{"id":964,"date":"2024-07-05T13:47:17","date_gmt":"2024-07-05T13:47:17","guid":{"rendered":"https:\/\/www.sudburymeals.org\/demarrer\/"},"modified":"2025-12-03T14:14:32","modified_gmt":"2025-12-03T14:14:32","slug":"ou-commencer","status":"publish","type":"page","link":"https:\/\/sudburymeals.org\/fr\/ou-commencer\/","title":{"rendered":"O\u00f9 commencer"},"content":{"rendered":"<p>[et_pb_section fb_built=\u00a0\u00bb1&Prime; _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb background_color=\u00a0\u00bb#2A3077&Prime; custom_padding=\u00a0\u00bb40px||40px||true|false\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_row _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4&Prime; _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_text _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb header_text_align=\u00a0\u00bbcenter\u00a0\u00bb header_text_color=\u00a0\u00bb#DBC28A\u00a0\u00bb header_font_size=\u00a0\u00bb45px\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<h1>Devenir un(e) client(e)<\/h1>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=\u00a0\u00bb1&Prime; _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_row column_structure=\u00a0\u00bb2_3,1_3&Prime; _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb2_3&Prime; _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_text _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb header_2_font_size=\u00a0\u00bb28px\u00a0\u00bb locked=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<h2>Admissibilit\u00e9<\/h2>\n<p>[\/et_pb_text][et_pb_text _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb locked=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<p>Nous offrons \u00e0 nos clients un large \u00e9ventail de repas maison sant\u00e9 de qualit\u00e9 sup\u00e9rieure. Nous sommes fiers de respecter l\u2019individualit\u00e9 des clients. <\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb locked=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<strong>Nos services visent une client\u00e8le vari\u00e9e :<\/strong><\/p>\n<ul style=\"column-count:2;\">\n<li>A\u00een\u00e9s de 65 ans ou plus<\/li>\n<li>Personnes ayant une maladie chronique<\/li>\n<li>Personnes en phase terminale<\/li>\n<li>Personnes en convalescence (r\u00e9tablissement)<\/li>\n<li>Personnes handicap\u00e9es<\/li>\n<li>Personnes atteintes d\u2019une maladie mentale<\/li>\n<li>Proches aidants<\/li>\n<li>Nouvelles m\u00e8res ou nouveaux parents<\/li>\n<\/ul>\n<p>[\/et_pb_text][et_pb_text _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb locked=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<p><span>Popote roulante (Sudbury) offre un programme de subvention aux personnes admissibles. Si nos programmes de repas vous int\u00e9ressent, mais que vous ne croyez pas pouvoir en payer les co\u00fbts, communiquez avec notre bureau au <a href=\"705-525-4554\">705 525-4554<\/a> pour en savoir plus. <\/span><\/p>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=\u00a0\u00bb1_3&Prime; _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_image src=\u00a0\u00bbhttps:\/\/sudburymeals.org\/wp-content\/uploads\/2024\/08\/HM-Cream-of-Mushroom-Soup-Chicken-Fingers-Diced-Squash-Butter-Parm-Noodles-Muffin.jpg\u00a0\u00bb alt=\u00a0\u00bbHot Meal &#8211; Cream of Mushroom Soup &#8211; Chicken Fingers &#8211; Diced Squash &#8211; Butter Parm Noodles &#8211; Muffin\u00a0\u00bb title_text=\u00a0\u00bbHot Meal &#8211; Cream of Mushroom Soup &#8211; Chicken Fingers &#8211; Diced Squash &#8211; Butter Parm Noodles &#8211; Muffin\u00a0\u00bb _builder_version=\u00a0\u00bb4.27.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][\/et_pb_image][et_pb_text _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb locked=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<p><strong>Si vous \u00eates un fournisseur de services de sant\u00e9, allez \u00e0 la page :<\/strong><\/p>\n<p>[\/et_pb_text][et_pb_button button_url=\u00a0\u00bbhttps:\/\/connect.northeasthealthline.ca\/Services\/NorthEastCSS\u00a0\u00bb url_new_window=\u00a0\u00bbon\u00a0\u00bb button_text=\u00a0\u00bbServices de soutien communautaires\u00a0\u00bb _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][\/et_pb_button][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=\u00a0\u00bb1&Prime; _builder_version=\u00a0\u00bb4.27.