{"id":8864,"date":"2020-06-23T23:40:52","date_gmt":"2020-06-23T21:40:52","guid":{"rendered":"https:\/\/www.accompagner.be\/vraag-voor-een-ambulante-begeleinding\/"},"modified":"2024-03-18T14:20:28","modified_gmt":"2024-03-18T13:20:28","slug":"aanvraag-om-een-begeleiding","status":"publish","type":"page","link":"https:\/\/test.accompagner.be\/nl\/aanvraag-om-een-begeleiding\/","title":{"rendered":"Aanvraag om een begeleiding"},"content":{"rendered":"\n<div>Vous pouvez <u>remplir<\/u> <u>ce formulaire en<\/u>\n<div role=\"navigation\" aria-label=\"Taalschakelaar\" class=\"wpml-ls-statics-footer wpml-ls wpml-ls-legacy-list-horizontal\">\n\t<ul><li class=\"wpml-ls-slot-footer wpml-ls-item wpml-ls-item-fr wpml-ls-first-item wpml-ls-item-legacy-list-horizontal\">\n\t\t\t\t<a href=\"https:\/\/test.accompagner.be\/fr\/\" hreflang=\"fr\" lang=\"fr\" class=\"wpml-ls-link\" aria-label=\"Overschakelen naar Fran\u00e7ais\" title=\"Overschakelen naar Fran\u00e7ais\">\n\t\t\t\t\t<span class=\"wpml-ls-native\">Fran\u00e7ais<\/span><\/a>\n\t\t\t<\/li><li class=\"wpml-ls-slot-footer wpml-ls-item wpml-ls-item-en wpml-ls-last-item wpml-ls-item-legacy-list-horizontal\">\n\t\t\t\t<a href=\"https:\/\/test.accompagner.be\/en\/\" hreflang=\"en\" lang=\"en\" class=\"wpml-ls-link\" aria-label=\"Overschakelen naar English\" title=\"Overschakelen naar English\">\n\t\t\t\t\t<span class=\"wpml-ls-native\">English<\/span><\/a>\n\t\t\t<\/li><\/ul>\n<\/div>\n.<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">De ruimtes van het formulier met een <span style=\"color:#cf2e2e\" class=\"tadv-color\">*<\/span> moeten ingevuld worden en mogen dus niet blanco gelaten worden. Het zijn essenti\u00eble gegevens voor het openen van een dossier en een goed verloop van een begeleiding. Onze Organisatie en onze vrijwilligers zijn gebonden aan het beroepsgeheim. Onze Organisatie en onze vrijwilligers zijn gebonden aan het beroepsgeheim. Gelieve rekening te houden dat onze vrijwilligers uw begunstigde niet op persoonlijk vlak kennen. SAls u tijd wilt besparen met uw volgende verzoeken, moet u de optie voor automatisch aanvullen in uw browser activeren (Google Chrome, Mozilla Forefox, Internet Explorer 7 en 8, Microsoft Edge). Om dat te doen opent u de <a aria-label=\"undefined (s\u2019ouvre dans un nouvel onglet)\" rel=\"noreferrer noopener\" href=\"http:\/\/www.accompagner.be\/wp-content\/uploads\/FORPARINT-Saisie-Automatique-Internet_NL.pdf\" target=\"_blank\">gids<\/a> en volgt u de procedure overeenkomstig de door u gebruikte browser. <b>Opgepast:<\/b> om te vermijden dat het bevestigingsformulier bij uw SPAM-berichten terechtkomt, doet u er goed aan om het mailadres <a href=\"mailto:info.saa@accompagner.be\">info.saa@accompager.be<\/a> in uw adresboek op te slagen. Neem contact met ons op voor meer informatie <strong>02\/580.20.33<\/strong> (9.00 tot 16.00 uur).<\/p>\n\n\n\n<div class=\"wp-block-columns has-pale-cyan-blue-background-color has-background is-layout-flex wp-container-core-columns-is-layout-8f761849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:100%\">\n<h4 class=\"has-text-align-center wp-block-heading\"><a href=\"https:\/\/accompagner.be\/wp-content\/uploads\/FORPARCGC_Conditions_generales_collaboration_2023_NL.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Voorwaarden voor samenwerking<\/strong><\/a><\/h4>\n\n\n\n<h4 class=\"has-text-align-center wp-block-heading\"><a href=\"https:\/\/accompagner.be\/wp-content\/uploads\/Clauses-de-sous-traitance.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Clause de Sous-traitance<\/strong><\/a><\/h4>\n<\/div>\n<\/div>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<p class=\"wp-block-paragraph\">\n\n<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-6401\"><form id=\"wpforms-form-6401\" class=\"wpforms-validate wpforms-form\" data-formid=\"6401\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/nl\/wp-json\/wp\/v2\/pages\/8864\"><div class=\"wpforms-field-container\"><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_26-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"26\"><h3 id=\"wpforms-6401-field_26\" name=\"wpforms[fields][26]\">Vos coordonn\u00e9es [Institution demandant l&#039;accompagnement]<\/h3><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_6-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_6\">Pr\u00e9nom et nom du travailleur <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-6401-field_6\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][6][first]\" placeholder=\"Pr\u00e9nom du travailleur\" required><label for=\"wpforms-6401-field_6\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-6401-field_6-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][6][last]\" placeholder=\"Nom du travailleur\" required><label for=\"wpforms-6401-field_6-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_11\">Nom de