{"id":2189,"date":"2023-02-20T15:06:34","date_gmt":"2023-02-20T20:06:34","guid":{"rendered":"https:\/\/ciasf.org\/?page_id=2189"},"modified":"2023-03-31T15:46:34","modified_gmt":"2023-03-31T19:46:34","slug":"formulaire-projet-selfie","status":"publish","type":"page","link":"https:\/\/ciasf.org\/en\/formulaire-projet-selfie\/","title":{"rendered":"Formulaire : Projet SELFIE"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2189\" class=\"elementor elementor-2189\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-34eba63 elementor-section-full_width elementor-section-stretched elementor-section-height-default elementor-section-height-default\" data-eae-slider=\"4551\" data-id=\"34eba63\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;mdp_selection_sticky_effect_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-5a466fd\" data-eae-slider=\"52123\" data-id=\"5a466fd\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;mdp_selection_sticky_column_effect_enable&quot;:false}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-9770a7f elementor-widget elementor-widget-template\" data-id=\"9770a7f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"template.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-template\">\n\t\t\t\t\t<div data-elementor-type=\"section\" data-elementor-id=\"2117\" class=\"elementor elementor-2117 elementor-1752 elementor-1752\" data-elementor-post-type=\"elementor_library\">\n\t\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-2328d41f elementor-section-full_width elementor-section-stretched elementor-section-height-default elementor-section-height-default\" data-eae-slider=\"86129\" data-id=\"2328d41f\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;mdp_selection_sticky_effect_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-66f2c980\" data-eae-slider=\"39403\" data-id=\"66f2c980\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;mdp_selection_sticky_column_effect_enable&quot;:false}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5bcdca4e e-transform e-transform sticky_btn_quitter_site elementor-widget elementor-widget-button\" data-id=\"5bcdca4e\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_transform_rotateZ_effect&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_rotateZ_effect_widescreen&quot;:{&quot;unit&quot;:&quot;deg&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_rotateZ_effect_laptop&quot;:{&quot;unit&quot;:&quot;deg&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_rotateZ_effect_tablet_extra&quot;:{&quot;unit&quot;:&quot;deg&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_rotateZ_effect_tablet&quot;:{&quot;unit&quot;:&quot;deg&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_rotateZ_effect_mobile_extra&quot;:{&quot;unit&quot;:&quot;deg&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_rotateZ_effect_mobile&quot;:{&quot;unit&quot;:&quot;deg&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateX_effect&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateX_effect_widescreen&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateX_effect_laptop&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateX_effect_tablet_extra&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateX_effect_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateX_effect_mobile_extra&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateX_effect_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateY_effect&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateY_effect_widescreen&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateY_effect_laptop&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateY_effect_tablet_extra&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateY_effect_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateY_effect_mobile_extra&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;_transform_translateY_effect_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]}}\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/www.google.com\/\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" fill=\"none\" height=\"19\" viewBox=\"0 0 19 19\" width=\"19\"><g stroke=\"#fff\" stroke-linecap=\"round\" stroke-linejoin=\"round\" stroke-width=\"2\"><path d=\"m11.7134 3.20413h3c.3978 0 .7793.15804 1.0606.43934.2813.28131.4394.66284.4394 1.06066v10.49997c0 .3979-.1581.7794-.4394 1.0607s-.6628.4393-1.0606.4393h-3\"><\/path><path d=\"m7.96338 13.7041 3.75002-3.74997-3.75002-3.75\"><\/path><path d=\"m11.7134 9.95413h-9.00002\"><\/path><\/g><\/svg>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Leave the site<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-7e2cb321 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-eae-slider=\"11693\" data-id=\"7e2cb321\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;mdp_selection_sticky_effect_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-1ac52904\" data-eae-slider=\"7555\" data-id=\"1ac52904\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;mdp_selection_sticky_column_effect_enable&quot;:false}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-72c545ec elementor-widget elementor-widget-heading\" data-id=\"72c545ec\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Projet SELFIE<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-ae9aecb elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-eae-slider=\"41406\" data-id=\"ae9aecb\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;mdp_selection_sticky_effect_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-c31b160\" data-eae-slider=\"40873\" data-id=\"c31b160\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;mdp_selection_sticky_column_effect_enable&quot;:false}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-603f174 elementor-widget elementor-widget-heading\" data-id=\"603f174\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Formulaire de r\u00e9f\u00e9rence<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-f0fccd4 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-eae-slider=\"51855\" data-id=\"f0fccd4\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;mdp_selection_sticky_effect_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6e49fbd\" data-eae-slider=\"56212\" data-id=\"6e49fbd\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;mdp_selection_sticky_column_effect_enable&quot;:false}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0ca5cc7 elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"0ca5cc7\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Suivant&quot;,&quot;step_previous_label&quot;:&quot;Pr\\u00e9c\\u00e9dent&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Projet SELFIE\" aria-label=\"Projet