{"id":14669,"date":"2024-08-22T11:39:26","date_gmt":"2024-08-22T09:39:26","guid":{"rendered":"https:\/\/www.jmlib.be\/site\/?page_id=14669"},"modified":"2024-08-22T11:39:26","modified_gmt":"2024-08-22T09:39:26","slug":"inscription-module-2-lenfant","status":"publish","type":"page","link":"https:\/\/www.jmlib.be\/site\/inscription-module-2-lenfant\/","title":{"rendered":"Inscription Module 2: L&rsquo;enfant\u00a0\u00bb"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f14668-o1\" lang=\"fr-FR\" dir=\"ltr\" data-wpcf7-id=\"14668\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/site\/wp-json\/wp\/v2\/pages\/14669#wpcf7-f14668-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulaire de contact\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"14668\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"fr_FR\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f14668-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<h3>\n\t<font color=\"#F79540\">\n\t\t<p><B>Informations Personnelles<\/b>\n\t\t<\/p>\n\t<\/font>\n<\/h3>\n<p>*Nom et pr\u00e9nom du jeune : <span class=\"wpcf7-form-control-wrap\" data-name=\"Nometprnom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Nometprnom\" \/><\/span>\n<\/p>\n<p>*Sexe: <span class=\"wpcf7-form-control-wrap\" data-name=\"Sexe\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Sexe\"><option value=\"\">&#8212;Veuillez choisir une option&#8212;<\/option><option value=\"M\">M<\/option><option value=\"F\">F<\/option><\/select><\/span>\n<\/p>\n<p>*Date de naissance : <span class=\"wpcf7-form-control-wrap\" data-name=\"Datedenaissance\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Datedenaissance\" \/><\/span><br \/>\n*Code postal et lieu de naissance : <span class=\"wpcf7-form-control-wrap\" data-name=\"lieudenaissance\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"lieudenaissance\" \/><\/span>\n<\/p>\n<p>*R\u00e9gime alimentaire: <span class=\"wpcf7-form-control-wrap\" data-name=\"Rgimealimentaire\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Rgimealimentaire\"><option value=\"Classique\">Classique<\/option><option value=\"V\u00e9g\u00e9tarien\">V\u00e9g\u00e9tarien<\/option><option value=\"Sans porc\">Sans porc<\/option><\/select><\/span>\n<\/p>\n<p>*Le jeune souffre t-il d'allergies alimentaires? <span class=\"wpcf7-form-control-wrap\" data-name=\"allergie\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"allergie\"><option value=\"\">&#8212;Veuillez choisir une option&#8212;<\/option><option value=\"Oui\">Oui<\/option><option value=\"Non\">Non<\/option><\/select><\/span>\n<\/p>\n<p>Si oui veuillez le pr\u00e9cisez: <span class=\"wpcf7-form-control-wrap\" data-name=\"allergietexte\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"allergietexte\" \/><\/span>\n<\/p>\n<p>*Adresse : <span class=\"wpcf7-form-control-wrap\" data-name=\"adresse\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"adresse\" \/><\/span> *n\u00b0 <span class=\"wpcf7-form-control-wrap\" data-name=\"number-713\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"number-713\" \/><\/span><br \/>\n*Commune: <span class=\"wpcf7-form-control-wrap\" data-name=\"Commune\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Commune\" \/><\/span> *Code postal: <span class=\"wpcf7-form-control-wrap\" data-name=\"number-614\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"number-614\" \/><\/span>\n<\/p>\n<p>*Civilit\u00e9: <span class=\"wpcf7-form-control-wrap\" data-name=\"Civilit\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Civilit\"><option value=\"\">&#8212;Veuillez choisir une option&#8212;<\/option><option value=\"Madame\">Madame<\/option><option value=\"Monsieur\">Monsieur<\/option><\/select><\/span><br \/>\n*Nom du chef de famille: <span class=\"wpcf7-form-control-wrap\" data-name=\"Chefdefamille\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Chefdefamille\" \/><\/span>\n<\/p>\n<p>*Email: <span class=\"wpcf7-form-control-wrap\" data-name=\"email-290\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email-290\" \/><\/span><br \/>\n*Email: <span class=\"wpcf7-form-control-wrap\" data-name=\"emaildeconfirmation\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"emaildeconfirmation\" \/><\/span> (confirmer votre Email.)