l\u2019institution sollicitant l\u2019accompagnement <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" required><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_13-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_13\">Nom de votre service<\/label><input type=\"text\" id=\"wpforms-6401-field_13\" class=\"wpforms-field-medium\" name=\"wpforms[fields][13]\" ><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_7-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_7\">Votre adresse mail <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"email\" id=\"wpforms-6401-field_7\" class=\"wpforms-field-required wpforms-field-email-primary\" name=\"wpforms[fields][7][primary]\" required><label for=\"wpforms-6401-field_7\" class=\"wpforms-field-sublabel after \">Email<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"email\" id=\"wpforms-6401-field_7-secondary\" class=\"wpforms-field-email-secondary wpforms-field-required\" data-rule-confirm=\"#wpforms-6401-field_7\" name=\"wpforms[fields][7][secondary]\" required><label for=\"wpforms-6401-field_7-secondary\" class=\"wpforms-field-sublabel after \">Confirm Email<\/label><\/div><\/div><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_98-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"98\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_98\">Adresse mail d&#039;un.e coll\u00e8gue si je suis absent.e <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"email\" id=\"wpforms-6401-field_98\" class=\"wpforms-field-required wpforms-field-email-primary\" name=\"wpforms[fields][98][primary]\" required><label for=\"wpforms-6401-field_98\" class=\"wpforms-field-sublabel after \">Email<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"email\" id=\"wpforms-6401-field_98-secondary\" class=\"wpforms-field-email-secondary wpforms-field-required\" data-rule-confirm=\"#wpforms-6401-field_98\" name=\"wpforms[fields][98][secondary]\" required><label for=\"wpforms-6401-field_98-secondary\" class=\"wpforms-field-sublabel after \">Confirm Email<\/label><\/div><\/div><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_78-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"78\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_78\">Num\u00e9ro de t\u00e9l\u00e9phone auquel vous joindre  <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_78\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][78]\" required><div class=\"wpforms-field-description\">Num\u00e9ro de t\u00e9l\u00e9phone belge fixe ou gsm.<\/div><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_20-container\" class=\"wpforms-field wpforms-field-divider h5\" data-field-id=\"20\"><h3 id=\"wpforms-6401-field_20\" name=\"wpforms[fields][20]\">Coordonn\u00e9es du b\u00e9n\u00e9ficiaire de l&#039;accompagnement<\/h3><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_16-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_16\">Pr\u00e9nom et nom de l&#039;usager <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-6401-field_16\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][16][first]\" required><label for=\"wpforms-6401-field_16\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-6401-field_16-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][16][last]\" required><label for=\"wpforms-6401-field_16-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_79-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"79\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_79\">Son num\u00e9ro de t\u00e9l\u00e9phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_79\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][79]\" required><div class=\"wpforms-field-description\">Num\u00e9ro de t\u00e9l\u00e9phone belge Fixe ou Gsm.<\/div><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_19-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_19\">Est-ce la 1\u00e8re demande pour cette personne ?  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_19\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_19_1\" name=\"wpforms[fields][19]\" value=\"Oui\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_19_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_19_2\" name=\"wpforms[fields][19]\" value=\"Non\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_19_2\">Non<\/label><\/li><\/ul><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_23-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"23\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_23\">Veuillez confirmer que le b\u00e9n\u00e9ficiaire est inform\u00e9 de la raison pour laquelle un accompagnement est demand\u00e9 ; qu&#039;il consent \u00e0 la mani\u00e8re dont l&#039;information et les donn\u00e9es personnelles circulent entre votre service et Les Amis