{"id":3506,"date":"2016-07-18T19:19:39","date_gmt":"2016-07-18T19:19:39","guid":{"rendered":"http:\/\/maisonsudburyhospice.org\/?page_id=3506"},"modified":"2025-02-03T15:09:08","modified_gmt":"2025-02-03T20:09:08","slug":"become-a-volunteer","status":"publish","type":"page","link":"https:\/\/maisonsudburyhospice.org\/fr\/become-a-volunteer\/","title":{"rendered":"Formulaire de candidature pour le b\u00e9n\u00e9volat"},"content":{"rendered":"[vc_row type=\u00a0\u00bbin_container\u00a0\u00bb full_screen_row_position=\u00a0\u00bbmiddle\u00a0\u00bb column_margin=\u00a0\u00bbdefault\u00a0\u00bb column_direction=\u00a0\u00bbdefault\u00a0\u00bb column_direction_tablet=\u00a0\u00bbdefault\u00a0\u00bb column_direction_phone=\u00a0\u00bbdefault\u00a0\u00bb scene_position=\u00a0\u00bbcenter\u00a0\u00bb text_color=\u00a0\u00bbdark\u00a0\u00bb text_align=\u00a0\u00bbleft\u00a0\u00bb row_border_radius=\u00a0\u00bbnone\u00a0\u00bb row_border_radius_applies=\u00a0\u00bbbg\u00a0\u00bb overflow=\u00a0\u00bbvisible\u00a0\u00bb overlay_strength=\u00a0\u00bb0.3&Prime; 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overlay_strength=\u00a0\u00bb0.3&Prime; gradient_direction=\u00a0\u00bbleft_to_right\u00a0\u00bb shape_divider_position=\u00a0\u00bbbottom\u00a0\u00bb bg_image_animation=\u00a0\u00bbnone\u00a0\u00bb gradient_type=\u00a0\u00bbdefault\u00a0\u00bb shape_type=\u00a0\u00bb\u00a0\u00bb][vc_column column_padding=\u00a0\u00bbno-extra-padding\u00a0\u00bb column_padding_tablet=\u00a0\u00bbinherit\u00a0\u00bb column_padding_phone=\u00a0\u00bbinherit\u00a0\u00bb column_padding_position=\u00a0\u00bball\u00a0\u00bb column_element_spacing=\u00a0\u00bbdefault\u00a0\u00bb background_color_opacity=\u00a0\u00bb1&Prime; background_hover_color_opacity=\u00a0\u00bb1&Prime; column_shadow=\u00a0\u00bbnone\u00a0\u00bb column_border_radius=\u00a0\u00bbnone\u00a0\u00bb column_link_target=\u00a0\u00bb_self\u00a0\u00bb column_position=\u00a0\u00bbdefault\u00a0\u00bb gradient_direction=\u00a0\u00bbleft_to_right\u00a0\u00bb overlay_strength=\u00a0\u00bb0.3&Prime; width=\u00a0\u00bb1\/1&Prime; tablet_width_inherit=\u00a0\u00bbdefault\u00a0\u00bb tablet_text_alignment=\u00a0\u00bbdefault\u00a0\u00bb phone_text_alignment=\u00a0\u00bbdefault\u00a0\u00bb animation_type=\u00a0\u00bbdefault\u00a0\u00bb bg_image_animation=\u00a0\u00bbnone\u00a0\u00bb border_type=\u00a0\u00bbsimple\u00a0\u00bb column_border_width=\u00a0\u00bbnone\u00a0\u00bb column_border_style=\u00a0\u00bbsolid\u00a0\u00bb][vc_column_text]\n<h2>Formulaire de candidature pour le b\u00e9n\u00e9volat<\/h2>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row type=\u00a0\u00bbin_container\u00a0\u00bb full_screen_row_position=\u00a0\u00bbmiddle\u00a0\u00bb column_margin=\u00a0\u00bbnone\u00a0\u00bb equal_height=\u00a0\u00bbyes\u00a0\u00bb content_placement=\u00a0\u00bbmiddle\u00a0\u00bb column_direction=\u00a0\u00bbdefault\u00a0\u00bb column_direction_tablet=\u00a0\u00bbdefault\u00a0\u00bb column_direction_phone=\u00a0\u00bbdefault\u00a0\u00bb bg_color=\u00a0\u00bb#ffffff\u00a0\u00bb scene_position=\u00a0\u00bbcenter\u00a0\u00bb text_color=\u00a0\u00bbdark\u00a0\u00bb text_align=\u00a0\u00bbleft\u00a0\u00bb row_border_radius=\u00a0\u00bbnone\u00a0\u00bb row_border_radius_applies=\u00a0\u00bbbg\u00a0\u00bb overflow=\u00a0\u00bbvisible\u00a0\u00bb advanced_gradient_angle=\u00a0\u00bb0&Prime; 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width=\u00a0\u00bb1\/2&Prime; tablet_width_inherit=\u00a0\u00bbdefault\u00a0\u00bb tablet_text_alignment=\u00a0\u00bbdefault\u00a0\u00bb phone_text_alignment=\u00a0\u00bbdefault\u00a0\u00bb animation_type=\u00a0\u00bbdefault\u00a0\u00bb bg_image_animation=\u00a0\u00bbnone\u00a0\u00bb border_type=\u00a0\u00bbsimple\u00a0\u00bb column_border_width=\u00a0\u00bbnone\u00a0\u00bb column_border_style=\u00a0\u00bbsolid\u00a0\u00bb gradient_type=\u00a0\u00bbdefault\u00a0\u00bb][vc_row_inner column_margin=\u00a0\u00bbdefault\u00a0\u00bb column_direction=\u00a0\u00bbdefault\u00a0\u00bb column_direction_tablet=\u00a0\u00bbdefault\u00a0\u00bb column_direction_phone=\u00a0\u00bbdefault\u00a0\u00bb text_align=\u00a0\u00bbleft\u00a0\u00bb row_position=\u00a0\u00bbdefault\u00a0\u00bb row_position_tablet=\u00a0\u00bbinherit\u00a0\u00bb row_position_phone=\u00a0\u00bbinherit\u00a0\u00bb overflow=\u00a0\u00bbvisible\u00a0\u00bb pointer_events=\u00a0\u00bball\u00a0\u00bb][vc_column_inner column_padding=\u00a0\u00bbno-extra-padding\u00a0\u00bb column_padding_tablet=\u00a0\u00bbinherit\u00a0\u00bb column_padding_phone=\u00a0\u00bbinherit\u00a0\u00bb column_padding_position=\u00a0\u00bball\u00a0\u00bb column_element_spacing=\u00a0\u00bbdefault\u00a0\u00bb background_color_opacity=\u00a0\u00bb1&Prime; background_hover_color_opacity=\u00a0\u00bb1&Prime; column_shadow=\u00a0\u00bbnone\u00a0\u00bb column_border_radius=\u00a0\u00bbnone\u00a0\u00bb column_link_target=\u00a0\u00bb_self\u00a0\u00bb gradient_direction=\u00a0\u00bbleft_to_right\u00a0\u00bb overlay_strength=\u00a0\u00bb0.3&Prime; width=\u00a0\u00bb1\/1&Prime; tablet_width_inherit=\u00a0\u00bbdefault\u00a0\u00bb animation_type=\u00a0\u00bbdefault\u00a0\u00bb enable_animation=\u00a0\u00bbtrue\u00a0\u00bb animation=\u00a0\u00bbfade-in-from-bottom\u00a0\u00bb bg_image_animation=\u00a0\u00bbnone\u00a0\u00bb