{"id":3908,"date":"2026-09-02T10:09:40","date_gmt":"2026-09-02T08:09:40","guid":{"rendered":"https:\/\/genomikadlapolski.pl\/?page_id=3908"},"modified":"2026-09-02T13:34:43","modified_gmt":"2026-09-02T11:34:43","slug":"kwestionariusz-uczestnika-badania-v-2","status":"publish","type":"page","link":"https:\/\/genomikadlapolski.pl\/en\/kwestionariusz-uczestnika-badania-v-2\/","title":{"rendered":"Kwestionariusz uczestnika badania v.2"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"3908\" class=\"elementor elementor-3908\" 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). Jego celem jest zebranie informacji pozwalaj\u0105cych na charakterystyk\u0119 Uczestnika badania w zakresie identyfikacji narodowo-etnicznej oraz og\u00f3lnego stanu zdrowia.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-a616837 e-con-full formularz2 e-flex e-con e-child\" data-id=\"a616837\" 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-d11bfc5 elementor-widget elementor-widget-jet-form-builder-form\" data-id=\"d11bfc5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"jet-form-builder-form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<link rel='stylesheet' id='wp-block-library-css' href='https:\/\/genomikadlapolski.pl\/wp-includes\/css\/dist\/block-library\/common.min.css?ver=0c535e06aa82b583246ec204c15d2302' media='all' \/>\n<link rel=\"preconnect\" href=\"https:\/\/fonts.gstatic.com\"><style id=\"jet-form-builder-3936-inline-css\">.jet-sm-gb-64a9b4d0-5da2-4a84-9415-97d8b3775b45 .jet-form-builder__desc{background-color: ;} .jet-sm-gb-bd448b93-63fc-45a7-ab07-a0af0dcf9197 .jet-form-builder__desc{background-color: ;} .jet-sm-gb-6e0a1d72-f292-43b7-bcae-b0cf5119de82 .jet-form-builder__desc{background-color: ;} .jet-sm-gb-1bb04464-042a-4a8a-8cfc-8030124bbc04 .jet-form-builder__desc{background-color: ;} .jet-sm-gb-d90db812-ef94-4702-984f-2f04e536d438 .jet-form-builder__desc{background-color: ;} .jet-sm-gb-4110bc25-33d5-4862-bb72-835414f88a62 .jet-form-builder__desc{background-color: ;} <\/style><form  class=\"jet-form-builder layout-column submit-type-reload\" action=\"https:\/\/genomikadlapolski.pl\/en\/wp-json\/wp\/v2\/pages\/3908\/?t8G86M=qP02D03R84ci&amp;method=reload\" method=\"POST\" data-form-id=\"3936\" data-layout=\"column\" enctype=\"multipart\/form-data\" novalidate=\"null\" ssr_validation_method=\"rest\"><input type=\"hidden\" id=\"_wpnonce_3936\" name=\"_wpnonce\" value=\"944de0620e\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/3908\" \/>\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=\"3936\">\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\/3908\/\">\n<input type=\"hidden\" class=\"jet-form-builder__field hidden-field\" name=\"__queried_post_id\" data-field-name=\"__queried_post_id\" value=\"3908\">\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  data-validation-type=\"advanced\" 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_ynDSV3uB\">\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_OIuN0pf1\">\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_nVA1at03\">\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>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><\/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_xn0tTVz4\">\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=\"v2-2 has-custom-css wp-custom-css-a89d1da2 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_DlU54aCb\">\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-972336a9-0114-4af8-9bca-784fb344c855\" data-block-id=\"jet-sm-gb-972336a9-0114-4af8-9bca-784fb344c855\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;Polska&quot;,&quot;field&quot;:&quot;1_jaki_jest_pani_pana_kraj_urodzenia_wed_ug_aktualnych_granic&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<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_5fahUkcE\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n\n<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>\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_KnBMwtyx\">\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_8SKyEr9o\">\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_ZSIejmbh\">\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_7aV6beC9\">\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_zQVP7xvu\">\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_RYTUjpN3\">\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_kr8nmcdB\">\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_MFU5fKwt\">\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_IolWnq2c\">\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_B0xwerPv\">\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=\"Nieznane\" >Nieznane<\/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=\"W\u0119grzy\" >W\u0119grzy<\/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=\"Nieznane\" >Nieznane<\/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=\"W\u0119grzy\" >W\u0119grzy<\/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=\"Nieznane\" >Nieznane<\/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=\"W\u0119grzy\" >W\u0119grzy<\/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=\"Nieznane\" >Nieznane<\/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=\"W\u0119grzy\" >W\u0119grzy<\/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=\"Nieznane\" >Nieznane<\/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=\"W\u0119grzy\" >W\u0119grzy<\/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=\"Nieznane\" >Nieznane<\/