d&#039;Accompagner. <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_23\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-6401-field_23_1\" name=\"wpforms[fields][23][]\" value=\"Oui\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_23_1\">Oui<\/label><\/li><\/ul><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_24-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"24\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_24\">Sexe <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_24\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_24_1\" name=\"wpforms[fields][24]\" value=\"H\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_24_1\">H<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_24_2\" name=\"wpforms[fields][24]\" value=\"F\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_24_2\">F<\/label><\/li><\/ul><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_25-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"25\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_25\">Sa date de naissance <span class=\"wpforms-required-label\">*<\/span><\/label><select name=\"wpforms[fields][25][date][d]\" id=\"wpforms-field_25-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][25][date][m]\" id=\"wpforms-field_25-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][25][date][y]\" id=\"wpforms-field_25-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_28-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"28\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_28\">Son adresse <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_28\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][28]\" placeholder=\"Si n\u00e9cessaire, merci de bien d\u00e9tailler cette adresse : sonnette, n\u00b0, \u00e9tage, etc\" required><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_29-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"29\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_29\">Sa nationalit\u00e9 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_29\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][29]\" required><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_30-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"30\" style=\"display:none;\"><div id=\"wpforms-6401-field_30\"><div><hr style=\"border-top: 2px dashed red;\" ;=\"\"> --- Si votre b\u00e9n\u00e9ficiaire n'est pas belge ou naturalis\u00e9 belge ---<\/div><\/div><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_31-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"31\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_31\">Sa date d&#039;arriv\u00e9e en Belgique<\/label><select name=\"wpforms[fields][31][date][d]\" id=\"wpforms-field_31-day\" class=\"wpforms-field-date-time-date-day\" ><option class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][31][date][m]\" id=\"wpforms-field_31-month\" class=\"wpforms-field-date-time-date-month\" ><option class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][31][date][y]\" id=\"wpforms-field_31-year\" class=\"wpforms-field-date-time-date-year\" ><option class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_32-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"32\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_32\">Son titre de s\u00e9jour <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-6401-field_32\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][32]\" required=\"required\"><option value=\"-- Choisir --\" >-- Choisir --<\/option><option value=\"Autorisation provisoire de s\u00e9jour\" >Autorisation provisoire de s\u00e9jour<\/option><option value=\"Carte de r\u00e9fugi\u00e9(e)\" >Carte de r\u00e9fugi\u00e9(e)<\/option><option value=\"Demande d&#039;asile\" >Demande d&#039;asile<\/option><option value=\"Demande de r\u00e9gularisation\" >Demande de r\u00e9gularisation<\/option><option value=\"Inscrit au Registre des \u00e9trangers\" >Inscrit au Registre des \u00e9trangers<\/option><option value=\"Sans statut\" >Sans statut<\/option><\/select><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_36-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"36\" style=\"display:none;\"><div id=\"wpforms-6401-field_36\"><hr style=\"border-top: 2px dashed red;\"><\/div><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_34-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"34\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_34\">Origine de ses ressources  <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-6401-field_34\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][34]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Il s&#039;agit de la ressource principale de votre usager<\/option><option value=\"Travail\" >Travail<\/option><option value=\"Allocation de ch\u00f4mage\" >Allocation de ch\u00f4mage<\/option><option value=\"Revenu d&#039;int\u00e9gration (CPAS)\" >Revenu d&#039;int\u00e9gration (CPAS)<\/option><option value=\"Pension de retraite\" >Pension de retraite<\/option><option value=\"Allocations