border_type=\u00a0\u00bbsimple\u00a0\u00bb column_border_width=\u00a0\u00bbnone\u00a0\u00bb column_border_style=\u00a0\u00bbsolid\u00a0\u00bb][vc_custom_heading text=\u00a0\u00bbNotez bien\u00a0\u00bb font_container=\u00a0\u00bbtag:h5|text_align:left|color:%238cc63f\u00a0\u00bb use_theme_fonts=\u00a0\u00bbyes\u00a0\u00bb css=\u00a0\u00bb.vc_custom_1632256807678{margin-bottom: 10px !important;}\u00a0\u00bb][vc_column_text]<span lang=\"FR-CA\">Nous vous remercions de votre int\u00e9r\u00eat de vouloir contribuer au fonctionnement de notre maison de soins palliatifs. En ce moment, nous recrutons SEULEMENT des b\u00e9n\u00e9voles pour les postes suivants : le jardinage et des visiteurs b\u00e9n\u00e9voles communautaire dans la r\u00e9gion de la Rivi\u00e8re des Fran\u00e7ais (Markstay, Hagar, St-Charles, Noelville et Alban) aussi dans la r\u00e9gion de Valley East (Capreol, Hanmer et Val Caron). Veuillez v\u00e9rifier de nouveau notre siteweb, car nos besoins pour des b\u00e9n\u00e9voles changent p\u00e9riodiquement.\u00a0 Si vous avez du temps, de l&rsquo;exp\u00e9rience et des comp\u00e9tences que vous aimeriez partager avec nous, veuillez remplir notre formulaire de demande de b\u00e9n\u00e9volat. Nous communiquerons avec les candidats qui r\u00e9pondent aux besoins de la Maison pour une entrevue.\u00a0<\/span><\/p>\n<p>Merci[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_column][vc_column column_padding=\u00a0\u00bbno-extra-padding\u00a0\u00bb column_padding_tablet=\u00a0\u00bbinherit\u00a0\u00bb column_padding_phone=\u00a0\u00bbinherit\u00a0\u00bb column_padding_position=\u00a0\u00bball\u00a0\u00bb column_element_spacing=\u00a0\u00bbdefault\u00a0\u00bb background_color_opacity=\u00a0\u00bb1&Prime; background_hover_color_opacity=\u00a0\u00bb1&Prime; background_image=\u00a0\u00bb3524&Prime; background_image_position=\u00a0\u00bbcenter center\u00a0\u00bb enable_bg_scale=\u00a0\u00bbtrue\u00a0\u00bb background_image_loading=\u00a0\u00bbdefault\u00a0\u00bb column_shadow=\u00a0\u00bbnone\u00a0\u00bb column_border_radius=\u00a0\u00bbnone\u00a0\u00bb column_link_target=\u00a0\u00bb_self\u00a0\u00bb column_position=\u00a0\u00bbdefault\u00a0\u00bb 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gradient_direction=\u00a0\u00bbleft_to_right\u00a0\u00bb overlay_strength=\u00a0\u00bb0.3&Prime; width=\u00a0\u00bb1\/1&Prime; tablet_width_inherit=\u00a0\u00bbdefault\u00a0\u00bb tablet_text_alignment=\u00a0\u00bbdefault\u00a0\u00bb phone_text_alignment=\u00a0\u00bbdefault\u00a0\u00bb animation_type=\u00a0\u00bbdefault\u00a0\u00bb bg_image_animation=\u00a0\u00bbnone\u00a0\u00bb border_type=\u00a0\u00bbsimple\u00a0\u00bb column_border_width=\u00a0\u00bbnone\u00a0\u00bb column_border_style=\u00a0\u00bbsolid\u00a0\u00bb]\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_2' >\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">B\u00e9n\u00e9vole<\/h3>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_2'  action='\/fr\/wp-json\/wp\/v2\/pages\/3506' data-formid='2' novalidate> \r\n <input type='hidden' class='gforms-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/>\n                        <div class='gform-body gform_body'><ul id='gform_fields_2' class='gform_fields left_label form_sublabel_below description_below validation_below'><li id=\"field_2_5\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_5\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Nom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_2_5'>\n                            \n                            <span id='input_2_5_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.3' id='input_2_5_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_2_5_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_2_5_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.6' id='input_2_5_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_2_5_6' class='gform-field-label gform-field-label--type-sub '>Surnom<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_2_3\" class=\"gfield gfield--type-address field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_3\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Addresse<\/label>    \n                    <div class='ginput_complex ginput_container has_city has_state has_zip ginput_container_address gform-grid-row' id='input_2_3' >\n                        <span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_2_3_3_container' >\n                                    <input type='text' name='input_3.3' id='input_2_3_3' value=''    aria-required='false'    \/>\n                                    <label for='input_2_3_3' id='input_2_3_3_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_2_3_4_container' >\n                                        <select name='input_3.4' id='input_2_3_4'     aria-required='false'    ><option value='' selected='selected'><\/option><option value='Alberta' >Alberta<\/option><option value='Colombie-Britannique' >Colombie-Britannique<\/option><option value='Manitoba' >Manitoba<\/option><option value='Nouveau-Brunswick' >Nouveau-Brunswick<\/option><option value='Terre-Neuve-et-Labrador' >Terre-Neuve-et-Labrador<\/option><option value='Territoires du Nord-Ouest' >Territoires du Nord-Ouest<\/option><option value='Nouvelle-\u00c9cosse' >Nouvelle-\u00c9cosse<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' >Ontario<\/option><option