{"id":2009,"date":"2022-07-12T15:21:03","date_gmt":"2022-07-12T19:21:03","guid":{"rendered":"https:\/\/communitylivingstormontcounty.ca\/formulaire-de-retroaction-sur-laccessibilite\/"},"modified":"2025-07-30T14:20:44","modified_gmt":"2025-07-30T18:20:44","slug":"formulaire-de-retroaction-sur-laccessibilite","status":"publish","type":"page","link":"https:\/\/communitylivingstormontcounty.ca\/fr\/a-propos-de-nous\/loi-sur-laccessibilite\/formulaire-de-retroaction-sur-laccessibilite\/","title":{"rendered":"Formulaire de retroaction sur l&rsquo;accessibilit\u00e9"},"content":{"rendered":"<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 InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return 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 gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_3' style='display:none'>\n                        <div class='gform_heading'>\n                            <p class='gform_description'>Int\u00e9gration Communautaire-comt\u00e9 de Stormont s\u2019engage \u00e0 fournir un service \u00e0 la client\u00e8le accessible. Vos commentaires sont les bienvenus pour nous aider \u00e0 surveiller et \u00e0 am\u00e9liorer nos services et vos exp\u00e9riences.  <\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_3'  action='\/fr\/wp-json\/wp\/v2\/pages\/2009' data-formid='3' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6Lc5beYgAAAAADzhoufzSReKVxVfdLDC2TtcO_d-' data-tabindex='0'><input id=\"input_758befbaf0db4f55f79edb12dec25966\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_758befbaf0db4f55f79edb12dec25966\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_3_1\" class=\"gfield gfield--type-time gfield--input-type-time gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Heure de votre visite :<\/span><\/legend><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_3_1'>\n                            <input type='number' name='input_1[]' id='input_3_1_1' value=''  min='0' max='12' step='1'  placeholder='HH' aria-required='false'   \/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_3_1_1'>Heures<\/label>\n                        <\/div>\n                        <div class=\"above hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_1[]' id='input_3_1_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='false'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_3_1_2'>Minutes<\/label>\n                        <\/div>\n                        <div class='gfield_time_ampm ginput_container ginput_container_time above gform-grid-col' >\n                                \n                                <select name='input_1[]' id='input_3_1_3'  >\n                                    <option value='am' >AM<\/option>\n                                    <option value='pm' >PM<\/option>\n                                <\/select>\n                                <label class='gform-field-label gform-field-label--type-sub am_pm_label screen-reader-text' for='input_3_1_3'>AM\/PM<\/label>\n                           <\/div>\n                    <\/div><\/fieldset><div id=\"field_3_2\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_2'><span class='gform-field-label__text'>Date<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatoire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_3_2'\n\t\t\t\t\tclass='datepicker gform-datepicker ymd_slash datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_2'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"9999\/99\/99\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_3_2' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_3_2' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_3_2' aria-label='Date: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_3_3\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_3'><span class='gform-field-label__text'>Quel \u00e9tait le but de votre visite?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_3' id='input_3_3' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_4\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">A QUEL SERVICE VOUS ETESVOUS ADRESSE?<\/h3><\/div><fieldset id=\"field_3_5\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Department<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_5'><div class='gchoice gchoice_3_5_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.1' type='checkbox'  value='Administration'  id='choice_3_5_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_5_1' id='label_3_5_1' class='gform-field-label gform-field-label--type-inline'>Administration<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_5_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.2' type='checkbox'  value='Services de soutien communautaire'  id='choice_3_5_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_5_2' id='label_3_5_2' class='gform-field-label gform-field-label--type-inline'>Services de soutien communautaire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_5_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.3' type='checkbox'  value='Programme Passeport'  id='choice_3_5_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_5_3' id='label_3_5_3' class='gform-field-label gform-field-label--type-inline'>Programme Passeport<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_5_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.4' type='checkbox'  value='R\u00e9ception'  id='choice_3_5_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_5_4' id='label_3_5_4' class='gform-field-label gform-field-label--type-inline'>R\u00e9ception<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_5_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.5' type='checkbox'  value='Services de soutien \u00e0 l\u2019autonomie'  id='choice_3_5_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_5_5' id='label_3_5_5' class='gform-field-label gform-field-label--type-inline'>Services de soutien \u00e0 l\u2019autonomie<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_5_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.6' type='checkbox'  value='Cr\u00e9er des liens d\u2019amiti\u00e9'  id='choice_3_5_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_5_6' id='label_3_5_6' class='gform-field-label gform-field-label--type-inline'>Cr\u00e9er des liens d\u2019amiti\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_6\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Le service vous a-t-il \u00e9t\u00e9 fourni d\u2019une mani\u00e8re ou sous une forme accessible?