SELFIE\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"2189\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"0ca5cc7\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"\" \/>\n\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-name elementor-col-30 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate de la r\u00e9f\u00e9rence\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field\" placeholder=\"Nom\" required=\"required\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_c677049 elementor-col-100\">\n\t\t\t\t\t<h3>1) Adolescente r\u00e9f\u00e9r\u00e9e:<\/h3>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-email elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNom\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Nom\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-message elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-message\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPr\u00e9nom\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[message]\" id=\"form-field-message\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Pr\u00e9nom\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_0eda4e1 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0eda4e1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDDN\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_0eda4e1]\" id=\"form-field-field_0eda4e1\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field\" placeholder=\"DDN\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_3efb63e elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3efb63e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t\u00c2ge\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_3efb63e]\" id=\"form-field-field_3efb63e\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"\u00c2ge\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_c3608fe elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c3608fe\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNom du tuteur l\u00e9gal de l\u2019enfant:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_c3608fe]\" id=\"form-field-field_c3608fe\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Nom du tuteur l\u00e9gal de l\u2019enfant:\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_032e09f elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_032e09f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tT\u00e9l\u00e9phone\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_032e09f]\" id=\"form-field-field_032e09f\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"T\u00e9l\u00e9phone\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_4ac2491 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4ac2491\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAdresse\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_4ac2491]\" id=\"form-field-field_4ac2491\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Adresse\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_51541a3 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_51541a3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tRTF  (milieu de vie) \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_51541a3]\" id=\"form-field-field_51541a3\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"RTF  (milieu de vie) \">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_8473da9 elementor-col-100\">\n\t\t\t\t\t<h3>2) Parents <\/h3>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_82dda3c elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_82dda3c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNom de la m\u00e8re\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_82dda3c]\" id=\"form-field-field_82dda3c\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Nom de la m\u00e8re\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_af99015 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_af99015\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAdresse\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_af99015]\" id=\"form-field-field_af99015\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Adresse\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_6025969 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6025969\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTel. (travail)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_6025969]\" id=\"form-field-field_6025969\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Tel. (travail)\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_8647189 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8647189\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPr\u00e9f\u00e9rence\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_8647189]\" id=\"form-field-field_8647189\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"--------\">--------<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"AM\">AM<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"PM\">PM<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_d7c5d26 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d7c5d26\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCellulaire\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_d7c5d26]\" id=\"form-field-field_d7c5d26\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Cellulaire\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_014a9ea elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_014a9ea\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTel. (Maison)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_014a9ea]\" id=\"form-field-field_014a9ea\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Tel. (Maison)\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_eeec3c0 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_eeec3c0\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPr\u00e9f\u00e9rence\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_eeec3c0]\" id=\"form-field-field_eeec3c0\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"--------\">--------<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"AM\">AM<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"PM\">PM<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_adbd53d elementor-col-100\">\n\t\t\t\t\t<hr style=\"margin-bottom:20px; margin-top:20px; border-width: 2px;\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_d43bd27 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d43bd27\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNom du p\u00e8re\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_d43bd27]\" id=\"form-field-field_d43bd27\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Nom de la m\u00e8re :\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_cdb9176 