{"id":16233,"date":"2024-01-07T23:10:07","date_gmt":"2024-01-07T23:10:07","guid":{"rendered":"https:\/\/adolesco.org\/dossier-dinscription-a-lintention-dadolesco-et-de-la-famille-transnationale\/"},"modified":"2024-01-07T23:37:18","modified_gmt":"2024-01-07T23:37:18","slug":"dossier-dinscription","status":"publish","type":"page","link":"https:\/\/adolesco.org\/fr\/dossier-dinscription\/","title":{"rendered":"Dossier d&#8217;inscription"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_44' style='display:none'><div id='gf_44' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">2.2_France<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_44'  action='\/fr\/wp-json\/wp\/v2\/pages\/16233#gf_44' data-formid='44' novalidate>\n        <div id='gf_progressbar_wrapper_44' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">\u00c9tape <span class='gf_step_current_page'>1<\/span> sur <span class='gf_step_page_count'>13<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_7' style='width:7%;'><span>7%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_44_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_44' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_44_5\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_5'><span class='gform-field-label__text'>Nom du candidat<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_44_5' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_6\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_6'><span class='gform-field-label__text'>Pr\u00e9nom<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_44_6' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_514\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><label class='gfield_label gform-field-label' for='input_44_514'><span class='gform-field-label__text'>connu sous le nom (si diff\u00e9rent)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_514' id='input_44_514' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_7\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Coordonn\u00e9es de la famille<\/h3><\/div><fieldset id=\"field_44_406\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>M\u00e8re \/ Parent 1 *<\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_44_406'>\n                            \n                            <span id='input_44_406_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_406.3' id='input_44_406_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_44_406_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_44_406_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_406.6' id='input_44_406_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_44_406_6' class='gform-field-label gform-field-label--type-sub '>NOM<\/label>\n                                                <\/span>\n                            \n                        <\/div><div class='gfield_description' id='gfield_description_44_406'>* Pr\u00e9sent dans le foyer principal de l&#8217;enfant<\/div><\/fieldset><div id=\"field_44_18\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_18'><span class='gform-field-label__text'>T\u00e9l\u00e9phone personnel<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_18' id='input_44_18' type='tel' value='' class='large'    aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_44_19\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_19'><span class='gform-field-label__text'>T\u00e9l\u00e9phone professionnel<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_19' id='input_44_19' type='tel' value='' class='large'    aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_44_36\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_36'><span class='gform-field-label__text'>Quelle est la meilleure heure pour vous joindre ?<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_44_36' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_38\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_38'><span class='gform-field-label__text'>Jusqu&#039;\u00e0 quelle heure pouvons nous vous contacter le soir ?<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_44_38' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_407\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>P\u00e8re \/ Parent 2 *<\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_44_407'>\n                            \n                            <span id='input_44_407_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_407.3' id='input_44_407_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_44_407_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_44_407_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_407.6' id='input_44_407_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_44_407_6' class='gform-field-label gform-field-label--type-sub '>NOM<\/label>\n                                                <\/span>\n                            \n                        <\/div><div class='gfield_description' id='gfield_description_44_407'>* pr\u00e9sent dans le foyer principal de l&#8217;enfant<\/div><\/fieldset><div id=\"field_44_20\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_20'><span class='gform-field-label__text'>T\u00e9l\u00e9phone personnel<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_20' id='input_44_20' type='tel' value='' class='large'    aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_44_21\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_21'><span class='gform-field-label__text'>T\u00e9l\u00e9phone professionnel<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_21' id='input_44_21' type='tel' value='' class='large'    aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_44_408\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_408'><span class='gform-field-label__text'>Quelle est la meilleure heure pour vous joindre ?<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_408' id='input_44_408' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_409\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_409'><span class='gform-field-label__text'>Jusqu&#039;\u00e0 quelle heure pouvons-nous vous joindre le soir ?<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_409' id='input_44_409' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_538\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_538'><span class='gform-field-label__text'>Le candidat a-t-il plusieurs adresses de domicile ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_538' id='input_44_538' class='large gfield_select'  aria-describedby=\"gfield_description_44_538\"   aria-invalid=\"false\" ><option value='' ><\/option><option value='Non' >Non<\/option><option value='Oui' >Oui<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_44_538'>R\u00e9pondre OUI si l&#8217;enfant vit alternativement chez ses parents s\u00e9par\u00e9s. <\/div><\/div><div id=\"field_44_296\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_296'><span class='gform-field-label__text'>Adresse courante<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_296' id='input_44_296' type='text' value='' class='large'  aria-describedby=\"gfield_description_44_296\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_44_296'>Si l&#8217;enfant vit chez deux parents s\u00e9par\u00e9s, merci d&#8217;inscrire ici l&#8217;adresse o\u00f9 il passe le plus de temps. La seconde adresse sera \u00e0 sp\u00e9cifier dans un encadr\u00e9 en fin de document. <\/div><\/div><div id=\"field_44_297\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_297'><span class='gform-field-label__text'>Compl\u00e9ment d&#039;adresse<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_297' id='input_44_297' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_298\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_298'><span class='gform-field-label__text'>Ville<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_298' id='input_44_298' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_300\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_300'><span class='gform-field-label__text'>Code postal<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_300' id='input_44_300' type='text' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_44_299\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_299'><span class='gform-field-label__text'>D\u00e9partement (pas le code)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_299' id='input_44_299' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_301\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_301'><span class='gform-field-label__text'>Grande ville la plus proche<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_301' id='input_44_301' type='text' value='' class='large'  aria-describedby=\"gfield_description_44_301\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_44_301'>Par exemple: \u00e0 20 km de RENNES<\/div><\/div><div id=\"field_44_302\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_302'><span class='gform-field-label__text'>Pays<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_302' id='input_44_302' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='USA' >USA<\/option><option value='Canada' >Canada<\/option><option value='France' >France<\/option><option value='Allemagne' >Allemagne<\/option><option value='Espagne' >Espagne<\/option><option value='Italie' >Italie<\/option><option value='Grande Bretagne' >Grande Bretagne<\/option><option value='Irlande' >Irlande<\/option><\/select><\/div><\/div><div id=\"field_44_34\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_34'><span class='gform-field-label__text'>T\u00e9l\u00e9phone fixe<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_34' id='input_44_34' type='tel' value='' class='large'    aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_44_387\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_387'><span class='gform-field-label__text'>Adresse E-mail de la M\u00e8re<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_387' id='input_44_387' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_44_389\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_389'><span class='gform-field-label__text'>Adresse E-mail du P\u00e8re<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_389' id='input_44_389' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_44_388\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_388'><span class='gform-field-label__text'>Adresse E-mail du candidat<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_388' id='input_44_388' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <button type='button' id='gform_next_button_44_279' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_44_2' class='gform_page' data-js='page-field-id-279' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_44_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_44_287\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">L&#039;enfant ou l&#039;adolescent(e) candidat(e)<\/h3><\/div><fieldset id=\"field_44_47\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datefield gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Date de naissance<\/span><\/legend><div id='input_44_47' class='ginput_container ginput_complex gform-grid-row'>\n                                    <div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_44_47_2_container'>\n                                        <input type='number' maxlength='2' name='input_47[]' id='input_44_47_2' value=''   aria-required='false'   placeholder='JJ' min='1' max='31' step='1'\/>\n                                        <label for='input_44_47_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Jour<\/label>\n                                    <\/div><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_44_47_1_container'>\n                                    <input type='number' maxlength='2' name='input_47[]' id='input_44_47_1' value=''   aria-required='false'   placeholder='MM' min='1' max='12' step='1'\/>\n                                    <label for='input_44_47_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Mois<\/label>\n                               <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_44_47_3_container'>\n                                    <input type='number' maxlength='4' name='input_47[]' id='input_44_47_3' value=''   aria-required='false'   placeholder='AAAA' min='1920' max='2027' step='1'\/>\n                                    <label for='input_44_47_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Ann\u00e9e<\/label>\n                               <\/div>\n                            <\/div><\/fieldset><div id=\"field_44_516\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_516'><span class='gform-field-label__text'>Lieu de naissance<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_516' id='input_44_516' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_517\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_517'><span class='gform-field-label__text'>Nationalit\u00e9<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_517' id='input_44_517' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_405\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_405'><span class='gform-field-label__text'>Sexe\/Genre<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_405' id='input_44_405' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_365\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_365'><span class='gform-field-label__text'>Taille<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_365' id='input_44_365' type='text' value='' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_55\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_55'><span class='gform-field-label__text'>Poids<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_55' id='input_44_55' type='number' step='any'   value='' class='small'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_44_518\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_518'><span class='gform-field-label__text'>L&#039;enfant est-il adopt\u00e9 ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_518' id='input_44_518' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Non' >Non<\/option><option value='Oui' >Oui<\/option><\/select><\/div><\/div><div id=\"field_44_57\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_57'><span class='gform-field-label__text'>Description g\u00e9n\u00e9rale de sa personnalit\u00e9 en quelques mots (caract\u00e8re, sensibilit\u00e9, relation aux autres&#8230;)<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_57' id='input_44_57' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_526\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Compl\u00e9tez cette partie en compagnie de l&#039;enfant<\/h3><\/div><div id=\"field_44_60\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_60'><span class='gform-field-label__text'>A-t-il une croyance religieuse, une pratique religieuse ou spirituelle r\u00e9guli\u00e8re ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_60' id='input_44_60' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_61\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_61'><span class='gform-field-label__text'>Aime-t-il lire ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_61' id='input_44_61' class='textarea small'  aria-describedby=\"gfield_description_44_61\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_44_61'>Si OUI, quel style de lecture ?<\/div><\/div><div id=\"field_44_62\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_62'><span class='gform-field-label__text'>Joue-t-il d&#039;un instrument ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_62' id='input_44_62' class='textarea small'  aria-describedby=\"gfield_description_44_62\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_44_62'>Si OUI, lequel et depuis combien de temps ?<\/div><\/div><div id=\"field_44_63\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_63'><span class='gform-field-label__text'>Quelles sont ses activit\u00e9s ext\u00e9rieures pr\u00e9f\u00e9r\u00e9es ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_63' id='input_44_63' class='textarea small'  aria-describedby=\"gfield_description_44_63\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_44_63'>Exemples: cin\u00e9ma, biblioth\u00e8que, piscine, skate-park, balade en for\u00eat,&#8230;.<\/div><\/div><div id=\"field_44_64\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_64'><span class='gform-field-label__text'>Est-il membre d&#039;une association ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_64' id='input_44_64' class='textarea small'  aria-describedby=\"gfield_description_44_64\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_44_64'>Exemples: th\u00e9\u00e2tre, danse, peinture, mod\u00e9lisme, scoutisme&#8230;<\/div><\/div><div id=\"field_44_65\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_65'><span class='gform-field-label__text'>Pratique-t-il un SPORT en club ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_65' id='input_44_65' class='textarea small'  aria-describedby=\"gfield_description_44_65\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_44_65'>Si OUI, lequel et depuis combien de temps ?<\/div><\/div><div id=\"field_44_66\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_66'><span class='gform-field-label__text'>A-t-il des activit\u00e9s physiques (hors club) ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_66' id='input_44_66' class='textarea small'  aria-describedby=\"gfield_description_44_66\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_44_66'>Exemples: balades \u00e0 v\u00e9lo, rollers, footing, renforcement musculaire,&#8230;<\/div><\/div><div id=\"field_44_67\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_67'><span class='gform-field-label__text'>Aime-t-il la comp\u00e9tition ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_67' id='input_44_67' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_44_68\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Sait-il nager ?<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_44_68'><div class='gchoice gchoice_44_68_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_68.1' type='checkbox'  value='Oui'  id='choice_44_68_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_68_1' id='label_44_68_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_68_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_68.2' type='checkbox'  value='Non'  id='choice_44_68_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_68_2' id='label_44_68_2' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_69\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_69'><span class='gform-field-label__text'>Quelle distance ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_69' id='input_44_69' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='parcourt difficilement 25m' >parcourt difficilement 25m<\/option><option value='\u00e0 l&#039;aise en eau calme' >\u00e0 l&#039;aise en eau calme<\/option><option value='\u00e0 l&#039;aise m\u00eame en mer' >\u00e0 l&#039;aise m\u00eame en mer<\/option><\/select><\/div><\/div><div id=\"field_44_70\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_70'><span class='gform-field-label__text'>Indiquez la quantit\u00e9 moyenne d&#039;heures de pratique sportive par semaine<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_70' id='input_44_70' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_71\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_71'><span class='gform-field-label__text'>Occupations favorites quand il a du temps libre \u00e0 la maison<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_71' id='input_44_71' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_44_304\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Posez lui la question: &quot; Penses-tu pouvoir laisser ton t\u00e9l\u00e9phone portable en France pendant la dur\u00e9e de ton s\u00e9jour ?