{"id":3461,"date":"2021-03-12T11:16:02","date_gmt":"2021-03-12T10:16:02","guid":{"rendered":"https:\/\/staging.avixi.be\/?page_id=3461"},"modified":"2021-12-16T15:31:10","modified_gmt":"2021-12-16T14:31:10","slug":"demande-droit-passerelle-quarantaine-soins-apportes-a-un-enfant","status":"publish","type":"page","link":"https:\/\/staging.avixi.be\/fr\/corona\/formulaires\/demande-droit-passerelle-quarantaine-soins-apportes-a-un-enfant\/","title":{"rendered":"Demande droit passerelle quarantaine\/soins apport\u00e9s \u00e0 un enfant"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1560px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_3_4 3_4 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:75%;--awb-margin-top-large:0px;--awb-spacing-right-large:2.56%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:2.56%;--awb-width-medium:75%;--awb-order-medium:0;--awb-spacing-right-medium:2.56%;--awb-spacing-left-medium:2.56%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><nav class=\"fusion-breadcrumbs fusion-breadcrumbs-1\" style=\"--awb-breadcrumb-sep:&#039;\/&#039;;\" aria-label=\"Breadcrumb\"><ol class=\"awb-breadcrumb-list\"><li class=\"fusion-breadcrumb-item awb-breadcrumb-sep awb-home\" ><a href=\"https:\/\/staging.avixi.be\/fr\/\" class=\"fusion-breadcrumb-link\"><span >Home<\/span><\/a><\/li><\/ol><\/nav><div class=\"fusion-text fusion-text-1\"><h1>Demande droit passerelle quarantaine\/soins apport\u00e9s \u00e0 un enfant<\/h1>\n<hr \/>\n<p><strong>Attention: veuillez noter que lorsque vous faites une demande de \u2018soins \u00e0 un enfant\u2019, vous \u00eates tenu (parfois) d\u2019ajouter un certificat.<\/strong><\/p>\n<ul>\n<li>Attestation de quarantaine<\/li>\n<li><strong><a href=\"https:\/\/staging.avixi.be\/wp-content\/uploads\/2021\/03\/certificat-ecole-ou-creche-sur-demande-corona-2021.pdf\" target=\"_blank\" rel=\"noopener\">Attestation \u00e9cole ou cr\u00e8che<\/a><\/strong><\/li>\n<li><strong><a href=\"https:\/\/staging.avixi.be\/wp-content\/uploads\/2021\/03\/certificat-enfant-handicape-sur-demande-corona-2021.pdf\" target=\"_blank\" rel=\"noopener\">Attestation centre d\u2019accueil des enfants handicap\u00e9s<\/a><\/strong><\/li>\n<\/ul>\n<p>Le formulaire indique dans quel cas vous devrez joindre un certificat.<\/p>\n<p><strong>Arrangement temporaire soins apport\u00e9s \u00e0 un enfant<\/strong><\/p>\n<ol>\n<li><strong><strong>Ecoles ferm\u00e9es (p\u00e9riode de 20 d\u00e9cembre au 24 d\u00e9cembre 2021, aucun certificat n\u2019est requis):<\/strong><\/strong><strong>\u00a0<\/strong>ces 5 jours de fermeture d\u2019\u00e9cole (maternelles et primaires) sont consid\u00e9r\u00e9s comme une interruption d\u2019activit\u00e9 de 7 jours civils cons\u00e9cutifs. S\u2019ils sont pris cons\u00e9cutivement, les ind\u00e9pendants entrent en consid\u00e9ration pour la prestation financi\u00e8re (m\u00eame s\u2019il n\u2019y a pas 7 jours civils au cours d\u2019un mois civil).<\/li>\n<li><strong>Ecoles ferm\u00e9es (p\u00e9riode de 29 mars au 4 avril 2021): <\/strong>ces 5 jours de fermeture d\u2019\u00e9cole sont consid\u00e9r\u00e9s comme une interruption d\u2019activit\u00e9 de 7 jours civils cons\u00e9cutifs. S\u2019ils sont pris cons\u00e9cutivement, les ind\u00e9pendants entrent en consid\u00e9ration pour la prestation financi\u00e8re (m\u00eame s\u2019il n\u2019y a pas 7 jours civils au cours d\u2019un mois civil).<\/li>\n<li><strong>Ecoles maternelles qui restent ouvertes ((p\u00e9riode de 29 mars au 4 avril 2021):<\/strong> la prestation financi\u00e8re dans la situation de garde d&rsquo;un enfant peut \u00e9galement \u00eatre accord\u00e9e aux travailleurs ind\u00e9pendants qui d\u00e9cident de ne pas laisser aller \u00e0 l\u2019\u00e9cole maternelle un enfant avec lequel il cohabite, et ce pour les jours o\u00f9 il assure lui-m\u00eame la garde de l\u2019enfant. S\u2019ils sont pris cons\u00e9cutivement, les ind\u00e9pendants entrent en consid\u00e9ration pour la prestation financi\u00e8re (m\u00eame s\u2019il n\u2019y a pas 7 jours civils au cours d\u2019un mois civil).<\/li>\n<li><strong>Cr\u00e8ches qui restent ouvertes (p\u00e9riode de 29 mars au 18 avril 2021):<\/strong> la prestation financi\u00e8re dans la situation de garde d&rsquo;un enfant peut \u00e9galement \u00eatre accord\u00e9e aux travailleurs ind\u00e9pendants qui d\u00e9cident de ne pas laisser aller \u00e0 la cr\u00e8che un enfant avec lequel il cohabite, et ce pour les jours o\u00f9 l\u2019enfant est normalement inscrit et pour lesquels il assure lui-m\u00eame la garde de l\u2019enfant.<\/li>\n<li><strong>C<\/strong><strong>amps et stages annul\u00e9s (pendant les vacances de P\u00e2ques): <\/strong>le travailleur ind\u00e9pendant qui, \u00e0 la suite de l&rsquo;annulation totale ou partielle d\u2019une colonie de vacances ou d\u2019un accueil extrascolaire organis\u00e9, doit assurer la garde d\u2019un enfant mineur avec lequel il cohabite pendant les vacances de P\u00e2ques, peut \u00e9galement pr\u00e9tendre \u00e0 la prestation financi\u00e8re pour les jours o\u00f9 il assure la garde de l\u2019enfant. La condition \u00e0 remplir est que l\u2019enfant ait \u00e9t\u00e9 inscrit au plus tard le 18 mars<\/li>\n<\/ol>\n<\/div><div class=\"fusion-separator fusion-full-width-sep\" style=\"align-self: center;margin-left: auto;margin-right: auto;margin-top:1rem;margin-bottom:1rem;width:100%;\"><div class=\"fusion-separator-border sep-single\" style=\"--awb-height:20px;--awb-amount:20px;border-color:#def0f4;border-top-width:2px;\"><\/div><\/div><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 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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 gform_legacy_markup_wrapper gform-theme--no-framework' 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type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_37_35\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_37_35'><span class='gform-field-label__text'>Num\u00e9ro de compte (IBAN)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_37_35' type='text' value='' class='medium'    placeholder='BE99 9999 9999 9999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"BE99 9999 9999 9999\"\/><\/div><\/li><li id=\"field_37_155\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above 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field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Lequel?