{"id":123,"date":"2019-08-05T21:30:22","date_gmt":"2019-08-05T19:30:22","guid":{"rendered":"https:\/\/couraubois224450043.wordpress.com\/?page_id=123"},"modified":"2026-04-16T17:16:26","modified_gmt":"2026-04-16T15:16:26","slug":"stage","status":"publish","type":"page","link":"https:\/\/www.couraubois.be\/index.php\/stage\/","title":{"rendered":"Stages"},"content":{"rendered":"\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<p>Pendants les vacances scolaires nous organisons des stages pour vos enfants (voir date au bar et sur notre site).<\/p>\n\n\n\n<p>Voici les renseignements demand\u00e9s par votre comptabilit\u00e9.<\/p>\n\n\n\n<p>Merci de bien remplir le formulaire au complet.<br>Il peut y avoir plusieurs formulaires \u00e0 la suite l\u2019un de l&rsquo;autre, s\u00e9lectionner celui qui correspond au stage d\u00e9sir\u00e9.<\/p>\n\n\n\n<p>Attention votre inscription ne sera valable qu\u2019une fois votre paiement re\u00e7u.<\/p>\n\n\n\n<p>Le prix du stage classique est de 250 euros pour la semaine avec repas chaud \u00e0 midi il faut compter 50 euros de moins soit un total de 200 euros sans repas chaud, si vous n\u2019avez pas d\u2019assurance \u00e9quitation annuelle il faut compter 10 euros la semaine.<br>Stage sous tente est de 300 euros.<br>Une fois votre formulaire valid\u00e9, votre enfant est inscrit, vous ne recevrez pas de mail de confirmation.<br>ATTENTION NOTRE NUM\u00c9RO DE COMPTE A CHANGE!!<\/p>\n\n\n\n<p>VOICI LE NUM\u00c9RO DE COMPTE POUR LE VERSEMENT au Cercle d\u2019\u00e9quitation cour au bois (CECAB) compte&nbsp;BNP BE68001978948934&nbsp;mentionner le nom et pr\u00e9nom de l\u2019enfant.<\/p>\n\n\n\n<p>Les stage d\u00e9bute \u00e0 8h30 jusqu\u2019\u00e0 16h00<\/p>\n\n\n\n<p>ATTENTION SUITE AUX PERSONNES QUI INSCRIVENT ABUSIVEMENT LEURS ENFANTS ET QUI NE SE PR\u00c9SENTE PAS LA SEMAINE CHOISI ET QUI NE L&rsquo;ONT PAS ANNUL\u00c9 1 MOIS AVANT LE D\u00c9BUT DE CELUI-CI UNE FACTURE VOUS SERA FACTURER<\/p>\n\n\n\n<p>L\u2019email re\u00e7u est un mail automatique ne pas r\u00e9pondre sur cette adresse vous n\u2019auriez aucune r\u00e9ponse.<br>En cas de questions merci d\u2019utiliser l\u2019adresse&nbsp;<a href=\"mailto:info@couraubois.be\" rel=\"noreferrer noopener\" target=\"_blank\">info@couraubois.be<\/a>&nbsp;ou nous contactez au 023669096<\/p>\n\n\n\n<p>POUR UNE RAISON INCONNUE CERTAINE PERSONNES NE RE\u00c7OIVENT PAS L\u2019EMAIL DE CONFIRMATION<br>SI VOTRE INSCRIPTION SAIS BIEN ENREGISTRER VOUS AVEZ UN CADRE VERT QUI VOUS LE SIGNAL.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"158\" src=\"https:\/\/www.couraubois.be\/wp-content\/uploads\/2025\/04\/Capture-decran-2025-04-28-a-09.28.53-1024x158.png\" alt=\"\" class=\"wp-image-1501\" srcset=\"https:\/\/www.couraubois.be\/wp-content\/uploads\/2025\/04\/Capture-decran-2025-04-28-a-09.28.53-1024x158.png 1024w, https:\/\/www.couraubois.be\/wp-content\/uploads\/2025\/04\/Capture-decran-2025-04-28-a-09.28.53-300x46.png 300w, https:\/\/www.couraubois.be\/wp-content\/uploads\/2025\/04\/Capture-decran-2025-04-28-a-09.28.53-768x118.png 768w, https:\/\/www.couraubois.be\/wp-content\/uploads\/2025\/04\/Capture-decran-2025-04-28-a-09.28.53-1536x236.png 1536w, https:\/\/www.couraubois.be\/wp-content\/uploads\/2025\/04\/Capture-decran-2025-04-28-a-09.28.53-1320x203.png 1320w, https:\/\/www.couraubois.be\/wp-content\/uploads\/2025\/04\/Capture-decran-2025-04-28-a-09.28.53-600x92.png 600w, https:\/\/www.couraubois.be\/wp-content\/uploads\/2025\/04\/Capture-decran-2025-04-28-a-09.28.53.png 1624w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">STAGES 2026<\/h2>\n\n\n\n<p>LES STAGES SONT A LA SUITES LES UN DES AUTRES MERCI DE REMPLIR CELUI QUI VOUS INTERESSE.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Stage Carnaval<\/h2>\n\n\n<p><div class=\"forminator-ui forminator-custom-form forminator-custom-form-1597 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-1597\" data-uid=\"6a0bf6fd458e0\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-1597\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-1597 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"1597\"\n\t\t\t\t data-color-option=\"default\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6a0bf6fd458e0\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a0bf6fd458e0\" id=\"forminator-field-name-1_6a0bf6fd458e0-label\" class=\"forminator-label\">Nom de l&#039;enfant<\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"Par exemple\u00a0: Jacques Martin\" id=\"forminator-field-name-1_6a0bf6fd458e0\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a0bf6fd458e0\" id=\"forminator-field-email-1_6a0bf6fd458e0-label\" class=\"forminator-label\">Adresse de messagerie <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"Par exemple\u00a0: jacques@martin.com\" id=\"forminator-field-email-1_6a0bf6fd458e0\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6a0bf6fd458e0\" id=\"forminator-field-phone-1_6a0bf6fd458e0-label\" class=\"forminator-label\">T\u00e9l\u00e9phone <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"Par exemple\u00a0: +1 02 03 05 06\" id=\"forminator-field-phone-1_6a0bf6fd458e0\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-6a0bf6fd458e0-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-6a0bf6fd458e0-label\" class=\"forminator-label\">Semaine de stage<\/span><label id=\"forminator-field-checkbox-1-1-6a0bf6fd458e0-label\" for=\"forminator-field-checkbox-1-1-6a0bf6fd458e0\" class=\"forminator-checkbox\" title=\"lundi 23 au 27 f\u00e9vrier\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"lundi 23 au 27 f\u00e9vrier\" id=\"forminator-field-checkbox-1-1-6a0bf6fd458e0\" aria-labelledby=\"forminator-field-checkbox-1-1-6a0bf6fd458e0-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">lundi 23 au 27 f\u00e9vrier<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1597__field--select-2_6a0bf6fd458e0\" id=\"forminator-form-1597__field--select-2_6a0bf6fd458e0-label\" class=\"forminator-label\">Repas chaud<\/label><select  id=\"forminator-form-1597__field--select-2_6a0bf6fd458e0\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-2\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1597__field--select-2_6a0bf6fd458e0-label\"><option value=\"one\"  data-calculation=\"0\">OUI<\/option><option value=\"two\"  data-calculation=\"0\">NON<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6a0bf6fd458e0\" id=\"forminator-field-textarea-1_6a0bf6fd458e0-label\" class=\"forminator-label\">Allergie<\/label><textarea name=\"textarea-1\" placeholder=\"merci d&#039;indiquer si votre enfant \u00e0 une allergie alimentaire.\" id=\"forminator-field-textarea-1_6a0bf6fd458e0\" class=\"forminator-textarea\" rows=\"6\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1597__field--select-1_6a0bf6fd458e0\" id=\"forminator-form-1597__field--select-1_6a0bf6fd458e0-label\" class=\"forminator-label\">Assurance<\/label><select  id=\"forminator-form-1597__field--select-1_6a0bf6fd458e0\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-1\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1597__field--select-1_6a0bf6fd458e0-label\" aria-describedby=\"forminator-form-1597__field--select-1_6a0bf6fd458e0-description\"><option value=\"one\"  data-calculation=\"0\">OUI<\/option><option value=\"two\"  data-calculation=\"0\">NON<\/option><\/select><span id=\"forminator-form-1597__field--select-1_6a0bf6fd458e0-description\" class=\"forminator-description\">votre enfant poss\u00e8de une assurance \u00e9questre a l&rsquo;ann\u00e9e<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-field-address forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-street_address_6a0bf6fd458e0\" id=\"forminator-field-address-1-street_address_6a0bf6fd458e0-label\" class=\"forminator-label\">Rue <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"Par exemple\u00a0: 10 grande rue\" id=\"forminator-field-address-1-street_address_6a0bf6fd458e0\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-line1\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-1-city\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-city_6a0bf6fd458e0\" id=\"forminator-field-address-1-city_6a0bf6fd458e0-label\" class=\"forminator-label\">Ville<\/label><input type=\"text\" name=\"address-1-city\" placeholder=\"Par exemple\u00a0: Paris\" id=\"forminator-field-address-1-city_6a0bf6fd458e0\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" autocomplete=\"address-level2\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"address-1-zip\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-zip_6a0bf6fd458e0\" id=\"forminator-field-address-1-zip_6a0bf6fd458e0-label\" class=\"forminator-label\">Code postal<\/label><input type=\"text\" name=\"address-1-zip\" placeholder=\"Par exemple\u00a0: 2000\" id=\"forminator-field-address-1-zip_6a0bf6fd458e0\" class=\"forminator-input\" autocomplete=\"postal-code\" value=\"\" \/><\/div><\/div><div id=\"address-1-country\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-1597__field--address-1-country_6a0bf6fd458e0\" id=\"forminator-field-1597__field--address-1-country_6a0bf6fd458e0-label\" class=\"forminator-label\">Pays<\/label><select name=\"address-1-country\" id=\"forminator-field-1597__field--address-1-country_6a0bf6fd458e0\" class=\"forminator-select2\" data-search=\"true\" data-placeholder=\"S\u00e9lectionner un pays\" autocomplete=\"country-name country\" data-default-value=\"Belgique\"><option value=\"\" data-country-code=\"\" selected=\"selected\"><\/option><option value=\"Afghanistan\" data-country-code=\"AF\" >Afghanistan<\/option><option value=\"Afrique du Sud\" data-country-code=\"ZA\" >Afrique du Sud<\/option><option value=\"Albanie\" data-country-code=\"AL\" >Albanie<\/option><option value=\"Alg\u00e9rie\" data-country-code=\"DZ\" >Alg\u00e9rie<\/option><option value=\"Allemagne\" data-country-code=\"DE\" >Allemagne<\/option><option value=\"Andorre\" data-country-code=\"AD\" >Andorre<\/option><option value=\"Angola\" data-country-code=\"AO\" >Angola<\/option><option value=\"Anguilla\" data-country-code=\"AI\" >Anguilla<\/option><option value=\"Antarctique\" data-country-code=\"AQ\" >Antarctique<\/option><option value=\"Antigua-et-Barbuda\" data-country-code=\"AG\" >Antigua-et-Barbuda<\/option><option value=\"Antilles N\u00e9erlandaises\" data-country-code=\"AN\" >Antilles N\u00e9erlandaises<\/option><option value=\"Apatrides\" data-country-code=\"XX\" >Apatrides<\/option><option value=\"Arabie Saoudite\" data-country-code=\"SA\" >Arabie Saoudite<\/option><option value=\"Argentine\" data-country-code=\"AR\" >Argentine<\/option><option value=\"Arm\u00e9nie\" data-country-code=\"AM\" >Arm\u00e9nie<\/option><option value=\"Aruba\" data-country-code=\"AW\" >Aruba<\/option><option value=\"Australie\" data-country-code=\"AU\" >Australie<\/option><option value=\"Autriche\" data-country-code=\"AT\" >Autriche<\/option><option value=\"Azerba\u00efdjan\" data-country-code=\"AZ\" >Azerba\u00efdjan<\/option><option value=\"Bahamas\" data-country-code=\"BS\" >Bahamas<\/option><option value=\"Bahre\u00efn\" data-country-code=\"BH\" >Bahre\u00efn<\/option><option value=\"Bangladesh\" data-country-code=\"BD\" >Bangladesh<\/option><option value=\"Belgique\" data-country-code=\"BE\" selected=\"selected\">Belgique<\/option><option value=\"Bermudes\" data-country-code=\"BM\" >Bermudes<\/option><option value=\"Bhoutan\" data-country-code=\"BT\" >Bhoutan<\/option><option value=\"Bi\u00e9lorussie\" data-country-code=\"BY\" >Bi\u00e9lorussie<\/option><option value=\"Bolivie\" data-country-code=\"BO\" >Bolivie<\/option><option value=\"Bosnie-Herz\u00e9govine\" data-country-code=\"BA\" >Bosnie-Herz\u00e9govine<\/option><option value=\"Botswana\" data-country-code=\"BW\" >Botswana<\/option><option value=\"Brunei\" data-country-code=\"BN\" >Brunei<\/option><option value=\"Br\u00e9sil\" data-country-code=\"BR\" >Br\u00e9sil<\/option><option value=\"Bulgarie\" data-country-code=\"BG\" >Bulgarie<\/option><option value=\"Burkina Faso\" data-country-code=\"BF\" >Burkina Faso<\/option><option value=\"Burundi\" data-country-code=\"BI\" >Burundi<\/option><option value=\"B\u00e9lize\" data-country-code=\"BZ\" >B\u00e9lize<\/option><option value=\"B\u00e9nin\" data-country-code=\"BJ\" >B\u00e9nin<\/option><option value=\"Cambodge\" data-country-code=\"KH\" >Cambodge<\/option><option value=\"Cameroun\" data-country-code=\"CM\" >Cameroun<\/option><option value=\"Canada\" data-country-code=\"CA\" >Canada<\/option><option value=\"Cap Vert\" data-country-code=\"CV\" >Cap Vert<\/option><option value=\"Chili\" data-country-code=\"CL\" >Chili<\/option><option value=\"Chine, R\u00e9publique populaire de\" data-country-code=\"CN\" >Chine, R\u00e9publique populaire de<\/option><option value=\"Chypre\" data-country-code=\"CY\" >Chypre<\/option><option value=\"Cit\u00e9 du Vatican\" data-country-code=\"VA\" >Cit\u00e9 du Vatican<\/option><option value=\"Colombie\" data-country-code=\"CO\" >Colombie<\/option><option value=\"Comores\" data-country-code=\"KM\" >Comores<\/option><option value=\"Congo, R\u00e9publique du\" data-country-code=\"CG\" >Congo, R\u00e9publique du<\/option><option value=\"Congo, R\u00e9publique d\u00e9mocratique du\" data-country-code=\"CD\" >Congo, R\u00e9publique d\u00e9mocratique du<\/option><option value=\"Cor\u00e9e, R\u00e9publique de\" data-country-code=\"KR\" >Cor\u00e9e, R\u00e9publique de<\/option><option value=\"Cor\u00e9e, R\u00e9publique d\u00e9mocratique populaire de\" data-country-code=\"KP\" >Cor\u00e9e, R\u00e9publique d\u00e9mocratique populaire de<\/option><option value=\"Costa Rica\" data-country-code=\"CR\" >Costa Rica<\/option><option value=\"Croatie\" data-country-code=\"HR\" >Croatie<\/option><option value=\"Cuba\" data-country-code=\"CU\" >Cuba<\/option><option value=\"Cura\u00e7ao\" data-country-code=\"CW\" >Cura\u00e7ao<\/option><option value=\"C\u00f4te d\u2019Ivoire\" data-country-code=\"CI\" >C\u00f4te d\u2019Ivoire<\/option><option value=\"Danemark\" data-country-code=\"DK\" >Danemark<\/option><option value=\"Djibouti\" data-country-code=\"DJ\" >Djibouti<\/option><option value=\"Dominique\" data-country-code=\"DM\" >Dominique<\/option><option value=\"Espagne\" data-country-code=\"ES\" >Espagne<\/option><option value=\"Estonie\" data-country-code=\"EE\" >Estonie<\/option><option value=\"Fidji\" data-country-code=\"FJ\" >Fidji<\/option><option value=\"Finlande\" data-country-code=\"FI\" >Finlande<\/option><option value=\"France\" data-country-code=\"FR\" >France<\/option><option value=\"France, M\u00e9tropolitaine\" data-country-code=\"FX\" >France, M\u00e9tropolitaine<\/option><option value=\"Gabon\" data-country-code=\"GA\" >Gabon<\/option><option value=\"Gambie\" data-country-code=\"GM\" >Gambie<\/option><option value=\"Ghana\" data-country-code=\"GH\" >Ghana<\/option><option value=\"Gibraltar\" data-country-code=\"GI\" >Gibraltar<\/option><option value=\"Grenade\" data-country-code=\"GD\" >Grenade<\/option><option value=\"Groenland\" data-country-code=\"GL\" >Groenland<\/option><option value=\"Gr\u00e8ce\" data-country-code=\"GR\" >Gr\u00e8ce<\/option><option value=\"Guadeloupe\" data-country-code=\"GP\" >Guadeloupe<\/option><option value=\"Guam\" data-country-code=\"GU\" >Guam<\/option><option value=\"Guat\u00e9mala\" data-country-code=\"GT\" >Guat\u00e9mala<\/option><option value=\"Guernesey\" data-country-code=\"GG\" >Guernesey<\/option><option value=\"Guin\u00e9e\" data-country-code=\"GN\" >Guin\u00e9e<\/option><option value=\"Guin\u00e9e \u00c9quatoriale\" data-country-code=\"GQ\" >Guin\u00e9e \u00c9quatoriale<\/option><option value=\"Guin\u00e9e-Bissau\" data-country-code=\"GW\" >Guin\u00e9e-Bissau<\/option><option value=\"Guyane\" data-country-code=\"GY\" >Guyane<\/option><option value=\"Guyane fran\u00e7aise\" data-country-code=\"GF\" >Guyane fran\u00e7aise<\/option><option value=\"G\u00e9orgie\" data-country-code=\"GE\" >G\u00e9orgie<\/option><option value=\"G\u00e9orgie du Sud et Sandwich du Sud\" data-country-code=\"GS\" >G\u00e9orgie du Sud et Sandwich du Sud<\/option><option value=\"Ha\u00efti\" data-country-code=\"HT\" >Ha\u00efti<\/option><option value=\"Honduras\" data-country-code=\"HN\" >Honduras<\/option><option value=\"Hong Kong\" data-country-code=\"HK\" >Hong Kong<\/option><option value=\"Hongrie\" data-country-code=\"HU\" >Hongrie<\/option><option value=\"Inde\" data-country-code=\"IN\" >Inde<\/option><option value=\"Indon\u00e9sie\" data-country-code=\"ID\" >Indon\u00e9sie<\/option><option value=\"Iran\" data-country-code=\"IR\" >Iran<\/option><option value=\"Iraq\" data-country-code=\"IQ\" >Iraq<\/option><option value=\"Irlande\" data-country-code=\"IE\" >Irlande<\/option><option value=\"Islande\" data-country-code=\"IS\" >Islande<\/option><option value=\"Israel\" data-country-code=\"IL\" >Israel<\/option><option value=\"Italie\" data-country-code=\"IT\" >Italie<\/option><option value=\"Jama\u00efque\" data-country-code=\"JM\" >Jama\u00efque<\/option><option value=\"Japon\" data-country-code=\"JP\" >Japon<\/option><option value=\"Jersey\" data-country-code=\"JE\" >Jersey<\/option><option value=\"Jordanie\" data-country-code=\"JO\" >Jordanie<\/option><option value=\"Kazakhstan\" data-country-code=\"KZ\" >Kazakhstan<\/option><option value=\"Kenya\" data-country-code=\"KE\" >Kenya<\/option><option value=\"Kirghizistan\" data-country-code=\"KG\" >Kirghizistan<\/option><option value=\"Kiribati\" data-country-code=\"KI\" >Kiribati<\/option><option value=\"Kosovo\" data-country-code=\"XK\" >Kosovo<\/option><option value=\"Kowe\u00eft\" data-country-code=\"KW\" >Kowe\u00eft<\/option><option value=\"La Barbade\" data-country-code=\"BB\" >La Barbade<\/option><option value=\"Lesotho\" data-country-code=\"LS\" >Lesotho<\/option><option value=\"Lettonie\" data-country-code=\"LV\" >Lettonie<\/option><option value=\"Liban\" data-country-code=\"LB\" >Liban<\/option><option value=\"Libye\" data-country-code=\"LY\" >Libye<\/option><option