&quot;<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_304'>\n\t\t\t<div class='gchoice gchoice_44_304_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_304' type='radio' value='OUI, parce que je n&#039;ai pas de t\u00e9l\u00e9phone'  id='choice_44_304_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_304_0' id='label_44_304_0' class='gform-field-label gform-field-label--type-inline'>OUI, parce que je n&#8217;ai pas de t\u00e9l\u00e9phone<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_304_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_304' type='radio' value='Oui, facilement'  id='choice_44_304_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_304_1' id='label_44_304_1' class='gform-field-label gform-field-label--type-inline'>Oui, facilement<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_304_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_304' type='radio' value='Peut-\u00eatre, mais \u00e7a sera difficile'  id='choice_44_304_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_304_2' id='label_44_304_2' class='gform-field-label gform-field-label--type-inline'>Peut-\u00eatre, mais \u00e7a sera difficile<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_304_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_304' type='radio' value='Non, j&#039;y suis tr\u00e8s attach\u00e9 et je n&#039;ai pas l&#039;intention de le laisser'  id='choice_44_304_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_304_3' id='label_44_304_3' class='gform-field-label gform-field-label--type-inline'>Non, j&#8217;y suis tr\u00e8s attach\u00e9 et je n&#8217;ai pas l&#8217;intention de le laisser<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_75\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_75'><span class='gform-field-label__text'>Votre enfant a-t-il d\u00e9j\u00e0 quitt\u00e9 ses parents et sa famille ? Si OUI, combien de temps et \u00e0 quelles occasions ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_75' id='input_44_75' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_44_76\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_list_4col field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Diriez-vous de votre enfant qu&#039;il est :<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_44_76'><div class='gchoice gchoice_44_76_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.1' type='checkbox'  value='ordonn\u00e9'  id='choice_44_76_1'   aria-describedby=\"gfield_description_44_76\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_44_76_1' id='label_44_76_1' class='gform-field-label gform-field-label--type-inline'>ordonn\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_76_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.2' type='checkbox'  value='peu attentif'  id='choice_44_76_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_76_2' id='label_44_76_2' class='gform-field-label gform-field-label--type-inline'>peu attentif<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_76_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.3' type='checkbox'  value='ponctuel'  id='choice_44_76_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_76_3' id='label_44_76_3' class='gform-field-label gform-field-label--type-inline'>ponctuel<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_76_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.4' type='checkbox'  value='r\u00eaveur'  id='choice_44_76_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_76_4' id='label_44_76_4' class='gform-field-label gform-field-label--type-inline'>r\u00eaveur<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_76_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.5' type='checkbox'  value='r\u00e9aliste'  id='choice_44_76_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_76_5' id='label_44_76_5' class='gform-field-label gform-field-label--type-inline'>r\u00e9aliste<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_76_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.6' type='checkbox'  value='sensible'  id='choice_44_76_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_76_6' id='label_44_76_6' class='gform-field-label gform-field-label--type-inline'>sensible<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_76_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.7' type='checkbox'  value='cr\u00e9atif'  id='choice_44_76_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_76_7' id='label_44_76_7' class='gform-field-label gform-field-label--type-inline'>cr\u00e9atif<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_76_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.8' type='checkbox'  value='pers\u00e9v\u00e9rant'  id='choice_44_76_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_76_8' id='label_44_76_8' class='gform-field-label gform-field-label--type-inline'>pers\u00e9v\u00e9rant<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_76_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.9' type='checkbox'  value='\u00e9motif'  id='choice_44_76_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_76_9' id='label_44_76_9' class='gform-field-label gform-field-label--type-inline'>\u00e9motif<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_76_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.11' type='checkbox'  value='bavard'  id='choice_44_76_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_76_11' id='label_44_76_11' class='gform-field-label gform-field-label--type-inline'>bavard<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_76_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.12' type='checkbox'  value='r\u00e9fl\u00e9chi'  id='choice_44_76_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_76_12' id='label_44_76_12' class='gform-field-label gform-field-label--type-inline'>r\u00e9fl\u00e9chi<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_76_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.13' type='checkbox'  value='\u00e9nergique'  id='choice_44_76_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_76_13' id='label_44_76_13' class='gform-field-label gform-field-label--type-inline'>\u00e9nergique<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_76_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.14' type='checkbox'  value='souriant'  id='choice_44_76_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_76_14' id='label_44_76_14' class='gform-field-label gform-field-label--type-inline'>souriant<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_76_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.15' type='checkbox'  value='cool et d\u00e9tendu'  id='choice_44_76_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_76_15' id='label_44_76_15' class='gform-field-label gform-field-label--type-inline'>cool et d\u00e9tendu<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_76_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.16' type='checkbox'  value='actif'  id='choice_44_76_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_76_16' id='label_44_76_16' class='gform-field-label gform-field-label--type-inline'>actif<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_76_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.17' type='checkbox'  value='curieux'  id='choice_44_76_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_76_17' id='label_44_76_17' class='gform-field-label gform-field-label--type-inline'>curieux<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_76_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.18' type='checkbox'  value='calme'  id='choice_44_76_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_76_18' id='label_44_76_18' class='gform-field-label gform-field-label--type-inline'>calme<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_76_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.19' type='checkbox'  value='r\u00e9serv\u00e9'  id='choice_44_76_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_76_19' id='label_44_76_19' class='gform-field-label gform-field-label--type-inline'>r\u00e9serv\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_76_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.21' type='checkbox'  value='spontan\u00e9'  id='choice_44_76_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_76_21' id='label_44_76_21' class='gform-field-label gform-field-label--type-inline'>spontan\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_44_76'>Cochez 6 cases maximum.<\/div><\/fieldset><div id=\"field_44_77\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_77'><span class='gform-field-label__text'>Votre enfant pense-t-il avoir des d\u00e9fauts ? Si OUI, lesquels ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_77' id='input_44_77' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_78\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_78'><span class='gform-field-label__text'>Pense-t-il avoir des qualit\u00e9s ? Si OUI, lesquelles ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_78' id='input_44_78' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_44_303' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_44_303' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_44_3' class='gform_page' data-js='page-field-id-303' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_44_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_44_90\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Questionnaire de sant\u00e9<\/h3><div class='gsection_description' id='gfield_description_44_90'>Cette page peut \u00eatre retir\u00e9e du dossier en cas d&#8217;urgence. Merci de r\u00e9inscrire le nom de l&#8217;enfant.<\/div><\/div><fieldset id=\"field_44_448\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Identit\u00e9<\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_44_448'>\n                            \n                            <span id='input_44_448_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_448.3' id='input_44_448_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_44_448_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_44_448_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_448.6' id='input_44_448_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_44_448_6' class='gform-field-label gform-field-label--type-sub '>NOM<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_44_449\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_449'><span class='gform-field-label__text'>Date de naissance<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_44_449'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_449'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_44_449' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_44_449' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_44_449' aria-label='Date de naissance: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_44_450\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Vaccinations<\/h3><div class='gsection_description' id='gfield_description_44_450'>Indiquez la date de la vaccination ou du rappel<\/div><\/div><fieldset id=\"field_44_454\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Dipht\u00e9rie\/ Diptheria<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_454'>\n\t\t\t<div class='gchoice gchoice_44_454_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_454' type='radio' value='Vaccin'  id='choice_44_454_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_454_0' id='label_44_454_0' class='gform-field-label gform-field-label--type-inline'>Vaccin<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_454_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_454' type='radio' value='Rappel'  id='choice_44_454_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_454_1' id='label_44_454_1' class='gform-field-label gform-field-label--type-inline'>Rappel<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_454_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_454' type='radio' value='Non vaccin\u00e9'  id='choice_44_454_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_454_2' id='label_44_454_2' class='gform-field-label gform-field-label--type-inline'>Non vaccin\u00e9<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_455\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_455'><span class='gform-field-label__text'>Date<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_44_455'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_455'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_44_455' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_44_455' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_44_455' aria-label='Date: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><fieldset id=\"field_44_500\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Coqueluche \/Whooping Cough<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_500'>\n\t\t\t<div class='gchoice gchoice_44_500_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_500' type='radio' value='Vaccin ou Rappel'  id='choice_44_500_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_500_0' id='label_44_500_0' class='gform-field-label gform-field-label--type-inline'>Vaccin ou Rappel<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_500_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_500' type='radio' value='Maladie'  id='choice_44_500_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_500_1' id='label_44_500_1' class='gform-field-label gform-field-label--type-inline'>Maladie<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_500_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_500' type='radio' value='Non vaccin\u00e9'  id='choice_44_500_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_500_2' id='label_44_500_2' class='gform-field-label gform-field-label--type-inline'>Non vaccin\u00e9<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_502\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_502'><span class='gform-field-label__text'>Date<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_44_502'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_502'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_44_502' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_44_502' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_44_502' aria-label='Date: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><fieldset id=\"field_44_499\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Tetanos \/Tetanus<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_499'>\n\t\t\t<div class='gchoice gchoice_44_499_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_499' type='radio' value='Vaccin'  id='choice_44_499_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_499_0' id='label_44_499_0' class='gform-field-label gform-field-label--type-inline'>Vaccin<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_499_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_499' type='radio' value='Rappel'  id='choice_44_499_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_499_1' id='label_44_499_1' class='gform-field-label gform-field-label--type-inline'>Rappel<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_499_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_499' type='radio' value='Non vaccin\u00e9'  id='choice_44_499_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_499_2' id='label_44_499_2' class='gform-field-label gform-field-label--type-inline'>Non vaccin\u00e9<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_501\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_501'><span class='gform-field-label__text'>Date<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_44_501'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_501'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_44_501' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_44_501' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_44_501' aria-label='Date: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><fieldset id=\"field_44_495\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Poliomy\u00e9lite \/ Polio<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_495'>\n\t\t\t<div class='gchoice gchoice_44_495_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_495' type='radio' value='Vaccin'  id='choice_44_495_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_495_0' id='label_44_495_0' class='gform-field-label gform-field-label--type-inline'>Vaccin<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_495_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_495' type='radio' value='Rappel'  id='choice_44_495_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_495_1' id='label_44_495_1' class='gform-field-label gform-field-label--type-inline'>Rappel<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_495_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_495' type='radio' value='Non vaccin\u00e9'  id='choice_44_495_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_495_2' id='label_44_495_2' class='gform-field-label gform-field-label--type-inline'>Non vaccin\u00e9<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_496\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_496'><span class='gform-field-label__text'>Date<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_44_496'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_496'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_44_496' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_44_496' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_44_496' aria-label='Date: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><fieldset id=\"field_44_456\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Rougeole \/ Measles<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_456'>\n\t\t\t<div class='gchoice gchoice_44_456_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_456' type='radio' value='Vaccin ou Rappel'  id='choice_44_456_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_456_0' id='label_44_456_0' class='gform-field-label gform-field-label--type-inline'>Vaccin ou Rappel<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_456_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_456' type='radio' value='Maladie'  id='choice_44_456_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_456_1' id='label_44_456_1' class='gform-field-label gform-field-label--type-inline'>Maladie<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_456_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_456' type='radio' value='Non vaccin\u00e9'  id='choice_44_456_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_456_2' id='label_44_456_2' class='gform-field-label gform-field-label--type-inline'>Non vaccin\u00e9<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_457\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_457'><span class='gform-field-label__text'>Date<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_44_457'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_457'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_44_457' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_44_457' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_44_457' aria-label='Date: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><fieldset id=\"field_44_503\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Oreillons \/ Mumps<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_503'>\n\t\t\t<div class='gchoice gchoice_44_503_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_503' type='radio' value='Vaccin ou Rappel'  id='choice_44_503_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_503_0' id='label_44_503_0' class='gform-field-label gform-field-label--type-inline'>Vaccin ou Rappel<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_503_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_503' type='radio' value='Maladie'  id='choice_44_503_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_503_1' id='label_44_503_1' class='gform-field-label gform-field-label--type-inline'>Maladie<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_503_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_503' type='radio' value='Non vaccin\u00e9'  id='choice_44_503_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_503_2' id='label_44_503_2' class='gform-field-label gform-field-label--type-inline'>Non vaccin\u00e9<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_505\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_505'><span class='gform-field-label__text'>Date<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_44_505'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_505'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_44_505' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_44_505' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_44_505' aria-label='Date: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><fieldset id=\"field_44_497\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Rub\u00e9ole \/ Rubella<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_497'>\n\t\t\t<div class='gchoice gchoice_44_497_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_497' type='radio' value='Vaccin ou Rappel'  id='choice_44_497_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_497_0' id='label_44_497_0' class='gform-field-label gform-field-label--type-inline'>Vaccin ou Rappel<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_497_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_497' type='radio' value='Maladie'  id='choice_44_497_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_497_1' id='label_44_497_1' class='gform-field-label gform-field-label--type-inline'>Maladie<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_497_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_497' type='radio' value='Non vaccin\u00e9'  id='choice_44_497_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_497_2' id='label_44_497_2' class='gform-field-label gform-field-label--type-inline'>Non vaccin\u00e9<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_498\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_498'><span class='gform-field-label__text'>Date<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_44_498'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_498'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_44_498' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_44_498' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_44_498' aria-label='Date: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><fieldset