familiales\" >Allocations familiales<\/option><option value=\"Pension alimentaire\" >Pension alimentaire<\/option><option value=\"Bourse d&#039;\u00e9tude\" >Bourse d&#039;\u00e9tude<\/option><option value=\"Sans revenus\" >Sans revenus<\/option><option value=\"Autre\" >Autre<\/option><\/select><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_77-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"77\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_77\">Veuillez pr\u00e9cisez <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_77\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][77]\" required><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_104-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"104\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_104\">Sa situation familiale <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-6401-field_104\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][104]\" required=\"required\"><option value=\"-- Choisir --\" >-- Choisir --<\/option><option value=\"Isol\u00e9(e)\" >Isol\u00e9(e)<\/option><option value=\"Couple sans enfant\" >Couple sans enfant<\/option><option value=\"Couple avec enfant(s)\" >Couple avec enfant(s)<\/option><option value=\"Cohabitant(e) de fait\" >Cohabitant(e) de fait<\/option><option value=\"Famille monoparentale\" >Famille monoparentale<\/option><\/select><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_37-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"37\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_37\">Son \u00e9tat civil <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-6401-field_37\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][37]\" required=\"required\"><option value=\"-- Choisir --\" >-- Choisir --<\/option><option value=\"C\u00e9libataire\" >C\u00e9libataire<\/option><option value=\"Mari\u00e9(e)\" >Mari\u00e9(e)<\/option><option value=\"S\u00e9par\u00e9(e)\" >S\u00e9par\u00e9(e)<\/option><option value=\"Divorc\u00e9(e)\" >Divorc\u00e9(e)<\/option><option value=\"Veuf(ve)\" >Veuf(ve)<\/option><\/select><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_39-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"39\"><h3 id=\"wpforms-6401-field_39\" name=\"wpforms[fields][39]\">Accompagnement \u00e0 effectuer<\/h3><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_40-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"40\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_40\">Date de l&#039;accompagnement <span class=\"wpforms-required-label\">*<\/span><\/label><select name=\"wpforms[fields][40][date][d]\" id=\"wpforms-field_40-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][40][date][m]\" id=\"wpforms-field_40-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][40][date][y]\" id=\"wpforms-field_40-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2026\" >2026<\/option><option value=\"2027\" >2027<\/option><\/select><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_73-container\" class=\"wpforms-field wpforms-field-date-time wpf_6pct\" data-field-id=\"73\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_73\">Heure du rendez-vous entre le b\u00e9n\u00e9ficiaire et l\u2019accompagnant <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_73-time\" class=\"wpforms-field-date-time-time\" data-rule-time24h=\"true\" data-time-format=\"H:i\" data-step=\"30\" name=\"wpforms[fields][73][time]\" placeholder=\"HH:MM\" required><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_112-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"112\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_112\">Lieu du rendez-vous b\u00e9n\u00e9ficiaire\/accompagnant <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_112\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][112]\" required><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_46-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"46\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_46\">Adresse du rendez-vous b\u00e9n\u00e9ficiaire\/accompagnant <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_46\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][46]\" placeholder=\"Merci de bien d\u00e9tailler l&#039;adresse : sonnette, n\u00b0, \u00e9tage, etc.