{"id":814,"date":"2021-12-06T20:02:54","date_gmt":"2021-12-06T15:02:54","guid":{"rendered":"https:\/\/carrefoursteusebe.com\/?page_id=814"},"modified":"2022-06-06T08:30:38","modified_gmt":"2022-06-06T13:30:38","slug":"inscription-beneficiaire","status":"publish","type":"page","link":"https:\/\/carrefoursteusebe.ca\/inscription-beneficiaire\/","title":{"rendered":"Fiche d&rsquo;inscription du b\u00e9n\u00e9ficiaire"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"814\" class=\"elementor elementor-814\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-9c452e6 elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"9c452e6\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-a5b5f77\" data-id=\"a5b5f77\" data-element_type=\"column\">\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-06c0947 elementor-widget elementor-widget-heading\" data-id=\"06c0947\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.21.0 - 30-04-2024 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h1 class=\"elementor-heading-title elementor-size-default\">Fiche d'inscription <br>du b\u00e9n\u00e9ficiaire<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-95f61e6 elementor-widget elementor-widget-text-editor\" data-id=\"95f61e6\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.21.0 - 30-04-2024 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p>\u00c0 la r\u00e9ception de votre formulaire, la coordonnatrice de la popote roulante contactera directement la personne.<\/p>\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=\"elementor-section elementor-top-section elementor-element elementor-element-a826fcf elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"a826fcf\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-913a655\" data-id=\"913a655\" data-element_type=\"column\">\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-be70965 elementor-button-align-center elementor-widget elementor-widget-form\" data-id=\"be70965\" data-element_type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&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<style>\/*! elementor-pro - v3.21.0 - 24-04-2024 *\/\n.elementor-button.elementor-hidden,.elementor-hidden{display:none}.e-form__step{width:100%}.e-form__step:not(.elementor-hidden){display:flex;flex-wrap:wrap}.e-form__buttons{flex-wrap:wrap}.e-form__buttons,.e-form__buttons__wrapper{display:flex}.e-form__indicators{display:flex;justify-content:space-between;align-items:center;flex-wrap:nowrap;font-size:13px;margin-bottom:var(--e-form-steps-indicators-spacing)}.e-form__indicators__indicator{display:flex;flex-direction:column;align-items:center;justify-content:center;flex-basis:0;padding:0 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.e-form__indicators__indicator__separator,.e-form__indicators--type-number .e-form__indicators__indicator__separator,.e-form__indicators--type-number_text .e-form__indicators__indicator__separator{margin-top:calc(var(--e-form-steps-indicator-padding, 30px) \/ 2 - var(--e-form-steps-divider-width, 1px) \/ 2)}.elementor-field-type-hidden{display:none}.elementor-field-type-html{display:inline-block}.elementor-field-type-tel input{direction:inherit}.elementor-login .elementor-lost-password,.elementor-login .elementor-remember-me{font-size:.85em}.elementor-field-type-recaptcha_v3 .elementor-field-label{display:none}.elementor-field-type-recaptcha_v3 .grecaptcha-badge{z-index:1}.elementor-button .elementor-form-spinner{order:3}.elementor-form .elementor-button>span{display:flex;justify-content:center;align-items:center}.elementor-form .elementor-button .elementor-button-text{white-space:normal;flex-grow:0}.elementor-form .elementor-button svg{height:auto}.elementor-form .elementor-button .e-font-icon-svg{height:1em}.elementor-select-wrapper .select-caret-down-wrapper{position:absolute;top:50%;transform:translateY(-50%);inset-inline-end:10px;pointer-events:none;font-size:11px}.elementor-select-wrapper .select-caret-down-wrapper svg{display:unset;width:1em;aspect-ratio:unset;fill:currentColor}.elementor-select-wrapper .select-caret-down-wrapper i{font-size:19px;line-height:2}.elementor-select-wrapper.remove-before:before{content:\"\"!important}<\/style>\t\t<form class=\"elementor-form\" method=\"post\" name=\"Inscription b\u00e9n\u00e9ficiaire\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"814\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"be70965\"\/>\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-radio elementor-field-group elementor-column elementor-field-group-field_ac99240 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ac99240\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSalutation\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Madame\" id=\"form-field-field_ac99240-0\" name=\"form_fields[field_ac99240]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_ac99240-0\">Madame<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Monsieur\" id=\"form-field-field_ac99240-1\" name=\"form_fields[field_ac99240]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_ac99240-1\">Monsieur<\/label><\/span><\/div>\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_9a972b8 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9a972b8\" 