id=\"field_44_507\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Varicelle \/ Chickenpox<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_507'>\n\t\t\t<div class='gchoice gchoice_44_507_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_507' type='radio' value='Vaccin ou Rappel'  id='choice_44_507_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_507_0' id='label_44_507_0' class='gform-field-label gform-field-label--type-inline'>Vaccin ou Rappel<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_507_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_507' type='radio' value='Maladie'  id='choice_44_507_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_507_1' id='label_44_507_1' class='gform-field-label gform-field-label--type-inline'>Maladie<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_507_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_507' type='radio' value='Non vaccin\u00e9'  id='choice_44_507_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_507_2' id='label_44_507_2' class='gform-field-label gform-field-label--type-inline'>Non vaccin\u00e9<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_508\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_508'><span class='gform-field-label__text'>Date<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_44_508'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_508'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_44_508' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_44_508' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_44_508' aria-label='Date: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><fieldset id=\"field_44_504\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Tuberculose \/ Tuberculosis<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_504'>\n\t\t\t<div class='gchoice gchoice_44_504_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_504' type='radio' value='Vaccin'  id='choice_44_504_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_504_0' id='label_44_504_0' class='gform-field-label gform-field-label--type-inline'>Vaccin<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_504_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_504' type='radio' value='Rappel'  id='choice_44_504_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_504_1' id='label_44_504_1' class='gform-field-label gform-field-label--type-inline'>Rappel<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_504_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_504' type='radio' value='Non vaccin\u00e9'  id='choice_44_504_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_504_2' id='label_44_504_2' class='gform-field-label gform-field-label--type-inline'>Non vaccin\u00e9<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_506\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_506'><span class='gform-field-label__text'>Date<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_44_506'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_506'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_44_506' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_44_506' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_44_506' aria-label='Date: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><fieldset id=\"field_44_410\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>L&#039;enfant a-t-il d\u00e9j\u00e0 \u00e9t\u00e9 op\u00e9r\u00e9 ?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_410'>\n\t\t\t<div class='gchoice gchoice_44_410_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_410' type='radio' value='Non'  id='choice_44_410_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_410_0' id='label_44_410_0' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_410_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_410' type='radio' value='Oui'  id='choice_44_410_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_410_1' id='label_44_410_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_92\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_92'><span class='gform-field-label__text'>Pr\u00e9cisez si n\u00e9cessaire<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_92' id='input_44_92' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_417\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>A-t-il d\u00e9j\u00e0 eu une anesth\u00e9sie g\u00e9n\u00e9rale ? Pr\u00e9cisez s&#039;il y a eu des complications.<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_417'>\n\t\t\t<div class='gchoice gchoice_44_417_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_417' type='radio' value='Non'  id='choice_44_417_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_417_0' id='label_44_417_0' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_417_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_417' type='radio' value='Oui'  id='choice_44_417_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_417_1' id='label_44_417_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_418\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_418'><span class='gform-field-label__text'>Pr\u00e9cisez si n\u00e9cessaire<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_418' id='input_44_418' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_419\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Pr\u00e9sente-t-il des allergies m\u00e9dicamenteuses ?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_419'>\n\t\t\t<div class='gchoice gchoice_44_419_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_419' type='radio' value='Non'  id='choice_44_419_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_419_0' id='label_44_419_0' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_419_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_419' type='radio' value='Oui'  id='choice_44_419_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_419_1' id='label_44_419_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_420\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_420'><span class='gform-field-label__text'>Pr\u00e9cisez si n\u00e9cessaire<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_420' id='input_44_420' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_421\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Pr\u00e9sente-t-il des allergies alimentaires ?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_421'>\n\t\t\t<div class='gchoice gchoice_44_421_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_421' type='radio' value='Non'  id='choice_44_421_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_421_0' id='label_44_421_0' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_421_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_421' type='radio' value='Oui'  id='choice_44_421_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_421_1' id='label_44_421_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_422\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_422'><span class='gform-field-label__text'>Pr\u00e9cisez si n\u00e9cessaire<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_422' id='input_44_422' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_411\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>A-t-il d\u00e9j\u00e0 eu des crises d&#039;\u00e9pilepsie ? Si Oui, pr\u00e9cisez la date de sa derni\u00e8re crise.<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_411'>\n\t\t\t<div class='gchoice gchoice_44_411_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_411' type='radio' value='Non'  id='choice_44_411_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_411_0' id='label_44_411_0' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_411_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_411' type='radio' value='Oui'  id='choice_44_411_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_411_1' id='label_44_411_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_104\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_104'><span class='gform-field-label__text'>Pr\u00e9cisez si n\u00e9cessaire<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_104' id='input_44_104' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_412\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Est-il asthmatique ?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_412'>\n\t\t\t<div class='gchoice gchoice_44_412_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_412' type='radio' value='Non'  id='choice_44_412_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_412_0' id='label_44_412_0' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_412_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_412' type='radio' value='Oui'  id='choice_44_412_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_412_1' id='label_44_412_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_106\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_106'><span class='gform-field-label__text'>Pr\u00e9cisez si n\u00e9cessaire<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_106' id='input_44_106' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_423\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Des probl\u00e8mes de sommeil ?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_423'>\n\t\t\t<div class='gchoice gchoice_44_423_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_423' type='radio' value='Non'  id='choice_44_423_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_44_423\"   \/>\n\t\t\t\t\t<label for='choice_44_423_0' id='label_44_423_0' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_423_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_423' type='radio' value='Oui'  id='choice_44_423_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_423_1' id='label_44_423_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_44_423'>Difficult\u00e9 \u00e0 s&#8217;endormir ? Cauchemars ? Somnambulisme ? <\/div><\/fieldset><div id=\"field_44_424\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_424'><span class='gform-field-label__text'>Pr\u00e9cisez si n\u00e9cessaire<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_424' id='input_44_424' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_413\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Probl\u00e8mes d&#039;\u00e9nur\u00e9sie ?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_413'>\n\t\t\t<div class='gchoice gchoice_44_413_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_413' type='radio' value='Non'  id='choice_44_413_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_413_0' id='label_44_413_0' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_413_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_413' type='radio' value='Oui'  id='choice_44_413_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_413_1' id='label_44_413_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_122\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_122'><span class='gform-field-label__text'>Pr\u00e9cisez si n\u00e9cessaire<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_122' id='input_44_122' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_425\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Des maux de t\u00eate ? Si Oui, pr\u00e9cisez la fr\u00e9quence et l&#039;intensit\u00e9.<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_425'>\n\t\t\t<div class='gchoice gchoice_44_425_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_425' type='radio' value='Non'  id='choice_44_425_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_425_0' id='label_44_425_0' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_425_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_425' type='radio' value='Oui'  id='choice_44_425_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_425_1' id='label_44_425_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_426\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_426'><span class='gform-field-label__text'>Pr\u00e9cisez si n\u00e9cessaire<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_426' id='input_44_426' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_427\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Maux de ventre ?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_427'>\n\t\t\t<div class='gchoice gchoice_44_427_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_427' type='radio' value='Non'  id='choice_44_427_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_427_0' id='label_44_427_0' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_427_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_427' type='radio' value='Oui'  id='choice_44_427_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_427_1' id='label_44_427_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_428\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_428'><span class='gform-field-label__text'>Pr\u00e9cisez si n\u00e9cessaire<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_428' id='input_44_428' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_429\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Constipation ?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_429'>\n\t\t\t<div class='gchoice gchoice_44_429_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_429' type='radio' value='Non'  id='choice_44_429_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_429_0' id='label_44_429_0' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_429_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_429' type='radio' value='Oui'  id='choice_44_429_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_429_1' id='label_44_429_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_430\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_430'><span class='gform-field-label__text'>Pr\u00e9cisez si n\u00e9cessaire<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_430' id='input_44_430' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_431\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Probl\u00e8mes de peau ?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_431'>\n\t\t\t<div class='gchoice gchoice_44_431_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_431' type='radio' value='Non'  id='choice_44_431_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_431_0' id='label_44_431_0' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_431_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_431' type='radio' value='Oui'  id='choice_44_431_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_431_1' id='label_44_431_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_432\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_432'><span class='gform-field-label__text'>Pr\u00e9cisez si n\u00e9cessaire<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_432' id='input_44_432' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_433\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>A-t-il d\u00e9j\u00e0 eu des malaises avec perte de connaissance ?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_433'>\n\t\t\t<div class='gchoice gchoice_44_433_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_433' type='radio' value='Non'  id='choice_44_433_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_433_0' id='label_44_433_0' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_433_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_433' type='radio' value='Oui'  id='choice_44_433_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_433_1' id='label_44_433_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_434\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_434'><span class='gform-field-label__text'>Pr\u00e9cisez si n\u00e9cessaire<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_434' id='input_44_434' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_435\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Suit-il un traitement ?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_435'>\n\t\t\t<div class='gchoice gchoice_44_435_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_435' type='radio' value='Non'  id='choice_44_435_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_435_0' id='label_44_435_0' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_435_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_435' type='radio' value='Oui'  id='choice_44_435_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_435_1' id='label_44_435_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_436\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_436'><span class='gform-field-label__text'>Pr\u00e9cisez si n\u00e9cessaire<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_436' id='input_44_436' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_437\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Porte-t-il des lunettes ?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_437'>\n\t\t\t<div class='gchoice gchoice_44_437_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_437' type='radio' value='Non'  id='choice_44_437_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_44_437\"   \/>\n\t\t\t\t\t<label for='choice_44_437_0' id='label_44_437_0' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_437_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_437' type='radio' value='Oui'  id='choice_44_437_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_437_1' id='label_44_437_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_44_437'>Si Oui, \u00e0 quelles occasions (en permanence, pour la  lecture, la TV, &#8230;) ?<\/div><\/fieldset><div id=\"field_44_438\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_438'><span class='gform-field-label__text'>Pr\u00e9cisez si n\u00e9cessaire<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_438' id='input_44_438' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_439\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Porte-t-il un appareil dentaire ou des bagues ?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_439'>\n\t\t\t<div class='gchoice gchoice_44_439_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_439' type='radio' value='Non'  id='choice_44_439_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_439_0' id='label_44_439_0' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_439_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_439' type='radio' value='Oui'  id='choice_44_439_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_439_1' id='label_44_439_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_440\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_440'><span class='gform-field-label__text'>Pr\u00e9cisez si n\u00e9cessaire<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_440' id='input_44_440' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_414\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>A-t-il une maladie dont il n&#039;a pas \u00e9t\u00e9 question ci-dessus ?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_414'>\n\t\t\t<div class='gchoice gchoice_44_414_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_414' type='radio' value='Non'  id='choice_44_414_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_414_0' id='label_44_414_0' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_414_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_414' type='radio' value='Oui'  id='choice_44_414_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_414_1' id='label_44_414_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_128\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_128'><span class='gform-field-label__text'>Pr\u00e9cisez si n\u00e9cessaire<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_128' id='input_44_128' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_415\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Aurait-il une contre-indication \u00e0 la pratique d&#039;un sport ?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_415'>\n\t\t\t<div class='gchoice gchoice_44_415_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_415' type='radio' value='Non'  id='choice_44_415_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_415_0' id='label_44_415_0' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_415_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_415' type='radio' value='Oui'  id='choice_44_415_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_415_1' id='label_44_415_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_136\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_136'><span class='gform-field-label__text'>Pr\u00e9cisez si n\u00e9cessaire<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_136' id='input_44_136' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_441\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Si l&#039;enfant est une fille, est-elle r\u00e9gl\u00e9e ?