value=\"Lib\u00e9ria\" data-country-code=\"LR\" >Lib\u00e9ria<\/option><option value=\"Liechtenstein\" data-country-code=\"LI\" >Liechtenstein<\/option><option value=\"Lithuanie\" data-country-code=\"LT\" >Lithuanie<\/option><option value=\"Luxembourg\" data-country-code=\"LU\" >Luxembourg<\/option><option value=\"Macao\" data-country-code=\"MO\" >Macao<\/option><option value=\"Mac\u00e9doine du Nord\" data-country-code=\"MK\" >Mac\u00e9doine du Nord<\/option><option value=\"Madagascar\" data-country-code=\"MG\" >Madagascar<\/option><option value=\"Malaisie\" data-country-code=\"MY\" >Malaisie<\/option><option value=\"Malawi\" data-country-code=\"MW\" >Malawi<\/option><option value=\"Maldives\" data-country-code=\"MV\" >Maldives<\/option><option value=\"Mali\" data-country-code=\"ML\" >Mali<\/option><option value=\"Malte\" data-country-code=\"MT\" >Malte<\/option><option value=\"Maroc\" data-country-code=\"MA\" >Maroc<\/option><option value=\"Martinique\" data-country-code=\"MQ\" >Martinique<\/option><option value=\"Mauritanie\" data-country-code=\"MR\" >Mauritanie<\/option><option value=\"Mayotte\" data-country-code=\"YT\" >Mayotte<\/option><option value=\"Mexique\" data-country-code=\"MX\" >Mexique<\/option><option value=\"Micron\u00e9sie\" data-country-code=\"FM\" >Micron\u00e9sie<\/option><option value=\"Moldavie\" data-country-code=\"MD\" >Moldavie<\/option><option value=\"Monaco\" data-country-code=\"MC\" >Monaco<\/option><option value=\"Mongolie\" data-country-code=\"MN\" >Mongolie<\/option><option value=\"Montserrat\" data-country-code=\"MS\" >Montserrat<\/option><option value=\"Mont\u00e9n\u00e9gro\" data-country-code=\"ME\" >Mont\u00e9n\u00e9gro<\/option><option value=\"Mozambique\" data-country-code=\"MZ\" >Mozambique<\/option><option value=\"Myanmar\" data-country-code=\"MM\" >Myanmar<\/option><option value=\"Namibie\" data-country-code=\"NA\" >Namibie<\/option><option value=\"Nauru\" data-country-code=\"NR\" >Nauru<\/option><option value=\"Nicaragua\" data-country-code=\"NI\" >Nicaragua<\/option><option value=\"Niger\" data-country-code=\"NE\" >Niger<\/option><option value=\"Nigeria\" data-country-code=\"NG\" >Nigeria<\/option><option value=\"Niu\u00e9\" data-country-code=\"NU\" >Niu\u00e9<\/option><option value=\"Norv\u00e8ge\" data-country-code=\"NO\" >Norv\u00e8ge<\/option><option value=\"Nouvelle Zelande\" data-country-code=\"NZ\" >Nouvelle Zelande<\/option><option value=\"Nouvelle-Cal\u00e9donie\" data-country-code=\"NC\" >Nouvelle-Cal\u00e9donie<\/option><option value=\"N\u00e9pal\" data-country-code=\"NP\" >N\u00e9pal<\/option><option value=\"Oman\" data-country-code=\"OM\" >Oman<\/option><option value=\"Ouganda\" data-country-code=\"UG\" >Ouganda<\/option><option value=\"Ouzb\u00e9kistan\" data-country-code=\"UZ\" >Ouzb\u00e9kistan<\/option><option value=\"Pakistan\" data-country-code=\"PK\" >Pakistan<\/option><option value=\"Palau\" data-country-code=\"PW\" >Palau<\/option><option value=\"Palestine, \u00c9tat de\" data-country-code=\"PS\" >Palestine, \u00c9tat de<\/option><option value=\"Panama\" data-country-code=\"PA\" >Panama<\/option><option value=\"Papouasie-Nouvelle-Guin\u00e9e\" data-country-code=\"PG\" >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value=\"Paraguay\" data-country-code=\"PY\" >Paraguay<\/option><option value=\"Pays-Bas\" data-country-code=\"NL\" >Pays-Bas<\/option><option value=\"Philippines\" data-country-code=\"PH\" >Philippines<\/option><option value=\"Pologne\" data-country-code=\"PL\" >Pologne<\/option><option value=\"Polyn\u00e9sie Fran\u00e7aise\" data-country-code=\"PF\" >Polyn\u00e9sie Fran\u00e7aise<\/option><option value=\"Porto Rico\" data-country-code=\"PR\" >Porto Rico<\/option><option value=\"Portugal\" data-country-code=\"PT\" >Portugal<\/option><option value=\"P\u00e9rou\" data-country-code=\"PE\" >P\u00e9rou<\/option><option value=\"Qatar\" data-country-code=\"QA\" >Qatar<\/option><option value=\"Roumanie\" data-country-code=\"RO\" >Roumanie<\/option><option value=\"Royaume-Uni\" data-country-code=\"GB\" >Royaume-Uni<\/option><option value=\"Russie\" data-country-code=\"RU\" >Russie<\/option><option value=\"Rwanda\" data-country-code=\"RW\" >Rwanda<\/option><option value=\"R\u00e9publique Centrafricaine\" data-country-code=\"CF\" >R\u00e9publique Centrafricaine<\/option><option value=\"R\u00e9publique Dominicaine\" data-country-code=\"DO\" >R\u00e9publique Dominicaine<\/option><option value=\"R\u00e9publique Tch\u00e8que\" data-country-code=\"CZ\" >R\u00e9publique Tch\u00e8que<\/option><option value=\"R\u00e9publique du Salvador\" data-country-code=\"SV\" >R\u00e9publique du Salvador<\/option><option value=\"R\u00e9publique d\u00e9mocratique populaire du Laos\" data-country-code=\"LA\" >R\u00e9publique d\u00e9mocratique populaire du Laos<\/option><option value=\"Sahara occidental\" data-country-code=\"EH\" >Sahara occidental<\/option><option value=\"Saint Pierre et Miquelon\" data-country-code=\"PM\" >Saint Pierre et Miquelon<\/option><option value=\"Saint-Kitts-et-Nevis\" data-country-code=\"KN\" >Saint-Kitts-et-Nevis<\/option><option value=\"Saint-Marin\" data-country-code=\"SM\" >Saint-Marin<\/option><option value=\"Saint-Martin (Royaume des Pays-Bas)\" data-country-code=\"MF\" >Saint-Martin (Royaume des Pays-Bas)<\/option><option value=\"Saint-Vincent-et-les-Grenadines\" data-country-code=\"VC\" >Saint-Vincent-et-les-Grenadines<\/option><option value=\"Sainte Lucie\" data-country-code=\"LC\" >Sainte Lucie<\/option><option value=\"Sainte-H\u00e9l\u00e8ne\" data-country-code=\"SH\" >Sainte-H\u00e9l\u00e8ne<\/option><option value=\"Samoa\" data-country-code=\"WS\" >Samoa<\/option><option value=\"Samoa am\u00e9ricaines\" data-country-code=\"AS\" >Samoa am\u00e9ricaines<\/option><option value=\"Sao Tom\u00e9-et-Principe\" data-country-code=\"ST\" >Sao Tom\u00e9-et-Principe<\/option><option value=\"Serbie\" data-country-code=\"RS\" >Serbie<\/option><option value=\"Seychelles\" data-country-code=\"SC\" >Seychelles<\/option><option value=\"Sierra Leone\" data-country-code=\"SL\" >Sierra Leone<\/option><option value=\"Singapour\" data-country-code=\"SG\" >Singapour<\/option><option value=\"Slovaquie\" data-country-code=\"SK\" >Slovaquie<\/option><option value=\"Slov\u00e9nie\" data-country-code=\"SI\" >Slov\u00e9nie<\/option><option value=\"Somalie\" data-country-code=\"SO\" >Somalie<\/option><option value=\"Soudan\" data-country-code=\"SD\" >Soudan<\/option><option value=\"Soudan, Sud\" data-country-code=\"SS\" >Soudan, Sud<\/option><option value=\"Sri Lanka\" data-country-code=\"LK\" >Sri Lanka<\/option><option value=\"Suisse\" data-country-code=\"CH\" >Suisse<\/option><option value=\"Suriname\" data-country-code=\"SR\" >Suriname<\/option><option value=\"Su\u00e8de\" data-country-code=\"SE\" >Su\u00e8de<\/option><option value=\"Svalbard et Jan Mayen\" data-country-code=\"SJ\" >Svalbard et Jan Mayen<\/option><option value=\"Swaziland\" data-country-code=\"SZ\" >Swaziland<\/option><option value=\"Syrie\" data-country-code=\"SY\" >Syrie<\/option><option value=\"S\u00e9n\u00e9gal\" data-country-code=\"SN\" >S\u00e9n\u00e9gal<\/option><option value=\"Tadjikistan\" data-country-code=\"TJ\" >Tadjikistan<\/option><option value=\"Taiwan, R\u00e9publique de Chine\" data-country-code=\"TW\" >Taiwan, R\u00e9publique de Chine<\/option><option value=\"Tanzanie\" data-country-code=\"TZ\" >Tanzanie<\/option><option value=\"Tchad\" data-country-code=\"TD\" >Tchad<\/option><option value=\"Terres australes et antarctiques fran\u00e7aises\" data-country-code=\"TF\" >Terres australes et antarctiques fran\u00e7aises<\/option><option value=\"Territoire britannique de l\u2019oc\u00e9an Indien\" data-country-code=\"IO\" >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value=\"Tha\u00eflande\" data-country-code=\"TH\" >Tha\u00eflande<\/option><option value=\"Timor-Oriental\" data-country-code=\"TL\" >Timor-Oriental<\/option><option value=\"Togo\" data-country-code=\"TG\" >Togo<\/option><option value=\"Tokelau\" data-country-code=\"TK\" >Tokelau<\/option><option value=\"Tonga\" data-country-code=\"TO\" >Tonga<\/option><option value=\"Trinit\u00e9 et Tobago\" data-country-code=\"TT\" >Trinit\u00e9 et Tobago<\/option><option value=\"Tunisie\" data-country-code=\"TN\" >Tunisie<\/option><option value=\"Turkm\u00e9nistan\" data-country-code=\"TM\" >Turkm\u00e9nistan<\/option><option value=\"Turquie\" data-country-code=\"TR\" >Turquie<\/option><option value=\"Tuvalu\" data-country-code=\"TV\" >Tuvalu<\/option><option value=\"Ukraine\" data-country-code=\"UA\" >Ukraine<\/option><option value=\"Uruguay\" data-country-code=\"UY\" >Uruguay<\/option><option value=\"Vanuatu\" data-country-code=\"VU\" >Vanuatu<\/option><option value=\"Vietnam\" data-country-code=\"VN\" >Vietnam<\/option><option value=\"V\u00e9n\u00e9zu\u00e9la\" data-country-code=\"VE\" >V\u00e9n\u00e9zu\u00e9la<\/option><option value=\"Yemen\" data-country-code=\"YE\" >Yemen<\/option><option value=\"Zambie\" data-country-code=\"ZM\" >Zambie<\/option><option value=\"Zimbabwe\" data-country-code=\"ZW\" >Zimbabwe<\/option><option value=\"\u00c9gypte\" data-country-code=\"EG\" >\u00c9gypte<\/option><option value=\"\u00c9mirats Arabes Unis\" data-country-code=\"AE\" >\u00c9mirats Arabes Unis<\/option><option value=\"\u00c9quateur\" data-country-code=\"EC\" >\u00c9quateur<\/option><option value=\"\u00c9rythr\u00e9e\" data-country-code=\"ER\" >\u00c9rythr\u00e9e<\/option><option value=\"\u00c9tats-Unis d\u2019Am\u00e9rique (USA)\" data-country-code=\"US\" >\u00c9tats-Unis d\u2019Am\u00e9rique (USA)<\/option><option value=\"\u00c9thiopie\" data-country-code=\"ET\" >\u00c9thiopie<\/option><option value=\"\u00cele Bouvet\" data-country-code=\"BV\" >\u00cele Bouvet<\/option><option value=\"\u00cele Christmas\" data-country-code=\"CX\" >\u00cele Christmas<\/option><option value=\"\u00cele Heard et \u00eele Mcdonald\" data-country-code=\"HM\" >\u00cele Heard et \u00eele Mcdonald<\/option><option value=\"\u00cele Johnston\" data-country-code=\"JT\" >\u00cele Johnston<\/option><option value=\"\u00cele Maurice\" data-country-code=\"MU\" >\u00cele Maurice<\/option><option value=\"\u00cele Norfolk\" data-country-code=\"NF\" >\u00cele Norfolk<\/option><option value=\"\u00cele de la R\u00e9union\" data-country-code=\"RE\" >\u00cele de la R\u00e9union<\/option><option value=\"\u00celes Ca\u00efmans\" data-country-code=\"KY\" >\u00celes Ca\u00efmans<\/option><option value=\"\u00celes Cocos\" data-country-code=\"CC\" >\u00celes Cocos<\/option><option value=\"\u00celes Cook\" data-country-code=\"CK\" >\u00celes Cook<\/option><option value=\"\u00celes Falkland\" data-country-code=\"FK\" >\u00celes Falkland<\/option><option value=\"\u00celes F\u00e9ro\u00e9\" data-country-code=\"FO\" >\u00celes F\u00e9ro\u00e9<\/option><option value=\"\u00celes Mariannes du Nord\" data-country-code=\"MP\" >\u00celes Mariannes du Nord<\/option><option value=\"\u00celes Marshall\" data-country-code=\"MH\" >\u00celes Marshall<\/option><option value=\"\u00celes Pitcairn\" data-country-code=\"PN\" >\u00celes Pitcairn<\/option><option value=\"\u00celes Salomon\" data-country-code=\"SB\" >\u00celes Salomon<\/option><option value=\"\u00celes Turques-et-Ca\u00efques\" data-country-code=\"TC\" >\u00celes Turques-et-Ca\u00efques<\/option><option value=\"\u00celes Vierges am\u00e9ricaines\" data-country-code=\"VI\" >\u00celes Vierges am\u00e9ricaines<\/option><option value=\"\u00celes Vierges britanniques\" data-country-code=\"VG\" >\u00celes Vierges britanniques<\/option><option value=\"\u00celes Wallis et Futuna\" data-country-code=\"WF\" >\u00celes Wallis et Futuna<\/option><option value=\"\u00celes mineures \u00e9loign\u00e9es des \u00c9tats-Unis\" data-country-code=\"UM\" >\u00celes mineures \u00e9loign\u00e9es des \u00c9tats-Unis<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"captcha-1\" class=\"forminator-field-captcha  forminator-col-6 \"><div class=\"forminator-captcha-left forminator-g-recaptcha recaptcha-invisible\" data-theme=\"light\" data-badge=\"bottomright\" data-sitekey=\"6Lf2UkApAAAAAG7Kj_tF8X3y7nW5fPOjscOjbQyV\" data-size=\"invisible\"><\/div> <\/div><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_6a0bf6fd458e0\" id=\"forminator-field-date-1-picker_6a0bf6fd458e0-label\" class=\"forminator-label\">Date de naissance <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"j\/m\/A\" id=\"forminator-field-date-1-picker_6a0bf6fd458e0\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" aria-describedby=\"forminator-field-date-1-picker_6a0bf6fd458e0-description\" \/><\/div><span id=\"forminator-field-date-1-picker_6a0bf6fd458e0-description\" class=\"forminator-description\">Date de naissance de votre enfant<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6a0bf6fd458e0\" id=\"forminator-field-textarea-2_6a0bf6fd458e0-label\" class=\"forminator-label\">Remarque \u00e9ventuelle<\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_6a0bf6fd458e0\" class=\"forminator-textarea\" rows=\"6\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Envoyer le message<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"f3c285c468\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/123\" \/><input type=\"hidden\" name=\"form_id\" value=\"1597\"><input type=\"hidden\" name=\"page_id\" value=\"123\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/www.couraubois.be\/index.php\/stage\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/p>\n<\/div><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Stage P\u00e2ques<\/h2>\n\n\n<p><div class=\"forminator-ui forminator-custom-form forminator-custom-form-1600 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-1600\" data-uid=\"6a0bf6fd4ff42\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-1600\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-1600 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"1600\"\n\t\t\t\t data-color-option=\"default\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6a0bf6fd4ff42\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a0bf6fd4ff42\" id=\"forminator-field-name-1_6a0bf6fd4ff42-label\" class=\"forminator-label\">Nom de l&#039;enfant<\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"Par exemple\u00a0: Jacques Martin\" id=\"forminator-field-name-1_6a0bf6fd4ff42\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a0bf6fd4ff42\" id=\"forminator-field-email-1_6a0bf6fd4ff42-label\" class=\"forminator-label\">Adresse de messagerie <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"Par exemple\u00a0: jacques@martin.com\" id=\"forminator-field-email-1_6a0bf6fd4ff42\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6a0bf6fd4ff42\" id=\"forminator-field-phone-1_6a0bf6fd4ff42-label\" class=\"forminator-label\">T\u00e9l\u00e9phone <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"Par exemple\u00a0: +1 02 03 05 06\" id=\"forminator-field-phone-1_6a0bf6fd4ff42\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-6a0bf6fd4ff42-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-6a0bf6fd4ff42-label\" class=\"forminator-label\">Semaine de stage<\/span><label id=\"forminator-field-checkbox-1-1-6a0bf6fd4ff42-label\" for=\"forminator-field-checkbox-1-1-6a0bf6fd4ff42\" class=\"forminator-checkbox\" title=\"lundi 27 avril au jeudi 30 avril\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"lundi 27 avril au jeudi 30 avril\" id=\"forminator-field-checkbox-1-1-6a0bf6fd4ff42\" aria-labelledby=\"forminator-field-checkbox-1-1-6a0bf6fd4ff42-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">lundi 27 avril au jeudi 30 avril<\/span><\/label><label id=\"forminator-field-checkbox-1-2-6a0bf6fd4ff42-label\" for=\"forminator-field-checkbox-1-2-6a0bf6fd4ff42\" class=\"forminator-checkbox\" title=\"lundi 4 mai au vendredi 8 mai\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"lundi 4 mai au vendredi 8 mai\" id=\"forminator-field-checkbox-1-2-6a0bf6fd4ff42\" aria-labelledby=\"forminator-field-checkbox-1-2-6a0bf6fd4ff42-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">lundi 4 mai au vendredi 8 mai<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1600__field--select-2_6a0bf6fd4ff42\" id=\"forminator-form-1600__field--select-2_6a0bf6fd4ff42-label\" class=\"forminator-label\">Repas chaud<\/label><select  id=\"forminator-form-1600__field--select-2_6a0bf6fd4ff42\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-2\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1600__field--select-2_6a0bf6fd4ff42-label\"><option value=\"one\"  data-calculation=\"0\">OUI<\/option><option value=\"two\"  data-calculation=\"0\">NON<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6a0bf6fd4ff42\" id=\"forminator-field-textarea-1_6a0bf6fd4ff42-label\" class=\"forminator-label\">Allergie<\/label><textarea name=\"textarea-1\" placeholder=\"merci d&#039;indiquer si votre enfant \u00e0 une allergie alimentaire.