value='\u00cele du Prince-\u00c9douard' >\u00cele du Prince-\u00c9douard<\/option><option value='Qu\u00e9bec' >Qu\u00e9bec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><\/select>\n                                        <label for='input_2_3_4' id='input_2_3_4_label' class='gform-field-label gform-field-label--type-sub '>Province<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_2_3_5_container' >\n                                    <input type='text' name='input_3.5' id='input_2_3_5' value=''    aria-required='false'    \/>\n                                    <label for='input_2_3_5' id='input_2_3_5_label' class='gform-field-label gform-field-label--type-sub '>Code postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_3.6' id='input_2_3_6' value='Pays' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_2_6\" class=\"gfield gfield--type-phone gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_6\" ><label class='gfield_label gform-field-label' for='input_2_6'>T\u00e9l\u00e9phone (domicile)<\/label><div class='ginput_container ginput_container_phone'><input name='input_6' id='input_2_6' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_7\" class=\"gfield gfield--type-phone gf_right_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_7\" ><label class='gfield_label gform-field-label' for='input_2_7'>T\u00e9l\u00e9phone (Cellulaire)<\/label><div class='ginput_container ginput_container_phone'><input name='input_7' id='input_2_7' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_4\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_4\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Courriel<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_2_4_container'>\n                                <span id='input_2_4_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_4' id='input_2_4' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_2_4' class='gform-field-label gform-field-label--type-sub '>Votre courriel<\/label>\n                                <\/span>\n                                <span id='input_2_4_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_4_2' id='input_2_4_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_2_4_2' class='gform-field-label gform-field-label--type-sub '>Confirmer votre courriel<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/li><li id=\"field_2_60\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_60\" ><h2 class=\"gsection_title\">Contacte d&#039;urgence (Primaire)<\/h2><\/li><li id=\"field_2_54\" class=\"gfield gfield--type-name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_54\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Nom<\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_2_54'>\n                            \n                            <span id='input_2_54_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_54.3' id='input_2_54_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_2_54_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_2_54_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_54.6' id='input_2_54_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_2_54_6' class='gform-field-label gform-field-label--type-sub '>Surnom<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_2_55\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_55\" ><label class='gfield_label gform-field-label' for='input_2_55'>Relation<\/label><div class='ginput_container ginput_container_text'><input name='input_55' id='input_2_55' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_56\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_56\" ><label class='gfield_label gform-field-label' for='input_2_56'>Domcile #<\/label><div class='ginput_container ginput_container_phone'><input name='input_56' id='input_2_56' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_57\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_57\" ><label class='gfield_label gform-field-label' for='input_2_57'>Travail #<\/label><div class='ginput_container ginput_container_phone'><input name='input_57' id='input_2_57' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_58\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_58\" ><label class='gfield_label gform-field-label' for='input_2_58'>t\u00e9l. cell. #<\/label><div class='ginput_container ginput_container_phone'><input name='input_58' id='input_2_58' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_61\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_61\" ><h2 class=\"gsection_title\">Contacte d&#039;urgence (Secondaire)<\/h2><\/li><li id=\"field_2_62\" class=\"gfield gfield--type-name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_62\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Nom<\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_2_62'>\n                            \n                            <span id='input_2_62_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_62.3' id='input_2_62_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_2_62_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_2_62_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_62.6' id='input_2_62_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_2_62_6' class='gform-field-label gform-field-label--type-sub '>Surnom<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_2_63\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_63\" ><label class='gfield_label gform-field-label' for='input_2_63'>Relation<\/label><div class='ginput_container ginput_container_text'><input name='input_63' id='input_2_63' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_66\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_66\" ><label class='gfield_label gform-field-label' for='input_2_66'>Domicile #<\/label><div class='ginput_container ginput_container_phone'><input name='input_66' id='input_2_66' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_65\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_65\" ><label class='gfield_label gform-field-label' for='input_2_65'>Travail #<\/label><div class='ginput_container ginput_container_phone'><input name='input_65' id='input_2_65' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_64\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_64\" ><label class='gfield_label gform-field-label' for='input_2_64'>t\u00e9l. cell. #<\/label><div class='ginput_container ginput_container_phone'><input name='input_64' id='input_2_64' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_2_8\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_8\" ><label class='gfield_label gform-field-label' >Peut-on vous contacter au travail ?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_8'>\n\t\t\t<li class='gchoice gchoice_2_8_0'>\n\t\t\t\t<input name='input_8' type='radio' value='Oui'  id='choice_2_8_0'    \/>\n\t\t\t\t<label for='choice_2_8_0' id='label_2_8_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_8_1'>\n\t\t\t\t<input name='input_8' type='radio' value='Non'  id='choice_2_8_1'    \/>\n\t\t\t\t<label for='choice_2_8_1' id='label_2_8_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_1\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_1\" ><h2 class=\"gsection_title\">Postes de b\u00e9n\u00e9volat et pr\u00e9f\u00e9rences<\/h2><\/li><li id=\"field_2_13\" class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_2col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_13\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >N&#039;h\u00e9sitez pas \u00e0 choisir plus qu&#039;un d\u00e9partement, si vous le d\u00e9sirez.<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_2_13'><li class='gchoice gchoice_2_13_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.1' type='checkbox'  value='Pr\u00e9l\u00e8vements de fonds'  id='choice_2_13_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_13_1' id='label_2_13_1' class='gform-field-label gform-field-label--type-inline'>Pr\u00e9l\u00e8vements de fonds<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_13_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.2' type='checkbox'  value='Service de visites en soins palliatifs'  id='choice_2_13_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_13_2' id='label_2_13_2' class='gform-field-label gform-field-label--type-inline'>Service de visites en soins palliatifs<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_13_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.3' type='checkbox'  value='Jardinage'  id='choice_2_13_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_13_3' id='label_2_13_3' class='gform-field-label gform-field-label--type-inline'>Jardinage<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_13_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.4' type='checkbox'  value='Entretien'  id='choice_2_13_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_13_4' id='label_2_13_4' class='gform-field-label gform-field-label--type-inline'>Entretien<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_13_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.5' type='checkbox'  value='Th\u00e9rapie compl\u00e9mentaire&lt;\/br&gt;(e.g. musique, art, m\u00e9ditation, etc.)'  id='choice_2_13_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_13_5' id='label_2_13_5' class='gform-field-label gform-field-label--type-inline'>Th\u00e9rapie compl\u00e9mentaire<\/br>(e.g. musique, art, m\u00e9ditation, etc.)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_13_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.6' type='checkbox'  value='Cuisine'  id='choice_2_13_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_13_6' id='label_2_13_6' class='gform-field-label gform-field-label--type-inline'>Cuisine<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_13_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.7' type='checkbox'  value='\u00c9v\u00e9nements sp\u00e9ciaux'  id='choice_2_13_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_13_7' id='label_2_13_7' class='gform-field-label gform-field-label--type-inline'>\u00c9v\u00e9nements sp\u00e9ciaux<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_13_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.8' type='checkbox'  value='Entretien d\u2019immeuble'  id='choice_2_13_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_13_8' id='label_2_13_8' class='gform-field-label gform-field-label--type-inline'>Entretien d\u2019immeuble<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_13_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.9' type='checkbox'  value='Service de