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_37_88'>\n\t\t\t<li class='gchoice gchoice_37_88_0'>\n\t\t\t\t<input name='input_88' type='radio' value='Droit passerelle'  id='choice_37_88_0'    \/>\n\t\t\t\t<label for='choice_37_88_0' id='label_37_88_0' class='gform-field-label gform-field-label--type-inline'>Droit passerelle<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_37_88_1'>\n\t\t\t\t<input name='input_88' type='radio' value='Indemnit\u00e9s d\u2019incapacit\u00e9 de travail ou d\u2019invalidit\u00e9'  id='choice_37_88_1'    \/>\n\t\t\t\t<label for='choice_37_88_1' id='label_37_88_1' class='gform-field-label gform-field-label--type-inline'>Indemnit\u00e9s d\u2019incapacit\u00e9 de travail ou d\u2019invalidit\u00e9<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_37_88_2'>\n\t\t\t\t<input name='input_88' type='radio' value='Pension'  id='choice_37_88_2'    \/>\n\t\t\t\t<label for='choice_37_88_2' id='label_37_88_2' class='gform-field-label gform-field-label--type-inline'>Pension<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_37_88_3'>\n\t\t\t\t<input name='input_88' type='radio' value='Allocations de ch\u00f4mage'  id='choice_37_88_3'    \/>\n\t\t\t\t<label for='choice_37_88_3' id='label_37_88_3' class='gform-field-label gform-field-label--type-inline'>Allocations de ch\u00f4mage<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_37_88_4'>\n\t\t\t\t<input name='input_88' type='radio' value='Autres'  id='choice_37_88_4'    \/>\n\t\t\t\t<label for='choice_37_88_4' id='label_37_88_4' class='gform-field-label gform-field-label--type-inline'>Autres<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_37_167\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_37_167'><span class='gform-field-label__text'>Pr\u00e9cisez:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_167' id='input_37_167' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_37_226\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_37_226'><span class='gform-field-label__text'>Quel est le montant brut de ce revenu de remplacement?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_226' id='input_37_226' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_37_227\" class=\"gfield gfield--type-fileupload field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_37_227'><span class='gform-field-label__text'>Veuillez si possible fournir une preuve, p.e. un extrait de Mypension.be<\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_37_227' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_37_227&quot;,&quot;container&quot;:&quot;gform_multifile_upload_37_227&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_37_227&quot;,&quot;filelist&quot;:&quot;gform_preview_37_227&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/?gf_page=f51d946b4550319&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers autoris\\u00e9s&quot;,&quot;extensions&quot;:&quot;doc,docx,txt,rtf,pdf,jpg,png,xlsx&quot;}],&quot;max_file_size&quot;:&quot;15728640b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:37,&quot;field_id&quot;:227,&quot;_gform_file_upload_nonce_37_227&quot;:&quot;672cfd27fe&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;10&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_37_227&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_37_227' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>D\u00e9posez les fichiers ici ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_37_227' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_37_227\"  >S\u00e9lectionnez des fichiers<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_37_227'>Types de fichiers accept\u00e9s\u00a0: doc, docx, txt, rtf, pdf, jpg, png, xlsx, Taille max. des fichiers\u00a0: 15 MB, Max. des fichiers\u00a0: 10.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_37_227'><\/ul> <div id='gform_preview_37_227' class='ginput_preview_list'><\/div><\/div><\/li><li id=\"field_37_158\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Raison<\/h2><\/li><li id=\"field_37_182\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Veuillez indiquer lequel des cas s&#039;applique \u00e0 votre situation:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_37_182'>\n\t\t\t<li class='gchoice gchoice_37_182_0'>\n\t\t\t\t<input name='input_182' type='radio' value='Quarantaine\/isolement'  id='choice_37_182_0'    \/>\n\t\t\t\t<label for='choice_37_182_0' id='label_37_182_0' class='gform-field-label gform-field-label--type-inline'>Quarantaine\/isolement<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_37_182_1'>\n\t\t\t\t<input name='input_182' type='radio' value='Prendre soin de mon (mes) enfant(s)'  id='choice_37_182_1'    \/>\n\t\t\t\t<label for='choice_37_182_1' id='label_37_182_1' class='gform-field-label gform-field-label--type-inline'>Prendre soin de mon (mes) enfant(s)<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_37_229\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >J'ai d\u00fb interrompre totalement mon activit\u00e9 ind\u00e9pendante pendant au moins 7 jours civils cons\u00e9cutifs en raison de ma mise en quarantaine ou en isolement apr\u00e8s un contact \u00e0 haut risque et ce, pendant la p\u00e9riode:<\/li><li id=\"field_37_206\" class=\"gfield gfield--type-date gfield--input-type-datedropdown gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Du:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_37_206' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\"><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_37_206_2_container'><label