\" id=\"forminator-field-textarea-1_6a0bf6fd4ff42\" class=\"forminator-textarea\" rows=\"6\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1600__field--select-1_6a0bf6fd4ff42\" id=\"forminator-form-1600__field--select-1_6a0bf6fd4ff42-label\" class=\"forminator-label\">Assurance<\/label><select  id=\"forminator-form-1600__field--select-1_6a0bf6fd4ff42\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-1\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1600__field--select-1_6a0bf6fd4ff42-label\" aria-describedby=\"forminator-form-1600__field--select-1_6a0bf6fd4ff42-description\"><option value=\"one\"  data-calculation=\"0\">OUI<\/option><option value=\"two\"  data-calculation=\"0\">NON<\/option><\/select><span id=\"forminator-form-1600__field--select-1_6a0bf6fd4ff42-description\" class=\"forminator-description\">votre enfant poss\u00e8de une assurance \u00e9questre a l&rsquo;ann\u00e9e<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-field-address forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-street_address_6a0bf6fd4ff42\" id=\"forminator-field-address-1-street_address_6a0bf6fd4ff42-label\" class=\"forminator-label\">Rue <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"Par exemple\u00a0: 10 grande rue\" id=\"forminator-field-address-1-street_address_6a0bf6fd4ff42\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-line1\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-1-city\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-city_6a0bf6fd4ff42\" id=\"forminator-field-address-1-city_6a0bf6fd4ff42-label\" class=\"forminator-label\">Ville<\/label><input type=\"text\" name=\"address-1-city\" placeholder=\"Par exemple\u00a0: Paris\" id=\"forminator-field-address-1-city_6a0bf6fd4ff42\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" autocomplete=\"address-level2\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"address-1-zip\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-zip_6a0bf6fd4ff42\" id=\"forminator-field-address-1-zip_6a0bf6fd4ff42-label\" class=\"forminator-label\">Code postal<\/label><input type=\"text\" name=\"address-1-zip\" placeholder=\"Par exemple\u00a0: 2000\" id=\"forminator-field-address-1-zip_6a0bf6fd4ff42\" class=\"forminator-input\" autocomplete=\"postal-code\" value=\"\" \/><\/div><\/div><div id=\"address-1-country\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-1600__field--address-1-country_6a0bf6fd4ff42\" id=\"forminator-field-1600__field--address-1-country_6a0bf6fd4ff42-label\" class=\"forminator-label\">Pays<\/label><select name=\"address-1-country\" id=\"forminator-field-1600__field--address-1-country_6a0bf6fd4ff42\" class=\"forminator-select2\" data-search=\"true\" data-placeholder=\"S\u00e9lectionner un pays\" autocomplete=\"country-name country\" data-default-value=\"Belgique\"><option value=\"\" data-country-code=\"\" selected=\"selected\"><\/option><option value=\"Afghanistan\" data-country-code=\"AF\" >Afghanistan<\/option><option value=\"Afrique du Sud\" data-country-code=\"ZA\" >Afrique du Sud<\/option><option value=\"Albanie\" data-country-code=\"AL\" >Albanie<\/option><option value=\"Alg\u00e9rie\" data-country-code=\"DZ\" >Alg\u00e9rie<\/option><option value=\"Allemagne\" data-country-code=\"DE\" >Allemagne<\/option><option value=\"Andorre\" data-country-code=\"AD\" >Andorre<\/option><option value=\"Angola\" data-country-code=\"AO\" >Angola<\/option><option value=\"Anguilla\" data-country-code=\"AI\" >Anguilla<\/option><option value=\"Antarctique\" data-country-code=\"AQ\" >Antarctique<\/option><option value=\"Antigua-et-Barbuda\" data-country-code=\"AG\" >Antigua-et-Barbuda<\/option><option value=\"Antilles N\u00e9erlandaises\" data-country-code=\"AN\" >Antilles N\u00e9erlandaises<\/option><option value=\"Apatrides\" data-country-code=\"XX\" >Apatrides<\/option><option value=\"Arabie Saoudite\" data-country-code=\"SA\" >Arabie Saoudite<\/option><option value=\"Argentine\" data-country-code=\"AR\" >Argentine<\/option><option value=\"Arm\u00e9nie\" data-country-code=\"AM\" >Arm\u00e9nie<\/option><option value=\"Aruba\" data-country-code=\"AW\" >Aruba<\/option><option value=\"Australie\" data-country-code=\"AU\" >Australie<\/option><option value=\"Autriche\" data-country-code=\"AT\" >Autriche<\/option><option value=\"Azerba\u00efdjan\" data-country-code=\"AZ\" >Azerba\u00efdjan<\/option><option value=\"Bahamas\" data-country-code=\"BS\" >Bahamas<\/option><option value=\"Bahre\u00efn\" data-country-code=\"BH\" >Bahre\u00efn<\/option><option value=\"Bangladesh\" data-country-code=\"BD\" >Bangladesh<\/option><option value=\"Belgique\" data-country-code=\"BE\" selected=\"selected\">Belgique<\/option><option value=\"Bermudes\" data-country-code=\"BM\" >Bermudes<\/option><option value=\"Bhoutan\" data-country-code=\"BT\" >Bhoutan<\/option><option value=\"Bi\u00e9lorussie\" data-country-code=\"BY\" >Bi\u00e9lorussie<\/option><option value=\"Bolivie\" data-country-code=\"BO\" >Bolivie<\/option><option value=\"Bosnie-Herz\u00e9govine\" data-country-code=\"BA\" >Bosnie-Herz\u00e9govine<\/option><option value=\"Botswana\" data-country-code=\"BW\" >Botswana<\/option><option value=\"Brunei\" data-country-code=\"BN\" >Brunei<\/option><option value=\"Br\u00e9sil\" data-country-code=\"BR\" >Br\u00e9sil<\/option><option value=\"Bulgarie\" data-country-code=\"BG\" >Bulgarie<\/option><option value=\"Burkina Faso\" data-country-code=\"BF\" >Burkina Faso<\/option><option value=\"Burundi\" data-country-code=\"BI\" >Burundi<\/option><option value=\"B\u00e9lize\" data-country-code=\"BZ\" >B\u00e9lize<\/option><option value=\"B\u00e9nin\" data-country-code=\"BJ\" >B\u00e9nin<\/option><option value=\"Cambodge\" data-country-code=\"KH\" >Cambodge<\/option><option value=\"Cameroun\" data-country-code=\"CM\" >Cameroun<\/option><option value=\"Canada\" data-country-code=\"CA\" >Canada<\/option><option value=\"Cap Vert\" data-country-code=\"CV\" >Cap Vert<\/option><option value=\"Chili\" data-country-code=\"CL\" >Chili<\/option><option value=\"Chine, R\u00e9publique populaire de\" data-country-code=\"CN\" >Chine, R\u00e9publique populaire de<\/option><option value=\"Chypre\" data-country-code=\"CY\" >Chypre<\/option><option value=\"Cit\u00e9 du Vatican\" data-country-code=\"VA\" >Cit\u00e9 du Vatican<\/option><option value=\"Colombie\" data-country-code=\"CO\" >Colombie<\/option><option value=\"Comores\" data-country-code=\"KM\" >Comores<\/option><option value=\"Congo, R\u00e9publique du\" data-country-code=\"CG\" >Congo, R\u00e9publique du<\/option><option value=\"Congo, R\u00e9publique d\u00e9mocratique du\" data-country-code=\"CD\" >Congo, R\u00e9publique d\u00e9mocratique du<\/option><option value=\"Cor\u00e9e, R\u00e9publique de\" data-country-code=\"KR\" >Cor\u00e9e, R\u00e9publique de<\/option><option value=\"Cor\u00e9e, R\u00e9publique d\u00e9mocratique populaire de\" data-country-code=\"KP\" >Cor\u00e9e, R\u00e9publique d\u00e9mocratique populaire de<\/option><option value=\"Costa Rica\" data-country-code=\"CR\" >Costa Rica<\/option><option value=\"Croatie\" data-country-code=\"HR\" >Croatie<\/option><option value=\"Cuba\" data-country-code=\"CU\" >Cuba<\/option><option value=\"Cura\u00e7ao\" data-country-code=\"CW\" >Cura\u00e7ao<\/option><option value=\"C\u00f4te d\u2019Ivoire\" data-country-code=\"CI\" >C\u00f4te d\u2019Ivoire<\/option><option value=\"Danemark\" data-country-code=\"DK\" >Danemark<\/option><option value=\"Djibouti\" data-country-code=\"DJ\" >Djibouti<\/option><option value=\"Dominique\" data-country-code=\"DM\" >Dominique<\/option><option value=\"Espagne\" data-country-code=\"ES\" >Espagne<\/option><option value=\"Estonie\" data-country-code=\"EE\" >Estonie<\/option><option value=\"Fidji\" data-country-code=\"FJ\" >Fidji<\/option><option value=\"Finlande\" data-country-code=\"FI\" >Finlande<\/option><option value=\"France\" data-country-code=\"FR\" >France<\/option><option value=\"France, M\u00e9tropolitaine\" data-country-code=\"FX\" >France, M\u00e9tropolitaine<\/option><option value=\"Gabon\" data-country-code=\"GA\" >Gabon<\/option><option value=\"Gambie\" data-country-code=\"GM\" >Gambie<\/option><option value=\"Ghana\" data-country-code=\"GH\" >Ghana<\/option><option value=\"Gibraltar\" data-country-code=\"GI\" >Gibraltar<\/option><option value=\"Grenade\" data-country-code=\"GD\" >Grenade<\/option><option value=\"Groenland\" data-country-code=\"GL\" >Groenland<\/option><option value=\"Gr\u00e8ce\" data-country-code=\"GR\" >Gr\u00e8ce<\/option><option value=\"Guadeloupe\" data-country-code=\"GP\" >Guadeloupe<\/option><option value=\"Guam\" data-country-code=\"GU\" >Guam<\/option><option value=\"Guat\u00e9mala\" data-country-code=\"GT\" >Guat\u00e9mala<\/option><option value=\"Guernesey\" data-country-code=\"GG\" >Guernesey<\/option><option value=\"Guin\u00e9e\" data-country-code=\"GN\" >Guin\u00e9e<\/option><option value=\"Guin\u00e9e \u00c9quatoriale\" data-country-code=\"GQ\" >Guin\u00e9e \u00c9quatoriale<\/option><option value=\"Guin\u00e9e-Bissau\" data-country-code=\"GW\" >Guin\u00e9e-Bissau<\/option><option value=\"Guyane\" data-country-code=\"GY\" >Guyane<\/option><option value=\"Guyane fran\u00e7aise\" data-country-code=\"GF\" >Guyane fran\u00e7aise<\/option><option value=\"G\u00e9orgie\" data-country-code=\"GE\" >G\u00e9orgie<\/option><option value=\"G\u00e9orgie du Sud et Sandwich du Sud\" data-country-code=\"GS\" >G\u00e9orgie du Sud et Sandwich du Sud<\/option><option value=\"Ha\u00efti\" data-country-code=\"HT\" >Ha\u00efti<\/option><option value=\"Honduras\" data-country-code=\"HN\" >Honduras<\/option><option value=\"Hong Kong\" data-country-code=\"HK\" >Hong Kong<\/option><option value=\"Hongrie\" data-country-code=\"HU\" >Hongrie<\/option><option value=\"Inde\" data-country-code=\"IN\" >Inde<\/option><option value=\"Indon\u00e9sie\" data-country-code=\"ID\" >Indon\u00e9sie<\/option><option value=\"Iran\" data-country-code=\"IR\" >Iran<\/option><option value=\"Iraq\" data-country-code=\"IQ\" >Iraq<\/option><option value=\"Irlande\" data-country-code=\"IE\" >Irlande<\/option><option value=\"Islande\" data-country-code=\"IS\" >Islande<\/option><option value=\"Israel\" data-country-code=\"IL\" >Israel<\/option><option value=\"Italie\" data-country-code=\"IT\" >Italie<\/option><option value=\"Jama\u00efque\" data-country-code=\"JM\" >Jama\u00efque<\/option><option value=\"Japon\" data-country-code=\"JP\" >Japon<\/option><option value=\"Jersey\" data-country-code=\"JE\" >Jersey<\/option><option value=\"Jordanie\" data-country-code=\"JO\" >Jordanie<\/option><option value=\"Kazakhstan\" data-country-code=\"KZ\" >Kazakhstan<\/option><option value=\"Kenya\" data-country-code=\"KE\" >Kenya<\/option><option value=\"Kirghizistan\" data-country-code=\"KG\" >Kirghizistan<\/option><option value=\"Kiribati\" data-country-code=\"KI\" >Kiribati<\/option><option value=\"Kosovo\" data-country-code=\"XK\" >Kosovo<\/option><option value=\"Kowe\u00eft\" data-country-code=\"KW\" >Kowe\u00eft<\/option><option value=\"La Barbade\" data-country-code=\"BB\" >La Barbade<\/option><option value=\"Lesotho\" data-country-code=\"LS\" >Lesotho<\/option><option value=\"Lettonie\" data-country-code=\"LV\" >Lettonie<\/option><option value=\"Liban\" data-country-code=\"LB\" >Liban<\/option><option value=\"Libye\" data-country-code=\"LY\" >Libye<\/option><option value=\"Lib\u00e9ria\" data-country-code=\"LR\" >Lib\u00e9ria<\/option><option value=\"Liechtenstein\" data-country-code=\"LI\" >Liechtenstein<\/option><option value=\"Lithuanie\" data-country-code=\"LT\" >Lithuanie<\/option><option value=\"Luxembourg\" data-country-code=\"LU\" >Luxembourg<\/option><option value=\"Macao\" data-country-code=\"MO\" >Macao<\/option><option value=\"Mac\u00e9doine du Nord\" data-country-code=\"MK\" >Mac\u00e9doine du Nord<\/option><option value=\"Madagascar\" data-country-code=\"MG\" >Madagascar<\/option><option value=\"Malaisie\" data-country-code=\"MY\" >Malaisie<\/option><option value=\"Malawi\" data-country-code=\"MW\" >Malawi<\/option><option value=\"Maldives\" data-country-code=\"MV\" >Maldives<\/option><option value=\"Mali\" data-country-code=\"ML\" >Mali<\/option><option value=\"Malte\" data-country-code=\"MT\" >Malte<\/option><option value=\"Maroc\" data-country-code=\"MA\" >Maroc<\/option><option value=\"Martinique\" data-country-code=\"MQ\" >Martinique<\/option><option value=\"Mauritanie\" data-country-code=\"MR\" >Mauritanie<\/option><option value=\"Mayotte\" data-country-code=\"YT\" >Mayotte<\/option><option value=\"Mexique\" data-country-code=\"MX\" >Mexique<\/option><option value=\"Micron\u00e9sie\" data-country-code=\"FM\" >Micron\u00e9sie<\/option><option value=\"Moldavie\" data-country-code=\"MD\" >Moldavie<\/option><option value=\"Monaco\" data-country-code=\"MC\" >Monaco<\/option><option value=\"Mongolie\" data-country-code=\"MN\" >Mongolie<\/option><option value=\"Montserrat\" data-country-code=\"MS\" >Montserrat<\/option><option value=\"Mont\u00e9n\u00e9gro\" data-country-code=\"ME\" >Mont\u00e9n\u00e9gro<\/option><option value=\"Mozambique\" data-country-code=\"MZ\" >Mozambique<\/option><option value=\"Myanmar\" data-country-code=\"MM\" >Myanmar<\/option><option value=\"Namibie\" data-country-code=\"NA\" >Namibie<\/option><option value=\"Nauru\" data-country-code=\"NR\" >Nauru<\/option><option value=\"Nicaragua\" data-country-code=\"NI\" >Nicaragua<\/option><option value=\"Niger\" data-country-code=\"NE\" >Niger<\/option><option value=\"Nigeria\" data-country-code=\"NG\" >Nigeria<\/option><option value=\"Niu\u00e9\" data-country-code=\"NU\" >Niu\u00e9<\/option><option value=\"Norv\u00e8ge\" data-country-code=\"NO\" >Norv\u00e8ge<\/option><option value=\"Nouvelle Zelande\" data-country-code=\"NZ\" >Nouvelle Zelande<\/option><option value=\"Nouvelle-Cal\u00e9donie\" data-country-code=\"NC\" >Nouvelle-Cal\u00e9donie<\/option><option value=\"N\u00e9pal\" data-country-code=\"NP\" >N\u00e9pal<\/option><option value=\"Oman\" data-country-code=\"OM\" >Oman<\/option><option value=\"Ouganda\" data-country-code=\"UG\" >Ouganda<\/option><option value=\"Ouzb\u00e9kistan\" data-country-code=\"UZ\" >Ouzb\u00e9kistan<\/option><option value=\"Pakistan\" data-country-code=\"PK\" >Pakistan<\/option><option value=\"Palau\" data-country-code=\"PW\" >Palau<\/option><option value=\"Palestine, \u00c9tat de\" data-country-code=\"PS\" >Palestine, \u00c9tat de<\/option><option value=\"Panama\" data-country-code=\"PA\" >Panama<\/option><option value=\"Papouasie-Nouvelle-Guin\u00e9e\" data-country-code=\"PG\" >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value=\"Paraguay\" data-country-code=\"PY\" >Paraguay<\/option><option value=\"Pays-Bas\" data-country-code=\"NL\" >Pays-Bas<\/option><option value=\"Philippines\" data-country-code=\"PH\" >Philippines<\/option><option value=\"Pologne\" data-country-code=\"PL\" >Pologne<\/option><option value=\"Polyn\u00e9sie Fran\u00e7aise\" data-country-code=\"PF\" >Polyn\u00e9sie Fran\u00e7aise<\/option><option value=\"Porto Rico\" data-country-code=\"PR\" >Porto Rico<\/option><option value=\"Portugal\" data-country-code=\"PT\" >Portugal<\/option><option value=\"P\u00e9rou\" data-country-code=\"PE\" >P\u00e9rou<\/option><option value=\"Qatar\" data-country-code=\"QA\" >Qatar<\/option><option value=\"Roumanie\" data-country-code=\"RO\" >Roumanie<\/option><option value=\"Royaume-Uni\" data-country-code=\"GB\" >Royaume-Uni<\/option><option value=\"Russie\" data-country-code=\"RU\" >Russie<\/option><option value=\"Rwanda\" data-country-code=\"RW\" >Rwanda<\/option><option value=\"R\u00e9publique Centrafricaine\" data-country-code=\"CF\" >R\u00e9publique Centrafricaine<\/option><option value=\"R\u00e9publique Dominicaine\" data-country-code=\"DO\" >R\u00e9publique Dominicaine<\/option><option value=\"R\u00e9publique Tch\u00e8que\" data-country-code=\"CZ\" >R\u00e9publique Tch\u00e8que<\/option><option value=\"R\u00e9publique du Salvador\" data-country-code=\"SV\" >R\u00e9publique du Salvador<\/option><option value=\"R\u00e9publique d\u00e9mocratique populaire du Laos\" data-country-code=\"LA\" >R\u00e9publique d\u00e9mocratique populaire du Laos<\/option><option value=\"Sahara occidental\" data-country-code=\"EH\" >Sahara occidental<\/option><option value=\"Saint Pierre et Miquelon\" data-country-code=\"PM\" >Saint Pierre et Miquelon<\/option><option value=\"Saint-Kitts-et-Nevis\" data-country-code=\"KN\" >Saint-Kitts-et-Nevis<\/option><option value=\"Saint-Marin\" data-country-code=\"SM\" >Saint-Marin<\/option><option value=\"Saint-Martin (Royaume des Pays-Bas)\" data-country-code=\"MF\" >Saint-Martin (Royaume des Pays-Bas)<\/option><option value=\"Saint-Vincent-et-les-Grenadines\" data-country-code=\"VC\" >Saint-Vincent-et-les-Grenadines<\/option><option value=\"Sainte Lucie\" data-country-code=\"LC\" >Sainte Lucie<\/option><option value=\"Sainte-H\u00e9l\u00e8ne\" data-country-code=\"SH\" >Sainte-H\u00e9l\u00e8ne<\/option><option value=\"Samoa\" data-country-code=\"WS\" >Samoa<\/option><option value=\"Samoa am\u00e9ricaines\" data-country-code=\"AS\" >Samoa am\u00e9ricaines<\/option><option value=\"Sao Tom\u00e9-et-Principe\" data-country-code=\"ST\" >Sao Tom\u00e9-et-Principe<\/option><option value=\"Serbie\" data-country-code=\"RS\" >Serbie<\/option><option value=\"Seychelles\" data-country-code=\"SC\" >Seychelles<\/option><option value=\"Sierra Leone\" data-country-code=\"SL\" >Sierra Leone<\/option><option value=\"Singapour\" data-country-code=\"SG\" >Singapour<\/option><option value=\"Slovaquie\" data-country-code=\"SK\" >Slovaquie<\/option><option value=\"Slov\u00e9nie\" data-country-code=\"SI\" >Slov\u00e9nie<\/option><option value=\"Somalie\" data-country-code=\"SO\" >Somalie<\/option><option value=\"Soudan\" data-country-code=\"SD\" >Soudan<\/option><option value=\"Soudan, Sud\" data-country-code=\"SS\" >Soudan, Sud<\/option><option value=\"Sri Lanka\" data-country-code=\"LK\" >Sri Lanka<\/option><option value=\"Suisse\" data-country-code=\"CH\" >Suisse<\/option><option value=\"Suriname\" data-country-code=\"SR\" >Suriname<\/option><option value=\"Su\u00e8de\" data-country-code=\"SE\" >Su\u00e8de<\/option><option value=\"Svalbard et Jan Mayen\" data-country-code=\"SJ\" >Svalbard et Jan Mayen<\/option><option value=\"Swaziland\" data-country-code=\"SZ\" >Swaziland<\/option><option value=\"Syrie\" data-country-code=\"SY\" >Syrie<\/option><option value=\"S\u00e9n\u00e9gal\" data-country-code=\"SN\" >S\u00e9n\u00e9gal<\/option><option value=\"Tadjikistan\" data-country-code=\"TJ\" >Tadjikistan<\/option><option value=\"Taiwan, R\u00e9publique de Chine\" data-country-code=\"TW\" >Taiwan, R\u00e9publique de Chine<\/option><option value=\"Tanzanie\" data-country-code=\"TZ\" >Tanzanie<\/option><option value=\"Tchad\" data-country-code=\"TD\" >Tchad<\/option><option value=\"Terres australes et antarctiques fran\u00e7aises\" data-country-code=\"TF\" >Terres australes et antarctiques fran\u00e7aises<\/option><option value=\"Territoire britannique de l\u2019oc\u00e9an Indien\" data-country-code=\"IO\" >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value=\"Tha\u00eflande\" data-country-code=\"TH\" >Tha\u00eflande<\/option><option