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb background_color=\u00a0\u00bb#F7FAFC\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_row _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4&Prime; _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_text _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb header_text_align=\u00a0\u00bbcenter\u00a0\u00bb header_2_text_align=\u00a0\u00bbcenter\u00a0\u00bb header_2_font_size=\u00a0\u00bb28px\u00a0\u00bb locked=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<h2>Comment demander des services<\/h2>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=\u00a0\u00bb1_3,1_3,1_3&Prime; _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb1_3&Prime; _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_icon font_icon=\u00a0\u00bb&#xf3cd;||fa||900&Prime; icon_color=\u00a0\u00bb#DBC28A\u00a0\u00bb icon_width=\u00a0\u00bb45px\u00a0\u00bb _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb background_color=\u00a0\u00bb#2A3077&Prime; custom_margin=\u00a0\u00bb||0px||false|false\u00a0\u00bb custom_padding=\u00a0\u00bb15px|15px|15px|15px|true|true\u00a0\u00bb custom_css_icon_element=\u00a0\u00bbwidth:50px;||height:50px;||||\u00a0\u00bb border_radii=\u00a0\u00bbon|50px|50px|50px|50px\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][\/et_pb_icon][dsm_card title=\u00a0\u00bb\u00c9TAPE N\u00b0 1&Prime; subtitle=\u00a0\u00bbCommuniquer avec Popote roulante (Sudbury)\u00a0\u00bb image_as_background=\u00a0\u00bboff\u00a0\u00bb image_alignment=\u00a0\u00bbcenter\u00a0\u00bb button_url_new_window=\u00a0\u00bb1&Prime; icon_content_font_size_tablet=\u00a0\u00bb60px\u00a0\u00bb icon_content_font_size_phone=\u00a0\u00bb60px\u00a0\u00bb icon_content_font_size_last_edited=\u00a0\u00bbon|desktop\u00a0\u00bb _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb header_level=\u00a0\u00bbh3&Prime; header_text_align=\u00a0\u00bbcenter\u00a0\u00bb header_text_color=\u00a0\u00bb#2A3077&Prime; header_font_size=\u00a0\u00bb25px\u00a0\u00bb subhead_font=\u00a0\u00bb|600||on|||||\u00a0\u00bb subhead_text_align=\u00a0\u00bbcenter\u00a0\u00bb subhead_text_color=\u00a0\u00bb#1A1E4A\u00a0\u00bb module_alignment=\u00a0\u00bbcenter\u00a0\u00bb custom_css_free_form=\u00a0\u00bbselector .dsm_card_description{||  margin-top:15px !important;||}||\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<p><span>Vous, votre m\u00e9decin, l\u2019infirmi\u00e8re qui s\u2019occupe de votre sortie de l\u2019h\u00f4pital, l\u2019\u00e9quipe Sant\u00e9 Ontario de votre r\u00e9gion, votre famille ou votre proche aidant pouvez communiquer avec Popote roulante (Sudbury) pour demander nos services. Toutes les portes sont bonnes. Vous   <\/span><a href=\"https:\/\/sudburymeals.org\/contact\/\">pouvez nous joindre en personne<\/a><span>, par t\u00e9l\u00e9phone, par courriel, par t\u00e9l\u00e9copieur ou pr\u00e9senter votre demande<\/span> <a href=\"https:\/\/sudburymeals.org\/client-application\/\">en ligne ici.<\/a><span>Toutes les coordonn\u00e9es se trouvent \u00e0 la page Nous joindre. Apr\u00e8s avoir re\u00e7u votre demande de services, nous communiquerons avec vous pour confirmer verbalement que vous commencerez \u00e0 recevoir nos services.   <\/span><\/p>\n<p>[\/dsm_card][\/et_pb_column][et_pb_column type=\u00a0\u00bb1_3&Prime; _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_icon font_icon=\u00a0\u00bb&#xf2e7;||fa||900&Prime; icon_color=\u00a0\u00bb#DBC28A\u00a0\u00bb icon_width=\u00a0\u00bb45px\u00a0\u00bb _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb background_color=\u00a0\u00bb#2A3077&Prime; custom_margin=\u00a0\u00bb||0px||false|false\u00a0\u00bb custom_padding=\u00a0\u00bb15px|15px|15px|15px|true|true\u00a0\u00bb custom_css_icon_element=\u00a0\u00bbwidth:50px;||height:50px;||||\u00a0\u00bb border_radii=\u00a0\u00bbon|50px|50px|50px|50px\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][\/et_pb_icon][dsm_card title=\u00a0\u00bb\u00c9TAPE N\u00b0 2&Prime; subtitle=\u00a0\u00bbRecevoir nos services\u00a0\u00bb image_as_background=\u00a0\u00bboff\u00a0\u00bb image_alignment=\u00a0\u00bbcenter\u00a0\u00bb button_url_new_window=\u00a0\u00bb1&Prime; icon_content_font_size_tablet=\u00a0\u00bb60px\u00a0\u00bb icon_content_font_size_phone=\u00a0\u00bb60px\u00a0\u00bb icon_content_font_size_last_edited=\u00a0\u00bbon|desktop\u00a0\u00bb _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb header_level=\u00a0\u00bbh3&Prime; header_text_align=\u00a0\u00bbcenter\u00a0\u00bb header_text_color=\u00a0\u00bb#2A3077&Prime; header_font_size=\u00a0\u00bb25px\u00a0\u00bb subhead_font=\u00a0\u00bb|600||on|||||\u00a0\u00bb subhead_text_align=\u00a0\u00bbcenter\u00a0\u00bb subhead_text_color=\u00a0\u00bb#1A1E4A\u00a0\u00bb module_alignment=\u00a0\u00bbcenter\u00a0\u00bb custom_css_free_form=\u00a0\u00bbselector .dsm_card_description{||  margin-top:15px !important;||}||\u00a0\u00bb border_color_all_image=\u00a0\u00bb#457A2F\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<p><span>Vous commencerez \u00e0 recevoir les services de Popote roulante (Sudbury) dans un d\u00e9lai de 24 \u00e0 48 heures, ou selon votre horaire.