b\u00e9n\u00e9voles-visiteurs&lt;\/br&gt;(formation de 30 h requise)'  id='choice_2_13_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_13_9' id='label_2_13_9' class='gform-field-label gform-field-label--type-inline'>Service de b\u00e9n\u00e9voles-visiteurs<\/br>(formation de 30 h requise)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_13_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.11' type='checkbox'  value='Service de b\u00e9n\u00e9voles r\u00e9sidentiels&lt;\/br&gt;(formation de 30 h requise)'  id='choice_2_13_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_13_11' id='label_2_13_11' class='gform-field-label gform-field-label--type-inline'>Service de b\u00e9n\u00e9voles r\u00e9sidentiels<\/br>(formation de 30 h requise)<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_10\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_10\" ><h2 class=\"gsection_title\">Exp\u00e9rience de travail et \u00e9ducation<\/h2><\/li><li id=\"field_2_11\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_11\" ><label class='gfield_label gform-field-label' >Avez-vous de l\u2019exp\u00e9rience de  b\u00e9n\u00e9volat ?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_11'>\n\t\t\t<li class='gchoice gchoice_2_11_0'>\n\t\t\t\t<input name='input_11' type='radio' value='Oui'  id='choice_2_11_0'    \/>\n\t\t\t\t<label for='choice_2_11_0' id='label_2_11_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_11_1'>\n\t\t\t\t<input name='input_11' type='radio' value='Non'  id='choice_2_11_1'    \/>\n\t\t\t\t<label for='choice_2_11_1' id='label_2_11_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_14\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_14\" ><label class='gfield_label gform-field-label' for='input_2_14'>Si oui, en quelle capacit\u00e9 ?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_14' id='input_2_14' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_2_15\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_15\" ><label class='gfield_label gform-field-label' for='input_2_15'>Veillez d\u00e9crire votre niveau d\u2019\u00e9ducation, vos comp\u00e9tences et vos aptitudes susceptibles d&#039;\u00eatre b\u00e9n\u00e9fiques pour notre organisation.<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_15' id='input_2_15' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_2_16\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_16\" ><h2 class=\"gsection_title\">Language et Culture<\/h2><\/li><li id=\"field_2_17\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_17\" ><label class='gfield_label gform-field-label' >Est-ce que vous parlez, \u00e9crivez ou lisez d\u2019autres langues que le fran\u00e7ais?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_17'>\n\t\t\t<li class='gchoice gchoice_2_17_0'>\n\t\t\t\t<input name='input_17' type='radio' value='Oui'  id='choice_2_17_0'    \/>\n\t\t\t\t<label for='choice_2_17_0' id='label_2_17_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_17_1'>\n\t\t\t\t<input name='input_17' type='radio' value='Non'  id='choice_2_17_1'    \/>\n\t\t\t\t<label for='choice_2_17_1' id='label_2_17_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_18\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_18\" ><label class='gfield_label gform-field-label' for='input_2_18'>Langue parl\u00e9e 1<\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_2_18' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_20\" class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_20\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Comp\u00e9tence linguistique 1<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_2_20'><li class='gchoice gchoice_2_20_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.1' type='checkbox'  value='Parl\u00e9e'  id='choice_2_20_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_20_1' id='label_2_20_1' class='gform-field-label gform-field-label--type-inline'>Parl\u00e9e<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_20_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.2' type='checkbox'  value='Lue'  id='choice_2_20_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_20_2' id='label_2_20_2' class='gform-field-label gform-field-label--type-inline'>Lue<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_20_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.3' type='checkbox'  value='\u00c9crite'  id='choice_2_20_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_20_3' id='label_2_20_3' class='gform-field-label gform-field-label--type-inline'>\u00c9crite<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_19\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_19\" ><label class='gfield_label gform-field-label' for='input_2_19'>Langue parl\u00e9e 2<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_2_19' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_21\" class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_3col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_21\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >Comp\u00e9tence linguistique 2<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_2_21'><li class='gchoice gchoice_2_21_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.1' type='checkbox'  value='Parl\u00e9e'  id='choice_2_21_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_21_1' id='label_2_21_1' class='gform-field-label