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_6'>\n\t\t\t<div class='gchoice gchoice_3_6_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='OUI'  id='choice_3_6_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_6_0' id='label_3_6_0' class='gform-field-label gform-field-label--type-inline'>OUI<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_6_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Non'  id='choice_3_6_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_6_1' id='label_3_6_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_7\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_7'><span class='gform-field-label__text'>Veuillez fournir des d\u00e9tails concernant votre exp\u00e9rience du service \u00e0 la client\u00e8le:<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_7' id='input_3_7' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_3_8\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Avez-vous rencontr\u00e9 des obstacles ou des difficult\u00e9s pour acc\u00e9der aux services?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_8'>\n\t\t\t<div class='gchoice gchoice_3_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='OUI'  id='choice_3_8_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_8_0' id='label_3_8_0' class='gform-field-label gform-field-label--type-inline'>OUI<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Non'  id='choice_3_8_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_8_1' id='label_3_8_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_20\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Avons-nous r\u00e9pondu \u00e0 vos besoins en mati\u00e8re de service \u00e0 la client\u00e8le?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_20'>\n\t\t\t<div class='gchoice gchoice_3_20_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='OUI'  id='choice_3_20_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_20_0' id='label_3_20_0' class='gform-field-label gform-field-label--type-inline'>OUI<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_20_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Non'  id='choice_3_20_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_20_1' id='label_3_20_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_19\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Souhaitez-vous \u00eatre contact\u00e9(e) au sujet de votre exp\u00e9rience du service \u00e0 la client\u00e8le?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_19'>\n\t\t\t<div class='gchoice gchoice_3_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='OUI'  id='choice_3_19_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_19_0' id='label_3_19_0' class='gform-field-label gform-field-label--type-inline'>OUI<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='Non'  id='choice_3_19_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_19_1' id='label_3_19_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_11\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Si oui, veuillez fournir les informations suivantes : <\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_11'>\n\t\t\t<div class='gchoice gchoice_3_11_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='\u00cates-vous un'  id='choice_3_11_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_11_0' id='label_3_11_0' class='gform-field-label gform-field-label--type-inline'>\u00cates-vous un<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_11_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='Membre de la famille'  id='choice_3_11_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_11_1' id='label_3_11_1' class='gform-field-label gform-field-label--type-inline'>Membre de la famille<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_11_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='gf_other_choice'  id='choice_3_11_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_11_2' id='label_3_11_2' class='gform-field-label gform-field-label--type-inline'>Autre<\/label><br \/><input id='input_3_11_other' class='gchoice_other_control' name='input_11_other' type='text' value='Autre' aria-label='Autre choix, veuillez sp\u00e9cifier'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_12\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nom<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatoire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_3_12'>\n                            \n                            <span id='input_3_12_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_12.3' id='input_3_12_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_3_12_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_3_12_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_12.6' id='input_3_12_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_3_12_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_3_13\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Adresse municipal<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatoire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_3_13' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_3_13_1_container' >\n                                        <input type='text' name='input_13.1' id='input_3_13_1' value=''    aria-required='true'    \/>\n                                        <label for='input_3_13_1' id='input_3_13_1_label' class='gform-field-label gform-field-label--type-sub '>Adresse<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_3_13_2_container' >\n                                        <input type='text' name='input_13.2' id='input_3_13_2' value=''     aria-required='false'   \/>\n                                        <label for='input_3_13_2' id='input_3_13_2_label' class='gform-field-label gform-field-label--type-sub '>Adresse ligne 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_3_13_3_container' >\n                                    <input type='text' name='input_13.3' id='input_3_13_3' value=''    aria-required='true'    \/>\n                                    <label for='input_3_13_3' id='input_3_13_3_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_3_13_4_container' >\n                                        <select name='input_13.4' id='input_3_13_4'     aria-required='true'    ><option value='' ><\/option><option value='Alberta' >Alberta<\/option><option value='Colombie-Britannique' >Colombie-Britannique<\/option><option value='Manitoba' >Manitoba<\/option><option value='Nouveau-Brunswick' >Nouveau-Brunswick<\/option><option value='Terre-Neuve-et-Labrador' >Terre-Neuve-et-Labrador<\/option><option value='Territoires du