<\/span><\/p>\n<p>[\/dsm_card][\/et_pb_column][et_pb_column type=\u00a0\u00bb1_3&Prime; _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_icon font_icon=\u00a0\u00bb&#xe065;||fa||900&Prime; icon_color=\u00a0\u00bb#DBC28A\u00a0\u00bb icon_width=\u00a0\u00bb45px\u00a0\u00bb _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb background_color=\u00a0\u00bb#2A3077&Prime; custom_margin=\u00a0\u00bb||0px||false|false\u00a0\u00bb custom_padding=\u00a0\u00bb15px|15px|15px|15px|true|true\u00a0\u00bb custom_css_icon_element=\u00a0\u00bbwidth:50px;||height:50px;||||\u00a0\u00bb border_radii=\u00a0\u00bbon|50px|50px|50px|50px\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][\/et_pb_icon][dsm_card title=\u00a0\u00bb\u00c9TAPE N\u00b0 3 &#8211; SI N\u00c9CESSAIRE\u00a0\u00bb subtitle=\u00a0\u00bbVisite \u00e0 domicile\u00a0\u00bb image_as_background=\u00a0\u00bboff\u00a0\u00bb image_alignment=\u00a0\u00bbcenter\u00a0\u00bb button_url_new_window=\u00a0\u00bb1&Prime; icon_content_font_size_tablet=\u00a0\u00bb60px\u00a0\u00bb icon_content_font_size_phone=\u00a0\u00bb60px\u00a0\u00bb icon_content_font_size_last_edited=\u00a0\u00bbon|desktop\u00a0\u00bb _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb header_level=\u00a0\u00bbh3&Prime; header_text_align=\u00a0\u00bbcenter\u00a0\u00bb header_text_color=\u00a0\u00bb#2A3077&Prime; header_font_size=\u00a0\u00bb25px\u00a0\u00bb subhead_font=\u00a0\u00bb|600||on|||||\u00a0\u00bb subhead_text_align=\u00a0\u00bbcenter\u00a0\u00bb subhead_text_color=\u00a0\u00bb#1A1E4A\u00a0\u00bb module_alignment=\u00a0\u00bbcenter\u00a0\u00bb hover_enabled=\u00a0\u00bb0&Prime; custom_css_free_form=\u00a0\u00bbselector .dsm_card_description{||  margin-top:15px !important;||}||\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb sticky_enabled=\u00a0\u00bb0&Prime;]<\/p>\n<p><span>Si vous pr\u00e9f\u00e9rez une visite \u00e0 domicile, un membre du personnel de Popote roulante (Sudbury) vous contactera pour fixer un rendez-vous avec le coordonnateur des services \u00e0 la client\u00e8le, qui vous fournira de plus amples d\u00e9tails sur les services et les diff\u00e9rents programmes de Popote roulante (Sudbury). Durant cette visite, le coordonnateur \u00e9valuera votre \u00e9tat de sant\u00e9 et vos besoins nutritionnels. L\u2019outil d\u2019\u00e9valuation \u00e0 domicile sert \u00e0 dresser le plan qui vous convient le mieux ainsi qu\u2019\u00e0 d\u00e9terminer si vous avez besoin d\u2019autres services communautaires. L\u2019\u00e9valuation comprend un questionnaire, une explication des politiques visant les clients et le personnel (b\u00e9n\u00e9voles), le plan de services, les choix de paiement et les services de livraison. <\/span><\/p>\n<p>[\/dsm_card][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=\u00a0\u00bb1&Prime; module_id=\u00a0\u00bbhot-meal-menu\u00a0\u00bb _builder_version=\u00a0\u00bb4.27.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb background_color=\u00a0\u00bb#F8FCF8&Prime; global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_row _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4&Prime; _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_text _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb header_text_align=\u00a0\u00bbcenter\u00a0\u00bb header_2_text_align=\u00a0\u00bbcenter\u00a0\u00bb header_2_font_size=\u00a0\u00bb28px\u00a0\u00bb locked=\u00a0\u00bboff\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<h2>Demande de services<\/h2>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb max_width=\u00a0\u00bb80%\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4&Prime; _builder_version=\u00a0\u00bb4.26.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_code _builder_version=\u00a0\u00bb4.27.0&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar 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3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform-theme gform-theme--foundation gform-theme--framework gform-theme--orbital' data-form-theme='orbital' data-form-index='0' id='gform_wrapper_6' style='display:none'><style>#gform_wrapper_6[data-form-index=\"0\"].gform-theme,[data-parent-form=\"6_0\"]{--gf-color-primary: 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#FFFFFF;--gf-color-in-ctrl-primary: #204ce5;--gf-color-in-ctrl-primary-rgb: 32, 76, 229;--gf-color-in-ctrl-primary-contrast: #fff;--gf-color-in-ctrl-primary-contrast-rgb: 255, 255, 255;--gf-color-in-ctrl-primary-darker: #001AB3;--gf-color-in-ctrl-primary-lighter: #527EFF;--gf-color-in-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-in-ctrl-light-rgb: 17, 35, 55;--gf-color-in-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-in-ctrl-light-lighter: #F5F5F5;--gf-color-in-ctrl-dark: #585e6a;--gf-color-in-ctrl-dark-rgb: 88, 94, 106;--gf-color-in-ctrl-dark-darker: #112337;--gf-color-in-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-radius: 3px;--gf-font-size-secondary: 14px;--gf-font-size-tertiary: 13px;--gf-icon-ctrl-number: url(\"data:image\/svg+xml,%3Csvg