value=\"Timor-Oriental\" data-country-code=\"TL\" >Timor-Oriental<\/option><option value=\"Togo\" data-country-code=\"TG\" >Togo<\/option><option value=\"Tokelau\" data-country-code=\"TK\" >Tokelau<\/option><option value=\"Tonga\" data-country-code=\"TO\" >Tonga<\/option><option value=\"Trinit\u00e9 et Tobago\" data-country-code=\"TT\" >Trinit\u00e9 et Tobago<\/option><option value=\"Tunisie\" data-country-code=\"TN\" >Tunisie<\/option><option value=\"Turkm\u00e9nistan\" data-country-code=\"TM\" >Turkm\u00e9nistan<\/option><option value=\"Turquie\" data-country-code=\"TR\" >Turquie<\/option><option value=\"Tuvalu\" data-country-code=\"TV\" >Tuvalu<\/option><option value=\"Ukraine\" data-country-code=\"UA\" >Ukraine<\/option><option value=\"Uruguay\" data-country-code=\"UY\" >Uruguay<\/option><option value=\"Vanuatu\" data-country-code=\"VU\" >Vanuatu<\/option><option value=\"Vietnam\" data-country-code=\"VN\" >Vietnam<\/option><option value=\"V\u00e9n\u00e9zu\u00e9la\" data-country-code=\"VE\" >V\u00e9n\u00e9zu\u00e9la<\/option><option value=\"Yemen\" data-country-code=\"YE\" >Yemen<\/option><option value=\"Zambie\" data-country-code=\"ZM\" >Zambie<\/option><option value=\"Zimbabwe\" data-country-code=\"ZW\" >Zimbabwe<\/option><option value=\"\u00c9gypte\" data-country-code=\"EG\" >\u00c9gypte<\/option><option value=\"\u00c9mirats Arabes Unis\" data-country-code=\"AE\" >\u00c9mirats Arabes Unis<\/option><option value=\"\u00c9quateur\" data-country-code=\"EC\" >\u00c9quateur<\/option><option value=\"\u00c9rythr\u00e9e\" data-country-code=\"ER\" >\u00c9rythr\u00e9e<\/option><option value=\"\u00c9tats-Unis d\u2019Am\u00e9rique (USA)\" data-country-code=\"US\" >\u00c9tats-Unis d\u2019Am\u00e9rique (USA)<\/option><option value=\"\u00c9thiopie\" data-country-code=\"ET\" >\u00c9thiopie<\/option><option value=\"\u00cele Bouvet\" data-country-code=\"BV\" >\u00cele Bouvet<\/option><option value=\"\u00cele Christmas\" data-country-code=\"CX\" >\u00cele Christmas<\/option><option value=\"\u00cele Heard et \u00eele Mcdonald\" data-country-code=\"HM\" >\u00cele Heard et \u00eele Mcdonald<\/option><option value=\"\u00cele Johnston\" data-country-code=\"JT\" >\u00cele Johnston<\/option><option value=\"\u00cele Maurice\" data-country-code=\"MU\" >\u00cele Maurice<\/option><option value=\"\u00cele Norfolk\" data-country-code=\"NF\" >\u00cele Norfolk<\/option><option value=\"\u00cele de la R\u00e9union\" data-country-code=\"RE\" >\u00cele de la R\u00e9union<\/option><option value=\"\u00celes Ca\u00efmans\" data-country-code=\"KY\" >\u00celes Ca\u00efmans<\/option><option value=\"\u00celes Cocos\" data-country-code=\"CC\" >\u00celes Cocos<\/option><option value=\"\u00celes Cook\" data-country-code=\"CK\" >\u00celes Cook<\/option><option value=\"\u00celes Falkland\" data-country-code=\"FK\" >\u00celes Falkland<\/option><option value=\"\u00celes F\u00e9ro\u00e9\" data-country-code=\"FO\" >\u00celes F\u00e9ro\u00e9<\/option><option value=\"\u00celes Mariannes du Nord\" data-country-code=\"MP\" >\u00celes Mariannes du Nord<\/option><option value=\"\u00celes Marshall\" data-country-code=\"MH\" >\u00celes Marshall<\/option><option value=\"\u00celes Pitcairn\" data-country-code=\"PN\" >\u00celes Pitcairn<\/option><option value=\"\u00celes Salomon\" data-country-code=\"SB\" >\u00celes Salomon<\/option><option value=\"\u00celes Turques-et-Ca\u00efques\" data-country-code=\"TC\" >\u00celes Turques-et-Ca\u00efques<\/option><option value=\"\u00celes Vierges am\u00e9ricaines\" data-country-code=\"VI\" >\u00celes Vierges am\u00e9ricaines<\/option><option value=\"\u00celes Vierges britanniques\" data-country-code=\"VG\" >\u00celes Vierges britanniques<\/option><option value=\"\u00celes Wallis et Futuna\" data-country-code=\"WF\" >\u00celes Wallis et Futuna<\/option><option value=\"\u00celes mineures \u00e9loign\u00e9es des \u00c9tats-Unis\" data-country-code=\"UM\" >\u00celes mineures \u00e9loign\u00e9es des \u00c9tats-Unis<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"captcha-1\" class=\"forminator-field-captcha  forminator-col-6 \"><div class=\"forminator-captcha-left forminator-g-recaptcha recaptcha-invisible\" data-theme=\"light\" data-badge=\"bottomright\" data-sitekey=\"6Lf2UkApAAAAAG7Kj_tF8X3y7nW5fPOjscOjbQyV\" data-size=\"invisible\"><\/div> <\/div><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_6a0bf6fd4ff42\" id=\"forminator-field-date-1-picker_6a0bf6fd4ff42-label\" class=\"forminator-label\">Date de naissance <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"j\/m\/A\" id=\"forminator-field-date-1-picker_6a0bf6fd4ff42\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" aria-describedby=\"forminator-field-date-1-picker_6a0bf6fd4ff42-description\" \/><\/div><span id=\"forminator-field-date-1-picker_6a0bf6fd4ff42-description\" class=\"forminator-description\">Date de naissance de votre enfant<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6a0bf6fd4ff42\" id=\"forminator-field-textarea-2_6a0bf6fd4ff42-label\" class=\"forminator-label\">Remarque \u00e9ventuelle<\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_6a0bf6fd4ff42\" class=\"forminator-textarea\" rows=\"6\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Envoyer le message<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"acf60650f9\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/123\" \/><input type=\"hidden\" name=\"form_id\" value=\"1600\"><input type=\"hidden\" name=\"page_id\" value=\"123\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/www.couraubois.be\/index.php\/stage\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Stage juillet<\/h2>\n\n\n<p><div class=\"forminator-ui forminator-custom-form forminator-custom-form-1606 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-1606\" data-uid=\"6a0bf6fd55ac0\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-1606\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-1606 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"1606\"\n\t\t\t\t data-color-option=\"default\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6a0bf6fd55ac0\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a0bf6fd55ac0\" id=\"forminator-field-name-1_6a0bf6fd55ac0-label\" class=\"forminator-label\">Nom de l&#039;enfant<\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"Par exemple\u00a0: Jacques Martin\" id=\"forminator-field-name-1_6a0bf6fd55ac0\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a0bf6fd55ac0\" id=\"forminator-field-email-1_6a0bf6fd55ac0-label\" class=\"forminator-label\">Adresse de messagerie <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"Par exemple\u00a0: jacques@martin.com\" id=\"forminator-field-email-1_6a0bf6fd55ac0\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6a0bf6fd55ac0\" id=\"forminator-field-phone-1_6a0bf6fd55ac0-label\" class=\"forminator-label\">T\u00e9l\u00e9phone <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"Par exemple\u00a0: +1 02 03 05 06\" id=\"forminator-field-phone-1_6a0bf6fd55ac0\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-6a0bf6fd55ac0-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-6a0bf6fd55ac0-label\" class=\"forminator-label\">Semaine de stage<\/span><label id=\"forminator-field-checkbox-1-1-6a0bf6fd55ac0-label\" for=\"forminator-field-checkbox-1-1-6a0bf6fd55ac0\" class=\"forminator-checkbox\" title=\"lundi 06 juillet au vendredi 10 juillet\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"lundi 06 juillet au vendredi 10 juillet\" id=\"forminator-field-checkbox-1-1-6a0bf6fd55ac0\" aria-labelledby=\"forminator-field-checkbox-1-1-6a0bf6fd55ac0-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">lundi 06 juillet au vendredi 10 juillet<\/span><\/label><label id=\"forminator-field-checkbox-1-2-6a0bf6fd55ac0-label\" for=\"forminator-field-checkbox-1-2-6a0bf6fd55ac0\" class=\"forminator-checkbox\" title=\"lundi 13 juillet au vendredi 17 juillet\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"lundi 13 juillet au vendredi 17 juillet\" id=\"forminator-field-checkbox-1-2-6a0bf6fd55ac0\" aria-labelledby=\"forminator-field-checkbox-1-2-6a0bf6fd55ac0-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">lundi 13 juillet au vendredi 17 juillet<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1606__field--select-2_6a0bf6fd55ac0\" id=\"forminator-form-1606__field--select-2_6a0bf6fd55ac0-label\" class=\"forminator-label\">Repas chaud<\/label><select  id=\"forminator-form-1606__field--select-2_6a0bf6fd55ac0\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-2\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1606__field--select-2_6a0bf6fd55ac0-label\"><option value=\"one\"  data-calculation=\"0\">OUI<\/option><option value=\"two\"  data-calculation=\"0\">NON<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6a0bf6fd55ac0\" id=\"forminator-field-textarea-1_6a0bf6fd55ac0-label\" class=\"forminator-label\">Allergie<\/label><textarea name=\"textarea-1\" placeholder=\"merci d&#039;indiquer si votre enfant \u00e0 une allergie alimentaire.\" id=\"forminator-field-textarea-1_6a0bf6fd55ac0\" class=\"forminator-textarea\" rows=\"6\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1606__field--select-1_6a0bf6fd55ac0\" id=\"forminator-form-1606__field--select-1_6a0bf6fd55ac0-label\" class=\"forminator-label\">Assurance<\/label><select  id=\"forminator-form-1606__field--select-1_6a0bf6fd55ac0\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-1\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1606__field--select-1_6a0bf6fd55ac0-label\" aria-describedby=\"forminator-form-1606__field--select-1_6a0bf6fd55ac0-description\"><option value=\"one\"  data-calculation=\"0\">OUI<\/option><option value=\"two\"  data-calculation=\"0\">NON<\/option><\/select><span id=\"forminator-form-1606__field--select-1_6a0bf6fd55ac0-description\" class=\"forminator-description\">votre enfant poss\u00e8de une assurance \u00e9questre a l&rsquo;ann\u00e9e<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-field-address forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-street_address_6a0bf6fd55ac0\" id=\"forminator-field-address-1-street_address_6a0bf6fd55ac0-label\" class=\"forminator-label\">Rue <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"Par exemple\u00a0: 10 grande rue\" id=\"forminator-field-address-1-street_address_6a0bf6fd55ac0\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-line1\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-1-city\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-city_6a0bf6fd55ac0\" id=\"forminator-field-address-1-city_6a0bf6fd55ac0-label\" class=\"forminator-label\">Ville<\/label><input type=\"text\" name=\"address-1-city\" placeholder=\"Par exemple\u00a0: Paris\" id=\"forminator-field-address-1-city_6a0bf6fd55ac0\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" autocomplete=\"address-level2\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"address-1-zip\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-zip_6a0bf6fd55ac0\" id=\"forminator-field-address-1-zip_6a0bf6fd55ac0-label\" class=\"forminator-label\">Code postal<\/label><input type=\"text\" name=\"address-1-zip\" placeholder=\"Par exemple\u00a0: 2000\" id=\"forminator-field-address-1-zip_6a0bf6fd55ac0\" class=\"forminator-input\" autocomplete=\"postal-code\" value=\"\" \/><\/div><\/div><div id=\"address-1-country\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-1606__field--address-1-country_6a0bf6fd55ac0\" id=\"forminator-field-1606__field--address-1-country_6a0bf6fd55ac0-label\" class=\"forminator-label\">Pays<\/label><select name=\"address-1-country\" id=\"forminator-field-1606__field--address-1-country_6a0bf6fd55ac0\" class=\"forminator-select2\" data-search=\"true\" data-placeholder=\"S\u00e9lectionner un pays\" autocomplete=\"country-name country\" data-default-value=\"Belgique\"><option value=\"\" data-country-code=\"\" selected=\"selected\"><\/option><option value=\"Afghanistan\" data-country-code=\"AF\" >Afghanistan<\/option><option value=\"Afrique du Sud\" data-country-code=\"ZA\" >Afrique du Sud<\/option><option value=\"Albanie\" data-country-code=\"AL\" >Albanie<\/option><option value=\"Alg\u00e9rie\" data-country-code=\"DZ\" >Alg\u00e9rie<\/option><option value=\"Allemagne\" data-country-code=\"DE\" >Allemagne<\/option><option value=\"Andorre\" data-country-code=\"AD\" >Andorre<\/option><option value=\"Angola\" data-country-code=\"AO\" >Angola<\/option><option value=\"Anguilla\" data-country-code=\"AI\" >Anguilla<\/option><option value=\"Antarctique\" data-country-code=\"AQ\" >Antarctique<\/option><option value=\"Antigua-et-Barbuda\" data-country-code=\"AG\" >Antigua-et-Barbuda<\/option><option value=\"Antilles N\u00e9erlandaises\" data-country-code=\"AN\" >Antilles N\u00e9erlandaises<\/option><option value=\"Apatrides\" data-country-code=\"XX\" >Apatrides<\/option><option value=\"Arabie Saoudite\" data-country-code=\"SA\" >Arabie Saoudite<\/option><option value=\"Argentine\" data-country-code=\"AR\" >Argentine<\/option><option value=\"Arm\u00e9nie\" data-country-code=\"AM\" >Arm\u00e9nie<\/option><option value=\"Aruba\" data-country-code=\"AW\" >Aruba<\/option><option value=\"Australie\" data-country-code=\"AU\" >Australie<\/option><option value=\"Autriche\" data-country-code=\"AT\" >Autriche<\/option><option value=\"Azerba\u00efdjan\" data-country-code=\"AZ\" >Azerba\u00efdjan<\/option><option value=\"Bahamas\" data-country-code=\"BS\" >Bahamas<\/option><option value=\"Bahre\u00efn\" data-country-code=\"BH\" >Bahre\u00efn<\/option><option value=\"Bangladesh\" data-country-code=\"BD\" >Bangladesh<\/option><option value=\"Belgique\" data-country-code=\"BE\" selected=\"selected\">Belgique<\/option><option value=\"Bermudes\" data-country-code=\"BM\" >Bermudes<\/option><option value=\"Bhoutan\" data-country-code=\"BT\" >Bhoutan<\/option><option value=\"Bi\u00e9lorussie\" data-country-code=\"BY\" >Bi\u00e9lorussie<\/option><option value=\"Bolivie\" data-country-code=\"BO\" >Bolivie<\/option><option value=\"Bosnie-Herz\u00e9govine\" data-country-code=\"BA\" >Bosnie-Herz\u00e9govine<\/option><option value=\"Botswana\" data-country-code=\"BW\" >Botswana<\/option><option value=\"Brunei\" data-country-code=\"BN\" >Brunei<\/option><option value=\"Br\u00e9sil\" data-country-code=\"BR\" >Br\u00e9sil<\/option><option value=\"Bulgarie\" data-country-code=\"BG\" >Bulgarie<\/option><option value=\"Burkina Faso\" data-country-code=\"BF\" >Burkina Faso<\/option><option value=\"Burundi\" data-country-code=\"BI\" >Burundi<\/option><option value=\"B\u00e9lize\" data-country-code=\"BZ\" >B\u00e9lize<\/option><option value=\"B\u00e9nin\" data-country-code=\"BJ\" >B\u00e9nin<\/option><option value=\"Cambodge\" data-country-code=\"KH\" >Cambodge<\/option><option value=\"Cameroun\" data-country-code=\"CM\" >Cameroun<\/option><option value=\"Canada\" data-country-code=\"CA\" >Canada<\/option><option value=\"Cap Vert\" data-country-code=\"CV\" >Cap Vert<\/option><option value=\"Chili\" data-country-code=\"CL\" >Chili<\/option><option value=\"Chine, R\u00e9publique populaire de\" data-country-code=\"CN\" >Chine, R\u00e9publique populaire de<\/option><option value=\"Chypre\" data-country-code=\"CY\" >Chypre<\/option><option value=\"Cit\u00e9 du Vatican\" data-country-code=\"VA\" >Cit\u00e9 du Vatican<\/option><option value=\"Colombie\" data-country-code=\"CO\" >Colombie<\/option><option value=\"Comores\" data-country-code=\"KM\" >Comores<\/option><option value=\"Congo, R\u00e9publique du\" data-country-code=\"CG\" >Congo, R\u00e9publique du<\/option><option value=\"Congo, R\u00e9publique d\u00e9mocratique du\" data-country-code=\"CD\" >Congo, R\u00e9publique d\u00e9mocratique du<\/option><option value=\"Cor\u00e9e, R\u00e9publique de\" data-country-code=\"KR\" >Cor\u00e9e, R\u00e9publique de<\/option><option value=\"Cor\u00e9e, R\u00e9publique d\u00e9mocratique populaire de\" data-country-code=\"KP\" >Cor\u00e9e, R\u00e9publique d\u00e9mocratique populaire de<\/option><option value=\"Costa Rica\" data-country-code=\"CR\" >Costa Rica<\/option><option value=\"Croatie\" data-country-code=\"HR\" >Croatie<\/option><option value=\"Cuba\" data-country-code=\"CU\" >Cuba<\/option><option value=\"Cura\u00e7ao\" data-country-code=\"CW\" >Cura\u00e7ao<\/option><option value=\"C\u00f4te d\u2019Ivoire\" data-country-code=\"CI\" >C\u00f4te d\u2019Ivoire<\/option><option value=\"Danemark\" data-country-code=\"DK\" >Danemark<\/option><option value=\"Djibouti\" data-country-code=\"DJ\" >Djibouti<\/option><option value=\"Dominique\" data-country-code=\"DM\" >Dominique<\/option><option value=\"Espagne\" data-country-code=\"ES\" >Espagne<\/option><option value=\"Estonie\" data-country-code=\"EE\" >Estonie<\/option><option value=\"Fidji\" data-country-code=\"FJ\" >Fidji<\/option><option value=\"Finlande\" data-country-code=\"FI\" >Finlande<\/option><option value=\"France\" data-country-code=\"FR\" >France<\/option><option value=\"France, M\u00e9tropolitaine\" data-country-code=\"FX\" >France, M\u00e9tropolitaine<\/option><option value=\"Gabon\" data-country-code=\"GA\" >Gabon<\/option><option value=\"Gambie\" data-country-code=\"GM\" >Gambie<\/option><option value=\"Ghana\" data-country-code=\"GH\" >Ghana<\/option><option value=\"Gibraltar\" data-country-code=\"GI\" >Gibraltar<\/option><option value=\"Grenade\" data-country-code=\"GD\" >Grenade<\/option><option value=\"Groenland\" data-country-code=\"GL\" >Groenland<\/option><option value=\"Gr\u00e8ce\" data-country-code=\"GR\" >Gr\u00e8ce<\/option><option value=\"Guadeloupe\" data-country-code=\"GP\" >Guadeloupe<\/option><option value=\"Guam\" data-country-code=\"GU\" >Guam<\/option><option value=\"Guat\u00e9mala\" data-country-code=\"GT\" >Guat\u00e9mala<\/option><option value=\"Guernesey\" data-country-code=\"GG\" >Guernesey<\/option><option value=\"Guin\u00e9e\" data-country-code=\"GN\" >Guin\u00e9e<\/option><option value=\"Guin\u00e9e \u00c9quatoriale\" data-country-code=\"GQ\" >Guin\u00e9e \u00c9quatoriale<\/option><option value=\"Guin\u00e9e-Bissau\" data-country-code=\"GW\" >Guin\u00e9e-Bissau<\/option><option value=\"Guyane\" data-country-code=\"GY\" >Guyane<\/option><option value=\"Guyane fran\u00e7aise\" data-country-code=\"GF\" >Guyane fran\u00e7aise<\/option><option value=\"G\u00e9orgie\" data-country-code=\"GE\" >G\u00e9orgie<\/option><option value=\"G\u00e9orgie du Sud et Sandwich du Sud\" data-country-code=\"GS\" >G\u00e9orgie du Sud et Sandwich du Sud<\/option><option value=\"Ha\u00efti\" data-country-code=\"HT\" >Ha\u00efti<\/option><option value=\"Honduras\" data-country-code=\"HN\" >Honduras<\/option><option value=\"Hong Kong\" data-country-code=\"HK\" >Hong Kong<\/option><option value=\"Hongrie\" data-country-code=\"HU\" >Hongrie<\/option><option value=\"Inde\" data-country-code=\"IN\" >Inde<\/option><option value=\"Indon\u00e9sie\" data-country-code=\"ID\" >Indon\u00e9sie<\/option><option value=\"Iran\" data-country-code=\"IR\" >Iran<\/option><option value=\"Iraq\" data-country-code=\"IQ\" >Iraq<\/option><option value=\"Irlande\" data-country-code=\"IE\" >Irlande<\/option><option value=\"Islande\" data-country-code=\"IS\" >Islande<\/option><option value=\"Israel\" data-country-code=\"IL\" >Israel<\/option><option value=\"Italie\" data-country-code=\"IT\" >Italie<\/option><option value=\"Jama\u00efque\" data-country-code=\"JM\" >Jama\u00efque<\/option><option value=\"Japon\" data-country-code=\"JP\" >Japon<\/option><option value=\"Jersey\" data-country-code=\"JE\" >Jersey<\/option><option value=\"Jordanie\" data-country-code=\"JO\" >Jordanie<\/option><option value=\"Kazakhstan\" data-country-code=\"KZ\" >Kazakhstan<\/option><option value=\"Kenya\" data-country-code=\"KE\" >Kenya<\/option><option value=\"Kirghizistan\" data-country-code=\"KG\" >Kirghizistan<\/option><option value=\"Kiribati\" data-country-code=\"KI\" >Kiribati<\/option><option value=\"Kosovo\" data-country-code=\"XK\" >Kosovo<\/option><option value=\"Kowe\u00eft\" data-country-code=\"KW\" >Kowe\u00eft<\/option><option value=\"La Barbade\" data-country-code=\"BB\" >La Barbade<\/option><option value=\"Lesotho\" data-country-code=\"LS\" >Lesotho<\/option><option value=\"Lettonie\" data-country-code=\"LV\" >Lettonie<\/option><option value=\"Liban\" data-country-code=\"LB\" >Liban<\/option><option value=\"Libye\" data-country-code=\"LY\" >Libye<\/option><option value=\"Lib\u00e9ria\" data-country-code=\"LR\" >Lib\u00e9ria<\/option><option value=\"Liechtenstein\" data-country-code=\"LI\" >Liechtenstein<\/option><option value=\"Lithuanie\" data-country-code=\"LT\" >Lithuanie<\/option><option value=\"Luxembourg\" data-country-code=\"LU\" >Luxembourg<\/option><option value=\"Macao\" data-country-code=\"MO\" >Macao<\/option><option value=\"Mac\u00e9doine du Nord\" data-country-code=\"MK\" >Mac\u00e9doine du Nord<\/option><option value=\"Madagascar\" data-country-code=\"MG\" >Madagascar<\/option><option value=\"Malaisie\" data-country-code=\"MY\" >Malaisie<\/option><option value=\"Malawi\" data-country-code=\"MW\" >Malawi<\/option><option value=\"Maldives\" data-country-code=\"MV\" >Maldives<\/option><option value=\"Mali\" data-country-code=\"ML\" >Mali<\/option><option value=\"Malte\" data-country-code=\"MT\" >Malte<\/option><option value=\"Maroc\" data-country-code=\"MA\" >Maroc<\/option><option value=\"Martinique\" data-country-code=\"MQ\" >Martinique<\/option><option value=\"Mauritanie\" data-country-code=\"MR\" >Mauritanie<\/option><option value=\"Mayotte\" data-country-code=\"YT\" >Mayotte<\/option><option value=\"Mexique\" data-country-code=\"MX\" >Mexique<\/option><option value=\"Micron\u00e9sie\" data-country-code=\"FM\" >Micron\u00e9sie<\/option><option value=\"Moldavie\" data-country-code=\"MD\" >Moldavie<\/option><option value=\"Monaco\" data-country-code=\"MC\" >Monaco<\/option><option value=\"Mongolie\" data-country-code=\"MN\" >Mongolie<\/option><option value=\"Montserrat\" data-country-code=\"MS\" >Montserrat<\/option><option value=\"Mont\u00e9n\u00e9gro\" data-country-code=\"ME\" >Mont\u00e9n\u00e9gro<\/option><option value=\"Mozambique\" data-country-code=\"MZ\" >Mozambique<\/option><option value=\"Myanmar\" data-country-code=\"MM\" >Myanmar<\/option><option value=\"Namibie\" data-country-code=\"NA\" >Namibie<\/option><option value=\"Nauru\" data-country-code=\"NR\" >Nauru<\/option><option value=\"Nicaragua\" data-country-code=\"NI\" >Nicaragua<\/option><option value=\"Niger\" data-country-code=\"NE\" >Niger<\/option><option value=\"Nigeria\" data-country-code=\"NG\" >Nigeria<\/option><option value=\"Niu\u00e9\" data-country-code=\"NU\" >Niu\u00e9<\/option><option value=\"Norv\u00e8ge\" data-country-code=\"NO\" >Norv\u00e8ge<\/option><option value=\"Nouvelle Zelande\" data-country-code=\"NZ\" >Nouvelle Zelande<\/option><option value=\"Nouvelle-Cal\u00e9donie\" data-country-code=\"NC\" >Nouvelle-Cal\u00e9donie<\/option><option value=\"N\u00e9pal\" data-country-code=\"NP\" >N\u00e9pal<\/option><option value=\"Oman\" data-country-code=\"OM\" >Oman<\/option><option value=\"Ouganda\" data-country-code=\"UG\" >Ouganda<\/option><option value=\"Ouzb\u00e9kistan\" data-country-code=\"UZ\" >Ouzb\u00e9kistan<\/option><option value=\"Pakistan\" data-country-code=\"PK\" >Pakistan<\/option><option value=\"Palau\" data-country-code=\"PW\" >Palau<\/option><option value=\"Palestine, \u00c9tat de\" data-country-code=\"PS\" >Palestine, \u00c9tat de<\/option><option value=\"Panama\" data-country-code=\"PA\" >Panama<\/option><option value=\"Papouasie-Nouvelle-Guin\u00e9e\" data-country-code=\"PG\" >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value=\"Paraguay\" data-country-code=\"PY\" >Paraguay<\/option><option value=\"Pays-Bas\" data-country-code=\"NL\" >Pays-Bas<\/option><option value=\"Philippines\" data-country-code=\"PH\" >Philippines<\/option><option value=\"Pologne\" data-country-code=\"PL\" >Pologne<\/option><option value=\"Polyn\u00e9sie Fran\u00e7aise\" data-country-code=\"PF\" >Polyn\u00e9sie Fran\u00e7aise<\/option><option value=\"Porto Rico\" data-country-code=\"PR\" >Porto Rico<\/option><option value=\"Portugal\" data-country-code=\"PT\" >Portugal<\/option><option value=\"P\u00e9rou\" data-country-code=\"PE\" >P\u00e9rou<\/option><option value=\"Qatar\" data-country-code=\"QA\" >Qatar<\/option><option value=\"Roumanie\" data-country-code=\"RO\" >Roumanie<\/option><option value=\"Royaume-Uni\" data-country-code=\"GB\" >Royaume-Uni<\/option><option value=\"Russie\" data-country-code=\"RU\" >Russie<\/option><option value=\"Rwanda\" data-country-code=\"RW\" >Rwanda<\/option><option value=\"R\u00e9publique Centrafricaine\" data-country-code=\"CF\" >R\u00e9publique Centrafricaine<\/option><option value=\"R\u00e9publique Dominicaine\" data-country-code=\"DO\" >R\u00e9publique Dominicaine<\/option><option value=\"R\u00e9publique Tch\u00e8que\" data-country-code=\"CZ\" >R\u00e9publique Tch\u00e8que<\/option><option value=\"R\u00e9publique du Salvador\" data-country-code=\"SV\" >R\u00e9publique du Salvador<\/option><option value=\"R\u00e9publique d\u00e9mocratique populaire du Laos\" data-country-code=\"LA\" >R\u00e9publique d\u00e9mocratique populaire du Laos<\/option><option value=\"Sahara occidental\" data-country-code=\"EH\" >Sahara occidental<\/option><option value=\"Saint Pierre et Miquelon\" data-country-code=\"PM\" >Saint Pierre et Miquelon<\/option><option value=\"Saint-Kitts-et-Nevis\" data-country-code=\"KN\" >Saint-Kitts-et-Nevis<\/option><option value=\"Saint-Marin\" data-country-code=\"SM\" >Saint-Marin<\/option><option value=\"Saint-Martin (Royaume des Pays-Bas)\" data-country-code=\"MF\" >Saint-Martin (Royaume des Pays-Bas)<\/option><option value=\"Saint-Vincent-et-les-Grenadines\" data-country-code=\"VC\" >Saint-Vincent-et-les-Grenadines<\/option><option value=\"Sainte Lucie\" data-country-code=\"LC\" >Sainte Lucie<\/option><option value=\"Sainte-H\u00e9l\u00e8ne\" data-country-code=\"SH\" >Sainte-H\u00e9l\u00e8ne<\/option><option value=\"Samoa\" data-country-code=\"WS\" >Samoa<\/option><option value=\"Samoa am\u00e9ricaines\" data-country-code=\"AS\" >Samoa am\u00e9ricaines<\/option><option value=\"Sao Tom\u00e9-et-Principe\" data-country-code=\"ST\" >Sao Tom\u00e9-et-Principe<\/option><option value=\"Serbie\" data-country-code=\"RS\" >Serbie<\/option><option value=\"Seychelles\" data-country-code=\"SC\" >Seychelles<\/option><option value=\"Sierra Leone\" data-country-code=\"SL\" >Sierra Leone<\/option><option value=\"Singapour\" data-country-code=\"SG\" >Singapour<\/option><option value=\"Slovaquie\" data-country-code=\"SK\" >Slovaquie<\/option><option value=\"Slov\u00e9nie\" data-country-code=\"SI\" >Slov\u00e9nie<\/option><option value=\"Somalie\" data-country-code=\"SO\" >Somalie<\/option><option value=\"Soudan\" data-country-code=\"SD\" >Soudan<\/option><option value=\"Soudan, Sud\" data-country-code=\"SS\" >Soudan, Sud<\/option><option value=\"Sri Lanka\" data-country-code=\"LK\" >Sri Lanka<\/option><option value=\"Suisse\" data-country-code=\"CH\" >Suisse<\/option><option value=\"Suriname\" data-country-code=\"SR\" >Suriname<\/option><option value=\"Su\u00e8de\" data-country-code=\"SE\" >Su\u00e8de<\/option><option value=\"Svalbard et Jan Mayen\" data-country-code=\"SJ\" >Svalbard et Jan Mayen<\/option><option value=\"Swaziland\" data-country-code=\"SZ\" >Swaziland<\/option><option value=\"Syrie\" data-country-code=\"SY\" >Syrie<\/option><option value=\"S\u00e9n\u00e9gal\" data-country-code=\"SN\" >S\u00e9n\u00e9gal<\/option><option value=\"Tadjikistan\" data-country-code=\"TJ\" >Tadjikistan<\/option><option value=\"Taiwan, R\u00e9publique de Chine\" data-country-code=\"TW\" >Taiwan, R\u00e9publique de Chine<\/option><option value=\"Tanzanie\" data-country-code=\"TZ\" >Tanzanie<\/option><option value=\"Tchad\" data-country-code=\"TD\" >Tchad<\/option><option value=\"Terres australes et antarctiques fran\u00e7aises\" data-country-code=\"TF\" >Terres australes et antarctiques fran\u00e7aises<\/option><option value=\"Territoire britannique de l\u2019oc\u00e9an Indien\" data-country-code=\"IO\" >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value=\"Tha\u00eflande\" data-country-code=\"TH\" >Tha\u00eflande<\/option><option value=\"Timor-Oriental\" data-country-code=\"TL\" >Timor-Oriental<\/option><option value=\"Togo\" data-country-code=\"TG\" >Togo<\/option><option value=\"Tokelau\" data-country-code=\"TK\" >Tokelau<\/option><option value=\"Tonga\" data-country-code=\"TO\" >Tonga<\/option><option value=\"Trinit\u00e9 et Tobago\" data-country-code=\"TT\" >Trinit\u00e9 et Tobago<\/option><option value=\"Tunisie\" data-country-code=\"TN\" >Tunisie<\/option><option value=\"Turkm\u00e9nistan\" data-country-code=\"TM\" >Turkm\u00e9nistan<\/option><option value=\"Turquie\" data-country-code=\"TR\" >Turquie<\/option><option value=\"Tuvalu\" data-country-code=\"TV\" >Tuvalu<\/option><option value=\"Ukraine\" data-country-code=\"UA\" >Ukraine<\/option><option value=\"Uruguay\" data-country-code=\"UY\" >Uruguay<\/option><option value=\"Vanuatu\" data-country-code=\"VU\" >Vanuatu<\/option><option value=\"Vietnam\" data-country-code=\"VN\" >Vietnam<\/option><option value=\"V\u00e9n\u00e9zu\u00e9la\" data-country-code=\"VE\" >V\u00e9n\u00e9zu\u00e9la<\/option><option value=\"Yemen\" data-country-code=\"YE\" >Yemen<\/option><option value=\"Zambie\" data-country-code=\"ZM\" >Zambie<\/option><option value=\"Zimbabwe\" data-country-code=\"ZW\" >Zimbabwe<\/option><option value=\"\u00c9gypte\" data-country-code=\"EG\" >\u00c9gypte<\/option><option value=\"\u00c9mirats Arabes Unis\" data-country-code=\"AE\" >\u00c9mirats Arabes Unis<\/option><option value=\"\u00c9quateur\" data-country-code=\"EC\" >\u00c9quateur<\/option><option value=\"\u00c9rythr\u00e9e\" data-country-code=\"ER\" >\u00c9rythr\u00e9e<\/option><option value=\"\u00c9tats-Unis d\u2019Am\u00e9rique (USA)\" data-country-code=\"US\" >\u00c9tats-Unis d\u2019Am\u00e9rique (USA)<\/option><option value=\"\u00c9thiopie\" data-country-code=\"ET\" >\u00c9thiopie<\/option><option value=\"\u00cele Bouvet\" data-country-code=\"BV\" >\u00cele Bouvet<\/option><option value=\"\u00cele Christmas\" data-country-code=\"CX\" >\u00cele Christmas<\/option><option value=\"\u00cele Heard et \u00eele Mcdonald\" data-country-code=\"HM\" >\u00cele Heard et \u00eele Mcdonald<\/option><option value=\"\u00cele Johnston\" data-country-code=\"JT\" >\u00cele Johnston<\/option><option value=\"\u00cele Maurice\" data-country-code=\"MU\" >\u00cele Maurice<\/option><option value=\"\u00cele Norfolk\" data-country-code=\"NF\" >\u00cele Norfolk<\/option><option value=\"\u00cele de la R\u00e9union\" data-country-code=\"RE\" >\u00cele de la R\u00e9union<\/option><option value=\"\u00celes Ca\u00efmans\" data-country-code=\"KY\" >\u00celes Ca\u00efmans<\/option><option value=\"\u00celes Cocos\" data-country-code=\"CC\" >\u00celes Cocos<\/option><option value=\"\u00celes Cook\" data-country-code=\"CK\" >\u00celes Cook<\/option><option value=\"\u00celes Falkland\" data-country-code=\"FK\" >\u00celes Falkland<\/option><option value=\"\u00celes F\u00e9ro\u00e9\" data-country-code=\"FO\" >\u00celes F\u00e9ro\u00e9<\/option><option value=\"\u00celes Mariannes du Nord\" data-country-code=\"MP\" >\u00celes Mariannes du Nord<\/option><option value=\"\u00celes Marshall\" data-country-code=\"MH\" >\u00celes Marshall<\/option><option value=\"\u00celes Pitcairn\" data-country-code=\"PN\" >\u00celes Pitcairn<\/option><option value=\"\u00celes Salomon\" data-country-code=\"SB\" >\u00celes Salomon<\/option><option value=\"\u00celes Turques-et-Ca\u00efques\" data-country-code=\"TC\" >\u00celes Turques-et-Ca\u00efques<\/option><option value=\"\u00celes Vierges am\u00e9ricaines\" data-country-code=\"VI\" >\u00celes Vierges am\u00e9ricaines<\/option><option value=\"\u00celes Vierges britanniques\" data-country-code=\"VG\" >\u00celes Vierges britanniques<\/option><option value=\"\u00celes Wallis et Futuna\" data-country-code=\"WF\" >\u00celes Wallis et Futuna<\/option><option value=\"\u00celes mineures \u00e9loign\u00e9es des \u00c9tats-Unis\" data-country-code=\"UM\" >\u00celes mineures \u00e9loign\u00e9es des \u00c9tats-Unis<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"captcha-1\" class=\"forminator-field-captcha  forminator-col-6 \"><div class=\"forminator-captcha-left forminator-g-recaptcha recaptcha-invisible\" data-theme=\"light\" data-badge=\"bottomright\" data-sitekey=\"6Lf2UkApAAAAAG7Kj_tF8X3y7nW5fPOjscOjbQyV\" data-size=\"invisible\"><\/div> <\/div><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_6a0bf6fd55ac0\" id=\"forminator-field-date-1-picker_6a0bf6fd55ac0-label\" class=\"forminator-label\">Date de naissance <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"j\/m\/A\" id=\"forminator-field-date-1-picker_6a0bf6fd55ac0\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" aria-describedby=\"forminator-field-date-1-picker_6a0bf6fd55ac0-description\" \/><\/div><span id=\"forminator-field-date-1-picker_6a0bf6fd55ac0-description\" class=\"forminator-description\">Date de naissance de votre enfant<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6a0bf6fd55ac0\" id=\"forminator-field-textarea-2_6a0bf6fd55ac0-label\" class=\"forminator-label\">Remarque \u00e9ventuelle<\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_6a0bf6fd55ac0\" class=\"forminator-textarea\" rows=\"6\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Envoyer le message<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"0c51d06a08\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/123\" \/><input type=\"hidden\" name=\"form_id\" value=\"1606\"><input type=\"hidden\" name=\"page_id\" value=\"123\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/www.couraubois.be\/index.php\/stage\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Stage ao\u00fbt<\/h2>\n\n\n<p><div class=\"forminator-ui forminator-custom-form forminator-custom-form-1612 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-1612\" data-uid=\"6a0bf6fd5d50d\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-1612\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-1612 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"1612\"\n\t\t\t\t data-color-option=\"default\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6a0bf6fd5d50d\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a0bf6fd5d50d\" id=\"forminator-field-name-1_6a0bf6fd5d50d-label\" class=\"forminator-label\">Nom de l&#039;enfant<\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"Par exemple\u00a0: Jacques Martin\" id=\"forminator-field-name-1_6a0bf6fd5d50d\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a0bf6fd5d50d\" id=\"forminator-field-email-1_6a0bf6fd5d50d-label\" class=\"forminator-label\">Adresse de messagerie <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"Par exemple\u00a0: jacques@martin.com\" id=\"forminator-field-email-1_6a0bf6fd5d50d\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6a0bf6fd5d50d\" id=\"forminator-field-phone-1_6a0bf6fd5d50d-label\" class=\"forminator-label\">T\u00e9l\u00e9phone <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"Par exemple\u00a0: +1 02 03 05 06\" id=\"forminator-field-phone-1_6a0bf6fd5d50d\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-6a0bf6fd5d50d-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-6a0bf6fd5d50d-label\" class=\"forminator-label\">Semaine de stage<\/span><label id=\"forminator-field-checkbox-1-1-6a0bf6fd5d50d-label\" for=\"forminator-field-checkbox-1-1-6a0bf6fd5d50d\" class=\"forminator-checkbox\" title=\"lundi 10 ao\u00fbt au vendredi 14 ao\u00fbt\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"lundi 10 ao\u00fbt au vendredi 14 ao\u00fbt\" id=\"forminator-field-checkbox-1-1-6a0bf6fd5d50d\" aria-labelledby=\"forminator-field-checkbox-1-1-6a0bf6fd5d50d-label\" data-calculation=\"0\" checked=\"checked\"  data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">lundi 10 ao\u00fbt au vendredi 14 ao\u00fbt<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1612__field--select-2_6a0bf6fd5d50d\" id=\"forminator-form-1612__field--select-2_6a0bf6fd5d50d-label\" class=\"forminator-label\">Repas chaud<\/label><select  id=\"forminator-form-1612__field--select-2_6a0bf6fd5d50d\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-2\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1612__field--select-2_6a0bf6fd5d50d-label\"><option value=\"one\"  data-calculation=\"0\">OUI<\/option><option value=\"two\"  data-calculation=\"0\">NON<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6a0bf6fd5d50d\" id=\"forminator-field-textarea-1_6a0bf6fd5d50d-label\" class=\"forminator-label\">Allergie<\/label><textarea name=\"textarea-1\" placeholder=\"merci d&#039;indiquer si votre enfant \u00e0 une allergie alimentaire.