Nord-Ouest' >Territoires du Nord-Ouest<\/option><option value='Nouvelle-\u00c9cosse' >Nouvelle-\u00c9cosse<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' selected='selected'>Ontario<\/option><option value='\u00cele du Prince-\u00c9douard' >\u00cele du Prince-\u00c9douard<\/option><option value='Qu\u00e9bec' >Qu\u00e9bec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><\/select>\n                                        <label for='input_3_13_4' id='input_3_13_4_label' class='gform-field-label gform-field-label--type-sub '>Province<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_3_13_5_container' >\n                                    <input type='text' name='input_13.5' id='input_3_13_5' value=''    aria-required='true'    \/>\n                                    <label for='input_3_13_5' id='input_3_13_5_label' class='gform-field-label gform-field-label--type-sub '>Code postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_13.6' id='input_3_13_6' value='CA' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_3_14\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_14'><span class='gform-field-label__text'>Num\u00e9ro de t\u00e9l\u00e9phone (en journ\u00e9e):<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_14' id='input_3_14' type='tel' value='' class='large'  placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_3_17\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_17'><span class='gform-field-label__text'>Num\u00e9ro de t\u00e9l\u00e9phone (en soir\u00e9e)<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_17' id='input_3_17' type='tel' value='' class='large'  placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_3_15\" class=\"gfield gfield--type-email gfield--input-type-email field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_15'><span class='gform-field-label__text'>Adresse de courriel:<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_15' id='input_3_15' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_3_16\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Comment souhaitez-vous \u00eatre contact\u00e9 (e)?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_16'>\n\t\t\t<div class='gchoice gchoice_3_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='T\u00e9l\u00e9phone'  id='choice_3_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_16_0' id='label_3_16_0' class='gform-field-label gform-field-label--type-inline'>T\u00e9l\u00e9phone<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Adresse de courriel'  id='choice_3_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_16_1' id='label_3_16_1' class='gform-field-label gform-field-label--type-inline'>Adresse de courriel<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_3' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Soumettre<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_3' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_3' id='gform_theme_3' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_3' id='gform_style_settings_3' value='{&quot;inputPrimaryColor&quot;:&quot;#204ce5&quot;}' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_3' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='3' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='CAD' value='0XtlA0HCGVYcUStwmG3qx\/5UJ3nINj0U6JydfpOGOVvLVPPi27ZK2fGDQ2pZ90G9VukcIlYC7SQH379YJ0OSxUbEBVVMhwJUPRlHNEND3epkGvI=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_3' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_3' id='gform_target_page_number_3' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_3' id='gform_source_page_number_3' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div>\n\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_3' style='display:none'>\n                        <div class='gform_heading'>\n                            <p class='gform_description'>Int\u00e9gration Communautaire-comt\u00e9 de Stormont s\u2019engage \u00e0 fournir un service \u00e0 la client\u00e8le accessible. Vos commentaires sont les bienvenus pour nous aider \u00e0 surveiller et \u00e0 am\u00e9liorer nos services et vos exp\u00e9riences.  <\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_3'  action='\/fr\/wp-json\/wp\/v2\/pages\/2009' data-formid='3' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6Lc5beYgAAAAADzhoufzSReKVxVfdLDC2TtcO_d-' data-tabindex='0'><input id=\"input_758befbaf0db4f55f79edb12dec25966\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_758befbaf0db4f55f79edb12dec25966\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_3_1\" class=\"gfield gfield--type-time gfield--input-type-time gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Heure de votre visite :<\/span><\/legend><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_3_1'>\n                            <input type='number' name='input_1[]' id='input_3_1_1' value=''  min='0' max='12' step='1'  placeholder='HH' aria-required='false'   \/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_3_1_1'>Heures<\/label>\n                        <\/div>\n                        <div class=\"above hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_1[]' id='input_3_1_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='false'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_3_1_2'>Minutes<\/label>\n                        <\/div>\n                        <div class='gfield_time_ampm ginput_container ginput_container_time above gform-grid-col' >\n                                \n                                <select name='input_1[]' id='input_3_1_3'  >\n                                    <option value='am' >AM<\/option>\n                                    <option value='pm' >PM<\/option>\n                                <\/select>\n                                <label class='gform-field-label gform-field-label--type-sub am_pm_label screen-reader-text' for='input_3_1_3'>AM\/PM<\/label>\n                           <\/div>\n                    <\/div><\/fieldset><div id=\"field_3_2\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_2'><span class='gform-field-label__text'>Date<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatoire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='jj\/mm\/aaaa'\n\t\t\t\t\tid='input_3_2'\n\t\t\t\t\tclass='datepicker gform-datepicker ymd_slash datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_2'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"9999\/99\/99\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_3_2' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_3_2' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_3_2' aria-label='Date: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_3_3\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_3'><span class='gform-field-label__text'>Quel \u00e9tait le but de votre visite?