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=\"W\u0119grzy\" >W\u0119grzy<\/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-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_DgUW2VCd\">\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_4u9bPlQp\">\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_2ziX3wcn\">\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-1bb04464-042a-4a8a-8cfc-8030124bbc04\" data-block-id=\"jet-sm-gb-1bb04464-042a-4a8a-8cfc-8030124bbc04\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;kobieta&quot;,&quot;field&quot;:&quot;plec&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\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<\/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_PDXVZ9KG\">\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_1zrpWBFx\">\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_nzsFHt5b\">\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_IaxtrCUA\">\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_pdAmDiUg\">\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_QPcjOm6R\">\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_e12XS3xi\">\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_E8aCW7FH\">\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_uSFdYbzN\">\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-efdc6034-acbc-4c8d-b198-a4e7b697a141\" data-block-id=\"jet-sm-gb-efdc6034-acbc-4c8d-b198-a4e7b697a141\" ><div  class=\"jet-form-builder-row field-type-media-field\" >\n<template class=\"jet-form-builder__preview-template\"><div class=\"jet-form-builder-file-upload__file\" data-file=\"%file_url%\">\n\t<!-- preview -->\n\t<!-- field -->\n\t<div class=\"jet-form-builder-file-upload__file-remove\" data-file-name=\"%file_name%\">\n\t\t<svg width=\"22\" height=\"22\" viewBox=\"0 0 14 15\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n\t\t\t<path d=\"M4.375 7H6.125V12.25H4.375V7ZM7.875 7H9.625V12.25H7.875V7ZM10.5 1.75C10.5 1.51302 10.4134 1.30794 10.2402 1.13477C10.0762 0.961589 9.87109 0.875 9.625 0.875H4.375C4.12891 0.875 3.91927 0.961589 3.74609 1.13477C3.58203 1.30794 3.5 1.51302 3.5 1.75V3.5H0V5.25H0.875V14C0.875 14.237 0.957031 14.4421 1.12109 14.6152C1.29427 14.7884 1.50391 14.875 1.75 14.875H12.25C12.4961 14.875 12.7012 14.7884 12.8652 14.6152C13.0384 14.4421 13.125 14.237 13.125 14V5.25H14V3.5H10.5V1.75ZM5.25 2.625H8.75V3.5H5.25V2.625ZM11.375 5.25V13.125H2.625V5.25H11.375Z\"><\/path>\n\t\t<\/svg>\n\t<\/div>\n\t<span\n\t\t\tclass=\"jet-form-builder-file-upload__file-invalid-marker\"\n\t\t\tstyle=\"display: none\">\n\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 20 20\" fill=\"currentcolor\" width=\"24\" height=\"24\" aria-hidden=\"true\" focusable=\"false\"><path d=\"M10 2c4.42 0 8 3.58 8 8s-3.58 8-8 8-8-3.58-8-8 3.58-8 8-8zm1.13 9.38l.35-6.46H8.52l.35 6.46h2.26zm-.09 3.36c.24-.23.37-.55.37-.96 0-.42-.12-.74-.36-.97s-.59-.35-1.06-.35-.82.12-1.07.35-.37.55-.37.97c0 .41.13.73.38.96.26.23.61.34 1.06.34s.8-.11 1.05-.34z\"><\/path><\/svg>\n\t<\/span>\n\t<!-- footer -->\n<\/div>\n<\/template><div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">56. Czy posiadasz dokumentacj\u0119 medyczn\u0105 dotycz\u0105c\u0105 diagnostyki genetycznej, kt\u00f3r\u0105 chcesz si\u0119 podzieli\u0107?<\/div><\/div><div class=\"jet-form-builder__field-wrap jet-form-builder-file-upload\">\n\t\t<div class=\"jet-form-builder-file-upload__content\">\n\t\t<div class=\"jet-form-builder-file-upload__loader\"><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"38\" height=\"38\" viewBox=\"0 0 38 38\" stroke=\"#fff\"><g fill=\"none\" fill-rule=\"evenodd\"><g transform=\"translate(1 1)\" stroke-width=\"2\"><circle stroke-opacity=\".5\" cx=\"18\" cy=\"18\" r=\"18\"\/><path d=\"M36 18c0-9.94-8.06-18-18-18\" transform=\"rotate(137.826 18 18)\"><animateTransform attributeName=\"transform\" type=\"rotate\" from=\"0 18 18\" to=\"360 18 18\" dur=\"1s\" repeatCount=\"indefinite\"\/><\/path><\/g><\/g><\/svg><\/div>\t\t<div class=\"jet-form-builder-file-upload__files\" data-args=\"{&quot;max_files&quot;:1,&quot;max_size&quot;:20971520}\">\n\t\t\t\t\t<\/div>\n\t<\/div>\n\t<div class=\"jet-form-builder-file-upload__fields\">\n\t\t<input class=\"jet-form-builder__field file-field jet-form-builder-file-upload__input\" name=\"56_czy_posiadasz_dokumentacje_medyczna_dotyczaca_diagnostyki_genetycznej__\" data-field-name=\"56_czy_posiadasz_dokumentacje_medyczna_dotyczaca_diagnostyki_genetycznej__\" type=\"file\" data-form_id=\"3936\" id=\"56_czy_posiadasz_dokumentacje_medyczna_dotyczaca_diagnostyki_genetycznej__\" data-jfb-sync=\"null\" data-max_size=\"20971520\">\n\t<\/div>\n\t<div class=\"jet-form-builder-file-upload__message\"><small>Maximum file size: 20 MB<\/small><\/div>\n\t<div class=\"jet-form-builder-file-upload__errors is-hidden\"><\/div>\n\t<\/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=\"3936\"><\/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-3908","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/genomikadlapolski.pl\/en\/wp-json\/wp\/v2\/pages\/3908","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=3908"}],"version-history":[{"count":29,"href":"https:\/\/genomikadlapolski.pl\/en\/wp-json\/wp\/v2\/pages\/3908\/revisions"}],"predecessor-version":[{"id":3978,"href":"https:\/\/genomikadlapolski.pl\/en\/wp-json\/wp\/v2\/pages\/3908\/revisions\/3978"}],"wp:attachment":[{"href":"https:\/\/genomikadlapolski.pl\/en\/wp-json\/wp\/v2\/media?parent=3908"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}