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[field_9a972b8]\" id=\"form-field-field_9a972b8\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\" aria-required=\"true\">\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_82c1fb4 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_82c1fb4\" 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[field_82c1fb4]\" id=\"form-field-field_82c1fb4\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\" aria-required=\"true\">\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_6c38804 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6c38804\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate de naissance\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_6c38804]\" id=\"form-field-field_6c38804\" class=\"elementor-field elementor-size-md  elementor-field-textual elementor-date-field elementor-use-native\" required=\"required\" aria-required=\"true\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\" min=\"1910-01-01\" max=\"2020-01-01\">\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_f3effa6 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f3effa6\" 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_f3effa6]\" id=\"form-field-field_f3effa6\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\" aria-required=\"true\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Seuls les caract\u00e8res de num\u00e9ros de t\u00e9l\u00e9phone (#, -, *, etc.) sont accept\u00e9s.\">\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-email elementor-col-100 elementor-field-required elementor-mark-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\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[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Inclure le num\u00e9ro d&#039;appartement et le code de la porte, s&#039;il y a lieu.\" required=\"required\" aria-required=\"true\">\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_b804c0e elementor-col-30 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b804c0e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCode postal\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_b804c0e]\" id=\"form-field-field_b804c0e\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\" aria-required=\"true\">\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_9bc4655 elementor-col-70\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9bc4655\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLa personne souffre-t-elle d'allergies? \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_9bc4655]\" id=\"form-field-field_9bc4655\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Si oui, pr\u00e9cisez.\">\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-checkbox elementor-field-group elementor-column elementor-field-group-field_02bbdbd elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_02bbdbd\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tRaison pour laquelle vous inscrivez cette personne *\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=\"Diab\u00e9tique\" id=\"form-field-field_02bbdbd-0\" name=\"form_fields[field_02bbdbd][]\"> <label for=\"form-field-field_02bbdbd-0\">Diab\u00e9tique<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Probl\u00e8me cognitif\" id=\"form-field-field_02bbdbd-1\" name=\"form_fields[field_02bbdbd][]\"> <label for=\"form-field-field_02bbdbd-1\">Probl\u00e8me cognitif<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Perte auditive\" id=\"form-field-field_02bbdbd-2\" name=\"form_fields[field_02bbdbd][]\"> <label for=\"form-field-field_02bbdbd-2\">Perte auditive<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"D\u00e9ficience visuelle\" id=\"form-field-field_02bbdbd-3\" name=\"form_fields[field_02bbdbd][]\"> <label for=\"form-field-field_02bbdbd-3\">D\u00e9ficience visuelle<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Mobilit\u00e9 r\u00e9duite\" id=\"form-field-field_02bbdbd-4\" name=\"form_fields[field_02bbdbd][]\"> <label for=\"form-field-field_02bbdbd-4\">Mobilit\u00e9 r\u00e9duite<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Probl\u00e8me de sant\u00e9 mentale\" id=\"form-field-field_02bbdbd-5\" name=\"form_fields[field_02bbdbd][]\"> <label for=\"form-field-field_02bbdbd-5\">Probl\u00e8me de sant\u00e9 mentale<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Personne seule\" id=\"form-field-field_02bbdbd-6\" name=\"form_fields[field_02bbdbd][]\"> <label for=\"form-field-field_02bbdbd-6\">Personne seule<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Autre\" id=\"form-field-field_02bbdbd-7\" name=\"form_fields[field_02bbdbd][]\"> <label for=\"form-field-field_02bbdbd-7\">Autre<\/label><\/span><\/div>\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_f117284 elementor-col-100\">\n\t\t\t\t\tEN CAS D'URGENCE<br>Personne \u00e0 contacter\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_075159a elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_075159a\" 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[field_075159a]\" id=\"form-field-field_075159a\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\" aria-required=\"true\">\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_6817dd3 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6817dd3\" 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[field_6817dd3]\" id=\"form-field-field_6817dd3\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\" aria-required=\"true\">\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_2260dda elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2260dda\" 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_2260dda]\" id=\"form-field-field_2260dda\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\" aria-required=\"true\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Seuls les caract\u00e8res de num\u00e9ros de t\u00e9l\u00e9phone (#, -, *, etc.) sont accept\u00e9s.