"zgoda\" data-field-name=\"zgoda_na_przetwarzanie_danych_osobowych\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;&quot;]\"><span>Wyra\u017cam zgod\u0119 na przetwarzanie przez Instytut Chemii Bioorganicznej Polskiej Akademii Nauk Pozna\u0144skie Centrum Superkomputerowo-Sieciowe z siedzib\u0105 w Poznaniu przy ul. Noskowskiego 12\/14 moich danych osobowych podanych w formularzu na potrzeby projektu Genomika dla Polski <a href=\"https:\/\/genomikadlapolski.pl\/wp-content\/uploads\/2026\/05\/klauzula-informacyjna-v.1.pdf\" target=\"_blank\"> Klauzula informacyjna <\/a><\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n\n<div class=\"jet-form-builder-row captcha-token-container\" data-validation-type=\"inherit\">\n\t<input type=\"hidden\" class=\"captcha-token\" name=\"_captcha_token\" value=\"\" data-jfb-sync required=\"required\">\n<\/div>\n\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-bb970411-3d1a-4b7c-a29b-c58ab24d91c1 cb-rm0dw3zn\" data-block-id=\"jet-sm-gb-bb970411-3d1a-4b7c-a29b-c58ab24d91c1\" ><div  class=\"jet-form-builder-row field-type-submit-field\" >\n\t<div data-type=\"submit\" class=\"jet-form-builder__action-button-wrapper jet-form-builder__submit-wrap has-prev\">\n<button type=\"button\" class=\"jet-form-builder__prev-page\" data-to-page=\"6\">Wr\u00f3\u0107 do poprzedniego kroku<\/button>\t<button class=\"jet-form-builder__action-button jet-form-builder__submit submit-type-reload\" type=\"submit\">Zako\u0144cz i wy\u015blij ankiet\u0119<\/button>\n\t<\/div>\n\t\n<\/div><\/div>\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n<\/div>\t<div class=\"jet-form-builder-messages-wrap\" data-form-id=\"1825\"><\/div>\n<\/form>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Kwestionariusz Uczestnika Badania Niniejszy kwestionariusz powsta\u0142 na potrzeby projektu \u201cGenomika dla Polski\u201d (G4PL). Jego celem jest zebranie informacji pozwalaj\u0105cych na charakterystyk\u0119 Uczestnika badania w zakresie identyfikacji narodowo-etnicznej oraz og\u00f3lnego stanu zdrowia. Dane uczestnika Wype\u0142nij pola formularza, aby przej\u015b\u0107 do ankiety Dane osobowe Imi\u0119 * P\u0142e\u0107 przy urodzeniu * Twoja p\u0142e\u0107kobietam\u0119\u017cczyzna Nazwisko * Rok urodzenia * [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_jet_sm_ready_style":"","_jet_sm_style":"","_jet_sm_controls_values":"","_jet_sm_fonts_collection":"","_jet_sm_fonts_links":"","footnotes":""},"class_list":["post-1855","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/genomikadlapolski.pl\/en\/wp-json\/wp\/v2\/pages\/1855","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/genomikadlapolski.pl\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/genomikadlapolski.pl\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/genomikadlapolski.pl\/en\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/genomikadlapolski.pl\/en\/wp-json\/wp\/v2\/comments?post=1855"}],"version-history":[{"count":191,"href":"https:\/\/genomikadlapolski.pl\/en\/wp-json\/wp\/v2\/pages\/1855\/revisions"}],"predecessor-version":[{"id":3478,"href":"https:\/\/genomikadlapolski.pl\/en\/wp-json\/wp\/v2\/pages\/1855\/revisions\/3478"}],"wp:attachment":[{"href":"https:\/\/genomikadlapolski.pl\/en\/wp-json\/wp\/v2\/media?parent=1855"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}