\" id=\"forminator-field-textarea-1_6a0bf6fd5d50d\" class=\"forminator-textarea\" rows=\"6\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1612__field--select-1_6a0bf6fd5d50d\" id=\"forminator-form-1612__field--select-1_6a0bf6fd5d50d-label\" class=\"forminator-label\">Assurance<\/label><select  id=\"forminator-form-1612__field--select-1_6a0bf6fd5d50d\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-1\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1612__field--select-1_6a0bf6fd5d50d-label\" aria-describedby=\"forminator-form-1612__field--select-1_6a0bf6fd5d50d-description\"><option value=\"one\"  data-calculation=\"0\">OUI<\/option><option value=\"two\"  data-calculation=\"0\">NON<\/option><\/select><span id=\"forminator-form-1612__field--select-1_6a0bf6fd5d50d-description\" class=\"forminator-description\">votre enfant poss\u00e8de une assurance \u00e9questre a l&rsquo;ann\u00e9e<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-field-address forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-street_address_6a0bf6fd5d50d\" id=\"forminator-field-address-1-street_address_6a0bf6fd5d50d-label\" class=\"forminator-label\">Rue <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"Par exemple\u00a0: 10 grande rue\" id=\"forminator-field-address-1-street_address_6a0bf6fd5d50d\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-line1\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-1-city\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-city_6a0bf6fd5d50d\" id=\"forminator-field-address-1-city_6a0bf6fd5d50d-label\" class=\"forminator-label\">Ville<\/label><input type=\"text\" name=\"address-1-city\" placeholder=\"Par exemple\u00a0: Paris\" id=\"forminator-field-address-1-city_6a0bf6fd5d50d\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" autocomplete=\"address-level2\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"address-1-zip\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-zip_6a0bf6fd5d50d\" id=\"forminator-field-address-1-zip_6a0bf6fd5d50d-label\" class=\"forminator-label\">Code postal<\/label><input type=\"text\" name=\"address-1-zip\" placeholder=\"Par exemple\u00a0: 2000\" id=\"forminator-field-address-1-zip_6a0bf6fd5d50d\" class=\"forminator-input\" autocomplete=\"postal-code\" value=\"\" \/><\/div><\/div><div id=\"address-1-country\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-1612__field--address-1-country_6a0bf6fd5d50d\" id=\"forminator-field-1612__field--address-1-country_6a0bf6fd5d50d-label\" class=\"forminator-label\">Pays<\/label><select name=\"address-1-country\" id=\"forminator-field-1612__field--address-1-country_6a0bf6fd5d50d\" class=\"forminator-select2\" data-search=\"true\" data-placeholder=\"S\u00e9lectionner un pays\" autocomplete=\"country-name country\" data-default-value=\"Belgique\"><option value=\"\" data-country-code=\"\" selected=\"selected\"><\/option><option value=\"Afghanistan\" data-country-code=\"AF\" >Afghanistan<\/option><option value=\"Afrique du Sud\" data-country-code=\"ZA\" >Afrique du Sud<\/option><option value=\"Albanie\" data-country-code=\"AL\" >Albanie<\/option><option value=\"Alg\u00e9rie\" data-country-code=\"DZ\" >Alg\u00e9rie<\/option><option value=\"Allemagne\" data-country-code=\"DE\" >Allemagne<\/option><option value=\"Andorre\" data-country-code=\"AD\" >Andorre<\/option><option value=\"Angola\" data-country-code=\"AO\" >Angola<\/option><option value=\"Anguilla\" data-country-code=\"AI\" >Anguilla<\/option><option value=\"Antarctique\" data-country-code=\"AQ\" >Antarctique<\/option><option value=\"Antigua-et-Barbuda\" data-country-code=\"AG\" >Antigua-et-Barbuda<\/option><option value=\"Antilles N\u00e9erlandaises\" data-country-code=\"AN\" >Antilles N\u00e9erlandaises<\/option><option value=\"Apatrides\" data-country-code=\"XX\" >Apatrides<\/option><option value=\"Arabie Saoudite\" data-country-code=\"SA\" >Arabie Saoudite<\/option><option value=\"Argentine\" data-country-code=\"AR\" >Argentine<\/option><option value=\"Arm\u00e9nie\" data-country-code=\"AM\" >Arm\u00e9nie<\/option><option value=\"Aruba\" data-country-code=\"AW\" >Aruba<\/option><option value=\"Australie\" data-country-code=\"AU\" >Australie<\/option><option value=\"Autriche\" data-country-code=\"AT\" >Autriche<\/option><option value=\"Azerba\u00efdjan\" data-country-code=\"AZ\" >Azerba\u00efdjan<\/option><option value=\"Bahamas\" data-country-code=\"BS\" >Bahamas<\/option><option value=\"Bahre\u00efn\" data-country-code=\"BH\" >Bahre\u00efn<\/option><option value=\"Bangladesh\" data-country-code=\"BD\" >Bangladesh<\/option><option value=\"Belgique\" data-country-code=\"BE\" selected=\"selected\">Belgique<\/option><option value=\"Bermudes\" data-country-code=\"BM\" >Bermudes<\/option><option value=\"Bhoutan\" data-country-code=\"BT\" >Bhoutan<\/option><option value=\"Bi\u00e9lorussie\" data-country-code=\"BY\" >Bi\u00e9lorussie<\/option><option value=\"Bolivie\" data-country-code=\"BO\" >Bolivie<\/option><option value=\"Bosnie-Herz\u00e9govine\" data-country-code=\"BA\" >Bosnie-Herz\u00e9govine<\/option><option value=\"Botswana\" data-country-code=\"BW\" >Botswana<\/option><option value=\"Brunei\" data-country-code=\"BN\" >Brunei<\/option><option value=\"Br\u00e9sil\" data-country-code=\"BR\" >Br\u00e9sil<\/option><option value=\"Bulgarie\" data-country-code=\"BG\" >Bulgarie<\/option><option value=\"Burkina Faso\" data-country-code=\"BF\" >Burkina Faso<\/option><option value=\"Burundi\" data-country-code=\"BI\" >Burundi<\/option><option value=\"B\u00e9lize\" data-country-code=\"BZ\" >B\u00e9lize<\/option><option value=\"B\u00e9nin\" data-country-code=\"BJ\" >B\u00e9nin<\/option><option value=\"Cambodge\" data-country-code=\"KH\" >Cambodge<\/option><option value=\"Cameroun\" data-country-code=\"CM\" >Cameroun<\/option><option value=\"Canada\" data-country-code=\"CA\" >Canada<\/option><option value=\"Cap Vert\" data-country-code=\"CV\" >Cap Vert<\/option><option value=\"Chili\" data-country-code=\"CL\" >Chili<\/option><option value=\"Chine, R\u00e9publique populaire de\" data-country-code=\"CN\" >Chine, R\u00e9publique populaire de<\/option><option value=\"Chypre\" data-country-code=\"CY\" >Chypre<\/option><option value=\"Cit\u00e9 du Vatican\" data-country-code=\"VA\" >Cit\u00e9 du Vatican<\/option><option value=\"Colombie\" data-country-code=\"CO\" >Colombie<\/option><option value=\"Comores\" data-country-code=\"KM\" >Comores<\/option><option value=\"Congo, R\u00e9publique du\" data-country-code=\"CG\" >Congo, R\u00e9publique du<\/option><option value=\"Congo, R\u00e9publique d\u00e9mocratique du\" data-country-code=\"CD\" >Congo, R\u00e9publique d\u00e9mocratique du<\/option><option value=\"Cor\u00e9e, R\u00e9publique de\" data-country-code=\"KR\" >Cor\u00e9e, R\u00e9publique de<\/option><option value=\"Cor\u00e9e, R\u00e9publique d\u00e9mocratique populaire de\" data-country-code=\"KP\" >Cor\u00e9e, R\u00e9publique d\u00e9mocratique populaire de<\/option><option value=\"Costa Rica\" data-country-code=\"CR\" >Costa Rica<\/option><option value=\"Croatie\" data-country-code=\"HR\" >Croatie<\/option><option value=\"Cuba\" data-country-code=\"CU\" >Cuba<\/option><option value=\"Cura\u00e7ao\" data-country-code=\"CW\" >Cura\u00e7ao<\/option><option value=\"C\u00f4te d\u2019Ivoire\" data-country-code=\"CI\" >C\u00f4te d\u2019Ivoire<\/option><option value=\"Danemark\" data-country-code=\"DK\" >Danemark<\/option><option value=\"Djibouti\" data-country-code=\"DJ\" >Djibouti<\/option><option value=\"Dominique\" data-country-code=\"DM\" >Dominique<\/option><option value=\"Espagne\" data-country-code=\"ES\" >Espagne<\/option><option value=\"Estonie\" data-country-code=\"EE\" >Estonie<\/option><option value=\"Fidji\" data-country-code=\"FJ\" >Fidji<\/option><option value=\"Finlande\" data-country-code=\"FI\" >Finlande<\/option><option value=\"France\" data-country-code=\"FR\" >France<\/option><option value=\"France, M\u00e9tropolitaine\" data-country-code=\"FX\" >France, M\u00e9tropolitaine<\/option><option value=\"Gabon\" data-country-code=\"GA\" >Gabon<\/option><option value=\"Gambie\" data-country-code=\"GM\" >Gambie<\/option><option value=\"Ghana\" data-country-code=\"GH\" >Ghana<\/option><option value=\"Gibraltar\" data-country-code=\"GI\" >Gibraltar<\/option><option value=\"Grenade\" data-country-code=\"GD\" >Grenade<\/option><option value=\"Groenland\" data-country-code=\"GL\" >Groenland<\/option><option value=\"Gr\u00e8ce\" data-country-code=\"GR\" >Gr\u00e8ce<\/option><option value=\"Guadeloupe\" data-country-code=\"GP\" >Guadeloupe<\/option><option value=\"Guam\" data-country-code=\"GU\" >Guam<\/option><option value=\"Guat\u00e9mala\" data-country-code=\"GT\" >Guat\u00e9mala<\/option><option value=\"Guernesey\" data-country-code=\"GG\" >Guernesey<\/option><option value=\"Guin\u00e9e\" data-country-code=\"GN\" >Guin\u00e9e<\/option><option value=\"Guin\u00e9e \u00c9quatoriale\" data-country-code=\"GQ\" >Guin\u00e9e \u00c9quatoriale<\/option><option value=\"Guin\u00e9e-Bissau\" data-country-code=\"GW\" >Guin\u00e9e-Bissau<\/option><option value=\"Guyane\" data-country-code=\"GY\" >Guyane<\/option><option value=\"Guyane fran\u00e7aise\" data-country-code=\"GF\" >Guyane fran\u00e7aise<\/option><option value=\"G\u00e9orgie\" data-country-code=\"GE\" >G\u00e9orgie<\/option><option value=\"G\u00e9orgie du Sud et Sandwich du Sud\" data-country-code=\"GS\" >G\u00e9orgie du Sud et Sandwich du Sud<\/option><option value=\"Ha\u00efti\" data-country-code=\"HT\" >Ha\u00efti<\/option><option value=\"Honduras\" data-country-code=\"HN\" >Honduras<\/option><option value=\"Hong Kong\" data-country-code=\"HK\" >Hong Kong<\/option><option value=\"Hongrie\" data-country-code=\"HU\" >Hongrie<\/option><option value=\"Inde\" data-country-code=\"IN\" >Inde<\/option><option value=\"Indon\u00e9sie\" data-country-code=\"ID\" >Indon\u00e9sie<\/option><option value=\"Iran\" data-country-code=\"IR\" >Iran<\/option><option value=\"Iraq\" data-country-code=\"IQ\" >Iraq<\/option><option value=\"Irlande\" data-country-code=\"IE\" >Irlande<\/option><option value=\"Islande\" data-country-code=\"IS\" >Islande<\/option><option value=\"Israel\" data-country-code=\"IL\" >Israel<\/option><option value=\"Italie\" data-country-code=\"IT\" >Italie<\/option><option value=\"Jama\u00efque\" data-country-code=\"JM\" >Jama\u00efque<\/option><option value=\"Japon\" data-country-code=\"JP\" >Japon<\/option><option value=\"Jersey\" data-country-code=\"JE\" >Jersey<\/option><option value=\"Jordanie\" data-country-code=\"JO\" >Jordanie<\/option><option value=\"Kazakhstan\" data-country-code=\"KZ\" >Kazakhstan<\/option><option value=\"Kenya\" data-country-code=\"KE\" >Kenya<\/option><option value=\"Kirghizistan\" data-country-code=\"KG\" >Kirghizistan<\/option><option value=\"Kiribati\" data-country-code=\"KI\" >Kiribati<\/option><option value=\"Kosovo\" data-country-code=\"XK\" >Kosovo<\/option><option value=\"Kowe\u00eft\" data-country-code=\"KW\" >Kowe\u00eft<\/option><option value=\"La Barbade\" data-country-code=\"BB\" >La Barbade<\/option><option value=\"Lesotho\" data-country-code=\"LS\" >Lesotho<\/option><option value=\"Lettonie\" data-country-code=\"LV\" >Lettonie<\/option><option value=\"Liban\" data-country-code=\"LB\" >Liban<\/option><option value=\"Libye\" data-country-code=\"LY\" >Libye<\/option><option value=\"Lib\u00e9ria\" data-country-code=\"LR\" >Lib\u00e9ria<\/option><option value=\"Liechtenstein\" data-country-code=\"LI\" >Liechtenstein<\/option><option value=\"Lithuanie\" data-country-code=\"LT\" >Lithuanie<\/option><option value=\"Luxembourg\" data-country-code=\"LU\" >Luxembourg<\/option><option value=\"Macao\" data-country-code=\"MO\" >Macao<\/option><option value=\"Mac\u00e9doine du Nord\" data-country-code=\"MK\" >Mac\u00e9doine du Nord<\/option><option value=\"Madagascar\" data-country-code=\"MG\" >Madagascar<\/option><option value=\"Malaisie\" data-country-code=\"MY\" >Malaisie<\/option><option value=\"Malawi\" data-country-code=\"MW\" >Malawi<\/option><option value=\"Maldives\" data-country-code=\"MV\" >Maldives<\/option><option value=\"Mali\" data-country-code=\"ML\" >Mali<\/option><option value=\"Malte\" data-country-code=\"MT\" >Malte<\/option><option value=\"Maroc\" data-country-code=\"MA\" >Maroc<\/option><option value=\"Martinique\" data-country-code=\"MQ\" >Martinique<\/option><option value=\"Mauritanie\" data-country-code=\"MR\" >Mauritanie<\/option><option value=\"Mayotte\" data-country-code=\"YT\" >Mayotte<\/option><option value=\"Mexique\" data-country-code=\"MX\" >Mexique<\/option><option value=\"Micron\u00e9sie\" data-country-code=\"FM\" >Micron\u00e9sie<\/option><option value=\"Moldavie\" data-country-code=\"MD\" >Moldavie<\/option><option value=\"Monaco\" data-country-code=\"MC\" >Monaco<\/option><option value=\"Mongolie\" data-country-code=\"MN\" >Mongolie<\/option><option value=\"Montserrat\" data-country-code=\"MS\" >Montserrat<\/option><option value=\"Mont\u00e9n\u00e9gro\" data-country-code=\"ME\" >Mont\u00e9n\u00e9gro<\/option><option value=\"Mozambique\" data-country-code=\"MZ\" >Mozambique<\/option><option value=\"Myanmar\" data-country-code=\"MM\" >Myanmar<\/option><option value=\"Namibie\" data-country-code=\"NA\" >Namibie<\/option><option value=\"Nauru\" data-country-code=\"NR\" >Nauru<\/option><option value=\"Nicaragua\" data-country-code=\"NI\" >Nicaragua<\/option><option value=\"Niger\" data-country-code=\"NE\" >Niger<\/option><option value=\"Nigeria\" data-country-code=\"NG\" >Nigeria<\/option><option value=\"Niu\u00e9\" data-country-code=\"NU\" >Niu\u00e9<\/option><option value=\"Norv\u00e8ge\" data-country-code=\"NO\" >Norv\u00e8ge<\/option><option value=\"Nouvelle Zelande\" data-country-code=\"NZ\" >Nouvelle Zelande<\/option><option value=\"Nouvelle-Cal\u00e9donie\" data-country-code=\"NC\" >Nouvelle-Cal\u00e9donie<\/option><option value=\"N\u00e9pal\" data-country-code=\"NP\" >N\u00e9pal<\/option><option value=\"Oman\" data-country-code=\"OM\" >Oman<\/option><option value=\"Ouganda\" data-country-code=\"UG\" >Ouganda<\/option><option value=\"Ouzb\u00e9kistan\" data-country-code=\"UZ\" >Ouzb\u00e9kistan<\/option><option value=\"Pakistan\" data-country-code=\"PK\" >Pakistan<\/option><option value=\"Palau\" data-country-code=\"PW\" >Palau<\/option><option value=\"Palestine, \u00c9tat de\" data-country-code=\"PS\" >Palestine, \u00c9tat de<\/option><option value=\"Panama\" data-country-code=\"PA\" >Panama<\/option><option value=\"Papouasie-Nouvelle-Guin\u00e9e\" data-country-code=\"PG\" >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value=\"Paraguay\" data-country-code=\"PY\" >Paraguay<\/option><option value=\"Pays-Bas\" data-country-code=\"NL\" >Pays-Bas<\/option><option value=\"Philippines\" data-country-code=\"PH\" >Philippines<\/option><option value=\"Pologne\" data-country-code=\"PL\" >Pologne<\/option><option value=\"Polyn\u00e9sie Fran\u00e7aise\" data-country-code=\"PF\" >Polyn\u00e9sie Fran\u00e7aise<\/option><option value=\"Porto Rico\" data-country-code=\"PR\" >Porto Rico<\/option><option value=\"Portugal\" data-country-code=\"PT\" >Portugal<\/option><option value=\"P\u00e9rou\" data-country-code=\"PE\" >P\u00e9rou<\/option><option value=\"Qatar\" data-country-code=\"QA\" >Qatar<\/option><option value=\"Roumanie\" data-country-code=\"RO\" >Roumanie<\/option><option value=\"Royaume-Uni\" data-country-code=\"GB\" >Royaume-Uni<\/option><option value=\"Russie\" data-country-code=\"RU\" >Russie<\/option><option value=\"Rwanda\" data-country-code=\"RW\" >Rwanda<\/option><option value=\"R\u00e9publique Centrafricaine\" data-country-code=\"CF\" >R\u00e9publique Centrafricaine<\/option><option value=\"R\u00e9publique Dominicaine\" data-country-code=\"DO\" >R\u00e9publique Dominicaine<\/option><option value=\"R\u00e9publique Tch\u00e8que\" data-country-code=\"CZ\" >R\u00e9publique Tch\u00e8que<\/option><option value=\"R\u00e9publique du Salvador\" data-country-code=\"SV\" >R\u00e9publique du Salvador<\/option><option value=\"R\u00e9publique d\u00e9mocratique populaire du Laos\" data-country-code=\"LA\" >R\u00e9publique d\u00e9mocratique populaire du Laos<\/option><option value=\"Sahara occidental\" data-country-code=\"EH\" >Sahara occidental<\/option><option value=\"Saint Pierre et Miquelon\" data-country-code=\"PM\" >Saint Pierre et Miquelon<\/option><option value=\"Saint-Kitts-et-Nevis\" data-country-code=\"KN\" >Saint-Kitts-et-Nevis<\/option><option value=\"Saint-Marin\" data-country-code=\"SM\" >Saint-Marin<\/option><option value=\"Saint-Martin (Royaume des Pays-Bas)\" data-country-code=\"MF\" >Saint-Martin (Royaume des Pays-Bas)<\/option><option value=\"Saint-Vincent-et-les-Grenadines\" data-country-code=\"VC\" >Saint-Vincent-et-les-Grenadines<\/option><option value=\"Sainte Lucie\" data-country-code=\"LC\" >Sainte Lucie<\/option><option value=\"Sainte-H\u00e9l\u00e8ne\" data-country-code=\"SH\" >Sainte-H\u00e9l\u00e8ne<\/option><option value=\"Samoa\" data-country-code=\"WS\" >Samoa<\/option><option value=\"Samoa am\u00e9ricaines\" data-country-code=\"AS\" >Samoa am\u00e9ricaines<\/option><option value=\"Sao Tom\u00e9-et-Principe\" data-country-code=\"ST\" >Sao