for='input_37_206_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Jour<\/label><select name='input_206[]' id='input_37_206_2'   aria-required='true'  ><option value=''>Jour<\/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><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_37_206_1_container'><label for='input_37_206_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Mois<\/label><select name='input_206[]' id='input_37_206_1'   aria-required='true'  ><option value=''>Mois<\/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><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_37_206_3_container'><label for='input_37_206_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Ann\u00e9e<\/label><select name='input_206[]' id='input_37_206_3'   aria-required='true'  ><option value=''>Ann\u00e9e<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/div><\/li><li id=\"field_37_201\" class=\"gfield gfield--type-date gfield--input-type-datedropdown gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Jusqu\u2019\u00e0 la date incluse:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_37_201' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\"><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_37_201_2_container'><label for='input_37_201_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Jour<\/label><select name='input_201[]' id='input_37_201_2'   aria-required='true'  ><option value=''>Jour<\/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><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_37_201_1_container'><label for='input_37_201_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Mois<\/label><select name='input_201[]' id='input_37_201_1'   aria-required='true'  ><option value=''>Mois<\/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><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_37_201_3_container'><label for='input_37_201_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Ann\u00e9e<\/label><select name='input_201[]' id='input_37_201_3'   aria-required='true'  ><option value=''>Ann\u00e9e<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/div><\/li><li id=\"field_37_189\" class=\"gfield gfield--type-fileupload gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_37_189'><span class='gform-field-label__text'>Ajoutez un certificat de quarantaine \u00e0 votre nom ou au nom de la personne enregistr\u00e9e \u00e0 la m\u00eame adresse.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_37_189' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_37_189&quot;,&quot;container&quot;:&quot;gform_multifile_upload_37_189&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_37_189&quot;,&quot;filelist&quot;:&quot;gform_preview_37_189&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/?gf_page=f51d946b4550319&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers autoris\\u00e9s&quot;,&quot;extensions&quot;:&quot;doc,docx,txt,rtf,pdf,jpg,png,xlsx&quot;}],&quot;max_file_size&quot;:&quot;15728640b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:37,&quot;field_id&quot;:189,&quot;_gform_file_upload_nonce_37_189&quot;:&quot;208dcd5868&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;10&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_37_189&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_37_189' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>D\u00e9posez les fichiers ici ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_37_189' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_37_189\"  >S\u00e9lectionnez des fichiers<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_37_189'>Types de fichiers accept\u00e9s\u00a0: doc, docx, txt, rtf, pdf, jpg, png, xlsx, Taille max. des fichiers\u00a0: 15 MB, Max. des fichiers\u00a0: 10.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_37_189'><\/ul> <div id='gform_preview_37_189' class='ginput_preview_list'><\/div><\/div><\/li><li id=\"field_37_244\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_37_244'><span class='gform-field-label__text'>Num\u00e9ro de registre national de votre enfant<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_244' id='input_37_244' type='text' value='' class='medium'    placeholder='99.99.99-999.99' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"99.99.99-999.99\"\/><\/div><\/li><li id=\"field_37_228\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>J&#039;ai d\u00fb interrompre totalement mon activit\u00e9 ind\u00e9pendante parce que je dois m&#039;occuper de mon (mes) enfant(s) de moins de 18 ans avec qui je vis (y compris en cas de co-parentalit\u00e9):<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_37_228'>\n\t\t\t<li class='gchoice gchoice_37_228_0'>\n\t\t\t\t<input name='input_228' type='radio' value='Durant au moins 7 jours calendrier parce que mon enfant ne peut pas aller \u00e0 la cr\u00e8che ou \u00e0 l&#039;\u00e9cole'  id='choice_37_228_0'    \/>\n\t\t\t\t<label for='choice_37_228_0' id='label_37_228_0' class='gform-field-label gform-field-label--type-inline'>Durant au moins 7 jours calendrier parce que mon enfant ne peut pas aller \u00e0 la cr\u00e8che ou \u00e0 l'\u00e9cole<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_37_228_1'>\n\t\t\t\t<input name='input_228' type='radio' value='Durant au moins 7 jours calendrier parce que mon enfant handicap\u00e9 ne peut pas se rendre dans un centre de soins pour personnes handicap\u00e9es, parce que ce centre est ferm\u00e9 ou lorsque les services ou traitements hospitaliers ou non hospitaliers organis\u00e9s ou reconnus par les Communaut\u00e9s sont temporairement interrompus \u00e0 la suite d&#039;une mesure visant \u00e0 limiter la propagation du coronavirus COVID-19.'  