width='8' height='14' viewBox='0 0 8 14' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M4 0C4.26522 5.96046e-08 4.51957 0.105357 4.70711 0.292893L7.70711 3.29289C8.09763 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#112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style><div id='gf_6' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_6'  action='\/fr\/wp-json\/wp\/v2\/pages\/964#gf_6' data-formid='6' novalidate>\n        <div id='gf_progressbar_wrapper_6' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">\u00c9tape <span class='gf_step_current_page'>1<\/span> sur <span class='gf_step_page_count'>4<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_25' style='width:25%;'><span>25%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_6_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_6_87\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_87'>Phone<\/label><div class='ginput_container'><input name='input_87' id='input_6_87' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_6_87'>Ce champ n\u2019est utilis\u00e9 qu\u2019\u00e0 des fins de validation et devrait rester inchang\u00e9.<\/div><\/div><div id=\"field_6_1\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Renseignements personnels sur le(a) client(e)<\/h3><\/div><fieldset id=\"field_6_3\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_6_3'>\n                            \n                            <span id='input_6_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.3' id='input_6_3_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_6_3_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_6_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.6' id='input_6_3_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_6_3_6' class='gform-field-label gform-field-label--type-sub '>Nom de famille<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_6_4\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Adresse de livraison<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_6_4' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_6_4_1_container' >\n                                        <input type='text' name='input_4.1' id='input_6_4_1' value=''    aria-required='true'    \/>\n                                        <label for='input_6_4_1' id='input_6_4_1_label' class='gform-field-label gform-field-label--type-sub '>Adresse postale<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_6_4_2_container' >\n                                        <input type='text' name='input_4.2' id='input_6_4_2' value=''     aria-required='false'   \/>\n                                        <label for='input_6_4_2' id='input_6_4_2_label' class='gform-field-label gform-field-label--type-sub '>Adresse ligne 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_6_4_3_container' >\n                                    <input type='text' name='input_4.3' id='input_6_4_3' value=''    aria-required='true'    \/>\n                                    <label for='input_6_4_3' id='input_6_4_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_6_4_4_container' >\n                                        <select name='input_4.4' id='input_6_4_4'     aria-required='true'    ><option value='' ><\/option><option value='Alberta' >Alberta<\/option><option value='Colombie-Britannique' >Colombie-Britannique<\/option><option value='Manitoba' >Manitoba<\/option><option value='Nouveau-Brunswick' >Nouveau-Brunswick<\/option><option value='Terre-Neuve-et-Labrador' >Terre-Neuve-et-Labrador<\/option><option value='Territoires du Nord-Ouest' >Territoires du Nord-Ouest<\/option><option value='Nouvelle-\u00c9cosse' >Nouvelle-\u00c9cosse<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' selected='selected'>Ontario<\/option><option value='\u00cele du Prince-\u00c9douard' >\u00cele du Prince-\u00c9douard<\/option><option value='Qu\u00e9bec' >Qu\u00e9bec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><\/select>\n                                        <label for='input_6_4_4' id='input_6_4_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_6_4_5_container' >\n                                    <input type='text' name='input_4.5' id='input_6_4_5' value=''    aria-required='true'    \/>\n                                    <label for='input_6_4_5' id='input_6_4_5_label' class='gform-field-label gform-field-label--type-sub '>Code postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_4.6' id='input_6_4_6' value='Canada' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_6_5\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Est-ce que l\u2019adresse postale est diff\u00e9rente de l&#039;adresse de livraison?