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_3' id='input_3_3' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_3_4\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">A QUEL SERVICE VOUS ETESVOUS ADRESSE?<\/h3><\/div><fieldset id=\"field_3_5\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Department<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_3_5'><div class='gchoice gchoice_3_5_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.1' type='checkbox'  value='Administration'  id='choice_3_5_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_5_1' id='label_3_5_1' class='gform-field-label gform-field-label--type-inline'>Administration<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_5_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.2' type='checkbox'  value='Services de soutien communautaire'  id='choice_3_5_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_5_2' id='label_3_5_2' class='gform-field-label gform-field-label--type-inline'>Services de soutien communautaire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_5_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.3' type='checkbox'  value='Programme Passeport'  id='choice_3_5_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_5_3' id='label_3_5_3' class='gform-field-label gform-field-label--type-inline'>Programme Passeport<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_5_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.4' type='checkbox'  value='R\u00e9ception'  id='choice_3_5_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_5_4' id='label_3_5_4' class='gform-field-label gform-field-label--type-inline'>R\u00e9ception<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_5_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.5' type='checkbox'  value='Services de soutien \u00e0 l\u2019autonomie'  id='choice_3_5_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_5_5' id='label_3_5_5' class='gform-field-label gform-field-label--type-inline'>Services de soutien \u00e0 l\u2019autonomie<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_3_5_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.6' type='checkbox'  value='Cr\u00e9er des liens d\u2019amiti\u00e9'  id='choice_3_5_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_5_6' id='label_3_5_6' class='gform-field-label gform-field-label--type-inline'>Cr\u00e9er des liens d\u2019amiti\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_6\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Le service vous a-t-il \u00e9t\u00e9 fourni d\u2019une mani\u00e8re ou sous une forme accessible?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_6'>\n\t\t\t<div class='gchoice gchoice_3_6_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='OUI'  id='choice_3_6_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_6_0' id='label_3_6_0' class='gform-field-label gform-field-label--type-inline'>OUI<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_6_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Non'  id='choice_3_6_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_6_1' id='label_3_6_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_3_7\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_7'><span class='gform-field-label__text'>Veuillez fournir des d\u00e9tails concernant votre exp\u00e9rience du service \u00e0 la client\u00e8le:<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_7' id='input_3_7' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_3_8\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Avez-vous rencontr\u00e9 des obstacles ou des difficult\u00e9s pour acc\u00e9der aux services?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_8'>\n\t\t\t<div class='gchoice gchoice_3_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='OUI'  id='choice_3_8_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_8_0' id='label_3_8_0' class='gform-field-label gform-field-label--type-inline'>OUI<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Non'  id='choice_3_8_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_8_1' id='label_3_8_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_20\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Avons-nous r\u00e9pondu \u00e0 vos besoins en mati\u00e8re de service \u00e0 la client\u00e8le?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_20'>\n\t\t\t<div class='gchoice gchoice_3_20_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='OUI'  id='choice_3_20_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_20_0' id='label_3_20_0' class='gform-field-label gform-field-label--type-inline'>OUI<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_20_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Non'  id='choice_3_20_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_20_1' id='label_3_20_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_19\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Souhaitez-vous \u00eatre contact\u00e9(e) au sujet de votre exp\u00e9rience du service \u00e0 la client\u00e8le?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_19'>\n\t\t\t<div class='gchoice gchoice_3_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='OUI'  id='choice_3_19_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_19_0' id='label_3_19_0' class='gform-field-label gform-field-label--type-inline'>OUI<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='Non'  id='choice_3_19_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_19_1' id='label_3_19_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_11\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Si oui, veuillez fournir les informations suivantes : <\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_11'>\n\t\t\t<div class='gchoice gchoice_3_11_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='\u00cates-vous un'  id='choice_3_11_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_11_0' id='label_3_11_0' class='gform-field-label gform-field-label--type-inline'>\u00cates-vous un<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_11_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='Membre de la famille'  id='choice_3_11_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_11_1' id='label_3_11_1' class='gform-field-label