gform-field-label--type-inline'>Parl\u00e9e<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_21_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.2' type='checkbox'  value='Lue'  id='choice_2_21_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_21_2' id='label_2_21_2' class='gform-field-label gform-field-label--type-inline'>Lue<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_21_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.3' type='checkbox'  value='\u00c9crite'  id='choice_2_21_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_21_3' id='label_2_21_3' class='gform-field-label gform-field-label--type-inline'>\u00c9crite<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_22\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_22\" ><h2 class=\"gsection_title\">Raison pour faire du b\u00e9n\u00e9volat<\/h2><\/li><li id=\"field_2_23\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_23\" ><label class='gfield_label gform-field-label' for='input_2_23'>Pourquoi voulez-vous faire du b\u00e9n\u00e9volat \u00e0 la Maison McCulloch Hospice?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_23' id='input_2_23' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_2_24\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_24\" ><label class='gfield_label gform-field-label' for='input_2_24'>Comment avez-vous entendu parler de la Maison McCulloch Hospice ?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_24' id='input_2_24' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_2_25\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_25\" ><h2 class=\"gsection_title\">Information de base<\/h2><\/li><li id=\"field_2_26\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_26\" ><label class='gfield_label gform-field-label' >Avez-vous de l\u2019exp\u00e9rience avec des personnes en phase terminale?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_26'>\n\t\t\t<li class='gchoice gchoice_2_26_0'>\n\t\t\t\t<input name='input_26' type='radio' value='Oui'  id='choice_2_26_0'    \/>\n\t\t\t\t<label for='choice_2_26_0' id='label_2_26_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_26_1'>\n\t\t\t\t<input name='input_26' type='radio' value='Non'  id='choice_2_26_1'    \/>\n\t\t\t\t<label for='choice_2_26_1' id='label_2_26_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_27\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_27\" ><label class='gfield_label gform-field-label' >Avez-vous perdu un \u00eatre ch\u00e8re au cours de la derni\u00e8re ann\u00e9e?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_27'>\n\t\t\t<li class='gchoice gchoice_2_27_0'>\n\t\t\t\t<input name='input_27' type='radio' value='Oui'  id='choice_2_27_0'    \/>\n\t\t\t\t<label for='choice_2_27_0' id='label_2_27_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_27_1'>\n\t\t\t\t<input name='input_27' type='radio' value='Non'  id='choice_2_27_1'    \/>\n\t\t\t\t<label for='choice_2_27_1' id='label_2_27_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_29\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_29\" ><label class='gfield_label gform-field-label' for='input_2_29'>Relation<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_29' id='input_2_29' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_2_28\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_28\" ><label class='gfield_label gform-field-label' >Avez vous des allergies?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_2_28'>\n\t\t\t<li class='gchoice gchoice_2_28_0'>\n\t\t\t\t<input name='input_28' type='radio' value='Oui'  id='choice_2_28_0'    \/>\n\t\t\t\t<label for='choice_2_28_0' id='label_2_28_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_2_28_1'>\n\t\t\t\t<input name='input_28' type='radio' value='Non'  id='choice_2_28_1'    \/>\n\t\t\t\t<label for='choice_2_28_1' id='label_2_28_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_30\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_30\" ><label class='gfield_label gform-field-label' for='input_2_30'>Si oui, \u00e0 quoi?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_30' id='input_2_30' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_2_31\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_31\" ><h2 class=\"gsection_title\">Quelles sont vos disponibilit\u00e9s?<\/h2><\/li><li id=\"field_2_32\" class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_5col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_32\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >lundi<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_2_32'><li class='gchoice gchoice_2_32_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.1' type='checkbox'  value='Matin'  id='choice_2_32_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_32_1' id='label_2_32_1' class='gform-field-label gform-field-label--type-inline'>Matin<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_32_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.2' type='checkbox'  value='Apr\u00e8s-midi'  id='choice_2_32_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_32_2' id='label_2_32_2' class='gform-field-label gform-field-label--type-inline'>Apr\u00e8s-midi<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_32_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_32.3' type='checkbox'  