\" required><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_47-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"47\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_47\">Nom du lieu o\u00f9 se rendre <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_47\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][47]\" placeholder=\"L&#039;institution o\u00f9 votre usager a rendez-vous\" required><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_66-container\" class=\"wpforms-field wpforms-field-text wpforms-two-fourths wpforms-first\" data-field-id=\"66\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_66\">Adresse du lieu o\u00f9 se rendre <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_66\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][66]\" placeholder=\"Nom de la rue \" required><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_70-container\" class=\"wpforms-field wpforms-field-number wpforms-one-third wpforms-first\" data-field-id=\"70\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_70\">Code postal et localit\u00e9 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" pattern=\"[0-9]*\" id=\"wpforms-6401-field_70\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][70]\" required><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_74-container\" class=\"wpforms-field wpforms-field-date-time wpf_6pct\" data-field-id=\"74\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_74\">Heure du rendez-vous ou de la permanence \u00e0 laquelle le b\u00e9n\u00e9ficiaire doit se rendre <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_74-time\" class=\"wpforms-field-date-time-time\" data-rule-time24h=\"true\" data-time-format=\"H:i\" data-step=\"30\" name=\"wpforms[fields][74][time]\" placeholder=\"HH:MM\" required><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_51-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"51\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_51\">Nom de la personne que le b\u00e9n\u00e9ficiaire doit rencontrer <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_51\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][51]\" placeholder=\"L&#039;interlocuteur de l&#039;usager lors de son rendez-vous\" required><div class=\"wpforms-field-description\">Sinon marquez : Inconnu<\/div><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_80-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"80\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_80\">Num\u00e9ro de t\u00e9l\u00e9phone de la personne que le b\u00e9n\u00e9ficiaire doit rencontrer <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_80\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][80]\" required><div class=\"wpforms-field-description\">Num\u00e9ro de t\u00e9l\u00e9phone belge Fixe ou Gsm.<\/div><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_108-container\" class=\"wpforms-field wpforms-field-select\" data-field-id=\"108\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_108\">Raison n\u00e9cessistant l&#039;accompagnement <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-6401-field_108\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][108]\" required=\"required\"><option value=\"Veuillez choisir ce qui correspond\" >Veuillez choisir ce qui correspond<\/option><option value=\"Soutien moral\" >Soutien moral<\/option><option value=\"Soutien linguistique\" >Soutien linguistique<\/option><option value=\"Aide \u00e0 la compr\u00e9hension\" >Aide \u00e0 la compr\u00e9hension<\/option><option value=\"Orientation dans l&#039;espace\" >Orientation dans l&#039;espace<\/option><option value=\"Soutien physique durant le d\u00e9placement\" >Soutien physique durant le d\u00e9placement<\/option><option value=\"Aide \u00e0 la prise de notes\" >Aide \u00e0 la prise de notes<\/option><option value=\"Classement\/organisation\" >Classement\/organisation<\/option><option value=\"Autre\" >Autre<\/option><\/select><div class=\"wpforms-field-description\">=>Attention, nous ne sommes pas un service sp\u00e9cialis\u00e9 dans la traduction. =>Attention, nos volontaires ne sont pas habilit\u00e9s \u00e0 transporter des bagages, ni \u00e0 pousser une chaise roulante, ni \u00e0 faire des accompagnements avec leur v\u00e9hicule.<\/div><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_110-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"110\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_110\">Veuillez expliciter votre choix<\/label><input type=\"text\" id=\"wpforms-6401-field_110\" class=\"wpforms-field-medium\" name=\"wpforms[fields][110]\" placeholder=\"Explicitez votre choix\" ><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_54-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_54\">Besoin de traduction (interpr\u00e9tariat) <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_54\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_54_1\" name=\"wpforms[fields][54]\" value=\"oui\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_54_1\">oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_54_2\" name=\"wpforms[fields][54]\" value=\"non\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_54_2\">non<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_54_3\" name=\"wpforms[fields][54]\" value=\"oui mais pas indispensable. Le b\u00e9n\u00e9ficiare ma\u00eetrise un peu la langue.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_54_3\">oui mais pas indispensable. Le b\u00e9n\u00e9ficiare ma\u00eetrise un peu la langue.