gform-field-label--type-inline'>Membre de la famille<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_11_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='gf_other_choice'  id='choice_3_11_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_11_2' id='label_3_11_2' class='gform-field-label gform-field-label--type-inline'>Autre<\/label><br \/><input id='input_3_11_other' class='gchoice_other_control' name='input_11_other' type='text' value='Autre' aria-label='Autre choix, veuillez sp\u00e9cifier'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_12\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nom<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatoire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_3_12'>\n                            \n                            <span id='input_3_12_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_12.3' id='input_3_12_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_3_12_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_3_12_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_12.6' id='input_3_12_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_3_12_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_3_13\" class=\"gfield gfield--type-address gfield--input-type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Adresse municipal<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatoire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_3_13' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_3_13_1_container' >\n                                        <input type='text' name='input_13.1' id='input_3_13_1' value=''    aria-required='true'    \/>\n                                        <label for='input_3_13_1' id='input_3_13_1_label' class='gform-field-label gform-field-label--type-sub '>Adresse<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_3_13_2_container' >\n                                        <input type='text' name='input_13.2' id='input_3_13_2' value=''     aria-required='false'   \/>\n                                        <label for='input_3_13_2' id='input_3_13_2_label' class='gform-field-label gform-field-label--type-sub '>Adresse ligne 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_3_13_3_container' >\n                                    <input type='text' name='input_13.3' id='input_3_13_3' value=''    aria-required='true'    \/>\n                                    <label for='input_3_13_3' id='input_3_13_3_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_3_13_4_container' >\n                                        <select name='input_13.4' id='input_3_13_4'     aria-required='true'    ><option value='' ><\/option><option value='Alberta' >Alberta<\/option><option value='Colombie-Britannique' >Colombie-Britannique<\/option><option value='Manitoba' >Manitoba<\/option><option value='Nouveau-Brunswick' >Nouveau-Brunswick<\/option><option value='Terre-Neuve-et-Labrador' >Terre-Neuve-et-Labrador<\/option><option value='Territoires du Nord-Ouest' >Territoires du Nord-Ouest<\/option><option value='Nouvelle-\u00c9cosse' >Nouvelle-\u00c9cosse<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' selected='selected'>Ontario<\/option><option value='\u00cele du Prince-\u00c9douard' >\u00cele du Prince-\u00c9douard<\/option><option value='Qu\u00e9bec' >Qu\u00e9bec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><\/select>\n                                        <label for='input_3_13_4' id='input_3_13_4_label' class='gform-field-label gform-field-label--type-sub '>Province<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_3_13_5_container' >\n                                    <input type='text' name='input_13.5' id='input_3_13_5' value=''    aria-required='true'    \/>\n                                    <label for='input_3_13_5' id='input_3_13_5_label' class='gform-field-label gform-field-label--type-sub '>Code postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_13.6' id='input_3_13_6' value='CA' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_3_14\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_14'><span class='gform-field-label__text'>Num\u00e9ro de t\u00e9l\u00e9phone (en journ\u00e9e):<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_14' id='input_3_14' type='tel' value='' class='large'  placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_3_17\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_17'><span class='gform-field-label__text'>Num\u00e9ro de t\u00e9l\u00e9phone (en soir\u00e9e)<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_17' id='input_3_17' type='tel' value='' class='large'  placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_3_15\" class=\"gfield gfield--type-email gfield--input-type-email field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_15'><span class='gform-field-label__text'>Adresse de courriel:<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_15' id='input_3_15' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_3_16\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Comment souhaitez-vous \u00eatre contact\u00e9 (e)?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_16'>\n\t\t\t<div class='gchoice gchoice_3_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='T\u00e9l\u00e9phone'  id='choice_3_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_16_0' id='label_3_16_0' class='gform-field-label gform-field-label--type-inline'>T\u00e9l\u00e9phone<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Adresse de courriel'  id='choice_3_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_16_1' id='label_3_16_1' class='gform-field-label gform-field-label--type-inline'>Adresse de courriel<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_3' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Soumettre<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_3' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_3' id='gform_theme_3' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_3' id='gform_style_settings_3' value='{&quot;inputPrimaryColor&quot;:&quot;#204ce5&quot;}' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_3' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='3' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='CAD' value='aXsjhV0P+YuI9YeSmsF0YymShvj2H1x\/YuAXcDtgA7cZHE3FRqc1CLlF\/j\/ntCmNxHqnKe8lPvtYORFGkhsqTg1ybvxQJx4yMdKZaQTlBIVKCeE=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_3' value='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' 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