id='choice_37_228_1'    \/>\n\t\t\t\t<label for='choice_37_228_1' id='label_37_228_1' class='gform-field-label gform-field-label--type-inline'>Durant au moins 7 jours calendrier parce que mon enfant handicap\u00e9 ne peut pas se rendre dans un centre de soins pour personnes handicap\u00e9es, parce que ce centre est ferm\u00e9 ou lorsque les services ou traitements hospitaliers ou non hospitaliers organis\u00e9s ou reconnus par les Communaut\u00e9s sont temporairement interrompus \u00e0 la suite d'une mesure visant \u00e0 limiter la propagation du coronavirus COVID-19.<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_37_228_2'>\n\t\t\t\t<input name='input_228' type='radio' value='Durant  5 jours cons\u00e9cutifs (p\u00e9riode de 20 d\u00e9cembre au 24 d\u00e9cembre 2021) suite \u00e0 la fermeture des \u00e9coles (maternelles et primaires)'  id='choice_37_228_2'    \/>\n\t\t\t\t<label for='choice_37_228_2' id='label_37_228_2' class='gform-field-label gform-field-label--type-inline'>Durant  5 jours cons\u00e9cutifs (p\u00e9riode de 20 d\u00e9cembre au 24 d\u00e9cembre 2021) suite \u00e0 la fermeture des \u00e9coles (maternelles et primaires)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_37_228_3'>\n\t\t\t\t<input name='input_228' type='radio' value='Durant  5 jours cons\u00e9cutifs (p\u00e9riode de 29 mars au 4 avril 2021) parce que mon enfant ne peut pas aller \u00e0 l&#039;\u00e9cole'  id='choice_37_228_3'    \/>\n\t\t\t\t<label for='choice_37_228_3' id='label_37_228_3' class='gform-field-label gform-field-label--type-inline'>Durant  5 jours cons\u00e9cutifs (p\u00e9riode de 29 mars au 4 avril 2021) parce que mon enfant ne peut pas aller \u00e0 l'\u00e9cole<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_37_228_4'>\n\t\t\t\t<input name='input_228' type='radio' value='Durant  5 jours cons\u00e9cutifs (p\u00e9riode de 29 mars au 4 avril 2021) parce que mon enfant ne peut pas aller \u00e0 l&#039;\u00e9cole maternelle'  id='choice_37_228_4'    \/>\n\t\t\t\t<label for='choice_37_228_4' id='label_37_228_4' class='gform-field-label gform-field-label--type-inline'>Durant  5 jours cons\u00e9cutifs (p\u00e9riode de 29 mars au 4 avril 2021) parce que mon enfant ne peut pas aller \u00e0 l'\u00e9cole maternelle<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_37_228_5'>\n\t\t\t\t<input name='input_228' type='radio' value='Pendant les jours o\u00f9 mon enfant est normalement inscrit \u00e0 la cr\u00e8che parce que je n\u2019ai pas laiss\u00e9 mon enfant aller \u00e0 la cr\u00e8che.'  id='choice_37_228_5'    \/>\n\t\t\t\t<label for='choice_37_228_5' id='label_37_228_5' class='gform-field-label gform-field-label--type-inline'>Pendant les jours o\u00f9 mon enfant est normalement inscrit \u00e0 la cr\u00e8che parce que je n\u2019ai pas laiss\u00e9 mon enfant aller \u00e0 la cr\u00e8che.<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_37_228_6'>\n\t\t\t\t<input name='input_228' type='radio' value='Pendant les vacances de P\u00e2ques pendant les jours o\u00f9 mon enfant a \u00e9t\u00e9 inscrit \u00e0 un camp de sport ou de vacances annul\u00e9.'  id='choice_37_228_6'    \/>\n\t\t\t\t<label for='choice_37_228_6' id='label_37_228_6' class='gform-field-label gform-field-label--type-inline'>Pendant les vacances de P\u00e2ques pendant les jours o\u00f9 mon enfant a \u00e9t\u00e9 inscrit \u00e0 un camp de sport ou de vacances annul\u00e9.<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_37_230\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Veuillez indiquer lequel des cas ci-dessous s&#039;applique \u00e0 votre situation:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_37_230'>\n\t\t\t<li class='gchoice gchoice_37_230_0'>\n\t\t\t\t<input name='input_230' type='radio' value='L&#039;enfant est en quarantaine ou en isolement'  id='choice_37_230_0'    \/>\n\t\t\t\t<label for='choice_37_230_0' id='label_37_230_0' class='gform-field-label gform-field-label--type-inline'>L'enfant est en quarantaine ou en isolement<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_37_230_1'>\n\t\t\t\t<input name='input_230' type='radio' value='La cr\u00e8che, la classe ou l&#039;\u00e9cole dont elle fait partie est totalement ou partiellement ferm\u00e9e en raison d&#039;une mesure visant \u00e0 limiter la propagation du coronavirus COVID-19 (attention : cela implique que les vacances scolaires normales ne seront pas prises en compte)'  id='choice_37_230_1'    \/>\n\t\t\t\t<label for='choice_37_230_1' id='label_37_230_1' class='gform-field-label gform-field-label--type-inline'>La cr\u00e8che, la classe ou l'\u00e9cole dont elle fait partie est totalement ou partiellement ferm\u00e9e en raison d'une mesure visant \u00e0 limiter la propagation du coronavirus COVID-19 (attention : cela implique que les vacances scolaires normales ne seront pas prises en compte)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_37_230_2'>\n\t\t\t\t<input name='input_230' type='radio' value='L&#039;enfant suit obligatoirement des cours sous forme d&#039;enseignement \u00e0 distance suite \u00e0 une d\u00e9cision de l&#039;autorit\u00e9 comp\u00e9tente de limiter la propagation du coronavirus COVID-19'  id='choice_37_230_2'    \/>\n\t\t\t\t<label for='choice_37_230_2' id='label_37_230_2' class='gform-field-label gform-field-label--type-inline'>L'enfant suit obligatoirement des cours sous forme d'enseignement \u00e0 distance suite \u00e0 une d\u00e9cision de l'autorit\u00e9 comp\u00e9tente de limiter la propagation du coronavirus COVID-19<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_37_231\" class=\"gfield gfield--type-fileupload gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_37_231'><span class='gform-field-label__text'>Ajouter un certificat de quarantaine.