{"id":616,"date":"2017-05-31T14:35:49","date_gmt":"2017-05-31T12:35:49","guid":{"rendered":"https:\/\/www.jmlib.be\/site\/?page_id=616"},"modified":"2023-01-25T12:29:38","modified_gmt":"2023-01-25T11:29:38","slug":"inscription-aventure","status":"publish","type":"page","link":"https:\/\/www.jmlib.be\/site\/stage-aventure-8-15-ans\/inscription-aventure\/","title":{"rendered":"Inscription Aventure"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f615-o1\" lang=\"fr-FR\" dir=\"ltr\" data-wpcf7-id=\"615\">\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\/616#wpcf7-f615-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=\"615\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"fr_FR\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f615-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\">Informations du jeune\n\t<\/font>\n<\/h3>\n<p>*Nom et pr\u00e9nom: <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><br \/>\n*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 du jeune: <span class=\"wpcf7-form-control-wrap\" data-name=\"datedenaissance\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"datedenaissance\" \/><\/span>\n<\/p>\n<p>*N\u00b0BCSS (Registre national): <span class=\"wpcf7-form-control-wrap\" data-name=\"numnat\"><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=\"numnat\" \/><\/span>\n<\/p>\n<p>*Lieu de naissance du jeune: <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> *Code postale de naissance du jeune: <span class=\"wpcf7-form-control-wrap\" data-name=\"cpnaissance\"><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=\"cpnaissance\" \/><\/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<h3>\n\t<font color=\"#F79540\">Adresse et coordonn\u00e9es\n\t<\/font>\n<\/h3>\n<p>______________________\n<\/p>\n<p>*Rue\/Av: <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=\"N\"><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=\"N\" \/><\/span>\n<\/p>\n<p>*Code postal: <span class=\"wpcf7-form-control-wrap\" data-name=\"codepost\"><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=\"codepost\" \/><\/span> *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>\n<\/p>\n<p>*E-mail de contact: <span class=\"wpcf7-form-control-wrap\" data-name=\"email-33\"><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-33\" \/><\/span>\n<\/p>\n<p>*T\u00e9l.\/GSM: <span class=\"wpcf7-form-control-wrap\" data-name=\"tel-595\"><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-595\" \/><\/span>\n<\/p>\n<h3>\n\t<font color=\"#F79540\">Administratif\n\t<\/font>\n<\/h3>\n<p>_____________\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 et pr\u00e9nom du chef de famille: <span class=\"wpcf7-form-control-wrap\" data-name=\"cheffamille\"><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=\"cheffamille\" \/><\/span><br \/>\n*N\u00b0BCSS (Registre national): <span class=\"wpcf7-form-control-wrap\" data-name=\"numnat1\"><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=\"numnat1\" \/><\/span><br \/>\n*Nom et pr\u00e9nom de la personne qui effectuera le paiement: <span class=\"wpcf7-form-control-wrap\" data-name=\"paiment\"><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=\"paiment\" \/><\/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=\"R\u00e9seaux sociaux\">R\u00e9seaux sociaux<\/option><option value=\"Recherche sur internet\">Recherche sur internet<\/option><option value=\"La brochure Impact\">La brochure Impact<\/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 JML\">Newsletter JML<\/option><option value=\"Newsletter ML\">Newsletter ML<\/option><option value=\"Affiches\/Flyers\">Affiches\/Flyers<\/option><option value=\"OJ.be\">OJ.be<\/option><option value=\"myONE.be\">myONE.be<\/option><option value=\"Autre : pr\u00e9ciser\">Autre : pr\u00e9ciser<\/option><\/select><\/span>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-272\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"textarea-272\"><\/textarea><\/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><div id=\"cf7sr-69f1529f653ec\" class=\"cf7sr-g-recaptcha\" data-theme=\"light\" data-type=\"image\" data-size=\"normal\" data-sitekey=\"6LeqWcEUAAAAABWj586Z-gipKv10P4psIwSNPhwR\"><\/div><span class=\"wpcf7-form-control-wrap cf7sr-recaptcha\"><input type=\"hidden\" name=\"cf7sr-recaptcha\" value=\"\" class=\"wpcf7-form-control\"><\/span><br \/>\n<input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Envoyer\" \/>\n<\/p>\n<h3>\n\t<font color=\"#FF0000\">! Apr\u00e8s confirmation ci-dessous vous allez recevoir un e-mail de confirmation. Si vous ne recevez pas cet e-mail, regardez dans votre dossier SPAM (courrier ind\u00e9sirable). Merci\n\t<\/font><\/h3\n<\/h3><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=\"206\"\/><script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n\/* ]]> *\/\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":517,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"template-fullwidth.php","meta":{"jetpack_post_was_ever_published":false,"footnotes":""},"class_list":["post-616","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/P93my9-9W","jetpack-related-posts":[{"id":17397,"url":"https:\/\/www.jmlib.be\/site\/inscription-stage-aventure\/","url_meta":{"origin":616,"position":0},"title":"Inscription stage aventure","author":"jmlib","date":"2 f\u00e9vrier 2026","format":false,"excerpt":"","rel":"","context":"Article similaire","block_context":{"text":"Article similaire","link":""},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":604,"url":"https:\/\/www.jmlib.be\/site\/inscription-test\/","url_meta":{"origin":616,"position":1},"title":"Inscription test","author":"jmlib","date":"31 mai 2017","format":false,"excerpt":"","rel":"","context":"Article similaire","block_context":{"text":"Article similaire","link":""},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":2181,"url":"https:\/\/www.jmlib.be\/site\/inscription-linguistique\/","url_meta":{"origin":616,"position":2},"title":"Inscription linguistique","author":"jmlib","date":"14 f\u00e9vrier 2019","format":false,"excerpt":"","rel":"","context":"Article similaire","block_context":{"text":"Article similaire","link":""},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":1544,"url":"https:\/\/www.jmlib.be\/site\/vacances-repit-famille\/inscription-repit-famille\/","url_meta":{"origin":616,"position":3},"title":"Inscription R\u00e9pit-famille","author":"jmlib","date":"7 f\u00e9vrier 2018","format":false,"excerpt":"","rel":"","context":"Article similaire","block_context":{"text":"Article similaire","link":""},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":564,"url":"https:\/\/www.jmlib.be\/site\/ados-fun-inscription\/","url_meta":{"origin":616,"position":4},"title":"Inscription Ados-Fun","author":"jmlib","date":"23 mai 2017","format":false,"excerpt":"","rel":"","context":"Article similaire","block_context":{"text":"Article similaire","link":""},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":15318,"url":"https:\/\/www.jmlib.be\/site\/inscription-carnaval-tournai\/","url_meta":{"origin":616,"position":5},"title":"inscription carnaval Tournai","author":"jmlib","date":"8 janvier 2025","format":false,"excerpt":"","rel":"","context":"Article similaire","block_context":{"text":"Article 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\/616","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=616"}],"version-history":[{"count":1,"href":"https:\/\/www.jmlib.be\/site\/wp-json\/wp\/v2\/pages\/616\/revisions"}],"predecessor-version":[{"id":617,"href":"https:\/\/www.jmlib.be\/site\/wp-json\/wp\/v2\/pages\/616\/revisions\/617"}],"up":[{"embeddable":true,"href":"https:\/\/www.jmlib.be\/site\/wp-json\/wp\/v2\/pages\/517"}],"wp:attachment":[{"href":"https:\/\/www.jmlib.be\/site\/wp-json\/wp\/v2\/media?parent=616"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}