Tom\u00e9-et-Principe<\/option><option value=\"Serbie\" data-country-code=\"RS\" >Serbie<\/option><option value=\"Seychelles\" data-country-code=\"SC\" >Seychelles<\/option><option value=\"Sierra Leone\" data-country-code=\"SL\" >Sierra Leone<\/option><option value=\"Singapour\" data-country-code=\"SG\" >Singapour<\/option><option value=\"Slovaquie\" data-country-code=\"SK\" >Slovaquie<\/option><option value=\"Slov\u00e9nie\" data-country-code=\"SI\" >Slov\u00e9nie<\/option><option value=\"Somalie\" data-country-code=\"SO\" >Somalie<\/option><option value=\"Soudan\" data-country-code=\"SD\" >Soudan<\/option><option value=\"Soudan, Sud\" data-country-code=\"SS\" >Soudan, Sud<\/option><option value=\"Sri Lanka\" data-country-code=\"LK\" >Sri Lanka<\/option><option value=\"Suisse\" data-country-code=\"CH\" >Suisse<\/option><option value=\"Suriname\" data-country-code=\"SR\" >Suriname<\/option><option value=\"Su\u00e8de\" data-country-code=\"SE\" >Su\u00e8de<\/option><option value=\"Svalbard et Jan Mayen\" data-country-code=\"SJ\" >Svalbard et Jan Mayen<\/option><option value=\"Swaziland\" data-country-code=\"SZ\" >Swaziland<\/option><option value=\"Syrie\" data-country-code=\"SY\" >Syrie<\/option><option value=\"S\u00e9n\u00e9gal\" data-country-code=\"SN\" >S\u00e9n\u00e9gal<\/option><option value=\"Tadjikistan\" data-country-code=\"TJ\" >Tadjikistan<\/option><option value=\"Taiwan, R\u00e9publique de Chine\" data-country-code=\"TW\" >Taiwan, R\u00e9publique de Chine<\/option><option value=\"Tanzanie\" data-country-code=\"TZ\" >Tanzanie<\/option><option value=\"Tchad\" data-country-code=\"TD\" >Tchad<\/option><option value=\"Terres australes et antarctiques fran\u00e7aises\" data-country-code=\"TF\" >Terres australes et antarctiques fran\u00e7aises<\/option><option value=\"Territoire britannique de l\u2019oc\u00e9an Indien\" data-country-code=\"IO\" >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value=\"Tha\u00eflande\" data-country-code=\"TH\" >Tha\u00eflande<\/option><option value=\"Timor-Oriental\" data-country-code=\"TL\" >Timor-Oriental<\/option><option value=\"Togo\" data-country-code=\"TG\" >Togo<\/option><option value=\"Tokelau\" data-country-code=\"TK\" >Tokelau<\/option><option value=\"Tonga\" data-country-code=\"TO\" >Tonga<\/option><option value=\"Trinit\u00e9 et Tobago\" data-country-code=\"TT\" >Trinit\u00e9 et Tobago<\/option><option value=\"Tunisie\" data-country-code=\"TN\" >Tunisie<\/option><option value=\"Turkm\u00e9nistan\" data-country-code=\"TM\" >Turkm\u00e9nistan<\/option><option value=\"Turquie\" data-country-code=\"TR\" >Turquie<\/option><option value=\"Tuvalu\" data-country-code=\"TV\" >Tuvalu<\/option><option value=\"Ukraine\" data-country-code=\"UA\" >Ukraine<\/option><option value=\"Uruguay\" data-country-code=\"UY\" >Uruguay<\/option><option value=\"Vanuatu\" data-country-code=\"VU\" >Vanuatu<\/option><option value=\"Vietnam\" data-country-code=\"VN\" >Vietnam<\/option><option value=\"V\u00e9n\u00e9zu\u00e9la\" data-country-code=\"VE\" >V\u00e9n\u00e9zu\u00e9la<\/option><option value=\"Yemen\" data-country-code=\"YE\" >Yemen<\/option><option value=\"Zambie\" data-country-code=\"ZM\" >Zambie<\/option><option value=\"Zimbabwe\" data-country-code=\"ZW\" >Zimbabwe<\/option><option value=\"\u00c9gypte\" data-country-code=\"EG\" >\u00c9gypte<\/option><option value=\"\u00c9mirats Arabes Unis\" data-country-code=\"AE\" >\u00c9mirats Arabes Unis<\/option><option value=\"\u00c9quateur\" data-country-code=\"EC\" >\u00c9quateur<\/option><option value=\"\u00c9rythr\u00e9e\" data-country-code=\"ER\" >\u00c9rythr\u00e9e<\/option><option value=\"\u00c9tats-Unis d\u2019Am\u00e9rique (USA)\" data-country-code=\"US\" >\u00c9tats-Unis d\u2019Am\u00e9rique (USA)<\/option><option value=\"\u00c9thiopie\" data-country-code=\"ET\" >\u00c9thiopie<\/option><option value=\"\u00cele Bouvet\" data-country-code=\"BV\" >\u00cele Bouvet<\/option><option value=\"\u00cele Christmas\" data-country-code=\"CX\" >\u00cele Christmas<\/option><option value=\"\u00cele Heard et \u00eele Mcdonald\" data-country-code=\"HM\" >\u00cele Heard et \u00eele Mcdonald<\/option><option value=\"\u00cele Johnston\" data-country-code=\"JT\" >\u00cele Johnston<\/option><option value=\"\u00cele Maurice\" data-country-code=\"MU\" >\u00cele Maurice<\/option><option value=\"\u00cele Norfolk\" data-country-code=\"NF\" >\u00cele Norfolk<\/option><option value=\"\u00cele de la R\u00e9union\" data-country-code=\"RE\" >\u00cele de la R\u00e9union<\/option><option value=\"\u00celes Ca\u00efmans\" data-country-code=\"KY\" >\u00celes Ca\u00efmans<\/option><option value=\"\u00celes Cocos\" data-country-code=\"CC\" >\u00celes Cocos<\/option><option value=\"\u00celes Cook\" data-country-code=\"CK\" >\u00celes Cook<\/option><option value=\"\u00celes Falkland\" data-country-code=\"FK\" >\u00celes Falkland<\/option><option value=\"\u00celes F\u00e9ro\u00e9\" data-country-code=\"FO\" >\u00celes F\u00e9ro\u00e9<\/option><option value=\"\u00celes Mariannes du Nord\" data-country-code=\"MP\" >\u00celes Mariannes du Nord<\/option><option value=\"\u00celes Marshall\" data-country-code=\"MH\" >\u00celes Marshall<\/option><option value=\"\u00celes Pitcairn\" data-country-code=\"PN\" >\u00celes Pitcairn<\/option><option value=\"\u00celes Salomon\" data-country-code=\"SB\" >\u00celes Salomon<\/option><option value=\"\u00celes Turques-et-Ca\u00efques\" data-country-code=\"TC\" >\u00celes Turques-et-Ca\u00efques<\/option><option value=\"\u00celes Vierges am\u00e9ricaines\" data-country-code=\"VI\" >\u00celes Vierges am\u00e9ricaines<\/option><option value=\"\u00celes Vierges britanniques\" data-country-code=\"VG\" >\u00celes Vierges britanniques<\/option><option value=\"\u00celes Wallis et Futuna\" data-country-code=\"WF\" >\u00celes Wallis et Futuna<\/option><option value=\"\u00celes mineures \u00e9loign\u00e9es des \u00c9tats-Unis\" data-country-code=\"UM\" >\u00celes mineures \u00e9loign\u00e9es des \u00c9tats-Unis<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"captcha-1\" class=\"forminator-field-captcha  forminator-col-6 \"><div class=\"forminator-captcha-left forminator-g-recaptcha recaptcha-invisible\" data-theme=\"light\" data-badge=\"bottomright\" data-sitekey=\"6Lf2UkApAAAAAG7Kj_tF8X3y7nW5fPOjscOjbQyV\" data-size=\"invisible\"><\/div> <\/div><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_6a0bf6fd5d50d\" id=\"forminator-field-date-1-picker_6a0bf6fd5d50d-label\" class=\"forminator-label\">Date de naissance <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"j\/m\/A\" id=\"forminator-field-date-1-picker_6a0bf6fd5d50d\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" aria-describedby=\"forminator-field-date-1-picker_6a0bf6fd5d50d-description\" \/><\/div><span id=\"forminator-field-date-1-picker_6a0bf6fd5d50d-description\" class=\"forminator-description\">Date de naissance de votre enfant<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6a0bf6fd5d50d\" id=\"forminator-field-textarea-2_6a0bf6fd5d50d-label\" class=\"forminator-label\">Remarque \u00e9ventuelle<\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_6a0bf6fd5d50d\" class=\"forminator-textarea\" rows=\"6\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Envoyer le message<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"1e27ee8352\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/123\" \/><input type=\"hidden\" name=\"form_id\" value=\"1612\"><input type=\"hidden\" name=\"page_id\" value=\"123\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/www.couraubois.be\/index.php\/stage\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Stage Ado sous tente 300\u20ac ( nombres limit\u00e9s ) si premi\u00e8re fois merci de nous contacter d&rsquo;abord<\/h2>\n\n\n<p><div class=\"forminator-ui forminator-custom-form forminator-custom-form-1616 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-1616\" data-uid=\"6a0bf6fd62f00\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-1616\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-1616 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"1616\"\n\t\t\t\t data-color-option=\"default\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6a0bf6fd62f00\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a0bf6fd62f00\" id=\"forminator-field-name-1_6a0bf6fd62f00-label\" class=\"forminator-label\">Nom de l&#039;enfant<\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"Par exemple\u00a0: Jacques Martin\" id=\"forminator-field-name-1_6a0bf6fd62f00\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a0bf6fd62f00\" id=\"forminator-field-email-1_6a0bf6fd62f00-label\" class=\"forminator-label\">Adresse de messagerie <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"Par exemple\u00a0: jacques@martin.com\" id=\"forminator-field-email-1_6a0bf6fd62f00\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6a0bf6fd62f00\" id=\"forminator-field-phone-1_6a0bf6fd62f00-label\" class=\"forminator-label\">T\u00e9l\u00e9phone <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"Par exemple\u00a0: +1 02 03 05 06\" id=\"forminator-field-phone-1_6a0bf6fd62f00\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-6a0bf6fd62f00-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-6a0bf6fd62f00-label\" class=\"forminator-label\">Semaine de stage<\/span><label id=\"forminator-field-checkbox-1-1-6a0bf6fd62f00-label\" for=\"forminator-field-checkbox-1-1-6a0bf6fd62f00\" class=\"forminator-checkbox\" title=\"lundi  17 ao\u00fbt au vendredi 21 ao\u00fbt\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"lundi  17 ao\u00fbt au vendredi 21 ao\u00fbt\" id=\"forminator-field-checkbox-1-1-6a0bf6fd62f00\" aria-labelledby=\"forminator-field-checkbox-1-1-6a0bf6fd62f00-label\" data-calculation=\"0\" checked=\"checked\"  data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">lundi  17 ao\u00fbt au vendredi 21 ao\u00fbt<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1616__field--select-2_6a0bf6fd62f00\" id=\"forminator-form-1616__field--select-2_6a0bf6fd62f00-label\" class=\"forminator-label\">Repas chaud<\/label><select  id=\"forminator-form-1616__field--select-2_6a0bf6fd62f00\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-2\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1616__field--select-2_6a0bf6fd62f00-label\"><option value=\"one\"  data-calculation=\"0\">OUI<\/option><option value=\"two\"  data-calculation=\"0\">NON<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6a0bf6fd62f00\" id=\"forminator-field-textarea-1_6a0bf6fd62f00-label\" class=\"forminator-label\">Allergie<\/label><textarea name=\"textarea-1\" placeholder=\"merci d&#039;indiquer si votre enfant \u00e0 une allergie alimentaire.\" id=\"forminator-field-textarea-1_6a0bf6fd62f00\" class=\"forminator-textarea\" rows=\"6\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1616__field--select-1_6a0bf6fd62f00\" id=\"forminator-form-1616__field--select-1_6a0bf6fd62f00-label\" class=\"forminator-label\">Assurance<\/label><select  id=\"forminator-form-1616__field--select-1_6a0bf6fd62f00\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-1\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1616__field--select-1_6a0bf6fd62f00-label\" aria-describedby=\"forminator-form-1616__field--select-1_6a0bf6fd62f00-description\"><option value=\"one\"  data-calculation=\"0\">OUI<\/option><option value=\"two\"  data-calculation=\"0\">NON<\/option><\/select><span id=\"forminator-form-1616__field--select-1_6a0bf6fd62f00-description\" class=\"forminator-description\">votre enfant poss\u00e8de une assurance \u00e9questre a l&rsquo;ann\u00e9e<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-field-address forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-street_address_6a0bf6fd62f00\" id=\"forminator-field-address-1-street_address_6a0bf6fd62f00-label\" class=\"forminator-label\">Rue <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"Par exemple\u00a0: 10 grande rue\" id=\"forminator-field-address-1-street_address_6a0bf6fd62f00\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-line1\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-1-city\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-city_6a0bf6fd62f00\" id=\"forminator-field-address-1-city_6a0bf6fd62f00-label\" class=\"forminator-label\">Ville<\/label><input type=\"text\" name=\"address-1-city\" placeholder=\"Par exemple\u00a0: Paris\" id=\"forminator-field-address-1-city_6a0bf6fd62f00\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" autocomplete=\"address-level2\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"address-1-zip\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-zip_6a0bf6fd62f00\" id=\"forminator-field-address-1-zip_6a0bf6fd62f00-label\" class=\"forminator-label\">Code postal<\/label><input type=\"text\" name=\"address-1-zip\" placeholder=\"Par exemple\u00a0: 2000\" id=\"forminator-field-address-1-zip_6a0bf6fd62f00\" class=\"forminator-input\" autocomplete=\"postal-code\" value=\"\" \/><\/div><\/div><div id=\"address-1-country\" class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-1616__field--address-1-country_6a0bf6fd62f00\" id=\"forminator-field-1616__field--address-1-country_6a0bf6fd62f00-label\" class=\"forminator-label\">Pays<\/label><select name=\"address-1-country\" id=\"forminator-field-1616__field--address-1-country_6a0bf6fd62f00\" class=\"forminator-select2\" data-search=\"true\" data-placeholder=\"S\u00e9lectionner un pays\" autocomplete=\"country-name country\" data-default-value=\"Belgique\"><option value=\"\" data-country-code=\"\" selected=\"selected\"><\/option><option value=\"Afghanistan\" data-country-code=\"AF\" >Afghanistan<\/option><option value=\"Afrique du Sud\" data-country-code=\"ZA\" >Afrique du Sud<\/option><option value=\"Albanie\" data-country-code=\"AL\" >Albanie<\/option><option value=\"Alg\u00e9rie\" data-country-code=\"DZ\" >Alg\u00e9rie<\/option><option value=\"Allemagne\" data-country-code=\"DE\" >Allemagne<\/option><option value=\"Andorre\" data-country-code=\"AD\" >Andorre<\/option><option value=\"Angola\" data-country-code=\"AO\" >Angola<\/option><option value=\"Anguilla\" data-country-code=\"AI\" >Anguilla<\/option><option value=\"Antarctique\" data-country-code=\"AQ\" >Antarctique<\/option><option value=\"Antigua-et-Barbuda\" data-country-code=\"AG\" >Antigua-et-Barbuda<\/option><option value=\"Antilles N\u00e9erlandaises\" data-country-code=\"AN\" >Antilles N\u00e9erlandaises<\/option><option value=\"Apatrides\" data-country-code=\"XX\" >Apatrides<\/option><option value=\"Arabie Saoudite\" data-country-code=\"SA\" >Arabie Saoudite<\/option><option value=\"Argentine\" data-country-code=\"AR\" >Argentine<\/option><option value=\"Arm\u00e9nie\" data-country-code=\"AM\" >Arm\u00e9nie<\/option><option value=\"Aruba\" data-country-code=\"AW\" >Aruba<\/option><option value=\"Australie\" data-country-code=\"AU\" >Australie<\/option><option value=\"Autriche\" data-country-code=\"AT\" >Autriche<\/option><option value=\"Azerba\u00efdjan\" data-country-code=\"AZ\" >Azerba\u00efdjan<\/option><option value=\"Bahamas\" data-country-code=\"BS\" >Bahamas<\/option><option value=\"Bahre\u00efn\" data-country-code=\"BH\" >Bahre\u00efn<\/option><option value=\"Bangladesh\" data-country-code=\"BD\" >Bangladesh<\/option><option value=\"Belgique\" data-country-code=\"BE\" selected=\"selected\">Belgique<\/option><option value=\"Bermudes\" data-country-code=\"BM\" >Bermudes<\/option><option value=\"Bhoutan\" data-country-code=\"BT\" >Bhoutan<\/option><option value=\"Bi\u00e9lorussie\" data-country-code=\"BY\" >Bi\u00e9lorussie<\/option><option value=\"Bolivie\" data-country-code=\"BO\" >Bolivie<\/option><option value=\"Bosnie-Herz\u00e9govine\" data-country-code=\"BA\" >Bosnie-Herz\u00e9govine<\/option><option value=\"Botswana\" data-country-code=\"BW\" >Botswana<\/option><option value=\"Brunei\" data-country-code=\"BN\" >Brunei<\/option><option value=\"Br\u00e9sil\" data-country-code=\"BR\" >Br\u00e9sil<\/option><option value=\"Bulgarie\" data-country-code=\"BG\" >Bulgarie<\/option><option value=\"Burkina Faso\" data-country-code=\"BF\" >Burkina Faso<\/option><option value=\"Burundi\" data-country-code=\"BI\" >Burundi<\/option><option value=\"B\u00e9lize\" data-country-code=\"BZ\" >B\u00e9lize<\/option><option value=\"B\u00e9nin\" data-country-code=\"BJ\" >B\u00e9nin<\/option><option value=\"Cambodge\" data-country-code=\"KH\" >Cambodge<\/option><option value=\"Cameroun\" data-country-code=\"CM\" >Cameroun<\/option><option value=\"Canada\" data-country-code=\"CA\" >Canada<\/option><option value=\"Cap Vert\" data-country-code=\"CV\" >Cap Vert<\/option><option value=\"Chili\" data-country-code=\"CL\" >Chili<\/option><option value=\"Chine, R\u00e9publique populaire de\" data-country-code=\"CN\" >Chine, R\u00e9publique populaire de<\/option><option value=\"Chypre\" data-country-code=\"CY\" >Chypre<\/option><option value=\"Cit\u00e9 du Vatican\" data-country-code=\"VA\" >Cit\u00e9 du Vatican<\/option><option value=\"Colombie\" data-country-code=\"CO\" >Colombie<\/option><option value=\"Comores\" data-country-code=\"KM\" >Comores<\/option><option value=\"Congo, R\u00e9publique du\" data-country-code=\"CG\" >Congo, R\u00e9publique du<\/option><option value=\"Congo, R\u00e9publique d\u00e9mocratique du\" data-country-code=\"CD\" >Congo, R\u00e9publique d\u00e9mocratique du<\/option><option value=\"Cor\u00e9e, R\u00e9publique de\" data-country-code=\"KR\" >Cor\u00e9e, R\u00e9publique de<\/option><option value=\"Cor\u00e9e, R\u00e9publique d\u00e9mocratique populaire de\" data-country-code=\"KP\" >Cor\u00e9e, R\u00e9publique d\u00e9mocratique populaire de<\/option><option value=\"Costa Rica\" data-country-code=\"CR\" >Costa Rica<\/option><option value=\"Croatie\" data-country-code=\"HR\" >Croatie<\/option><option value=\"Cuba\" data-country-code=\"CU\" >Cuba<\/option><option value=\"Cura\u00e7ao\" data-country-code=\"CW\" >Cura\u00e7ao<\/option><option value=\"C\u00f4te