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_37_231' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_37_231&quot;,&quot;container&quot;:&quot;gform_multifile_upload_37_231&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_37_231&quot;,&quot;filelist&quot;:&quot;gform_preview_37_231&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/?gf_page=f51d946b4550319&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers autoris\\u00e9s&quot;,&quot;extensions&quot;:&quot;doc,docx,txt,rtf,pdf,jpg,png,xlsx&quot;}],&quot;max_file_size&quot;:&quot;15728640b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:37,&quot;field_id&quot;:231,&quot;_gform_file_upload_nonce_37_231&quot;:&quot;92516a55e5&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;10&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_37_231&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_37_231' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>D\u00e9posez les fichiers ici ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_37_231' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_37_231\"  >S\u00e9lectionnez des fichiers<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_37_231'>Types de fichiers accept\u00e9s\u00a0: doc, docx, txt, rtf, pdf, jpg, png, xlsx, Taille max. des fichiers\u00a0: 15 MB, Max. des fichiers\u00a0: 10.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_37_231'><\/ul> <div id='gform_preview_37_231' class='ginput_preview_list'><\/div><\/div><\/li><li id=\"field_37_232\" class=\"gfield gfield--type-fileupload gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_37_232'><span class='gform-field-label__text'>Veuillez remplir l&#039;attestation de fermeture da la cr\u00e8che ou de l&#039;\u00e9cole et la joindre \u00e0 votre demande. Vous pouveze t\u00e9l\u00e9charger l\u2019attestation en haut de cette page.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_37_232' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_37_232&quot;,&quot;container&quot;:&quot;gform_multifile_upload_37_232&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_37_232&quot;,&quot;filelist&quot;:&quot;gform_preview_37_232&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/?gf_page=f51d946b4550319&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers autoris\\u00e9s&quot;,&quot;extensions&quot;:&quot;doc,docx,txt,rtf,pdf,jpg,png,xlsx&quot;}],&quot;max_file_size&quot;:&quot;15728640b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:37,&quot;field_id&quot;:232,&quot;_gform_file_upload_nonce_37_232&quot;:&quot;da3335e7fa&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;10&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_37_232&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_37_232' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>D\u00e9posez les fichiers ici ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_37_232' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_37_232\"  >S\u00e9lectionnez des fichiers<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_37_232'>Types de fichiers accept\u00e9s\u00a0: doc, docx, txt, rtf, pdf, jpg, png, xlsx, Taille max. des fichiers\u00a0: 15 MB, Max. des fichiers\u00a0: 10.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_37_232'><\/ul> <div id='gform_preview_37_232' class='ginput_preview_list'><\/div><\/div><\/li><li id=\"field_37_233\" class=\"gfield gfield--type-fileupload gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_37_233'><span class='gform-field-label__text'>Veuillez remplir l&#039;attestation de fermeture da la cr\u00e8che ou de l&#039;\u00e9cole et la joindre \u00e0 votre demande. Vous pouveze t\u00e9l\u00e9charger l\u2019attestation en haut de cette page.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_37_233' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_37_233&quot;,&quot;container&quot;:&quot;gform_multifile_upload_37_233&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_37_233&quot;,&quot;filelist&quot;:&quot;gform_preview_37_233&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/?gf_page=f51d946b4550319&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers autoris\\u00e9s&quot;,&quot;extensions&quot;:&quot;doc,docx,txt,rtf,pdf,jpg,png,xlsx&quot;}],&quot;max_file_size&quot;:&quot;15728640b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:37,&quot;field_id&quot;:233,&quot;_gform_file_upload_nonce_37_233&quot;:&quot;2c542ae240&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;10&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_37_233&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_37_233' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>D\u00e9posez les fichiers ici ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_37_233' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_37_233\"  >S\u00e9lectionnez des fichiers<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_37_233'>Types de fichiers accept\u00e9s\u00a0: doc, docx, txt, rtf, pdf, jpg, png, xlsx, Taille max. des fichiers\u00a0: 15 MB, Max. des fichiers\u00a0: 10.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_37_233'><\/ul> <div id='gform_preview_37_233' class='ginput_preview_list'><\/div><\/div><\/li><li id=\"field_37_234\" class=\"gfield gfield--type-fileupload gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_37_234'><span class='gform-field-label__text'>Veuillez remplir l&#039;attestation de fermeture du centre d&#039;accueil pour personnes handicap\u00e9es et la joindre \u00e0 votre demande. Vous pouveze t\u00e9l\u00e9charger l\u2019attestation en haut de cette page.