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_441'>\n\t\t\t<div class='gchoice gchoice_44_441_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_441' type='radio' value='Non'  id='choice_44_441_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_441_0' id='label_44_441_0' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_441_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_441' type='radio' value='Oui'  id='choice_44_441_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_441_1' id='label_44_441_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_442\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_442'><span class='gform-field-label__text'>Pr\u00e9cisez si n\u00e9cessaire<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_442' id='input_44_442' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_443\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_443'><span class='gform-field-label__text'>Connaissez-vous son groupe sanguin ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_443' id='input_44_443' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='A +' >A +<\/option><option value='A -' >A &#8211;<\/option><option value='B +' >B +<\/option><option value='B -' >B &#8211;<\/option><option value='AB +' >AB +<\/option><option value='AB -' >AB &#8211;<\/option><option value='O +' >O +<\/option><option value='O -' >O &#8211;<\/option><\/select><\/div><\/div><div id=\"field_44_140\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_140'><span class='gform-field-label__text'>Autres remarques ? anorexie, handicaps, troubles de l&#039;\u00e9locution, dyspraxie, dyslexie, &#8230;<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_140' id='input_44_140' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_141\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_141'><span class='gform-field-label__text'>Votre enfant a-t-il d\u00e9j\u00e0 consult\u00e9 un psychologue (ou psychoth\u00e9rapeute ou psychiatre) ? Si oui, merci d&#039;en pr\u00e9ciser la raison et le traitement \u00e9ventuel.<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_141' id='input_44_141' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_142\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_142'><span class='gform-field-label__text'>Si vous avez une fa\u00e7on personnelle ou alternative de soigner ou de soulager votre enfant dans certains cas, merci de le pr\u00e9ciser.<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_142' id='input_44_142' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_444\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_444'><span class='gform-field-label__text'>Quels aliments ou plats votre enfant n&#039;appr\u00e9cie-t-il  pas (en dehors des raisons m\u00e9dicales, religieuses ou philosophiques) ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_444' id='input_44_444' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_44_305' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_44_305' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_44_4' class='gform_page' data-js='page-field-id-305' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_44_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_44_307\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">L&#039;\u00e9cole<\/h3><\/div><fieldset id=\"field_44_308\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Votre enfant est-il scolaris\u00e9 \u00e0 la maison ?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_44_308'>\n\t\t\t<div class='gchoice gchoice_44_308_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_308' type='radio' value='Non'  id='choice_44_308_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_308_0' id='label_44_308_0' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_44_308_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_308' type='radio' value='Oui'  id='choice_44_308_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_44_308_1' id='label_44_308_1' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_309\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_309'><span class='gform-field-label__text'>Type d&#039;\u00e9tablissement<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_309' id='input_44_309' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Primaire' >Primaire<\/option><option value='Coll\u00e8ge' >Coll\u00e8ge<\/option><option value='Lyc\u00e9e g\u00e9n\u00e9ral' >Lyc\u00e9e g\u00e9n\u00e9ral<\/option><option value='Lyc\u00e9e professionnel' >Lyc\u00e9e professionnel<\/option><\/select><\/div><\/div><div id=\"field_44_310\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_310'><span class='gform-field-label__text'>Public ou Priv\u00e9<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_310' id='input_44_310' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Public' >Public<\/option><option value='Priv\u00e9' >Priv\u00e9<\/option><\/select><\/div><\/div><div id=\"field_44_311\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_311'><span class='gform-field-label__text'>Gar\u00e7ons\/Filles<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_311' id='input_44_311' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Gar\u00e7ons' >Gar\u00e7ons<\/option><option value='Filles' >Filles<\/option><option value='Mixte' >Mixte<\/option><\/select><\/div><\/div><div id=\"field_44_445\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_445'><span class='gform-field-label__text'>Nombre approximatif d&#039;\u00e9l\u00e8ves dans l&#039;\u00e9tablissement<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_445' id='input_44_445' type='text' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_44_312\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_312'><span class='gform-field-label__text'>Nom de l&#039;\u00e9tablissement<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_312' id='input_44_312' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_313\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_313'><span class='gform-field-label__text'>Adresse<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_313' id='input_44_313' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_314\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_314'><span class='gform-field-label__text'>Compl\u00e9ment d&#039;adresse<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_314' id='input_44_314' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_315\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_315'><span class='gform-field-label__text'>Ville<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_315' id='input_44_315' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_316\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_316'><span class='gform-field-label__text'>Code postal<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_316' id='input_44_316' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_317\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_317'><span class='gform-field-label__text'>T\u00e9l\u00e9phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_317' id='input_44_317' type='tel' value='' class='large'    aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_44_318\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_318'><span class='gform-field-label__text'>E-mail<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_318' id='input_44_318' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_44_319\" class=\"gfield gfield--type-website gfield--input-type-website gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_319'><span class='gform-field-label__text'>Site internet de l&#039;\u00e9tablissement<\/span><\/label><div class='ginput_container ginput_container_website'>\n                    <input name='input_319' id='input_44_319' type='url' value='' class='large'    placeholder='https:\/\/'  aria-invalid=\"false\" \/>\n                <\/div><\/div><div id=\"field_44_527\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_527'><span class='gform-field-label__text'>Nom du chef d&#039;\u00e9tablissement<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_527' id='input_44_527' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_528\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><label class='gfield_label gform-field-label' for='input_44_528'><span class='gform-field-label__text'>Nom du professeur principal<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_528' id='input_44_528' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_321\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_321'><span class='gform-field-label__text'>Niveau de classe actuel<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_321' id='input_44_321' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_519\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_519'><span class='gform-field-label__text'>Son niveau g\u00e9n\u00e9ral<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_519' id='input_44_519' class='large gfield_select'  aria-describedby=\"gfield_description_44_519\"   aria-invalid=\"false\" ><option value='' ><\/option><option value='Au-dessus de la moyenne de classe' >Au-dessus de la moyenne de classe<\/option><option value='Autour de la moyenne de classe' >Autour de la moyenne de classe<\/option><option value='Au-dessous de la moyenne de classe' >Au-dessous de la moyenne de classe<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_44_519'>Indiquez son niveau par rapport \u00e0 la moyenne de la classe<\/div><\/div><div id=\"field_44_520\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_520'><span class='gform-field-label__text'>Des informations \u00e0 partager concernant son niveau scolaire ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_520' id='input_44_520' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_325\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_325'><span class='gform-field-label__text'>Temps de trajet pour se rendre \u00e0 l&#039;\u00e9cole<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_325' id='input_44_325' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_326\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_326'><span class='gform-field-label__text'>Moyen de transport pour aller \u00e0 l&#039;\u00e9cole<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_326' id='input_44_326' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_366\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_366'><span class='gform-field-label__text'>Votre \u00e9tablissement scolaire est en Zone:<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_366' id='input_44_366' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_367\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_367'><span class='gform-field-label__text'>Acad\u00e9mie de:<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_367' id='input_44_367' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_530\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">A la rentr\u00e9e prochaine<\/h3><div class='gsection_description' id='gfield_description_44_530'>A ne remplir que si l&#8217;enfant change d&#8217;\u00e9tablissement<\/div><\/div><div id=\"field_44_531\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_531'><span class='gform-field-label__text'>Nom de l&#039;\u00e9tablissement<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_531' id='input_44_531' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_529\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><span class='gform-field-label__text'><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street2 has_city has_zip ginput_container_address gform-grid-row' id='input_44_529' >\n                        <span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_44_529_2_container' >\n                                        <input type='text' name='input_529.2' id='input_44_529_2' value=''     aria-required='false'   \/>\n                                        <label for='input_44_529_2' id='input_44_529_2_label' class='gform-field-label gform-field-label--type-sub '>Adresse<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_44_529_3_container' >\n                                    <input type='text' name='input_529.3' id='input_44_529_3' value=''    aria-required='false'    \/>\n                                    <label for='input_44_529_3' id='input_44_529_3_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_529.4' id='input_44_529_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_44_529_5_container' >\n                                    <input type='text' name='input_529.5' id='input_44_529_5' value=''    aria-required='false'    \/>\n                                    <label for='input_44_529_5' id='input_44_529_5_label' class='gform-field-label gform-field-label--type-sub '>Code postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_529.6' id='input_44_529_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_44_532\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_532'><span class='gform-field-label__text'>T\u00e9l\u00e9phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_532' id='input_44_532' type='tel' value='' class='large'    aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_44_533\" class=\"gfield gfield--type-website gfield--input-type-website gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_533'><span class='gform-field-label__text'>Site internet<\/span><\/label><div class='ginput_container ginput_container_website'>\n                    <input name='input_533' id='input_44_533' type='url' value='' class='large'    placeholder='https:\/\/'  aria-invalid=\"false\" \/>\n                <\/div><\/div><div id=\"field_44_534\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_534'><span class='gform-field-label__text'>Nom du chef d&#039;\u00e9tablissement<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_534' id='input_44_534' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_44_194' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_44_194' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_44_5' class='gform_page' data-js='page-field-id-194' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_44_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_44_510\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Fr\u00e8res et Soeurs<\/h3><\/div><div id=\"field_44_195\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Enfant 1<\/h3><\/div><div id=\"field_44_196\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_196'><span class='gform-field-label__text'>Pr\u00e9nom<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_196' id='input_44_196' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_197\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_197'><span class='gform-field-label__text'>Genre<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_197' id='input_44_197' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='fille' >fille<\/option><option value='gar\u00e7on' >gar\u00e7on<\/option><option value='yel' >yel<\/option><\/select><\/div><\/div><div id=\"field_44_198\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_198'><span class='gform-field-label__text'>Date de N.<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_44_198'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_198'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_44_198' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_44_198' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_44_198' aria-label='Date de N.: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_44_199\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_199'><span class='gform-field-label__text'>Vit \u00e0 la maison ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_199' id='input_44_199' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Oui' >Oui<\/option><option value='Non' >Non<\/option><\/select><\/div><\/div><div id=\"field_44_201\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Enfant 2<\/h3><\/div><div id=\"field_44_202\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_202'><span class='gform-field-label__text'>Pr\u00e9nom<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_202' id='input_44_202' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_203\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_203'><span class='gform-field-label__text'>Genre<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_203' id='input_44_203' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Fille' >Fille<\/option><option value='Gar\u00e7on' >Gar\u00e7on<\/option><option value='Yel' >Yel<\/option><\/select><\/div><\/div><div id=\"field_44_204\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_204'><span class='gform-field-label__text'>Date de N.<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_44_204'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_204'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_44_204' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_44_204' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_44_204' aria-label='Date de N.: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_44_205\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_205'><span class='gform-field-label__text'>Vit \u00e0 la maison ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_205' id='input_44_205' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Oui' >Oui<\/option><option value='Non' >Non<\/option><\/select><\/div><\/div><div id=\"field_44_207\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Enfant 3<\/h3><\/div><div id=\"field_44_208\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_208'><span class='gform-field-label__text'>Pr\u00e9nom<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_208' id='input_44_208' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_209\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_209'><span class='gform-field-label__text'>Genre<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_209' id='input_44_209' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Fille' >Fille<\/option><option value='Gar\u00e7on' >Gar\u00e7on<\/option><option value='Yel' >Yel<\/option><\/select><\/div><\/div><div id=\"field_44_210\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_210'><span class='gform-field-label__text'>Date de N.<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_44_210'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_210'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_44_210' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_44_210' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_44_210' aria-label='Date de N.: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_44_211\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_211'><span class='gform-field-label__text'>Vit \u00e0 la maison ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_211' id='input_44_211' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Oui' >Oui<\/option><option value='Non' >Non<\/option><\/select><\/div><\/div><div id=\"field_44_327\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Enfant 4<\/h3><\/div><div id=\"field_44_328\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_328'><span class='gform-field-label__text'>Pr\u00e9nom<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_328' id='input_44_328' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_329\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_329'><span class='gform-field-label__text'>Genre<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_329' id='input_44_329' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Fille' >Fille<\/option><option value='Gar\u00e7on' >Gar\u00e7on<\/option><option value='Yel' >Yel<\/option><\/select><\/div><\/div><div id=\"field_44_330\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_330'><span class='gform-field-label__text'>Date de N.<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_44_330'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_330'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_44_330' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_44_330' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_44_330' aria-label='Date de N.: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_44_331\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_331'><span class='gform-field-label__text'>Vit \u00e0 la maison ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_331' id='input_44_331' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Oui' >Oui<\/option><option value='Non' >Non<\/option><\/select><\/div><\/div><div id=\"field_44_332\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Enfant 5<\/h3><\/div><div id=\"field_44_333\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_333'><span class='gform-field-label__text'>Pr\u00e9nom<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_333' id='input_44_333' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_334\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_334'><span class='gform-field-label__text'>Genre<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_334' id='input_44_334' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Fille' >Fille<\/option><option value='Gar\u00e7on' >Gar\u00e7on<\/option><option value='Yel' >Yel<\/option><\/select><\/div><\/div><div id=\"field_44_335\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_335'><span class='gform-field-label__text'>Date de N.