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_cdb9176\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAdresse\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_cdb9176]\" id=\"form-field-field_cdb9176\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Adresse\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_f2d999d elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f2d999d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTel. (travail)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_f2d999d]\" id=\"form-field-field_f2d999d\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Tel. (travail)\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_787ed48 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_787ed48\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPr\u00e9f\u00e9rence\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_787ed48]\" id=\"form-field-field_787ed48\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"--------\">--------<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"AM\">AM<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"PM\">PM<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_abaf024 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_abaf024\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCellulaire\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_abaf024]\" id=\"form-field-field_abaf024\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Cellulaire\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_4662d32 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4662d32\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTel. (Maison)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_4662d32]\" id=\"form-field-field_4662d32\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Tel. (Maison)\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_b27f46c elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b27f46c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPr\u00e9f\u00e9rence\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_b27f46c]\" id=\"form-field-field_b27f46c\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"--------\">--------<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"AM\">AM<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"PM\">PM<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_4a7414c elementor-col-100\">\n\t\t\t\t\t<h3>3) Profil de l\u2019adolescente et de la famille<\/h3>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_d9802b8 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d9802b8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\ta. Situation de l\u2019adolescente suspect\u00e9e en mati\u00e8re d\u2019exploitation sexuelle\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_d9802b8]\" id=\"form-field-field_d9802b8\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"--------\">--------<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Jeune suspect\u00e9e d\u2019avoir des activit\u00e9s de prostitution\">Jeune suspect\u00e9e d\u2019avoir des activit\u00e9s de prostitution<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Jeune suspect\u00e9e comme agissant comme prox\u00e9n\u00e8te ou recruteuse aupr\u00e8s des d\u2019autres adolescentes\">Jeune suspect\u00e9e comme agissant comme prox\u00e9n\u00e8te ou recruteuse aupr\u00e8s des d\u2019autres adolescentes<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Jeune suspect\u00e9e comme \u00e9tant dans les premi\u00e8res phases du cycle d\u2019engagement dans le milieu (lune de miel, d\u00e9sensibilisation)\">Jeune suspect\u00e9e comme \u00e9tant dans les premi\u00e8res phases du cycle d\u2019engagement dans le milieu (lune de miel, d\u00e9sensibilisation)<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Situation inconnue pour le moment.\">Situation inconnue pour le moment.<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_536ca39 elementor-col-100\">\n\t\t\t\t\t<h5>b. Inventaire des facteurs de vuln\u00e9rabilit\u00e9 pr\u00e9sents chez la jeune <\/h5>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_58ce2d3 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_58ce2d3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFacteurs de risque\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Faible estime de soi\" id=\"form-field-field_58ce2d3-0\" name=\"form_fields[field_58ce2d3][]\"> <label for=\"form-field-field_58ce2d3-0\">Faible estime de soi<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Mauvaise communication parent-enfant\" id=\"form-field-field_58ce2d3-1\" name=\"form_fields[field_58ce2d3][]\"> <label for=\"form-field-field_58ce2d3-1\">Mauvaise communication parent-enfant<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Absence de liens s\u00e9curitaires et solides avec un adulte\" id=\"form-field-field_58ce2d3-2\" name=\"form_fields[field_58ce2d3][]\"> <label for=\"form-field-field_58ce2d3-2\">Absence de liens s\u00e9curitaires et solides avec un adulte<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Normes sexuelles et valeurs morales peu d\u00e9finies\" id=\"form-field-field_58ce2d3-3\" name=\"form_fields[field_58ce2d3][]\"> <label for=\"form-field-field_58ce2d3-3\">Normes sexuelles et valeurs morales peu d\u00e9finies<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Isolement social ou rejet par les pairs\" id=\"form-field-field_58ce2d3-4\" name=\"form_fields[field_58ce2d3][]\"> <label for=\"form-field-field_58ce2d3-4\">Isolement social ou rejet par les pairs<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_12bfb9b elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_12bfb9b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFacteurs de protection\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Estime de soi\" id=\"form-field-field_12bfb9b-0\" name=\"form_fields[field_12bfb9b][]\"> <label for=\"form-field-field_12bfb9b-0\">Estime de soi<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Communication positive dans la famille\" id=\"form-field-field_12bfb9b-1\" name=\"form_fields[field_12bfb9b][]\"> <label for=\"form-field-field_12bfb9b-1\">Communication positive dans la famille<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Relation sinc\u00e8re significative avec un adulte de confiance et maintien de l\u2019attachement\" id=\"form-field-field_12bfb9b-2\" name=\"form_fields[field_12bfb9b][]\"> <label for=\"form-field-field_12bfb9b-2\">Relation sinc\u00e8re significative avec un adulte de confiance et maintien de l\u2019attachement<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"\u00c9ducation \u00e0 la sexualit\u00e9\" id=\"form-field-field_12bfb9b-3\" name=\"form_fields[field_12bfb9b][]\"> <label for=\"form-field-field_12bfb9b-3\">\u00c9ducation \u00e0 la sexualit\u00e9<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Aptitudes \u00e0 la socialisation et capacit\u00e9s