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_37_234' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_37_234&quot;,&quot;container&quot;:&quot;gform_multifile_upload_37_234&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_37_234&quot;,&quot;filelist&quot;:&quot;gform_preview_37_234&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/?gf_page=f51d946b4550319&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers autoris\\u00e9s&quot;,&quot;extensions&quot;:&quot;doc,docx,txt,rtf,pdf,jpg,png,xlsx&quot;}],&quot;max_file_size&quot;:&quot;15728640b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:37,&quot;field_id&quot;:234,&quot;_gform_file_upload_nonce_37_234&quot;:&quot;418feda7e1&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;10&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_37_234&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_37_234' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>D\u00e9posez les fichiers ici ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_37_234' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_37_234\"  >S\u00e9lectionnez des fichiers<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_37_234'>Types de fichiers accept\u00e9s\u00a0: doc, docx, txt, rtf, pdf, jpg, png, xlsx, Taille max. des fichiers\u00a0: 15 MB, Max. des fichiers\u00a0: 10.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_37_234'><\/ul> <div id='gform_preview_37_234' class='ginput_preview_list'><\/div><\/div><\/li><li id=\"field_37_241\" class=\"gfield gfield--type-fileupload gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_37_241'><span class='gform-field-label__text'>Veuillez remplir le certificat scolaire et l\u2019envoyer avec votre demande. Vous pouvez t\u00e9l\u00e9charger ce certificat en haut de ce formulaire de demande<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_37_241' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_37_241&quot;,&quot;container&quot;:&quot;gform_multifile_upload_37_241&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_37_241&quot;,&quot;filelist&quot;:&quot;gform_preview_37_241&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/?gf_page=f51d946b4550319&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers autoris\\u00e9s&quot;,&quot;extensions&quot;:&quot;doc,docx,txt,rtf,pdf,jpg,png,xlsx&quot;}],&quot;max_file_size&quot;:&quot;15728640b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:37,&quot;field_id&quot;:241,&quot;_gform_file_upload_nonce_37_241&quot;:&quot;03f2b8fe05&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;10&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_37_241&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_37_241' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>D\u00e9posez les fichiers ici ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_37_241' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_37_241\"  >S\u00e9lectionnez des fichiers<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_37_241'>Types de fichiers accept\u00e9s\u00a0: doc, docx, txt, rtf, pdf, jpg, png, xlsx, Taille max. des fichiers\u00a0: 15 MB, Max. des fichiers\u00a0: 10.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_37_241'><\/ul> <div id='gform_preview_37_241' class='ginput_preview_list'><\/div><\/div><\/li><li id=\"field_37_242\" class=\"gfield gfield--type-fileupload gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_37_242'><span class='gform-field-label__text'>Veuillez envoyer un certificat de la cr\u00e8che avec les jours o\u00f9 l\u2019enfant est normalement inscrit \u00e0 la garderie. Vous devez demander ce certificat \u00e0 votre cr\u00e8che.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_37_242' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_37_242&quot;,&quot;container&quot;:&quot;gform_multifile_upload_37_242&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_37_242&quot;,&quot;filelist&quot;:&quot;gform_preview_37_242&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/?gf_page=f51d946b4550319&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers autoris\\u00e9s&quot;,&quot;extensions&quot;:&quot;doc,docx,txt,rtf,pdf,jpg,png,xlsx&quot;}],&quot;max_file_size&quot;:&quot;15728640b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:37,&quot;field_id&quot;:242,&quot;_gform_file_upload_nonce_37_242&quot;:&quot;be2a50b6e5&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;10&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_37_242&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_37_242' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>D\u00e9posez les fichiers ici ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_37_242' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_37_242\"  >S\u00e9lectionnez des fichiers<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_37_242'>Types de fichiers accept\u00e9s\u00a0: doc, docx, txt, rtf, pdf, jpg, png, xlsx, Taille max. des fichiers\u00a0: 15 MB, Max. des fichiers\u00a0: 10.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_37_242'><\/ul> <div id='gform_preview_37_242' class='ginput_preview_list'><\/div><\/div><\/li><li id=\"field_37_243\" class=\"gfield gfield--type-fileupload gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_37_243'><span class='gform-field-label__text'>Veuillez envoyer le certificat d\u2019inscription des camps de sport ou de vacances annul\u00e9s \u00e0 votre demande.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_37_243' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_37_243&quot;,&quot;container&quot;:&quot;gform_multifile_upload_37_243&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_37_243&quot;,&quot;filelist&quot;:&quot;gform_preview_37_243&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/?gf_page=f51d946b4550319&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/staging.avixi.be\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers autoris\\u00e9s&quot;,&quot;extensions&quot;:&quot;doc,docx,txt,rtf,pdf,jpg,png,xlsx&quot;}],&quot;max_file_size&quot;:&quot;15728640b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:37,&quot;field_id&quot;:243,&quot;_gform_file_upload_nonce_37_243&quot;:&quot;69e584d3f4&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;10&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_37_243&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_37_243' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>D\u00e9posez les fichiers ici ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_37_243' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_37_243\"  >S\u00e9lectionnez des fichiers<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_37_243'>Types de fichiers accept\u00e9s\u00a0: doc, docx, txt, rtf, pdf, jpg, png, xlsx, Taille max. des fichiers\u00a0: 15 MB, Max. des fichiers\u00a0: 10.