value='En soir\u00e9e'  id='choice_2_32_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_32_3' id='label_2_32_3' class='gform-field-label gform-field-label--type-inline'>En soir\u00e9e<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_72\" class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_5col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_72\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >mardi<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_2_72'><li class='gchoice gchoice_2_72_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_72.1' type='checkbox'  value='Matin'  id='choice_2_72_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_72_1' id='label_2_72_1' class='gform-field-label gform-field-label--type-inline'>Matin<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_72_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_72.2' type='checkbox'  value='Apr\u00e8s-midi'  id='choice_2_72_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_72_2' id='label_2_72_2' class='gform-field-label gform-field-label--type-inline'>Apr\u00e8s-midi<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_72_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_72.3' type='checkbox'  value='En soir\u00e9e'  id='choice_2_72_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_72_3' id='label_2_72_3' class='gform-field-label gform-field-label--type-inline'>En soir\u00e9e<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_71\" class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_5col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_71\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >mercredi<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_2_71'><li class='gchoice gchoice_2_71_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_71.1' type='checkbox'  value='Matin'  id='choice_2_71_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_71_1' id='label_2_71_1' class='gform-field-label gform-field-label--type-inline'>Matin<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_71_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_71.2' type='checkbox'  value='Apr\u00e8s-midi'  id='choice_2_71_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_71_2' id='label_2_71_2' class='gform-field-label gform-field-label--type-inline'>Apr\u00e8s-midi<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_71_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_71.3' type='checkbox'  value='En soir\u00e9e'  id='choice_2_71_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_71_3' id='label_2_71_3' class='gform-field-label gform-field-label--type-inline'>En soir\u00e9e<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_70\" class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_5col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_70\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >jeudi<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_2_70'><li class='gchoice gchoice_2_70_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_70.1' type='checkbox'  value='Matin'  id='choice_2_70_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_70_1' id='label_2_70_1' class='gform-field-label gform-field-label--type-inline'>Matin<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_70_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_70.2' type='checkbox'  value='Apr\u00e8s-midi'  id='choice_2_70_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_70_2' id='label_2_70_2' class='gform-field-label gform-field-label--type-inline'>Apr\u00e8s-midi<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_70_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_70.3' type='checkbox'  value='En soir\u00e9e'  id='choice_2_70_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_70_3' id='label_2_70_3' class='gform-field-label gform-field-label--type-inline'>En soir\u00e9e<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_69\" class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_5col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_69\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >vendredi<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_2_69'><li class='gchoice gchoice_2_69_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.1' type='checkbox'  value='Matin'  id='choice_2_69_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_69_1' id='label_2_69_1' class='gform-field-label gform-field-label--type-inline'>Matin<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_69_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.2' type='checkbox'  value='Apr\u00e8s-midi'  id='choice_2_69_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_69_2' id='label_2_69_2' class='gform-field-label gform-field-label--type-inline'>Apr\u00e8s-midi<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_69_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_69.3' type='checkbox'  value='En soir\u00e9e'  id='choice_2_69_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_69_3' id='label_2_69_3' class='gform-field-label gform-field-label--type-inline'>En