<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_44_335'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_335'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_44_335' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_44_335' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_44_335' aria-label='Date de N.: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_44_336\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_336'><span class='gform-field-label__text'>Vit \u00e0 la maison ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_336' id='input_44_336' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Oui' >Oui<\/option><option value='Non' >Non<\/option><\/select><\/div><\/div><div id=\"field_44_337\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Enfant 6<\/h3><\/div><div id=\"field_44_338\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_338'><span class='gform-field-label__text'>Pr\u00e9nom<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_338' id='input_44_338' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_339\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_339'><span class='gform-field-label__text'>Genre<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_339' id='input_44_339' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Fille' >Fille<\/option><option value='Gar\u00e7on' >Gar\u00e7on<\/option><option value='Yel' >Yel<\/option><\/select><\/div><\/div><div id=\"field_44_340\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_340'><span class='gform-field-label__text'>Date de N.<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_44_340'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_340'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_44_340' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_44_340' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_44_340' aria-label='Date de N.: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_44_341\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_341'><span class='gform-field-label__text'>Vit-il \u00e0 la maison?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_341' id='input_44_341' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Oui' >Oui<\/option><option value='Non' >Non<\/option><\/select><\/div><\/div><div id=\"field_44_342\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Enfant 7<\/h3><\/div><div id=\"field_44_343\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_343'><span class='gform-field-label__text'>Pr\u00e9nom<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_343' id='input_44_343' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_344\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_344'><span class='gform-field-label__text'>Genre<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_344' id='input_44_344' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Fille' >Fille<\/option><option value='Gar\u00e7on' >Gar\u00e7on<\/option><option value='Yel' >Yel<\/option><\/select><\/div><\/div><div id=\"field_44_345\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_345'><span class='gform-field-label__text'>Date de N.<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_44_345'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_345'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_44_345' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_44_345' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_44_345' aria-label='Date de N.: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_44_346\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_346'><span class='gform-field-label__text'>Vit-il \u00e0 la maison ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_346' id='input_44_346' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Oui' >Oui<\/option><option value='Non' >Non<\/option><\/select><\/div><\/div><div id=\"field_44_511\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_44_222\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_222'><span class='gform-field-label__text'>Le candidat a-t-il un jumeau?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_222' id='input_44_222' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Non' >Non<\/option><option value='Oui' >Oui<\/option><\/select><\/div><\/div><div id=\"field_44_223\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_223'><span class='gform-field-label__text'>Une naissance prochaine est-elle pr\u00e9vue ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_223' id='input_44_223' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Non' >Non<\/option><option value='Oui' >Oui<\/option><\/select><\/div><\/div><div id=\"field_44_224\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_224'><span class='gform-field-label__text'>L&#039;un des enfants de la fratrie souffre-t-il d&#039;un handicap mental ou physique?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_224' id='input_44_224' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_227\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_227'><span class='gform-field-label__text'>D\u00e9crivez succinctement les relations du candidat avec ses fr\u00e8res et s\u0153urs.<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_227' id='input_44_227' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_44_58' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_44_58' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_44_6' class='gform_page' data-js='page-field-id-58' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_44_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_44_350\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">M\u00e8re * \/ Belle m\u00e8re *\/ Autre parent *<\/h3><div class='gsection_description' id='gfield_description_44_350'>* si existence d&#8217;un deuxi\u00e8me foyer pour l&#8217;enfant<\/div><\/div><div id=\"field_44_351\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_351'><span class='gform-field-label__text'>Nom<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_351' id='input_44_351' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_352\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_352'><span class='gform-field-label__text'>Nom de jeune fille<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_352' id='input_44_352' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_353\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_353'><span class='gform-field-label__text'>Pr\u00e9nom<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_353' id='input_44_353' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_147\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><label class='gfield_label gform-field-label' for='input_44_147'><span class='gform-field-label__text'>Known As (if different)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_147' id='input_44_147' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_148\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datefield gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Date de N.<\/span><\/legend><div id='input_44_148' class='ginput_container ginput_complex gform-grid-row'>\n                                    <div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_44_148_2_container'>\n                                        <input type='number' maxlength='2' name='input_148[]' id='input_44_148_2' value=''   aria-required='false'   placeholder='JJ' min='1' max='31' step='1'\/>\n                                        <label for='input_44_148_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Jour<\/label>\n                                    <\/div><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_44_148_1_container'>\n                                    <input type='number' maxlength='2' name='input_148[]' id='input_44_148_1' value=''   aria-required='false'   placeholder='MM' min='1' max='12' step='1'\/>\n                                    <label for='input_44_148_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Mois<\/label>\n                               <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_44_148_3_container'>\n                                    <input type='number' maxlength='4' name='input_148[]' id='input_44_148_3' value=''   aria-required='false'   placeholder='AAAA' min='1920' max='2027' step='1'\/>\n                                    <label for='input_44_148_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Ann\u00e9e<\/label>\n                               <\/div>\n                            <\/div><\/fieldset><div id=\"field_44_151\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_151'><span class='gform-field-label__text'>Divorc\u00e9 ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_151' id='input_44_151' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Non' >Non<\/option><option value='Oui' >Oui<\/option><\/select><\/div><\/div><div id=\"field_44_152\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_152'><span class='gform-field-label__text'>S\u00e9par\u00e9 ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_152' id='input_44_152' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Non' >Non<\/option><option value='Oui' >Oui<\/option><\/select><\/div><\/div><div id=\"field_44_153\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_153'><span class='gform-field-label__text'>Avez vous des probl\u00e8mes de sant\u00e9 ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_153' id='input_44_153' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_154\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_154'><span class='gform-field-label__text'>Etes vous fumeur ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_154' id='input_44_154' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Non' >Non<\/option><option value='Oui' >Oui<\/option><\/select><\/div><\/div><div id=\"field_44_155\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_155'><span class='gform-field-label__text'>Si Oui, combien de cigarettes par jour ?<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_155' id='input_44_155' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_156\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_156'><span class='gform-field-label__text'>Fumez vous \u00e0 la maison ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_156' id='input_44_156' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Non' >Non<\/option><option value='Oui' >Oui<\/option><\/select><\/div><\/div><div id=\"field_44_157\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_157'><span class='gform-field-label__text'>Religion ? Pratiquant ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_157' id='input_44_157' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_158\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_158'><span class='gform-field-label__text'>Comment d\u00e9cririez vous votre caract\u00e8re ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_158' id='input_44_158' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_159\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_159'><span class='gform-field-label__text'>Profession (indiquez vos horaires de travail)<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_159' id='input_44_159' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_161\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_161'><span class='gform-field-label__text'>Centres d&#039;int\u00e9r\u00eat et occupations favorites :<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_161' id='input_44_161' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_162\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_162'><span class='gform-field-label__text'>Votre niveau d&#039;\u00e9tude :<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_162' id='input_44_162' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_535\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_535'><span class='gform-field-label__text'>Le fran\u00e7ais est-il votre langue maternelle ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_535' id='input_44_535' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Oui' >Oui<\/option><option value='Non' >Non<\/option><\/select><\/div><\/div><div id=\"field_44_163\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Quel est votre niveau en :<\/h3><\/div><div id=\"field_44_166\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_166'><span class='gform-field-label__text'>Anglais<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_166' id='input_44_166' class='medium gfield_select'     aria-invalid=\"false\" ><option value='aucune notion' >aucune notion<\/option><option value='d\u00e9butant' >d\u00e9butant<\/option><option value='d\u00e9brouill\u00e9' >d\u00e9brouill\u00e9<\/option><option value='parle couramment' >parle couramment<\/option><\/select><\/div><\/div><div id=\"field_44_164\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_164'><span class='gform-field-label__text'>Allemand<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_164' id='input_44_164' class='medium gfield_select'     aria-invalid=\"false\" ><option value='aucune notion' >aucune notion<\/option><option value='d\u00e9butant' >d\u00e9butant<\/option><option value='d\u00e9brouill\u00e9' >d\u00e9brouill\u00e9<\/option><option value='parle couramment' >parle couramment<\/option><\/select><\/div><\/div><div id=\"field_44_289\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_289'><span class='gform-field-label__text'>Italien<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_289' id='input_44_289' class='medium gfield_select'     aria-invalid=\"false\" ><option value='aucune notion' >aucune notion<\/option><option value='d\u00e9buttant' >d\u00e9buttant<\/option><option value='d\u00e9brouill\u00e9' >d\u00e9brouill\u00e9<\/option><option value='parle couramment' >parle couramment<\/option><\/select><\/div><\/div><div id=\"field_44_165\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_165'><span class='gform-field-label__text'>Espagnol<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_165' id='input_44_165' class='medium gfield_select'     aria-invalid=\"false\" ><option value='aucune notion' >aucune notion<\/option><option value='d\u00e9butant' >d\u00e9butant<\/option><option value='d\u00e9brouill\u00e9' >d\u00e9brouill\u00e9<\/option><option value='parle couramment' >parle couramment<\/option><\/select><\/div><\/div><div id=\"field_44_167\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_167'><span class='gform-field-label__text'>Avez-vous d\u00e9j\u00e0 r\u00e9alis\u00e9 des s\u00e9jours \u00e0 l&#039;\u00e9tranger ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_167' id='input_44_167' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Non' >Non<\/option><option value='Oui' >Oui<\/option><\/select><\/div><\/div><div id=\"field_44_168\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_168'><span class='gform-field-label__text'>Si Oui, dans quel pays et pour quelle dur\u00e9e ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_168' id='input_44_168' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_44_169' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_44_169' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_44_7' class='gform_page' data-js='page-field-id-169' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_44_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_44_354\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">P\u00e8re * \/ Beau-p\u00e8re * \/ Autre parent *<\/h3><div class='gsection_description' id='gfield_description_44_354'>* si existence d&#8217;un deuxi\u00e8me foyer pour l&#8217;enfant<\/div><\/div><div id=\"field_44_355\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_355'><span class='gform-field-label__text'>Nom<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_355' id='input_44_355' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_356\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_356'><span class='gform-field-label__text'>Pr\u00e9nom<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_356' id='input_44_356' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_172\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><label class='gfield_label gform-field-label' for='input_44_172'><span class='gform-field-label__text'>Known As (if different)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_172' id='input_44_172' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_173\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datefield gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Date de N.<\/span><\/legend><div id='input_44_173' class='ginput_container ginput_complex gform-grid-row'>\n                                    <div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_44_173_2_container'>\n                                        <input type='number' maxlength='2' name='input_173[]' id='input_44_173_2' value=''   aria-required='false'   placeholder='JJ' min='1' max='31' step='1'\/>\n                                        <label for='input_44_173_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Jour<\/label>\n                                    <\/div><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_44_173_1_container'>\n                                    <input type='number' maxlength='2' name='input_173[]' id='input_44_173_1' value=''   aria-required='false'   placeholder='MM' min='1' max='12' step='1'\/>\n                                    <label for='input_44_173_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Mois<\/label>\n                               <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_44_173_3_container'>\n                                    <input type='number' maxlength='4' name='input_173[]' id='input_44_173_3' value=''   aria-required='false'   placeholder='AAAA' min='1920' max='2027' step='1'\/>\n                                    <label for='input_44_173_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Ann\u00e9e<\/label>\n                               <\/div>\n                            <\/div><\/fieldset><div id=\"field_44_512\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_512'><span class='gform-field-label__text'>Divorc\u00e9 ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_512' id='input_44_512' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Non' >Non<\/option><option value='Oui' >Oui<\/option><\/select><\/div><\/div><div id=\"field_44_513\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_513'><span class='gform-field-label__text'>S\u00e9par\u00e9 ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_513' id='input_44_513' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Non' >Non<\/option><option value='Oui' >Oui<\/option><\/select><\/div><\/div><div id=\"field_44_178\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_178'><span class='gform-field-label__text'>Avez vous des probl\u00e8mes de sant\u00e9 ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_178' id='input_44_178' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_179\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_179'><span class='gform-field-label__text'>Etes vous fumeur ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_179' id='input_44_179' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Non' >Non<\/option><option value='Oui' >Oui<\/option><\/select><\/div><\/div><div id=\"field_44_180\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_180'><span class='gform-field-label__text'>Si Oui, combien de cigarettes par jour ?