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_37_243'><\/ul> <div id='gform_preview_37_243' class='ginput_preview_list'><\/div><\/div><\/li><li id=\"field_37_235\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>L&#039;enfant est \u00e0 votre charge (sur le plan fiscal)?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_37_235'>\n\t\t\t<li class='gchoice gchoice_37_235_0'>\n\t\t\t\t<input name='input_235' type='radio' value='Oui'  id='choice_37_235_0'    \/>\n\t\t\t\t<label for='choice_37_235_0' id='label_37_235_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_37_235_1'>\n\t\t\t\t<input name='input_235' type='radio' value='Non'  id='choice_37_235_1'    \/>\n\t\t\t\t<label for='choice_37_235_1' id='label_37_235_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_37_236\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Indiquez ici les jours o\u00f9 vous avez d\u00fb interrompre votre activit\u00e9 d\u2019ind\u00e9pendant enti\u00e8rement:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_37_236'>\n\t\t\t<li class='gchoice gchoice_37_236_0'>\n\t\t\t\t<input name='input_236' type='radio' value='jours civils cons\u00e9cutifs'  id='choice_37_236_0'    \/>\n\t\t\t\t<label for='choice_37_236_0' id='label_37_236_0' class='gform-field-label gform-field-label--type-inline'>jours civils cons\u00e9cutifs<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_37_236_1'>\n\t\t\t\t<input name='input_236' type='radio' value='jours civils non cons\u00e9cutifs'  id='choice_37_236_1'    \/>\n\t\t\t\t<label for='choice_37_236_1' id='label_37_236_1' class='gform-field-label gform-field-label--type-inline'>jours civils non cons\u00e9cutifs<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_37_219\" class=\"gfield gfield--type-date gfield--input-type-datedropdown gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Du:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_37_219' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\"><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_37_219_2_container'><label for='input_37_219_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Jour<\/label><select name='input_219[]' id='input_37_219_2'   aria-required='true'  ><option value=''>Jour<\/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><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_37_219_1_container'><label for='input_37_219_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Mois<\/label><select name='input_219[]' id='input_37_219_1'   aria-required='true'  ><option value=''>Mois<\/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><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_37_219_3_container'><label for='input_37_219_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Ann\u00e9e<\/label><select name='input_219[]' id='input_37_219_3'   aria-required='true'  ><option value=''>Ann\u00e9e<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/div><\/li><li id=\"field_37_220\" class=\"gfield gfield--type-date gfield--input-type-datedropdown gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Jusqu\u2019\u00e0 la date incluse:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_37_220' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\"><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_37_220_2_container'><label for='input_37_220_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Jour<\/label><select name='input_220[]' id='input_37_220_2'   aria-required='true'  ><option value=''>Jour<\/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><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_37_220_1_container'><label for='input_37_220_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Mois<\/label><select name='input_220[]' id='input_37_220_1'   aria-required='true'  ><option value=''>Mois<\/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><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_37_220_3_container'><label for='input_37_220_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Ann\u00e9e<\/label><select name='input_220[]' id='input_37_220_3'   aria-required='true'  ><option value=''>Ann\u00e9e<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/div><\/li><li id=\"field_37_238\" class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_37_238'><span class='gform-field-label__text'>Indiquez les jours:<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_238' id='input_37_238' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_37_222\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Je d\u00e9clare<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_37_222'>\n\t\t\t<li class='gchoice gchoice_37_222_0'>\n\t\t\t\t<input name='input_222' type='radio' value='que je n&#039;ai pas voyag\u00e9 sciemment dans un pays ou une r\u00e9gion qui se trouvait en zone rouge au moment de mon d\u00e9part et suis, pour cette raison, mis obligatoirement en quarantaine.'  id='choice_37_222_0'    \/>\n\t\t\t\t<label for='choice_37_222_0' id='label_37_222_0' class='gform-field-label gform-field-label--type-inline'>que je n'ai pas voyag\u00e9 sciemment dans un pays ou une r\u00e9gion qui se trouvait en zone rouge au moment de mon d\u00e9part et suis, pour cette raison, mis obligatoirement en quarantaine.<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_37_239\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Je d\u00e9clare<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_37_239'>\n\t\t\t<li class='gchoice gchoice_37_239_0'>\n\t\t\t\t<input name='input_239' type='radio' value='que mon enfant n&#039;a pas voyag\u00e9 dans un pays ou une r\u00e9gion qui se trouvait en zone rouge au moment du d\u00e9part et est, pour cette raison, mis obligatoirement en quarantaine.'  