soir\u00e9e<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_68\" class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_5col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_68\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >samedi<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_2_68'><li class='gchoice gchoice_2_68_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_68.1' type='checkbox'  value='Matin'  id='choice_2_68_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_68_1' id='label_2_68_1' class='gform-field-label gform-field-label--type-inline'>Matin<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_68_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_68.2' type='checkbox'  value='Apr\u00e8s-midi'  id='choice_2_68_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_68_2' id='label_2_68_2' class='gform-field-label gform-field-label--type-inline'>Apr\u00e8s-midi<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_68_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_68.3' type='checkbox'  value='En soir\u00e9e'  id='choice_2_68_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_68_3' id='label_2_68_3' class='gform-field-label gform-field-label--type-inline'>En soir\u00e9e<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_67\" class=\"gfield gfield--type-checkbox gfield--type-choice gf_list_5col field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_67\" ><label class='gfield_label gform-field-label gfield_label_before_complex' >dimanche<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_2_67'><li class='gchoice gchoice_2_67_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.1' type='checkbox'  value='Matin'  id='choice_2_67_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_67_1' id='label_2_67_1' class='gform-field-label gform-field-label--type-inline'>Matin<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_67_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.2' type='checkbox'  value='Apr\u00e8s-midi'  id='choice_2_67_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_67_2' id='label_2_67_2' class='gform-field-label gform-field-label--type-inline'>Apr\u00e8s-midi<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_2_67_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_67.3' type='checkbox'  value='En soir\u00e9e'  id='choice_2_67_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_2_67_3' id='label_2_67_3' class='gform-field-label gform-field-label--type-inline'>En soir\u00e9e<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_2_39\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_39\" ><h2 class=\"gsection_title\">R\u00e9f\u00e9rences<\/h2><\/li><li id=\"field_2_40\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_40\" >Veuillez fournir deux r\u00e9f\u00e9rences (autre qu'un membre de la famille).<\/li><li id=\"field_2_41\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_41\" ><label class='gfield_label gform-field-label' for='input_2_41'>Nom 1<\/label><div class='ginput_container ginput_container_text'><input name='input_41' id='input_2_41' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_44\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_44\" ><label class='gfield_label gform-field-label' for='input_2_44'>Nature de la relation 1<\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_2_44' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_50\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_50\" ><label class='gfield_label gform-field-label' for='input_2_50'>Courriel 1<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_50' id='input_2_50' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_2_42\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_42\" ><label class='gfield_label gform-field-label' for='input_2_42'>T\u00e9l\u00e9phone 1<\/label><div class='ginput_container ginput_container_text'><input name='input_42' id='input_2_42' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_43\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_43\" ><label class='gfield_label gform-field-label' for='input_2_43'>Nom 2<\/label><div class='ginput_container ginput_container_text'><input name='input_43' id='input_2_43' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_51\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_51\" ><label class='gfield_label gform-field-label' for='input_2_51'>Courriel 2<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_51' id='input_2_51' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_2_45\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_45\" ><label class='gfield_label gform-field-label' for='input_2_45'>T\u00e9l\u00e9phone 2<\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_2_45' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_46\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_46\" ><label class='gfield_label gform-field-label' for='input_2_46'>Nature de la relation 2<\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_2_46' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_2_49\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_2_49\" ><p>Afin de maintenir l\u2019int\u00e9grit\u00e9 de la Maison McCulloch Hospice et pour la protection des r\u00e9sident(e)s\/client(e)s et leurs familles, la proc\u00e9dure de s\u00e9lection comprendra une entrevue, la v\u00e9rification de vos r\u00e9f\u00e9rences et une v\u00e9rification 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