<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_180' id='input_44_180' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_181\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_181'><span class='gform-field-label__text'>Fumez-vous \u00e0 la maison ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_181' id='input_44_181' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Non' >Non<\/option><option value='Oui' >Oui<\/option><\/select><\/div><\/div><div id=\"field_44_182\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_182'><span class='gform-field-label__text'>Religion? Pratiquant ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_182' id='input_44_182' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_183\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_183'><span class='gform-field-label__text'>Pourriez vous d\u00e9crire vos traits de caract\u00e8re ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_183' id='input_44_183' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_184\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_184'><span class='gform-field-label__text'>Profession (Indiquez \u00e9galement vos horaires de travail)<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_184' id='input_44_184' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_186\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_186'><span class='gform-field-label__text'>Centres d&#039;int\u00e9r\u00eat et occupations favorites<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_186' id='input_44_186' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_187\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_187'><span class='gform-field-label__text'>Niveau d&#039;\u00e9tude<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_187' id='input_44_187' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_536\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_536'><span class='gform-field-label__text'>Le fran\u00e7ais est il votre langue maternelle ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_536' id='input_44_536' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Oui' >Oui<\/option><option value='Non' >Non<\/option><\/select><\/div><\/div><div id=\"field_44_188\" class=\"gfield gfield--type-section gfield--input-type-section gsection [margin-top: 50px;] field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Quel est votre niveau en:<\/h3><\/div><div id=\"field_44_191\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_191'><span class='gform-field-label__text'>Anglais<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_191' id='input_44_191' class='medium gfield_select'     aria-invalid=\"false\" ><option value='aucune base' >aucune base<\/option><option value='d\u00e9butant' >d\u00e9butant<\/option><option value='d\u00e9brouill\u00e9' >d\u00e9brouill\u00e9<\/option><option value='parle couramment' >parle couramment<\/option><\/select><\/div><\/div><div id=\"field_44_189\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_189'><span class='gform-field-label__text'>Allemand<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_189' id='input_44_189' class='medium gfield_select'     aria-invalid=\"false\" ><option value='aucune base' >aucune base<\/option><option value='d\u00e9butant' >d\u00e9butant<\/option><option value='d\u00e9brouill\u00e9' >d\u00e9brouill\u00e9<\/option><option value='parle couramment' >parle couramment<\/option><\/select><\/div><\/div><div id=\"field_44_285\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_285'><span class='gform-field-label__text'>Italien<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_285' id='input_44_285' class='medium gfield_select'     aria-invalid=\"false\" ><option value='aucune base' >aucune base<\/option><option value='d\u00e9butant' >d\u00e9butant<\/option><option value='d\u00e9brouill\u00e9' >d\u00e9brouill\u00e9<\/option><option value='parle couramment' >parle couramment<\/option><\/select><\/div><\/div><div id=\"field_44_190\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_190'><span class='gform-field-label__text'>Espagnol<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_190' id='input_44_190' class='medium gfield_select'     aria-invalid=\"false\" ><option value='aucune base' >aucune base<\/option><option value='d\u00e9butant' >d\u00e9butant<\/option><option value='d\u00e9brouill\u00e9' >d\u00e9brouill\u00e9<\/option><option value='parle couramment' >parle couramment<\/option><\/select><\/div><\/div><div id=\"field_44_192\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_192'><span class='gform-field-label__text'>Avez vous d\u00e9j\u00e0 r\u00e9alis\u00e9 des s\u00e9jours \u00e0 l&#039;\u00e9tranger ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_192' id='input_44_192' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Non' >Non<\/option><option value='Oui' >Oui<\/option><\/select><\/div><\/div><div id=\"field_44_193\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_193'><span class='gform-field-label__text'>Si Oui, dans quel pays et sur quelle dur\u00e9e ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_193' id='input_44_193' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_44_357' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_44_357' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_44_8' class='gform_page' data-js='page-field-id-357' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_44_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_44_229\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">La maison<\/h3><\/div><div id=\"field_44_236\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_236'><span class='gform-field-label__text'>Votre lieu d&#039;habitation est<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_236' id='input_44_236' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='en centre ville' >en centre ville<\/option><option value='en p\u00e9riph\u00e9rie de ville' >en p\u00e9riph\u00e9rie de ville<\/option><option value='en campagne' >en campagne<\/option><\/select><\/div><\/div><div id=\"field_44_358\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><label class='gfield_label gform-field-label' for='input_44_358'><span class='gform-field-label__text'>Home, other:<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_358' id='input_44_358' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_237\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_237'><span class='gform-field-label__text'>situ\u00e9 :<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_237' id='input_44_237' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='pr\u00e8s d&#039;une route principale' >pr\u00e8s d&#039;une route principale<\/option><option value='sur une route secondaire' >sur une route secondaire<\/option><option value='en lotissement' >en lotissement<\/option><\/select><\/div><\/div><div id=\"field_44_238\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_238'><span class='gform-field-label__text'>Vous habitez<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_238' id='input_44_238' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='une maison ind\u00e9pendante' >une maison ind\u00e9pendante<\/option><option value='une maison mitoyenne' >une maison mitoyenne<\/option><option value='un appartement' >un appartement<\/option><\/select><\/div><\/div><div id=\"field_44_359\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_359'><span class='gform-field-label__text'>Pour un appartement, \u00e0 quel \u00e9tage ?<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_359' id='input_44_359' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_44_239\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_239'><span class='gform-field-label__text'>Poss\u00e9dez vous un jardin ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_239' id='input_44_239' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Non' >Non<\/option><option value='Oui' >Oui<\/option><\/select><\/div><\/div><div id=\"field_44_240\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_240'><span class='gform-field-label__text'>Si oui, de quelle superficie ?<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_240' id='input_44_240' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_241\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_241'><span class='gform-field-label__text'>Pendant l&#039;accueil, l&#039;enfant partenaire aura :<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_241' id='input_44_241' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='une chambre pour lui seul' >une chambre pour lui seul<\/option><option value='une chambre partag\u00e9e' >une chambre partag\u00e9e<\/option><option value='le choix entre les deux' >le choix entre les deux<\/option><\/select><\/div><\/div><div id=\"field_44_242\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_242'><span class='gform-field-label__text'>Dans le cas d&#039;une chambre partag\u00e9e, quelle en sera la superficie ?<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_242' id='input_44_242' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_360\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><label class='gfield_label gform-field-label screen-reader-text' for='input_44_360'><span class='gform-field-label__text'><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_360' id='input_44_360' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='No' >No<\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/div><div id=\"field_44_458\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_458'><span class='gform-field-label__text'>Nombre de personnes habitant \u00e0 la maison pendant la semaine ?<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_458' id='input_44_458' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_44_459\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_459'><span class='gform-field-label__text'>pendant le weekend?<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_459' id='input_44_459' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_44_348\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_348'><span class='gform-field-label__text'>Y-a t-il une personne ext\u00e9rieure \u00e0 la famille qui vient aider (m\u00e9nage, garde d&#039;enfants&#8230;) ?<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_348' id='input_44_348' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_349\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_349'><span class='gform-field-label__text'>Merci de d\u00e9tailler la nature et la fr\u00e9quence de l&#039;aide<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_349' id='input_44_349' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_245\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_245'><span class='gform-field-label__text'>combien de voitures \u00e0 la maison ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_245' id='input_44_245' class='medium gfield_select'     aria-invalid=\"false\" ><option value='0' >0<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><\/select><\/div><\/div><div id=\"field_44_361\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><label class='gfield_label gform-field-label' for='input_44_361'><span class='gform-field-label__text'>Combien de deux roues motoris\u00e9s ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_361' id='input_44_361' class='medium gfield_select'     aria-invalid=\"false\" ><option value='0' >0<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><\/select><\/div><\/div><div id=\"field_44_246\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_246'><span class='gform-field-label__text'>Combien de v\u00e9los ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_246' id='input_44_246' class='medium gfield_select'     aria-invalid=\"false\" ><option value='0' >0<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><\/select><\/div><\/div><div id=\"field_44_248\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_248'><span class='gform-field-label__text'>Animaux de compagnie ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_248' id='input_44_248' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_44_247\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Poss\u00e9dez vous<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_44_247'><div class='gchoice gchoice_44_247_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_247.1' type='checkbox'  value='une t\u00e9l\u00e9vision'  id='choice_44_247_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_247_1' id='label_44_247_1' class='gform-field-label gform-field-label--type-inline'>une t\u00e9l\u00e9vision<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_247_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_247.2' type='checkbox'  value='un ordinateur'  id='choice_44_247_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_247_2' id='label_44_247_2' class='gform-field-label gform-field-label--type-inline'>un ordinateur<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_247_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_247.3' type='checkbox'  value='un piano'  id='choice_44_247_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_247_3' id='label_44_247_3' class='gform-field-label gform-field-label--type-inline'>un piano<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_247_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_247.4' type='checkbox'  value='une console de jeux vid\u00e9o'  id='choice_44_247_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_247_4' id='label_44_247_4' class='gform-field-label gform-field-label--type-inline'>une console de jeux vid\u00e9o<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_249\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_249'><span class='gform-field-label__text'>Y a-t-il des armes \u00e0 feu \u00e0 la maison ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_249' id='input_44_249' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Non' >Non<\/option><option value='Oui' >Oui<\/option><\/select><\/div><\/div><div id=\"field_44_250\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_250'><span class='gform-field-label__text'>Si Oui, merci de pr\u00e9ciser :<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_250' id='input_44_250' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_521\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Assurance<\/h3><\/div><div id=\"field_44_522\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_522'><span class='gform-field-label__text'>Nom de la compagnie d&#039;assurance responsabilit\u00e9 civile<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_522' id='input_44_522' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_524\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Adresse de la compagnie d&#039;assurance<\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_zip has_country ginput_container_address gform-grid-row' id='input_44_524' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_44_524_1_container' >\n                                        <input type='text' name='input_524.1' id='input_44_524_1' value=''    aria-required='false'    \/>\n                                        <label for='input_44_524_1' id='input_44_524_1_label' class='gform-field-label gform-field-label--type-sub '>Rue<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_44_524_2_container' >\n                                        <input type='text' name='input_524.2' id='input_44_524_2' value=''     aria-required='false'   \/>\n                                        <label for='input_44_524_2' id='input_44_524_2_label' class='gform-field-label gform-field-label--type-sub '>Compl\u00e9ment d&#8217;adresse<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_44_524_3_container' >\n                                    <input type='text' name='input_524.3' id='input_44_524_3' value=''    aria-required='false'    \/>\n                                    <label for='input_44_524_3' id='input_44_524_3_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_524.4' id='input_44_524_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_44_524_5_container' >\n                                    <input type='text' name='input_524.5' id='input_44_524_5' value=''    aria-required='false'    \/>\n                                    <label for='input_44_524_5' id='input_44_524_5_label' class='gform-field-label gform-field-label--type-sub '>Code postal<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_44_524_6_container' >\n                                        <select name='input_524.6' id='input_44_524_6'   aria-required='false'    ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='ZA' >Afrique du Sud<\/option><option value='AL' >Albanie<\/option><option value='DZ' >Alg\u00e9rie<\/option><option value='DE' >Allemagne<\/option><option value='AD' >Andorre<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctique<\/option><option value='AG' >Antigua-et-Barbuda<\/option><option value='SA' >Arabie Saoudite<\/option><option value='AR' >Argentine<\/option><option value='AM' >Arm\u00e9nie<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australie<\/option><option value='AT' >Autriche<\/option><option value='AZ' >Azerba\u00efdjan<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahre\u00efn<\/option><option value='BD' >Bangladesh<\/option><option value='BY' >Belarus<\/option><option value='BE' >Belgique<\/option><option value='BZ' >Belize<\/option><option value='BJ' >B\u00e9nin<\/option><option value='BM' >Bermudes<\/option><option value='BT' >Bhoutan<\/option><option value='BO' >Bolivie<\/option><option value='BQ' >Bonaire, Saint-Eustache et Saba<\/option><option value='BA' >Bosnie-Herz\u00e9govine<\/option><option value='BW' >Botswana<\/option><option value='BR' >Br\u00e9sil<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgarie<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KH' >Cambodge<\/option><option value='CM' >Cameroun<\/option><option value='CA' >Canada<\/option><option value='CV' >Cap-Vert<\/option><option value='CL' >Chili<\/option><option value='CN' >Chine<\/option><option value='CY' >Chypre<\/option><option value='CO' >Colombie<\/option><option value='KM' >Comores<\/option><option value='CG' >Congo<\/option><option value='KR' >Cor\u00e9e (R\u00e9publique de)<\/option><option value='KP' >Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)<\/option><option value='CR' >Costa Rica<\/option><option value='CI' >C\u00f4te d\u2019Ivoire<\/option><option value='HR' >Croatie<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='DK' >Danemark<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominique<\/option><option value='EG' >\u00c9gypte<\/option><option value='AE' >\u00c9mirats arabes unis<\/option><option value='EC' >\u00c9quateur<\/option><option value='ER' >\u00c9rythr\u00e9e<\/option><option value='ES' >Espagne<\/option><option value='EE' >Estonie<\/option><option value='SZ' >Eswatini<\/option><option value='PS' >\u00c9tat palestinien<\/option><option value='US' >\u00c9tats-Unis<\/option><option value='ET' >\u00c9thiopie<\/option><option value='RU' >F\u00e9d\u00e9ration Russe<\/option><option value='FJ' >Fidji<\/option><option value='FI' >Finlande<\/option><option value='FR' >France<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambie<\/option><option value='GE' >G\u00e9orgie<\/option><option value='GS' >G\u00e9orgie du Sud et \u00celes Sandwich du Sud<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GR' >Gr\u00e8ce<\/option><option value='GD' >Grenade<\/option><option value='GL' >Groenland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guin\u00e9e<\/option><option value='GQ' >Guin\u00e9e \u00e9quatoriale<\/option><option value='GW' >Guin\u00e9e-Bissau<\/option><option value='GF' >Guyane<\/option><option value='GY' >Guyane<\/option><option value='HT' >Ha\u00efti<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hongrie<\/option><option value='BV' >\u00cele Bouvet<\/option><option value='CX' >\u00cele Christmas<\/option><option value='IM' >\u00cele de Man<\/option><option value='MU' >\u00cele Maurice<\/option><option value='NF' >\u00cele Norfolk<\/option><option value='AX' >\u00celes \u00c5land<\/option><option value='KY' >\u00celes Cayman<\/option><option value='CC' >\u00celes Cocos<\/option><option value='CK' >\u00celes Cook<\/option><option value='SJ' >\u00celes de Svalbard et Jan Mayen<\/option><option value='FK' >\u00celes Falkland<\/option><option value='FO' >\u00celes F\u00e9ro\u00e9<\/option><option value='HM' >\u00celes Heard et McDonald<\/option><option value='MP' >\u00celes Mariannes du Nord<\/option><option value='MH' >\u00celes Marshall<\/option><option value='UM' >\u00celes mineures am\u00e9ricaines<\/option><option value='PN' >\u00celes Pitcairn<\/option><option value='SB' >\u00celes Salomon<\/option><option value='TC' >\u00celes Turques et Ca\u00efques<\/option><option value='VI' >\u00celes Vierges am\u00e9ricaines<\/option><option value='VG' >\u00celes Vierges britanniques<\/option><option value='IN' >Inde<\/option><option value='ID' >Indon\u00e9sie<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IE' >Irlande<\/option><option value='IS' >Islande<\/option><option value='IL' >Isra\u00ebl<\/option><option value='IT' >Italie<\/option><option value='JM' >Jama\u00efque<\/option><option value='JP' >Japon<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordanie<\/option><option value='KZ' >Kazakhstan<\/option><option value='KE' >Kenya<\/option><option value='KG' >Kirghizistan<\/option><option value='KI' >Kiribati<\/option><option value='KW' >Kowe\u00eft<\/option><option value='BB' >La Barbade<\/option><option value='RE' >La R\u00e9union<\/option><option value='LS' >Lesotho<\/option><option value='LV' >Lettonie<\/option><option value='LB' >Liban<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libye<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Lituanie<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao<\/option><option value='MK' >Mac\u00e9doine du Nord<\/option><option value='MG' >Madagascar<\/option><option value='MY' >Malaisie<\/option><option value='MW' >Malawi<\/option><option value='MV' >Maldives<\/option><option value='ML' >Mali<\/option><option value='MT' >Malte<\/option><option value='MA' >Maroc<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritanie<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexique<\/option><option value='FM' >Micron\u00e9sie<\/option><option value='MD' >Moldavie<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolie<\/option><option value='ME' >Mont\u00e9n\u00e9gro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibie<\/option><option value='NR' >Nauru<\/option><option value='NP' >N\u00e9pal<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nig\u00e9ria<\/option><option value='NU' >Niu\u00e9<\/option><option value='NO' >Norv\u00e8ge<\/option><option value='NC' >Nouvelle-Cal\u00e9donie<\/option><option