\n<\/p>\n<p>*T\u00e9l\/GSM: <span class=\"wpcf7-form-control-wrap\" data-name=\"tel-726\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"tel-726\" \/><\/span>\n<\/p>\n<h3>\n\t<font color=\"#F79540\">\n\t\t<p><B>Administratif<\/b>\n\t\t<\/p>\n\t<\/font>\n<\/h3>\n<p><label> *Nom et pr\u00e9nom de la personne qui effectuera le paiement <\/label> :\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Nomprnom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Nomprnom\" \/><\/span>\n<\/p>\n<p><label>*Si vous \u00eates membre des Mutualit\u00e9s Lib\u00e9rales, veuillez cocher le num\u00e9ro de votre mutualit\u00e9 (num\u00e9ro \u00e0 3 chiffres mentionn\u00e9 sur le haut de votre vignette):<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-290\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"menu-290\"><option value=\"-\">-<\/option><option value=\"Non-membre\">Non-membre<\/option><option value=\"401\">401<\/option><option value=\"403\">403<\/option><option value=\"404\">404<\/option><option value=\"407\">407<\/option><option value=\"409\">409<\/option><option value=\"413\">413<\/option><option value=\"414\">414<\/option><option value=\"415\">415<\/option><option value=\"417\">417<\/option><option value=\"418\">418<\/option><\/select><\/span>\n<\/p>\n<p><label>*Comment connaissez vous les JML?<\/label> :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"CommentconnaissezvouslesJML\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"CommentconnaissezvouslesJML\"><option value=\"-\">-<\/option><option value=\"R\u00e9seaux sociaux\">R\u00e9seaux sociaux<\/option><option value=\"Recherche sur internet\">Recherche sur internet<\/option><option value=\"La brochure Carton\">La brochure Carton<\/option><option value=\"Via la Mutualit\u00e9 Lib\u00e9rale\">Via la Mutualit\u00e9 Lib\u00e9rale<\/option><option value=\"Bouche \u00e0 oreille\">Bouche \u00e0 oreille<\/option><option value=\"Newsletter\">Newsletter<\/option><\/select><\/span>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-145\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"checkbox-145[]\" value=\"J\u2019ai lu les conditions g\u00e9n\u00e9rales des JML et je les ai comprises et accept\u00e9es. -\" \/><span class=\"wpcf7-list-item-label\">J\u2019ai lu les conditions g\u00e9n\u00e9rales des JML et je les ai comprises et accept\u00e9es. -<\/span><\/span><\/span><\/span><label><a href=\"https:\/\/www.jmlib.be\/site\/wp-content\/uploads\/2017\/04\/conditions-g\u00e9n\u00e9rales.pdf\" target=\"_blank\"> Conditions g\u00e9n\u00e9rales<\/a><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-148\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"checkbox-148[]\" value=\"J\u2019ai lu politique de confidentialit\u00e9 des JML et je les ai comprises et accept\u00e9es. -\" \/><span class=\"wpcf7-list-item-label\">J\u2019ai lu politique de confidentialit\u00e9 des JML et je les ai comprises et accept\u00e9es. -<\/span><\/span><\/span><\/span><label><a href=\"https:\/\/www.jmlib.be\/site\/rgpd\/\" target=\"_blank\"> Politique de confidentialit\u00e9<\/a><\/label>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Envoyer\" \/>\n<\/p><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"208\"\/><script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-14669","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/P93my9-3OB","jetpack-related-posts":[{"id":649,"url":"https:\/\/www.jmlib.be\/site\/module-jeux-semaine-inscription\/","url_meta":{"origin":14669,"position":0},"title":"Module 1 : jouons","author":"jmlib","date":"1 juin 2017","format":false,"excerpt":"","rel":"","context":"Article similaire","block_context":{"text":"Article similaire","link":""},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":15533,"url":"https:\/\/www.jmlib.be\/site\/formations-danimateurs\/","url_meta":{"origin":14669,"position":1},"title":"Formations d\u2019animateurs","author":"jmlib","date":"6 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similaire","link":""},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]}],"jetpack_likes_enabled":true,"_links":{"self":[{"href":"https:\/\/www.jmlib.be\/site\/wp-json\/wp\/v2\/pages\/14669","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.jmlib.be\/site\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.jmlib.be\/site\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.jmlib.be\/site\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.jmlib.be\/site\/wp-json\/wp\/v2\/comments?post=14669"}],"version-history":[{"count":1,"href":"https:\/\/www.jmlib.be\/site\/wp-json\/wp\/v2\/pages\/14669\/revisions"}],"predecessor-version":[{"id":14670,"href":"https:\/\/www.jmlib.be\/site\/wp-json\/wp\/v2\/pages\/14669\/revisions\/14670"}],"wp:attachment":[{"href":"https:\/\/www.jmlib.be\/site\/wp-json\/wp\/v2\/media?parent=14669"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}