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_6_5'><div class='gchoice gchoice_6_5_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.1' type='checkbox'  value='Non' checked='checked' id='choice_6_5_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_5_1' id='label_6_5_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_5_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.2' type='checkbox'  value='Oui'  id='choice_6_5_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_5_2' id='label_6_5_2' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_6_6\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Adresse postale<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_6_6' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_6_6_1_container' >\n                                        <input type='text' name='input_6.1' id='input_6_6_1' value=''    aria-required='false'    \/>\n                                        <label for='input_6_6_1' id='input_6_6_1_label' class='gform-field-label gform-field-label--type-sub '>Adresse postale<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_6_6_2_container' >\n                                        <input type='text' name='input_6.2' id='input_6_6_2' value=''     aria-required='false'   \/>\n                                        <label for='input_6_6_2' id='input_6_6_2_label' class='gform-field-label gform-field-label--type-sub '>Adresse ligne 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_6_6_3_container' >\n                                    <input type='text' name='input_6.3' id='input_6_6_3' value=''    aria-required='false'    \/>\n                                    <label for='input_6_6_3' id='input_6_6_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_6_6_4_container' >\n                                        <select name='input_6.4' id='input_6_6_4'     aria-required='false'    ><option value='' ><\/option><option value='Alberta' >Alberta<\/option><option value='Colombie-Britannique' >Colombie-Britannique<\/option><option value='Manitoba' >Manitoba<\/option><option value='Nouveau-Brunswick' >Nouveau-Brunswick<\/option><option value='Terre-Neuve-et-Labrador' >Terre-Neuve-et-Labrador<\/option><option value='Territoires du Nord-Ouest' >Territoires du Nord-Ouest<\/option><option value='Nouvelle-\u00c9cosse' >Nouvelle-\u00c9cosse<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' selected='selected'>Ontario<\/option><option value='\u00cele du Prince-\u00c9douard' >\u00cele du Prince-\u00c9douard<\/option><option value='Qu\u00e9bec' >Qu\u00e9bec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><\/select>\n                                        <label for='input_6_6_4' id='input_6_6_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_6_6_5_container' >\n                                    <input type='text' name='input_6.5' id='input_6_6_5' value=''    aria-required='false'    \/>\n                                    <label for='input_6_6_5' id='input_6_6_5_label' class='gform-field-label gform-field-label--type-sub '>Code postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_6.6' id='input_6_6_6' value='Canada' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_6_7\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_7'>Indications routi\u00e8res pr\u00e9cises pour se rendre chez le(a) client(e) :<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_7' id='input_6_7' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_6_8\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_8'>Date de naissance<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_8' id='input_6_8' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/jj\/aaaa' aria-describedby=\"input_6_8_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_6_8_date_format' class='screen-reader-text'>MM slash JJ slash AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_6_8' class='gform_hidden' value='https:\/\/sudburymeals.org\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_6_9\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_9'>Num\u00e9ro de t\u00e9l\u00e9phone principal<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_9' id='input_6_9' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_10\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_10'>Autre num\u00e9ro de t\u00e9l\u00e9phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_10' id='input_6_10' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_6_13\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Langue premi\u00e8re<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_6_13'>\n\t\t\t<div class='gchoice gchoice_6_13_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Anglais'  id='choice_6_13_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_13_0' id='label_6_13_0' class='gform-field-label gform-field-label--type-inline'>Anglais<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_13_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Fran\u00e7ais'  