id='choice_37_239_0'    \/>\n\t\t\t\t<label for='choice_37_239_0' id='label_37_239_0' class='gform-field-label gform-field-label--type-inline'>que mon enfant n'a pas voyag\u00e9 dans un pays ou une r\u00e9gion qui se trouvait en zone rouge au moment du d\u00e9part et est, pour cette raison, mis obligatoirement en quarantaine.<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_37_223\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Je d\u00e9clare<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_37_223'>\n\t\t\t<li class='gchoice gchoice_37_223_0'>\n\t\t\t\t<input name='input_223' type='radio' value='qu\u2019il s\u2019agit d\u2019une interruption compl\u00e8te de mes activit\u00e9s et que pendant la p\u00e9riode d\u2019interruption, il n&#039;y avait pas de possibilit\u00e9 d\u2019organiser les activit\u00e9s depuis mon domicile.'  id='choice_37_223_0'    \/>\n\t\t\t\t<label for='choice_37_223_0' id='label_37_223_0' class='gform-field-label gform-field-label--type-inline'>qu\u2019il s\u2019agit d\u2019une interruption compl\u00e8te de mes activit\u00e9s et que pendant la p\u00e9riode d\u2019interruption, il n'y avait pas de possibilit\u00e9 d\u2019organiser les activit\u00e9s depuis mon domicile.<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_37_100\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Je demande le droit passerelle quarantaine\/soins apport\u00e9s \u00e0 un enfant<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_37_100'>Je d\u00e9clare sur l\u2019honneur avoir rempli ce formulaire en toute sinc\u00e9rit\u00e9. Je suis au courant du fait que ma demande ne peut pas \u00eatre trait\u00e9e sans les pi\u00e8ces justificatives\ndemand\u00e9es. Je m'engage \u00e0 signaler imm\u00e9diatement \u00e0 ma caisse d'assurances sociales toute modification dans les renseignements mentionn\u00e9s ci-dessus. Je suis conscient que cette d\u00e9claration est soumise aux v\u00e9rifications n\u00e9cessaires. Je suis conscient que toute d\u00e9claration fausse ou incompl\u00e8te visant \u00e0 obtenir le versement indu de prestations constitue une violation de l'article 233 du code p\u00e9nal social et peut entra\u00eener le recouvrement des prestations ind\u00fbment vers\u00e9es ainsi qu\u2019\u00e0 des poursuites judiciaires.<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_37_100'>\n\t\t\t<li class='gchoice gchoice_37_100_0'>\n\t\t\t\t<input name='input_100' type='radio' value='Lu et approuv\u00e9'  id='choice_37_100_0'    \/>\n\t\t\t\t<label for='choice_37_100_0' id='label_37_100_0' class='gform-field-label gform-field-label--type-inline'>Lu et approuv\u00e9<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_37_240\" class=\"gfield gfield--type-captcha gfield--captcha-invisible field_sublabel_below gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><div id='input_37_240' 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style=\"--awb-bg-size:cover;--awb-width-large:25%;--awb-margin-top-large:0px;--awb-spacing-right-large:7.68%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:7.68%;--awb-width-medium:25%;--awb-order-medium:0;--awb-spacing-right-medium:7.68%;--awb-spacing-left-medium:7.68%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-reading-box-container reading-box-container-1\" style=\"--awb-title-color:#002f47;--awb-margin-top:0px;--awb-margin-bottom:20px;\"><div class=\"reading-box\" style=\"background-color:#def2f2;border-width:0px;border-color:#f6f6f6;border-right-width:3px;border-right-color:var(--primary_color);border-style:solid;\"><a class=\"button fusion-button button-default fusion-button-default-size button-default-size button-flat fusion-desktop-button fusion-tagline-button continue fusion-desktop-button-margin continue-right\" style=\"-webkit-box-shadow:none;-moz-box-shadow:none;box-shadow:none;border-radius:50px 50px 50px 50px\" href=\"https:\/\/staging.avixi.be\/fr\/contact\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span>Contact<\/span><\/a><h2>Des questions?<\/h2><div class=\"reading-box-additional fusion-reading-box-additional\">\n<p>Prenez contact avec votre gestionnaire de relation client:<\/p>\n<p>Mechelen: <strong>015 45 12 60<br \/><\/strong>Brugge: <strong>050 40 65 65<br \/><\/strong>Hasselt: <strong>011 22 27 46<\/strong><\/p>\n<p>ou envoyez un e-mail \u00e0 <a href=\"mailto:info@avixi.be\">info@avixi.be<\/a><\/p>\n<p>Clients de l&rsquo;ex-l\u2019Entraide:<\/p>\n<p>Bruxelles: <b>02<\/b> <b>743 05 10<\/b><\/p>\n<p>Ou envoyez votre message par e-mail \u00e0 clasti@avixi.be<\/p>\n<\/div><div class=\"fusion-clearfix\"><\/div><a class=\"button fusion-button button-default fusion-button-default-size button-default-size 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noreferrer\"><span>Contact<\/span><\/a><\/div><\/div>\n<\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":3316,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-3461","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/staging.avixi.be\/fr\/wp-json\/wp\/v2\/pages\/3461","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/staging.avixi.be\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/staging.avixi.be\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/staging.avixi.be\/fr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/staging.avixi.be\/fr\/wp-json\/wp\/v2\/comments?post=3461"}],"version-history":[{"count":12,"href":"https:\/\/staging.avixi.be\/fr\/wp-json\/wp\/v2\/pages\/3461\/revisions"}],"predecessor-version":[{"id":6744,"href":"https:\/\/staging.avixi.be\/fr\/wp-json\/wp\/v2\/pages\/3461\/revisions\/6744"}],"up":[{"embeddable":true,"href":"https:\/\/staging.avixi.be\/fr\/wp-json\/wp\/v2\/pages\/3316"}],"wp:attachment":[{"href":"https:\/\/staging.avixi.be\/fr\/wp-json\/wp\/v2\/media?parent=3461"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}