<\/label><\/li><\/ul><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_55-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"55\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_55\">Langue parl\u00e9e par le b\u00e9n\u00e9ficiaire<\/label><input type=\"text\" id=\"wpforms-6401-field_55\" class=\"wpforms-field-small\" name=\"wpforms[fields][55]\" placeholder=\"A remplir si la traduction est souhait\u00e9e\" ><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_57-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"57\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_57\">D\u00e9tails de la d\u00e9marche \u00e0 r\u00e9aliser <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-6401-field_57\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][57]\" placeholder=\"D\u00e9tailler la d\u00e9marche que le b\u00e9n\u00e9ficiaire voudrait r\u00e9aliser avec l\u2019aide du b\u00e9n\u00e9vole. 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Description de la situation, du but \u00e0 atteindre, des documents \u00e0 obtenir,...\" required><\/textarea><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_58-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"58\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_58\">Informations compl\u00e9mentaires<\/label><textarea id=\"wpforms-6401-field_58\" class=\"wpforms-field-medium\" name=\"wpforms[fields][58]\" placeholder=\"Le cas \u00e9ch\u00e9ant, indiquer les sp\u00e9cificit\u00e9s du b\u00e9n\u00e9ficiaire si celles-ci risquent d\u2019influencer le d\u00e9roulement de l\u2019accompagnement. 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Je consens \u00e0 ce que Les Amis d&#039;Accompagner stocke mes informations afin de r\u00e9pondre \u00e0 ma requ\u00eate.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_103_1\">J'ai lu et j'accepte les conditions g\u00e9n\u00e9rales de collaboration. Je consens \u00e0 ce que Les Amis d'Accompagner stocke mes informations afin de r\u00e9pondre \u00e0 ma requ\u00eate.<\/label><\/li><\/ul><\/div><br \/>\n<b>Warning<\/b>:  Undefined variable $form_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<br \/>\n<b>Warning<\/b>:  Undefined variable $field_id in <b>\/home\/clients\/aa56989a12ecb1e50c7d560fcf9692bf\/sites\/test.accompagner.be\/wp-content\/plugins\/code-snippets\/php\/snippet-ops.php(663) : eval()'d code<\/b> on line <b>14<\/b><br \/>\n<div id=\"wpforms-6401-field_90-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"90\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_90\">En soumettant ce formulaire, j&#039;accepte que l&#039;ASBL Les Amis d&#039;Accompagner<\/label><ul id=\"wpforms-6401-field_90\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-6401-field_90_1\" name=\"wpforms[fields][90][]\" value=\"me contacte pour me transmettre des informations la concernant\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_90_1\">me contacte pour me transmettre des informations la concernant<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-6401-field_90_2\" name=\"wpforms[fields][90][]\" value=\"m\u2019envoie la newsletter\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_90_2\">m\u2019envoie la newsletter<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms-6401-field-hp\" class=\"wpforms-field-label\">Phone<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms-6401-field-hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"6401\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"8\"><button type=\"submit\" name=\"wpforms[submit]\" class=\"wpforms-submit \" id=\"wpforms-submit-6401\" value=\"wpforms-submit\" aria-live=\"assertive\" data-alt-text=\"Envoi en cours...\" data-submit-text=\"Envoyer\">Envoyer<\/button><\/div><\/form><\/div>  <!-- .wpforms-container -->\n\n<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Vous pouvez remplir ce formulaire en. De ruimtes van het formulier met een * moeten ingevuld worden en mogen dus niet blanco gelaten worden. Het zijn essenti\u00eble gegevens voor het openen van een dossier en een goed verloop van een begeleiding. Onze Organisatie en onze vrijwilligers zijn gebonden aan het beroepsgeheim. Onze Organisatie en onze [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"advgb_blocks_editor_width":"","advgb_blocks_columns_visual_guide":"","footnotes":""},"class_list":["post-8864","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Aanvraag om een begeleiding - Les Amis d\u2019Accompagner<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/test.accompagner.be\/nl\/aanvraag-om-een-begeleiding\/\" \/>\n<meta property=\"og:locale\" content=\"nl_NL\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Aanvraag om een begeleiding - Les Amis d\u2019Accompagner\" \/>\n<meta property=\"og:description\" content=\"Vous pouvez remplir ce formulaire en. 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