id='choice_6_13_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_13_1' id='label_6_13_1' class='gform-field-label gform-field-label--type-inline'>Fran\u00e7ais<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_13_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='gf_other_choice'  id='choice_6_13_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_13_2' id='label_6_13_2' class='gform-field-label gform-field-label--type-inline'>Autre<\/label><br \/><input id='input_6_13_other' class='gchoice_other_control' name='input_13_other' type='text' value='Autre' aria-label='Autre choix, veuillez sp\u00e9cifier'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_6_14\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Langue officielle<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_6_14'>\n\t\t\t<div class='gchoice gchoice_6_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Anglais'  id='choice_6_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_14_0' id='label_6_14_0' class='gform-field-label gform-field-label--type-inline'>Anglais<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Fran\u00e7ais'  id='choice_6_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_14_1' id='label_6_14_1' class='gform-field-label gform-field-label--type-inline'>Fran\u00e7ais<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_14_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='gf_other_choice'  id='choice_6_14_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_14_2' id='label_6_14_2' class='gform-field-label gform-field-label--type-inline'>Autre<\/label><br \/><input id='input_6_14_other' class='gchoice_other_control' name='input_14_other' type='text' value='Autre' aria-label='Autre choix, veuillez sp\u00e9cifier'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_6_15\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_15'>Num\u00e9ro de carte Sant\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_15' id='input_6_15' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_6_16\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_16'>Adresse \u00e9lectronique<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_16' id='input_6_16' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_6_17\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Est-ce que le(a) client(e) aimerait recevoir des mises \u00e0 jour et des communiqu\u00e9s de Popote roulante (Sudbury) par courriel?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_6_17'>\n\t\t\t<div class='gchoice gchoice_6_17_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Oui' checked='checked' id='choice_6_17_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_17_0' id='label_6_17_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_17_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Non'  id='choice_6_17_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_17_1' id='label_6_17_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_6_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Le(a) client(e) vit seul(e)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_6_18'>\n\t\t\t<div class='gchoice gchoice_6_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Oui'  id='choice_6_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_18_0' id='label_6_18_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Non'  id='choice_6_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_18_1' id='label_6_18_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_6_19\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_19'>Nom de la personne avec laquelle le(a) client(e) vit<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_6_19' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_20\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_20'>La relation<\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_6_20' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_6_21\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Ou\u00efe<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_6_21'><div class='gchoice gchoice_6_21_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.1' type='checkbox'  value='Certaine perte'  id='choice_6_21_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_21_1' id='label_6_21_1' class='gform-field-label gform-field-label--type-inline'>Certaine perte<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_21_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.2' type='checkbox'  value='Proth\u00e8se gauche'  id='choice_6_21_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_21_2' id='label_6_21_2' class='gform-field-label gform-field-label--type-inline'>Proth\u00e8se gauche<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_21_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.3' type='checkbox'  value='Proth\u00e8se droite'  