value='NZ' >Nouvelle-Z\u00e9lande<\/option><option value='OM' >Oman<\/option><option value='UG' >Ouganda<\/option><option value='UZ' >Ouzb\u00e9kistan<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PA' >Panama<\/option><option value='PG' >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value='PY' >Paraguay<\/option><option value='NL' >Pays-Bas<\/option><option value='PE' >P\u00e9rou<\/option><option value='PH' >Philippines<\/option><option value='PL' >Pologne<\/option><option value='PF' >Polyn\u00e9sie fran\u00e7aise<\/option><option value='PR' >Porto Rico<\/option><option value='PT' >Portugal<\/option><option value='QA' >Qatar<\/option><option value='SY' >R\u00e9publique arabe syrienne<\/option><option value='CF' >R\u00e9publique centrafricaine<\/option><option value='CD' >R\u00e9publique d\u00e9mocratique du Congo<\/option><option value='LA' >R\u00e9publique d\u00e9mocratique populaire du Laos<\/option><option value='DO' >R\u00e9publique Dominicaine<\/option><option value='CZ' >R\u00e9publique Tch\u00e8que<\/option><option value='RO' >Roumanie<\/option><option value='GB' >Royaume-Uni<\/option><option value='RW' >Rwanda<\/option><option value='EH' >Sahara occidental<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='MF' >Saint Martin<\/option><option value='PM' >Saint Pierre et Miquelon<\/option><option value='KN' >Saint-Christophe-et-Nevis<\/option><option value='SM' >Saint-Marin<\/option><option value='VA' >Saint-Si\u00e8ge<\/option><option value='VC' >Saint-Vincent-et-les Grenadines<\/option><option value='SH' >Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha<\/option><option value='LC' >Sainte-Lucie<\/option><option value='SV' >Salvador<\/option><option value='WS' >Samoa<\/option><option value='AS' >Samoa am\u00e9ricaines<\/option><option value='ST' >Sao Tom\u00e9 et Principe<\/option><option value='SN' >S\u00e9n\u00e9gal<\/option><option value='RS' >Serbie<\/option><option value='SC' >Seychelles<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapour<\/option><option value='SX' >Sint Maarten<\/option><option value='SK' >Slovaquie<\/option><option value='SI' >Slov\u00e9nie<\/option><option value='SO' >Somalie<\/option><option value='SD' >Soudan<\/option><option value='SS' >Soudan du Sud<\/option><option value='LK' >Sri Lanka<\/option><option value='SE' >Su\u00e8de<\/option><option value='CH' >Suisse<\/option><option value='SR' >Suriname<\/option><option value='TJ' >Tadjikistan<\/option><option value='TW' >Ta\u00efwan<\/option><option value='TZ' >Tanzanie (R\u00e9publique-Unie de)<\/option><option value='TD' >Tchad<\/option><option value='TF' >Terres Australes Fran\u00e7aises<\/option><option value='IO' >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value='TH' >Tha\u00eflande<\/option><option value='TL' >Timor oriental<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinit\u00e9 et Tobago<\/option><option value='TN' >Tunisie<\/option><option value='TM' >Turkm\u00e9nistan<\/option><option value='TR' >Turquie<\/option><option value='TV' >Tuvalu<\/option><option value='UA' >Ukraine<\/option><option value='UY' >Uruguay<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Vietnam<\/option><option value='WF' >Wallis et Futuna<\/option><option value='YE' >Y\u00e9men<\/option><option value='ZM' >Zambie<\/option><option value='ZW' >Zimbabwe<\/option><\/select>\n                                        <label for='input_44_524_6' id='input_44_524_6_label' class='gform-field-label gform-field-label--type-sub '>Pays<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_44_523\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_523'><span class='gform-field-label__text'>Num\u00e9ro de la police d&#039;assurance<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_523' id='input_44_523' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_525\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_525'><span class='gform-field-label__text'>Avez-vous une assurance sant\u00e9 compl\u00e9mentaire ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_525' id='input_44_525' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Oui' >Oui<\/option><option value='Non' >Non<\/option><\/select><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_44_364' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_44_364' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_44_9' class='gform_page' data-js='page-field-id-364' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_44_9' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_44_252\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Vie quotidienne<\/h3><div class='gsection_description' id='gfield_description_44_252'>Pour aider le partenaire \u00e9tranger \u00e0 mieux comprendre et s&#8217;adapter \u00e0 vos habitudes familiales, merci de d\u00e9crire honn\u00eatement votre quotidien.  <\/div><\/div><div id=\"field_44_253\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_253'><span class='gform-field-label__text'>Quand votre enfant d\u00e9passe les limites (vos r\u00e8gles familiales), comment r\u00e9agissez vous ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_253' id='input_44_253' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_254\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_254'><span class='gform-field-label__text'>Des sanctions ? Lesquelles ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_254' id='input_44_254' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_256\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_256'><span class='gform-field-label__text'>Partagez vous des repas en famille ? Lesquels ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_256' id='input_44_256' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_463\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_463'><span class='gform-field-label__text'>Avez vous des exigences sur la tenue \u00e0 table ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_463' id='input_44_463' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_465\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_465'><span class='gform-field-label__text'>Vos enfants ont-ils un acc\u00e8s libre au r\u00e9frig\u00e9rateur et confiseries ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_465' id='input_44_465' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_462\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_462'><span class='gform-field-label__text'>Avez-vous des exigences \u00e0 la maison en g\u00e9n\u00e9ral (des r\u00e8gles de vie quotidienne)?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_462' id='input_44_462' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_461\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_461'><span class='gform-field-label__text'>D\u00e9crivez une journ\u00e9e typique de votre enfant (en semaine).<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_461' id='input_44_461' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_464\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_464'><span class='gform-field-label__text'>Est-ce que vous suivez le travail scolaire quotidien de votre enfant ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_464' id='input_44_464' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_261\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_261'><span class='gform-field-label__text'>Votre enfant a-t-il un acc\u00e8s libre et illimit\u00e9 \u00e0 un ordinateur ? \u00e0 internet ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_261' id='input_44_261' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_44_262\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Dans sa chambre on trouve<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_44_262'><div class='gchoice gchoice_44_262_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_262.1' type='checkbox'  value='une t\u00e9l\u00e9vision'  id='choice_44_262_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_262_1' id='label_44_262_1' class='gform-field-label gform-field-label--type-inline'>une t\u00e9l\u00e9vision<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_262_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_262.2' type='checkbox'  value='un ordinateur connect\u00e9'  id='choice_44_262_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_262_2' id='label_44_262_2' class='gform-field-label gform-field-label--type-inline'>un ordinateur connect\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_262_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_262.3' type='checkbox'  value='ordinateur portable'  id='choice_44_262_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_262_3' id='label_44_262_3' class='gform-field-label gform-field-label--type-inline'>ordinateur portable<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_44_262_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_262.4' type='checkbox'  value='une tablette'  id='choice_44_262_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_44_262_4' id='label_44_262_4' class='gform-field-label gform-field-label--type-inline'>une tablette<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_44_263\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_263'><span class='gform-field-label__text'>Votre enfant poss\u00e8de-t-il un t\u00e9l\u00e9phone portable ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_263' id='input_44_263' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Non' >Non<\/option><option value='Oui' >Oui<\/option><\/select><\/div><\/div><div id=\"field_44_264\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_264'><span class='gform-field-label__text'>Par jour, quelle est la dur\u00e9e moyenne d&#039;exposition de votre enfant aux \u00e9crans (t\u00e9l\u00e9, ordinateur, t\u00e9l\u00e9phone&#8230;)?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_264' id='input_44_264' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_274\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_274'><span class='gform-field-label__text'>D\u00e9crivez une journ\u00e9e de la famille en semaine<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_274' id='input_44_274' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_275\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_275'><span class='gform-field-label__text'>D\u00e9crivez les t\u00e2ches que vous demandez \u00e0 vos enfants d&#039;assurer \u00e0 la maison et celles que vous demanderiez au partenaire d&#039;\u00e9change.<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_275' id='input_44_275' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_268\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_268'><span class='gform-field-label__text'>Votre enfant appr\u00e9cie-t-il la vie en groupe ou pr\u00e9f\u00e8re-t-il s&#039;occuper seul ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_268' id='input_44_268' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_460\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_460'><span class='gform-field-label__text'>Votre enfant est il autoris\u00e9 \u00e0 sortir seul le soir ? En journ\u00e9e ? Le partenaire le sera-t-il ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_460' id='input_44_460' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_471\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_471'><span class='gform-field-label__text'>Quelle latitude (libert\u00e9 de sortie, horaires, conditions particuli\u00e8res) comptez vous laisser au partenaire \u00e9tranger ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_471' id='input_44_471' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_469\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_469'><span class='gform-field-label__text'>Votre enfant est-il autoris\u00e9 \u00e0 fumer ? \u00e0 boire de l&#039;alcool ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_469' id='input_44_469' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_468\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_468'><span class='gform-field-label__text'>Connaissez vous les amis de votre enfant ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_468' id='input_44_468' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_466\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_466'><span class='gform-field-label__text'>Donnez-vous \u00e0 votre enfant de l&#039;argent de poche ? Si Oui, merci de pr\u00e9ciser combien et \u00e0 quelle fr\u00e9quence.<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_466' id='input_44_466' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_470\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_470'><span class='gform-field-label__text'>Votre enfant voit il souvent ses grands parents ? A quelles occasions ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_470' id='input_44_470' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_467\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_467'><span class='gform-field-label__text'>Votre enfant utilise-t-il les transports en commun en autonomie ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_467' id='input_44_467' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_278\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_278'><span class='gform-field-label__text'>Que serait pour vous un \u00e9change r\u00e9ussi pour votre enfant ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_278' id='input_44_278' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_472\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_472'><span class='gform-field-label__text'>Quelles activit\u00e9s ou sorties pourriez-vous envisager de faire avec le partenaire d&#039;\u00e9change ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_472' id='input_44_472' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_44_494' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_44_494' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_44_10' class='gform_page' data-js='page-field-id-494' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_44_10' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_44_80\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Choix de pays<\/h3><div class='gsection_description' id='gfield_description_44_80'>Apr\u00e8s discussion avec votre enfant, classez vos v\u0153ux de pays en attribuant un pourcentage de priorit\u00e9. La somme des choix est \u00e9gale \u00e0 100. \n\nTrois langues minimum doivent \u00eatre choisis. \n\nRemarque importante: si un dossier d&#8217;un pays \u00e0 faible pourcentage vous est propos\u00e9, accueillez le projet avec 100% de motivation !<\/div><\/div><div id=\"field_44_81\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-quarter field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_81'><span class='gform-field-label__text'>Allemagne<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_81' id='input_44_81' type='number' step='any'   value='' class='medium'      aria-invalid=\"false\" aria-describedby=\"gfield_description_44_81\" \/><\/div><div class='gfield_description' id='gfield_description_44_81'>de 0 \u00e0 100%<\/div><\/div><div id=\"field_44_370\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_370'><span class='gform-field-label__text'>Langue anglaise en Europe<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_370' id='input_44_370' type='number' step='any'   value='' class='medium'      aria-invalid=\"false\" aria-describedby=\"gfield_description_44_370\" \/><\/div><div class='gfield_description' id='gfield_description_44_370'>de 0 \u00e0 100%<\/div><\/div><div id=\"field_44_369\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_369'><span class='gform-field-label__text'>Langue anglaise en Am\u00e9rique<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_369' id='input_44_369' type='number' step='any'   value='' class='medium'      aria-invalid=\"false\" aria-describedby=\"gfield_description_44_369\" \/><\/div><div class='gfield_description' id='gfield_description_44_369'>de 0 \u00e0 100%<\/div><\/div><div id=\"field_44_82\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-quarter field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_82'><span class='gform-field-label__text'>Espagne<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_82' id='input_44_82' type='number' step='any'   value='' class='medium'      aria-invalid=\"false\" aria-describedby=\"gfield_description_44_82\" \/><\/div><div class='gfield_description' id='gfield_description_44_82'>de 0 \u00e0 100 %. <\/div><\/div><div id=\"field_44_83\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-quarter field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><label class='gfield_label gform-field-label' for='input_44_83'><span class='gform-field-label__text'>Anglais<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_83' id='input_44_83' type='number' step='any' min='0' max='100' value='' class='medium'      aria-invalid=\"false\" aria-describedby=\"gfield_instruction_44_83 gfield_description_44_83\" \/><div class='gfield_description instruction ' id='gfield_instruction_44_83'>Veuillez saisir un nombre entre <strong>0<\/strong> et <strong>100<\/strong>.<\/div><\/div><div class='gfield_description' id='gfield_description_44_83'>de 0 \u00e0 100 %<\/div><\/div><div id=\"field_44_283\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-quarter field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_283'><span class='gform-field-label__text'>Italie<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_283' id='input_44_283' type='number' step='any'   value='' class='large'      aria-invalid=\"false\" aria-describedby=\"gfield_description_44_283\" \/><\/div><div class='gfield_description' id='gfield_description_44_283'>de 0 \u00e0 100%. <\/div><\/div><div id=\"field_44_84\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_84'><span class='gform-field-label__text'>Expliquez vos choix. N&#039;oubliez pas que plus vous \u00e9largissez vos v\u0153ux et plus votre enfant a des chances de vivre une aventure Adolesco !<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_84' id='input_44_84' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_85\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_85'><span class='gform-field-label__text'>Quelle dur\u00e9e de s\u00e9jour envisagez vous \u00e0 l&#039;\u00e9tranger ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_85' id='input_44_85' class='medium gfield_select'  aria-describedby=\"gfield_description_44_85\"   aria-invalid=\"false\" ><option value='' ><\/option><option value='3-6 semaines' >3-6 semaines<\/option><option value='6-9 semaines' >6-9 semaines<\/option><option value='9-12 semaines' >9-12 semaines<\/option><option value='Ouvert, de 3 \u00e0 12 semaines' >Ouvert, de 3 \u00e0 12 semaines<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_44_85'>Rappel: la philosophie d&#8217;ADOLESCO vous encourage \u00e0 accepter \u00e9ventuellement des diff\u00e9rences de dur\u00e9es entre l&#8217;accueil et le d\u00e9part. <\/div><\/div><div id=\"field_44_87\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_87'><span class='gform-field-label__text'>Votre enfant pr\u00e9f\u00e8re \u00e9changer avec :<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_87' id='input_44_87' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='un gar\u00e7on' >un gar\u00e7on<\/option><option value='une fille' >une fille<\/option><option value='peu importe' >peu importe<\/option><\/select><\/div><\/div><div id=\"field_44_88\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_88'><span class='gform-field-label__text'>Si votre enfant a 16 ans, merci d&#039;indiquer la date de ses 18 ans<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_44_88'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_88'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_44_88' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_44_88' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_44_88' aria-label='Si votre enfant a 16 ans, merci d'indiquer la date de ses 18 ans: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_44_371' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_44_371' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_44_11' class='gform_page' data-js='page-field-id-371' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_44_11' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_44_59\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Familles de r\u00e9f\u00e9rence<\/h3><div class='gsection_description' id='gfield_description_44_59'>Veuillez indiquer le nom de deux familles (ou personnes) qui connaissent bien votre enfant et votre famille (sans appartenir \u00e0 votre famille). Nous les contacterons. <\/div><\/div><fieldset id=\"field_44_446\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Famille 1<\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_44_446'>\n                            \n                            <span