relationnelles\" id=\"form-field-field_12bfb9b-4\" name=\"form_fields[field_12bfb9b][]\"> <label for=\"form-field-field_12bfb9b-4\">Aptitudes \u00e0 la socialisation et capacit\u00e9s relationnelles<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_1b9492c elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1b9492c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tc. R\u00e9action de l\u2019adolescente face au projet Selfie\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_1b9492c]\" id=\"form-field-field_1b9492c\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"-------\">-------<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"volontaire\">volontaire<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"ambivalente\">ambivalente<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_642e164 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_642e164\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\td. Consentement du parent \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Les parents ont \u00e9t\u00e9 inform\u00e9s de la r\u00e9f\u00e9rence pour leur jeune.\" id=\"form-field-field_642e164-0\" name=\"form_fields[field_642e164][]\"> <label for=\"form-field-field_642e164-0\">Les parents ont \u00e9t\u00e9 inform\u00e9s de la r\u00e9f\u00e9rence pour leur jeune.<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Les parents consentent aux services offerts.\" id=\"form-field-field_642e164-1\" name=\"form_fields[field_642e164][]\"> <label for=\"form-field-field_642e164-1\">Les parents consentent aux services offerts.<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Les parents acceptent les services parents offerts en ligne par le CAVAC.\" id=\"form-field-field_642e164-2\" name=\"form_fields[field_642e164][]\"> <label for=\"form-field-field_642e164-2\">Les parents acceptent les services parents offerts en ligne par le CAVAC.<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_dda0be7 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_dda0be7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\te. Informations compl\u00e9mentaires sur le profil de l\u2019adolescente  (Conditions physiques, psychologiques, comportementales ou intellectuelles)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_dda0be7]\" id=\"form-field-field_dda0be7\" rows=\"4\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_5185de6 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5185de6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tf. Dynamique familiale\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_5185de6]\" id=\"form-field-field_5185de6\" rows=\"4\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_8307421 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8307421\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tg. Commentaires additionnels pertinents pour mieux comprendre la r\u00e9f\u00e9rence\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_8307421]\" id=\"form-field-field_8307421\" rows=\"4\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_b786f04 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b786f04\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\th. Est-ce que l\u2019enfant re\u00e7oit d\u2019autres services?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[field_b786f04]\" id=\"form-field-field_b786f04\" rows=\"4\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_3a8bd67 elementor-col-100\">\n\t\t\t\t\t<h3> 4) Professionnel responsable du dossier<\/h3>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_3e922f6 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3e922f6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNom de l\u2019intervenant (e)  \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_3e922f6]\" id=\"form-field-field_3e922f6\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Nom de l\u2019intervenant (e)  \">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_d79847b elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d79847b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tT\u00e9l\u00e9phone et poste\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_d79847b]\" id=\"form-field-field_d79847b\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"T\u00e9l\u00e9phone et poste\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_549527a elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_549527a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCourriel\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[field_549527a]\" id=\"form-field-field_549527a\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Courriel\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_c23dec8 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c23dec8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tOrganisation\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_c23dec8]\" id=\"form-field-field_c23dec8\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Organisation\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-field_a919998 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a919998\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAutorisation de communiquer l\u2019information\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[field_a919998]\" id=\"form-field-field_a919998\" class=\"elementor-field elementor-size-sm  elementor-upload-field\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Envoyer<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<input\n                    class=\"apbct_special_field apbct_email_id__elementor_form\"\n                    name=\"apbct__email_id__elementor_form\"\n                    aria-label=\"apbct__label_id__elementor_form\"\n                    type=\"text\" size=\"30\" maxlength=\"200\" autocomplete=\"off\"\n                    value=\"\"\n                \/><\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Projet SELFIE Formulaire de r\u00e9f\u00e9rence<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_seopress_robots_primary_cat":"","_seopress_titles_title":"","_seopress_titles_desc":"","_seopress_robots_index":"yes","inline_featured_image":false,"footnotes":""},"class_list":["post-2189","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/ciasf.org\/en\/wp-json\/wp\/v2\/pages\/2189","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ciasf.org\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/ciasf.org\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/ciasf.org\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/ciasf.org\/en\/wp-json\/wp\/v2\/comments?post=2189"}],"version-history":[{"count":0,"href":"https:\/\/ciasf.org\/en\/wp-json\/wp\/v2\/pages\/2189\/revisions"}],"wp:attachment":[{"href":"https:\/\/ciasf.org\/en\/wp-json\/wp\/v2\/media?parent=2189"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}