id='choice_6_21_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_21_3' id='label_6_21_3' class='gform-field-label gform-field-label--type-inline'>Proth\u00e8se droite<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_21_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.4' type='checkbox'  value='Sourd(e)'  id='choice_6_21_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_21_4' id='label_6_21_4' class='gform-field-label gform-field-label--type-inline'>Sourd(e)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_21_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.5' type='checkbox'  value='Normale'  id='choice_6_21_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_21_5' id='label_6_21_5' class='gform-field-label gform-field-label--type-inline'>Normale<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_21_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.6' type='checkbox'  value='N\u2019utilise pas de proth\u00e8se auditive'  id='choice_6_21_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_21_6' id='label_6_21_6' class='gform-field-label gform-field-label--type-inline'>N\u2019utilise pas de proth\u00e8se auditive<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_6_22\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Mobilit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_6_22'><div class='gchoice gchoice_6_22_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.1' type='checkbox'  value='Fauteuil roulant'  id='choice_6_22_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_22_1' id='label_6_22_1' class='gform-field-label gform-field-label--type-inline'>Fauteuil roulant<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_22_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.2' type='checkbox'  value='Marchette'  id='choice_6_22_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_22_2' id='label_6_22_2' class='gform-field-label gform-field-label--type-inline'>Marchette<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_22_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.3' type='checkbox'  value='Canne'  id='choice_6_22_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_22_3' id='label_6_22_3' class='gform-field-label gform-field-label--type-inline'>Canne<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_22_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.4' type='checkbox'  value='Normale'  id='choice_6_22_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_22_4' id='label_6_22_4' class='gform-field-label gform-field-label--type-inline'>Normale<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_22_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_22.5' type='checkbox'  value='Autre'  id='choice_6_22_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_22_5' id='label_6_22_5' class='gform-field-label gform-field-label--type-inline'>Autre<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_6_23\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Vision<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_6_23'><div class='gchoice gchoice_6_23_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.1' type='checkbox'  value='Certaine perte'  id='choice_6_23_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_23_1' id='label_6_23_1' class='gform-field-label gform-field-label--type-inline'>Certaine perte<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_23_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.2' type='checkbox'  value='Peut voir de l&#039;\u0153il droit'  id='choice_6_23_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_23_2' id='label_6_23_2' class='gform-field-label gform-field-label--type-inline'>Peut voir de l'\u0153il droit<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_23_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.3' type='checkbox'  value='Peut voir de l&#039;\u0153il gauche'  id='choice_6_23_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_23_3' id='label_6_23_3' class='gform-field-label gform-field-label--type-inline'>Peut voir de l'\u0153il gauche<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_23_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.4' type='checkbox'  value='Aveugle'  id='choice_6_23_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_23_4' id='label_6_23_4' class='gform-field-label gform-field-label--type-inline'>Aveugle<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_23_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.5' type='checkbox'  value='Lunettes'  id='choice_6_23_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_23_5' id='label_6_23_5' class='gform-field-label gform-field-label--type-inline'>Lunettes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_23_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.6' type='checkbox'  value='Normale'  