id='input_44_446_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_446.3' id='input_44_446_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_44_446_3' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_44_446_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_446.6' id='input_44_446_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_44_446_6' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom(s)<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_44_372\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><label class='gfield_label gform-field-label' for='input_44_372'><span class='gform-field-label__text'>Occupation<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_372' id='input_44_372' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_374\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_374'><span class='gform-field-label__text'>T\u00e9l\u00e9phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_374' id='input_44_374' type='tel' value='' class='large'    aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_44_23\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_23'><span class='gform-field-label__text'>E-mail<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_23' id='input_44_23' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_44_447\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Famille 2<\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_44_447'>\n                            \n                            <span id='input_44_447_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_447.3' id='input_44_447_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_44_447_3' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_44_447_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_447.6' id='input_44_447_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_44_447_6' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom(s)<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_44_376\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><label class='gfield_label gform-field-label' for='input_44_376'><span class='gform-field-label__text'>Occupation<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_376' id='input_44_376' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_377\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_377'><span class='gform-field-label__text'>T\u00e9l\u00e9phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_377' id='input_44_377' type='tel' value='' class='large'    aria-invalid=\"false\"    \/><\/div><\/div><div id=\"field_44_378\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_378'><span class='gform-field-label__text'>E-mail<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_378' id='input_44_378' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_44_379\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Exp\u00e9riences pr\u00e9c\u00e9dentes<\/h3><\/div><div id=\"field_44_380\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_380'><span class='gform-field-label__text'>Avez-vous (votre famille) d\u00e9j\u00e0 particip\u00e9 \u00e0 un \u00e9change ou un s\u00e9jour de longue dur\u00e9e ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_380' id='input_44_380' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Non' >Non<\/option><option value='Oui' >Oui<\/option><\/select><\/div><\/div><div id=\"field_44_381\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_381'><span class='gform-field-label__text'>Si Oui, avec quel organisme ?<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_381' id='input_44_381' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_382\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_382'><span class='gform-field-label__text'>Veuillez indiquer le nom et l&#039;adresse \u00e9lectronique de la famille \u00e9trang\u00e8re concern\u00e9e.<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_382' id='input_44_382' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_383\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_383'><span class='gform-field-label__text'>Comment avez-vous connu Adolesco ? Merci de nommer vos contacts.<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_383' id='input_44_383' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_44_390' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_44_390' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_44_12' class='gform_page' data-js='page-field-id-390' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_44_12' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_44_473\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Autre parent<\/h3><div class='gsection_description' id='gfield_description_44_473'>Page \u00e0 remplir si vous n&#8217;habitez pas avec l&#8217;enfant candidat. <\/div><\/div><div id=\"field_44_474\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_474'><span class='gform-field-label__text'>Nom<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_474' id='input_44_474' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_475\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_475'><span class='gform-field-label__text'>Pr\u00e9nom<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_475' id='input_44_475' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_476\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><label class='gfield_label gform-field-label' for='input_44_476'><span class='gform-field-label__text'>Known As (if different)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_476' id='input_44_476' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_44_477\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datefield gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Date de N.<\/span><\/legend><div id='input_44_477' class='ginput_container ginput_complex gform-grid-row'>\n                                    <div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_44_477_2_container'>\n                                        <input type='number' maxlength='2' name='input_477[]' id='input_44_477_2' value=''   aria-required='false'   placeholder='JJ' min='1' max='31' step='1'\/>\n                                        <label for='input_44_477_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Jour<\/label>\n                                    <\/div><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_44_477_1_container'>\n                                    <input type='number' maxlength='2' name='input_477[]' id='input_44_477_1' value=''   aria-required='false'   placeholder='MM' min='1' max='12' step='1'\/>\n                                    <label for='input_44_477_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Mois<\/label>\n                               <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_44_477_3_container'>\n                                    <input type='number' maxlength='4' name='input_477[]' id='input_44_477_3' value=''   aria-required='false'   placeholder='AAAA' min='1920' max='2027' step='1'\/>\n                                    <label for='input_44_477_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Ann\u00e9e<\/label>\n                               <\/div>\n                            <\/div><\/fieldset><div id=\"field_44_478\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_478'><span class='gform-field-label__text'>Avez-vous des probl\u00e8mes de sant\u00e9 ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_478' id='input_44_478' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_479\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_479'><span class='gform-field-label__text'>Etes vous fumeur ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_479' id='input_44_479' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Non' >Non<\/option><option value='Oui' >Oui<\/option><\/select><\/div><\/div><div id=\"field_44_480\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_480'><span class='gform-field-label__text'>Si Oui, combien de cigarettes par jour ?<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_480' id='input_44_480' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_481\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_481'><span class='gform-field-label__text'>Fumez vous \u00e0 la maison ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_481' id='input_44_481' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Non' >Non<\/option><option value='Oui' >Oui<\/option><\/select><\/div><\/div><div id=\"field_44_482\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_482'><span class='gform-field-label__text'>Religion ? Etes vous pratiquant ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_482' id='input_44_482' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_483\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_483'><span class='gform-field-label__text'>Comment d\u00e9cririez vous votre caract\u00e8re ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_483' id='input_44_483' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_484\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_484'><span class='gform-field-label__text'>Profession et horaires de travail<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_484' id='input_44_484' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_485\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_485'><span class='gform-field-label__text'>Centres d&#039;int\u00e9r\u00eat et occupations favorites<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_485' id='input_44_485' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_44_486\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_486'><span class='gform-field-label__text'>Votre niveau d&#039;\u00e9tude<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_486' id='input_44_486' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_539\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_539'><span class='gform-field-label__text'>Le fran\u00e7ais est-il votre langue maternelle ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_539' id='input_44_539' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Oui' >Oui<\/option><option value='Non' >Non<\/option><\/select><\/div><\/div><div id=\"field_44_487\" class=\"gfield gfield--type-section gfield--input-type-section gsection [margin-top: 50px;] field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Quel est votre niveau en :<\/h3><\/div><div id=\"field_44_488\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_488'><span class='gform-field-label__text'>Anglais<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_488' id='input_44_488' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Aucune base' >Aucune base<\/option><option value='D\u00e9butant' >D\u00e9butant<\/option><option value='D\u00e9brouill\u00e9' >D\u00e9brouill\u00e9<\/option><option value='Parle couramment' >Parle couramment<\/option><\/select><\/div><\/div><div id=\"field_44_489\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_489'><span class='gform-field-label__text'>Allemand<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_489' id='input_44_489' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Aucune base' >Aucune base<\/option><option value='D\u00e9butant' >D\u00e9butant<\/option><option value='D\u00e9brouill\u00e9' >D\u00e9brouill\u00e9<\/option><option value='Parle couramment' >Parle couramment<\/option><\/select><\/div><\/div><div id=\"field_44_490\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_490'><span class='gform-field-label__text'>Italien<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_490' id='input_44_490' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Aucune base' >Aucune base<\/option><option value='D\u00e9butant' >D\u00e9butant<\/option><option value='D\u00e9brouill\u00e9' >D\u00e9brouill\u00e9<\/option><option value='Parle couramment' >Parle couramment<\/option><\/select><\/div><\/div><div id=\"field_44_491\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_491'><span class='gform-field-label__text'>Espagnol<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_491' id='input_44_491' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Aucune base' >Aucune base<\/option><option value='D\u00e9butant' >D\u00e9butant<\/option><option value='D\u00e9brouill\u00e9' >D\u00e9brouill\u00e9<\/option><option value='Parle couramment' >Parle couramment<\/option><\/select><\/div><\/div><div id=\"field_44_492\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_492'><span class='gform-field-label__text'>Avez vous d\u00e9j\u00e0 effectu\u00e9 des s\u00e9jours \u00e0 l&#039;\u00e9tranger ?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_492' id='input_44_492' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Non' >Non<\/option><option value='Oui' >Oui<\/option><\/select><\/div><\/div><div id=\"field_44_493\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_493'><span class='gform-field-label__text'>Si oui, dans quel pays et sur quelle dur\u00e9e ?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_493' id='input_44_493' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_44_509' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_44_509' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_44_13' class='gform_page' data-js='page-field-id-509' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_44_13' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_44_391\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Protection des donn\u00e9es<\/h3><div class='gsection_description' id='gfield_description_44_391'>Voir notre politique sur la protection des donn\u00e9es sur notre site : www.adolesco.org <\/div><\/div><div id=\"field_44_392\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_392'><span class='gform-field-label__text'>Nom du responsable l\u00e9gal 1<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_392' id='input_44_392' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_393\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_393'><span class='gform-field-label__text'>Date (aujourd&#039;hui)<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_44_393'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_393'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_44_393' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_44_393' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_44_393' aria-label='Date (aujourd'hui): Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_44_395\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_395'><span class='gform-field-label__text'>Utilisation des donn\u00e9es<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_395' id='input_44_395' class='large gfield_select'  aria-describedby=\"gfield_description_44_395\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Oui, j&#039;accepte' >Oui, j&#039;accepte<\/option><option value='Non, je refuse' >Non, je refuse<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_44_395'>En soumettant ce formulaire, j&#8217;accepte que les informations saisies ici et les informations envoy\u00e9es directement par e-mail \u00e0 Adolesco soient exploit\u00e9es pour permettre de trouver un \u00e9change pour mon enfant, pour travailler avec les repr\u00e9sentants de l&#8217;association et pour me contacter.<\/div><\/div><div id=\"field_44_396\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_396'><span class='gform-field-label__text'>Pre-inscription<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_396' id='input_44_396' class='large gfield_select'  aria-describedby=\"gfield_description_44_396\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Oui, j&#039;accepte' >Oui, j&#039;accepte<\/option><option value='Non, je refuse' >Non, je refuse<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_44_396'>J&#8217;accepte que la pr\u00e9-inscription soit envoy\u00e9e au repr\u00e9sentant local qui me rendra visite (visite obligatoire dans le cadre de mon inscription \u00e0 Adolesco).<\/div><\/div><div id=\"field_44_397\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_397'><span class='gform-field-label__text'>Communication future<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_397' id='input_44_397' class='large gfield_select'  aria-describedby=\"gfield_description_44_397\"   aria-invalid=\"false\" ><option value='' ><\/option><option value='Oui, j&#039;accepte' >Oui, j&#039;accepte<\/option><option value='Non, je refuse' >Non, je refuse<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_44_397'>Si l&#8217;\u00e9change de mon enfant se r\u00e9alise, j&#8217;accepte d&#8217;\u00eatre recontact\u00e9 \u00e0 l&#8217;avenir par Adolesco pour t\u00e9moigner de mon exp\u00e9rience  ou aider \u00e0 la r\u00e9alisation d&#8217;un \u00e9change d&#8217;une autre famille.<\/div><\/div><div id=\"field_44_398\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_398'><span class='gform-field-label__text'>Actualit\u00e9 d&#039;Adolesco<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_398' id='input_44_398' class='large gfield_select'  aria-describedby=\"gfield_description_44_398\"   aria-invalid=\"false\" ><option value='' ><\/option><option value='Oui, j&#039;accepte' >Oui, j&#039;accepte<\/option><option value='Non, je refuse' >Non, je refuse<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_44_398'>J&#8217;accepte de recevoir des informations sur les activit\u00e9s et nouvelles destinations propos\u00e9es par Adolesco.<\/div><\/div><div id=\"field_44_399\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_399'><span class='gform-field-label__text'>Nom du responsable l\u00e9gal 2<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_399' id='input_44_399' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_44_400\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_400'><span class='gform-field-label__text'>Date (aujourd&#039;hui)<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_44_400'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_400'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_44_400' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_44_400' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_44_400' aria-label='Date (aujourd'hui): Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_44_401\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_401'><span class='gform-field-label__text'>Utilisation des donn\u00e9es<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_401' id='input_44_401' class='large gfield_select'  aria-describedby=\"gfield_description_44_401\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Oui, j&#039;accepte' >Oui, j&#039;accepte<\/option><option value='Non, je refuse' >Non, je refuse<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_44_401'>En soumettant ce formulaire, j&#8217;accepte que les informations saisies ici et les informations envoy\u00e9es directement par e-mail \u00e0 Adolesco soient exploit\u00e9es pour permettre de trouver un \u00e9change pour mon enfant, pour travailler avec les repr\u00e9sentants de l&#8217;association et pour me contacter.<\/div><\/div><div id=\"field_44_402\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_402'><span class='gform-field-label__text'>Pr\u00e9-inscription<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_402' id='input_44_402' class='large gfield_select'  aria-describedby=\"gfield_description_44_402\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Oui, j&#039;accepte' >Oui, j&#039;accepte<\/option><option value='Non, je refuse' >Non, je refuse<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_44_402'>J&#8217;accepte que la pr\u00e9-inscription soit envoy\u00e9e au repr\u00e9sentant local qui me rendra visite (visite obligatoire dans le cadre de mon inscription \u00e0 Adolesco).<\/div><\/div><div id=\"field_44_403\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_403'><span class='gform-field-label__text'>Communication future<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_403' id='input_44_403' class='large gfield_select'  aria-describedby=\"gfield_description_44_403\"   aria-invalid=\"false\" ><option value='' ><\/option><option value='Oui, j&#039;accepte' >Oui, j&#039;accepte<\/option><option value='Non, je refuse' >Non, je refuse<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_44_403'>Si l&#8217;\u00e9change de mon enfant se r\u00e9alise, j&#8217;accepte d&#8217;\u00eatre recontact\u00e9 \u00e0 l&#8217;avenir par Adolesco pour t\u00e9moigner de mon exp\u00e9rience  ou aider \u00e0 la r\u00e9alisation d&#8217;un \u00e9change d&#8217;une autre famille. <\/div><\/div><div id=\"field_44_404\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_44_404'><span class='gform-field-label__text'>Actualit\u00e9 d&#039;Adolesco<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_404' id='input_44_404' class='large gfield_select'  aria-describedby=\"gfield_description_44_404\"   aria-invalid=\"false\" ><option value='' ><\/option><option value='Oui, j&#039;accepte' >Oui, j&#039;accepte<\/option><option value='Non, je refuse' >Non, je refuse<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_44_404'>J&#8217;accepte de recevoir des informations sur les activit\u00e9s et nouvelles destinations propos\u00e9es par Adolesco.<\/div><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><button type='submit' id='gform_previous_button_44' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' 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