\">\n\n\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_4c5d03a elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4c5d03a\" 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_4c5d03a]\" id=\"form-field-field_4c5d03a\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\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_008e36d elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_008e36d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLien (parent\u00e9 ou autre)\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_008e36d]\" id=\"form-field-field_008e36d\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\" aria-required=\"true\">\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_529b283 elementor-col-100\">\n\t\t\t\t\tR\u00e9f\u00e9r\u00e9 par\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_aba149f elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_aba149f\" 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[field_aba149f]\" id=\"form-field-field_aba149f\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\" aria-required=\"true\">\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_4a6daf6 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4a6daf6\" 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[field_4a6daf6]\" id=\"form-field-field_4a6daf6\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\" aria-required=\"true\">\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_0cdc77d elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0cdc77d\" 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_0cdc77d]\" id=\"form-field-field_0cdc77d\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\" aria-required=\"true\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Seuls les caract\u00e8res de num\u00e9ros de t\u00e9l\u00e9phone (#, -, *, etc.) sont accept\u00e9s.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-number elementor-field-group elementor-column elementor-field-group-field_f2fb5f6 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f2fb5f6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPoste\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"number\" name=\"form_fields[field_f2fb5f6]\" id=\"form-field-field_f2fb5f6\" class=\"elementor-field elementor-size-md  elementor-field-textual\" min=\"\" max=\"\" >\n\t\t\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-message elementor-col-100\">\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\tMessage\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[message]\" id=\"form-field-message\" rows=\"4\" placeholder=\"Optionnel\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text\">\n\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_87510d8]\" id=\"form-field-field_87510d8\" class=\"elementor-field elementor-size-md \" style=\"display:none !important;\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-recaptcha elementor-field-group elementor-column elementor-field-group-field_efb022f elementor-col-100\">\n\t\t\t\t\t<div class=\"elementor-field\" id=\"form-field-field_efb022f\"><div class=\"elementor-g-recaptcha\" data-sitekey=\"6Lf6KZYgAAAAAFcvJA9sc9h9AdcfuOYyvlJZKFc8\" data-type=\"v2_checkbox\" data-theme=\"dark\" data-size=\"normal\"><\/div><\/div>\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 type=\"submit\" class=\"elementor-button elementor-size-md\">\n\t\t\t\t\t\t<span >\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\" elementor-button-icon\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\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\">TRANSMETTRE<\/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<\/form>\n\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>Fiche d&rsquo;inscription du b\u00e9n\u00e9ficiaire \u00c0 la r\u00e9ception de votre formulaire, la coordonnatrice de la popote roulante contactera directement la personne.<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"_links":{"self":[{"href":"https:\/\/carrefoursteusebe.ca\/wp-json\/wp\/v2\/pages\/814"}],"collection":[{"href":"https:\/\/carrefoursteusebe.ca\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/carrefoursteusebe.ca\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/carrefoursteusebe.ca\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/carrefoursteusebe.ca\/wp-json\/wp\/v2\/comments?post=814"}],"version-history":[{"count":152,"href":"https:\/\/carrefoursteusebe.ca\/wp-json\/wp\/v2\/pages\/814\/revisions"}],"predecessor-version":[{"id":4450,"href":"https:\/\/carrefoursteusebe.ca\/wp-json\/wp\/v2\/pages\/814\/revisions\/4450"}],"wp:attachment":[{"href":"https:\/\/carrefoursteusebe.ca\/wp-json\/wp\/v2\/media?parent=814"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}