d\u2019Ivoire\" data-country-code=\"CI\" >C\u00f4te d\u2019Ivoire<\/option><option value=\"Danemark\" data-country-code=\"DK\" >Danemark<\/option><option value=\"Djibouti\" data-country-code=\"DJ\" >Djibouti<\/option><option value=\"Dominique\" data-country-code=\"DM\" >Dominique<\/option><option value=\"Espagne\" data-country-code=\"ES\" >Espagne<\/option><option value=\"Estonie\" data-country-code=\"EE\" >Estonie<\/option><option value=\"Fidji\" data-country-code=\"FJ\" >Fidji<\/option><option value=\"Finlande\" data-country-code=\"FI\" >Finlande<\/option><option value=\"France\" data-country-code=\"FR\" >France<\/option><option value=\"France, M\u00e9tropolitaine\" data-country-code=\"FX\" >France, M\u00e9tropolitaine<\/option><option value=\"Gabon\" data-country-code=\"GA\" >Gabon<\/option><option value=\"Gambie\" data-country-code=\"GM\" >Gambie<\/option><option value=\"Ghana\" data-country-code=\"GH\" >Ghana<\/option><option value=\"Gibraltar\" data-country-code=\"GI\" >Gibraltar<\/option><option value=\"Grenade\" data-country-code=\"GD\" >Grenade<\/option><option value=\"Groenland\" data-country-code=\"GL\" >Groenland<\/option><option value=\"Gr\u00e8ce\" data-country-code=\"GR\" >Gr\u00e8ce<\/option><option value=\"Guadeloupe\" data-country-code=\"GP\" >Guadeloupe<\/option><option value=\"Guam\" data-country-code=\"GU\" >Guam<\/option><option value=\"Guat\u00e9mala\" data-country-code=\"GT\" >Guat\u00e9mala<\/option><option value=\"Guernesey\" data-country-code=\"GG\" >Guernesey<\/option><option value=\"Guin\u00e9e\" data-country-code=\"GN\" >Guin\u00e9e<\/option><option value=\"Guin\u00e9e \u00c9quatoriale\" data-country-code=\"GQ\" >Guin\u00e9e \u00c9quatoriale<\/option><option value=\"Guin\u00e9e-Bissau\" data-country-code=\"GW\" >Guin\u00e9e-Bissau<\/option><option value=\"Guyane\" data-country-code=\"GY\" >Guyane<\/option><option value=\"Guyane fran\u00e7aise\" data-country-code=\"GF\" >Guyane fran\u00e7aise<\/option><option value=\"G\u00e9orgie\" data-country-code=\"GE\" >G\u00e9orgie<\/option><option value=\"G\u00e9orgie du Sud et Sandwich du Sud\" data-country-code=\"GS\" >G\u00e9orgie du Sud et Sandwich du Sud<\/option><option value=\"Ha\u00efti\" data-country-code=\"HT\" >Ha\u00efti<\/option><option value=\"Honduras\" data-country-code=\"HN\" >Honduras<\/option><option value=\"Hong Kong\" data-country-code=\"HK\" >Hong Kong<\/option><option value=\"Hongrie\" data-country-code=\"HU\" >Hongrie<\/option><option value=\"Inde\" data-country-code=\"IN\" >Inde<\/option><option value=\"Indon\u00e9sie\" data-country-code=\"ID\" >Indon\u00e9sie<\/option><option value=\"Iran\" data-country-code=\"IR\" >Iran<\/option><option value=\"Iraq\" data-country-code=\"IQ\" >Iraq<\/option><option value=\"Irlande\" data-country-code=\"IE\" >Irlande<\/option><option value=\"Islande\" data-country-code=\"IS\" >Islande<\/option><option value=\"Israel\" data-country-code=\"IL\" >Israel<\/option><option value=\"Italie\" data-country-code=\"IT\" >Italie<\/option><option value=\"Jama\u00efque\" data-country-code=\"JM\" >Jama\u00efque<\/option><option value=\"Japon\" data-country-code=\"JP\" >Japon<\/option><option value=\"Jersey\" data-country-code=\"JE\" >Jersey<\/option><option value=\"Jordanie\" data-country-code=\"JO\" >Jordanie<\/option><option value=\"Kazakhstan\" data-country-code=\"KZ\" >Kazakhstan<\/option><option value=\"Kenya\" data-country-code=\"KE\" >Kenya<\/option><option value=\"Kirghizistan\" data-country-code=\"KG\" >Kirghizistan<\/option><option value=\"Kiribati\" data-country-code=\"KI\" >Kiribati<\/option><option value=\"Kosovo\" data-country-code=\"XK\" >Kosovo<\/option><option value=\"Kowe\u00eft\" data-country-code=\"KW\" >Kowe\u00eft<\/option><option value=\"La Barbade\" data-country-code=\"BB\" >La Barbade<\/option><option value=\"Lesotho\" data-country-code=\"LS\" >Lesotho<\/option><option value=\"Lettonie\" data-country-code=\"LV\" >Lettonie<\/option><option value=\"Liban\" data-country-code=\"LB\" >Liban<\/option><option value=\"Libye\" data-country-code=\"LY\" >Libye<\/option><option value=\"Lib\u00e9ria\" data-country-code=\"LR\" >Lib\u00e9ria<\/option><option value=\"Liechtenstein\" data-country-code=\"LI\" >Liechtenstein<\/option><option value=\"Lithuanie\" data-country-code=\"LT\" >Lithuanie<\/option><option value=\"Luxembourg\" data-country-code=\"LU\" >Luxembourg<\/option><option value=\"Macao\" data-country-code=\"MO\" >Macao<\/option><option value=\"Mac\u00e9doine du Nord\" data-country-code=\"MK\" >Mac\u00e9doine du Nord<\/option><option value=\"Madagascar\" data-country-code=\"MG\" >Madagascar<\/option><option value=\"Malaisie\" data-country-code=\"MY\" >Malaisie<\/option><option value=\"Malawi\" data-country-code=\"MW\" >Malawi<\/option><option value=\"Maldives\" data-country-code=\"MV\" >Maldives<\/option><option value=\"Mali\" data-country-code=\"ML\" >Mali<\/option><option value=\"Malte\" data-country-code=\"MT\" >Malte<\/option><option value=\"Maroc\" data-country-code=\"MA\" >Maroc<\/option><option value=\"Martinique\" data-country-code=\"MQ\" >Martinique<\/option><option value=\"Mauritanie\" data-country-code=\"MR\" >Mauritanie<\/option><option value=\"Mayotte\" data-country-code=\"YT\" >Mayotte<\/option><option value=\"Mexique\" data-country-code=\"MX\" >Mexique<\/option><option value=\"Micron\u00e9sie\" data-country-code=\"FM\" >Micron\u00e9sie<\/option><option value=\"Moldavie\" data-country-code=\"MD\" >Moldavie<\/option><option value=\"Monaco\" data-country-code=\"MC\" >Monaco<\/option><option value=\"Mongolie\" data-country-code=\"MN\" >Mongolie<\/option><option value=\"Montserrat\" data-country-code=\"MS\" >Montserrat<\/option><option value=\"Mont\u00e9n\u00e9gro\" data-country-code=\"ME\" >Mont\u00e9n\u00e9gro<\/option><option value=\"Mozambique\" data-country-code=\"MZ\" >Mozambique<\/option><option value=\"Myanmar\" data-country-code=\"MM\" >Myanmar<\/option><option value=\"Namibie\" data-country-code=\"NA\" >Namibie<\/option><option value=\"Nauru\" data-country-code=\"NR\" >Nauru<\/option><option value=\"Nicaragua\" data-country-code=\"NI\" >Nicaragua<\/option><option value=\"Niger\" data-country-code=\"NE\" >Niger<\/option><option value=\"Nigeria\" data-country-code=\"NG\" >Nigeria<\/option><option value=\"Niu\u00e9\" data-country-code=\"NU\" >Niu\u00e9<\/option><option value=\"Norv\u00e8ge\" data-country-code=\"NO\" >Norv\u00e8ge<\/option><option value=\"Nouvelle Zelande\" data-country-code=\"NZ\" >Nouvelle Zelande<\/option><option value=\"Nouvelle-Cal\u00e9donie\" data-country-code=\"NC\" >Nouvelle-Cal\u00e9donie<\/option><option value=\"N\u00e9pal\" data-country-code=\"NP\" >N\u00e9pal<\/option><option value=\"Oman\" data-country-code=\"OM\" >Oman<\/option><option value=\"Ouganda\" data-country-code=\"UG\" >Ouganda<\/option><option value=\"Ouzb\u00e9kistan\" data-country-code=\"UZ\" >Ouzb\u00e9kistan<\/option><option value=\"Pakistan\" data-country-code=\"PK\" >Pakistan<\/option><option value=\"Palau\" data-country-code=\"PW\" >Palau<\/option><option value=\"Palestine, \u00c9tat de\" data-country-code=\"PS\" >Palestine, \u00c9tat de<\/option><option value=\"Panama\" data-country-code=\"PA\" >Panama<\/option><option value=\"Papouasie-Nouvelle-Guin\u00e9e\" data-country-code=\"PG\" >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value=\"Paraguay\" data-country-code=\"PY\" >Paraguay<\/option><option value=\"Pays-Bas\" data-country-code=\"NL\" >Pays-Bas<\/option><option value=\"Philippines\" data-country-code=\"PH\" >Philippines<\/option><option value=\"Pologne\" data-country-code=\"PL\" >Pologne<\/option><option value=\"Polyn\u00e9sie Fran\u00e7aise\" data-country-code=\"PF\" >Polyn\u00e9sie Fran\u00e7aise<\/option><option value=\"Porto Rico\" data-country-code=\"PR\" >Porto Rico<\/option><option value=\"Portugal\" data-country-code=\"PT\" >Portugal<\/option><option value=\"P\u00e9rou\" data-country-code=\"PE\" >P\u00e9rou<\/option><option value=\"Qatar\" data-country-code=\"QA\" >Qatar<\/option><option value=\"Roumanie\" data-country-code=\"RO\" >Roumanie<\/option><option value=\"Royaume-Uni\" data-country-code=\"GB\" >Royaume-Uni<\/option><option value=\"Russie\" data-country-code=\"RU\" >Russie<\/option><option value=\"Rwanda\" data-country-code=\"RW\" >Rwanda<\/option><option value=\"R\u00e9publique Centrafricaine\" data-country-code=\"CF\" >R\u00e9publique Centrafricaine<\/option><option value=\"R\u00e9publique Dominicaine\" data-country-code=\"DO\" >R\u00e9publique Dominicaine<\/option><option value=\"R\u00e9publique Tch\u00e8que\" data-country-code=\"CZ\" >R\u00e9publique Tch\u00e8que<\/option><option value=\"R\u00e9publique du Salvador\" data-country-code=\"SV\" >R\u00e9publique du Salvador<\/option><option value=\"R\u00e9publique d\u00e9mocratique populaire du Laos\" data-country-code=\"LA\" >R\u00e9publique d\u00e9mocratique populaire du Laos<\/option><option value=\"Sahara occidental\" data-country-code=\"EH\" >Sahara occidental<\/option><option value=\"Saint Pierre et Miquelon\" data-country-code=\"PM\" >Saint Pierre et Miquelon<\/option><option value=\"Saint-Kitts-et-Nevis\" data-country-code=\"KN\" >Saint-Kitts-et-Nevis<\/option><option value=\"Saint-Marin\" data-country-code=\"SM\" >Saint-Marin<\/option><option value=\"Saint-Martin (Royaume des Pays-Bas)\" data-country-code=\"MF\" >Saint-Martin (Royaume des Pays-Bas)<\/option><option value=\"Saint-Vincent-et-les-Grenadines\" data-country-code=\"VC\" >Saint-Vincent-et-les-Grenadines<\/option><option value=\"Sainte Lucie\" data-country-code=\"LC\" >Sainte Lucie<\/option><option value=\"Sainte-H\u00e9l\u00e8ne\" data-country-code=\"SH\" >Sainte-H\u00e9l\u00e8ne<\/option><option value=\"Samoa\" data-country-code=\"WS\" >Samoa<\/option><option value=\"Samoa am\u00e9ricaines\" data-country-code=\"AS\" >Samoa am\u00e9ricaines<\/option><option value=\"Sao Tom\u00e9-et-Principe\" data-country-code=\"ST\" >Sao Tom\u00e9-et-Principe<\/option><option value=\"Serbie\" data-country-code=\"RS\" >Serbie<\/option><option value=\"Seychelles\" data-country-code=\"SC\" >Seychelles<\/option><option value=\"Sierra Leone\" data-country-code=\"SL\" >Sierra Leone<\/option><option value=\"Singapour\" data-country-code=\"SG\" >Singapour<\/option><option value=\"Slovaquie\" data-country-code=\"SK\" >Slovaquie<\/option><option value=\"Slov\u00e9nie\" data-country-code=\"SI\" >Slov\u00e9nie<\/option><option value=\"Somalie\" data-country-code=\"SO\" >Somalie<\/option><option value=\"Soudan\" data-country-code=\"SD\" >Soudan<\/option><option value=\"Soudan, Sud\" data-country-code=\"SS\" >Soudan, Sud<\/option><option value=\"Sri Lanka\" data-country-code=\"LK\" >Sri Lanka<\/option><option value=\"Suisse\" data-country-code=\"CH\" >Suisse<\/option><option value=\"Suriname\" data-country-code=\"SR\" >Suriname<\/option><option value=\"Su\u00e8de\" data-country-code=\"SE\" >Su\u00e8de<\/option><option value=\"Svalbard et Jan Mayen\" data-country-code=\"SJ\" >Svalbard et Jan Mayen<\/option><option value=\"Swaziland\" data-country-code=\"SZ\" >Swaziland<\/option><option value=\"Syrie\" data-country-code=\"SY\" >Syrie<\/option><option value=\"S\u00e9n\u00e9gal\" data-country-code=\"SN\" >S\u00e9n\u00e9gal<\/option><option value=\"Tadjikistan\" data-country-code=\"TJ\" >Tadjikistan<\/option><option value=\"Taiwan, R\u00e9publique de Chine\" data-country-code=\"TW\" >Taiwan, R\u00e9publique de Chine<\/option><option value=\"Tanzanie\" data-country-code=\"TZ\" >Tanzanie<\/option><option value=\"Tchad\" data-country-code=\"TD\" >Tchad<\/option><option value=\"Terres australes et antarctiques fran\u00e7aises\" data-country-code=\"TF\" >Terres australes et antarctiques fran\u00e7aises<\/option><option value=\"Territoire britannique de l\u2019oc\u00e9an Indien\" data-country-code=\"IO\" >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value=\"Tha\u00eflande\" data-country-code=\"TH\" >Tha\u00eflande<\/option><option value=\"Timor-Oriental\" data-country-code=\"TL\" >Timor-Oriental<\/option><option value=\"Togo\" data-country-code=\"TG\" >Togo<\/option><option value=\"Tokelau\" data-country-code=\"TK\" >Tokelau<\/option><option value=\"Tonga\" data-country-code=\"TO\" >Tonga<\/option><option value=\"Trinit\u00e9 et Tobago\" data-country-code=\"TT\" >Trinit\u00e9 et Tobago<\/option><option value=\"Tunisie\" data-country-code=\"TN\" >Tunisie<\/option><option value=\"Turkm\u00e9nistan\" data-country-code=\"TM\" >Turkm\u00e9nistan<\/option><option value=\"Turquie\" data-country-code=\"TR\" >Turquie<\/option><option value=\"Tuvalu\" data-country-code=\"TV\" >Tuvalu<\/option><option value=\"Ukraine\" data-country-code=\"UA\" >Ukraine<\/option><option value=\"Uruguay\" data-country-code=\"UY\" >Uruguay<\/option><option value=\"Vanuatu\" data-country-code=\"VU\" >Vanuatu<\/option><option value=\"Vietnam\" data-country-code=\"VN\" >Vietnam<\/option><option value=\"V\u00e9n\u00e9zu\u00e9la\" data-country-code=\"VE\" >V\u00e9n\u00e9zu\u00e9la<\/option><option value=\"Yemen\" data-country-code=\"YE\" >Yemen<\/option><option value=\"Zambie\" data-country-code=\"ZM\" >Zambie<\/option><option value=\"Zimbabwe\" data-country-code=\"ZW\" >Zimbabwe<\/option><option value=\"\u00c9gypte\" data-country-code=\"EG\" >\u00c9gypte<\/option><option value=\"\u00c9mirats Arabes Unis\" data-country-code=\"AE\" >\u00c9mirats Arabes Unis<\/option><option value=\"\u00c9quateur\" data-country-code=\"EC\" >\u00c9quateur<\/option><option value=\"\u00c9rythr\u00e9e\" data-country-code=\"ER\" >\u00c9rythr\u00e9e<\/option><option value=\"\u00c9tats-Unis d\u2019Am\u00e9rique (USA)\" data-country-code=\"US\" >\u00c9tats-Unis d\u2019Am\u00e9rique (USA)<\/option><option value=\"\u00c9thiopie\" data-country-code=\"ET\" >\u00c9thiopie<\/option><option value=\"\u00cele Bouvet\" data-country-code=\"BV\" >\u00cele Bouvet<\/option><option value=\"\u00cele Christmas\" data-country-code=\"CX\" >\u00cele Christmas<\/option><option value=\"\u00cele Heard et \u00eele Mcdonald\" data-country-code=\"HM\" >\u00cele Heard et \u00eele Mcdonald<\/option><option value=\"\u00cele Johnston\" data-country-code=\"JT\" >\u00cele Johnston<\/option><option value=\"\u00cele Maurice\" data-country-code=\"MU\" >\u00cele Maurice<\/option><option value=\"\u00cele Norfolk\" data-country-code=\"NF\" >\u00cele Norfolk<\/option><option value=\"\u00cele de la R\u00e9union\" data-country-code=\"RE\" >\u00cele de la R\u00e9union<\/option><option value=\"\u00celes Ca\u00efmans\" data-country-code=\"KY\" >\u00celes Ca\u00efmans<\/option><option value=\"\u00celes Cocos\" data-country-code=\"CC\" >\u00celes Cocos<\/option><option value=\"\u00celes Cook\" data-country-code=\"CK\" >\u00celes Cook<\/option><option value=\"\u00celes Falkland\" data-country-code=\"FK\" >\u00celes Falkland<\/option><option value=\"\u00celes F\u00e9ro\u00e9\" data-country-code=\"FO\" >\u00celes F\u00e9ro\u00e9<\/option><option value=\"\u00celes Mariannes du Nord\" data-country-code=\"MP\" >\u00celes Mariannes du Nord<\/option><option value=\"\u00celes Marshall\" data-country-code=\"MH\" >\u00celes Marshall<\/option><option value=\"\u00celes Pitcairn\" data-country-code=\"PN\" >\u00celes Pitcairn<\/option><option value=\"\u00celes Salomon\" data-country-code=\"SB\" >\u00celes Salomon<\/option><option value=\"\u00celes Turques-et-Ca\u00efques\" data-country-code=\"TC\" >\u00celes Turques-et-Ca\u00efques<\/option><option value=\"\u00celes Vierges am\u00e9ricaines\" data-country-code=\"VI\" >\u00celes Vierges am\u00e9ricaines<\/option><option value=\"\u00celes Vierges britanniques\" data-country-code=\"VG\" >\u00celes Vierges britanniques<\/option><option value=\"\u00celes Wallis et Futuna\" data-country-code=\"WF\" >\u00celes Wallis et Futuna<\/option><option value=\"\u00celes mineures \u00e9loign\u00e9es des \u00c9tats-Unis\" data-country-code=\"UM\" >\u00celes mineures \u00e9loign\u00e9es des \u00c9tats-Unis<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"captcha-1\" class=\"forminator-field-captcha  forminator-col-6 \"><div class=\"forminator-captcha-left forminator-g-recaptcha recaptcha-invisible\" data-theme=\"light\" data-badge=\"bottomright\" data-sitekey=\"6Lf2UkApAAAAAG7Kj_tF8X3y7nW5fPOjscOjbQyV\" data-size=\"invisible\"><\/div> <\/div><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_6a0bf6fd62f00\" id=\"forminator-field-date-1-picker_6a0bf6fd62f00-label\" class=\"forminator-label\">Date de naissance <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"j\/m\/A\" id=\"forminator-field-date-1-picker_6a0bf6fd62f00\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd\/mm\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" aria-describedby=\"forminator-field-date-1-picker_6a0bf6fd62f00-description\" \/><\/div><span id=\"forminator-field-date-1-picker_6a0bf6fd62f00-description\" class=\"forminator-description\">Date de naissance de votre enfant<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6a0bf6fd62f00\" id=\"forminator-field-textarea-2_6a0bf6fd62f00-label\" class=\"forminator-label\">Remarque \u00e9ventuelle<\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_6a0bf6fd62f00\" class=\"forminator-textarea\" rows=\"6\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Envoyer le message<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"40322abc30\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/123\" \/><input type=\"hidden\" name=\"form_id\" value=\"1616\"><input type=\"hidden\" name=\"page_id\" value=\"123\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/www.couraubois.be\/index.php\/stage\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Pendants les vacances scolaires nous organisons des stages pour vos enfants (voir date au bar et sur notre site). Voici les renseignements demand\u00e9s par votre comptabilit\u00e9. Merci de bien remplir le formulaire au complet.Il peut y avoir plusieurs formulaires \u00e0 la suite l\u2019un de l&rsquo;autre, s\u00e9lectionner celui qui correspond au stage d\u00e9sir\u00e9. 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