id='choice_6_23_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_23_6' id='label_6_23_6' class='gform-field-label gform-field-label--type-inline'>Normale<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_6_24\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Services de soutien \u00e0 domicile<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_6_24'>\n\t\t\t<div class='gchoice gchoice_6_24_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Oui'  id='choice_6_24_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_24_0' id='label_6_24_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_24_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Non'  id='choice_6_24_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_24_1' id='label_6_24_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_6_25\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_25'>D\u00e9tails (qui? quand? pourquoi?)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_25' id='input_6_25' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_6_84' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Page suivante'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_6_2' class='gform_page' data-js='page-field-id-84' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_6_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_6_26\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Contact d&#039;urgence 1<\/h3><\/div><fieldset id=\"field_6_28\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nom<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_6_28'>\n                            \n                            <span id='input_6_28_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_28.3' id='input_6_28_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_6_28_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_6_28_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_28.6' id='input_6_28_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_6_28_6' class='gform-field-label gform-field-label--type-sub '>Nom de famille<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_6_29\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_29'>Lien<\/label><div class='ginput_container ginput_container_text'><input name='input_29' id='input_6_29' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_30\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_30'>T\u00e9l. (maison)<\/label><div class='ginput_container ginput_container_phone'><input name='input_30' id='input_6_30' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_31\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_31'>T\u00e9l. (travail)<\/label><div class='ginput_container ginput_container_phone'><input name='input_31' id='input_6_31' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_32\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_32'>Cellulaire :<\/label><div class='ginput_container ginput_container_phone'><input name='input_32' id='input_6_32' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_33\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_33'>Courriel<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_33' id='input_6_33' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_6_34\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Est-ce que la personne contact aimerait recevoir des mises \u00e0 jour et des communiqu\u00e9s de Popote roulante (Sudbury) par courriel?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_6_34'>\n\t\t\t<div class='gchoice gchoice_6_34_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Oui' checked='checked' id='choice_6_34_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_34_0' id='label_6_34_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_34_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Non'  id='choice_6_34_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_34_1' id='label_6_34_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_6_35\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_35'>Gestionnaire de cas<\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_6_35' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_36\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_36'>Num\u00e9ro de t\u00e9l\u00e9phone du gestionnaire de cas<\/label><div class='ginput_container ginput_container_phone'><input name='input_36' id='input_6_36' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_37\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_37'>Num\u00e9ro de poste du gestionnaire de cas<\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_6_37' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_38\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Contact d&#039;urgence 2<\/h3><\/div><fieldset id=\"field_6_39\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nom<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_6_39'>\n                            \n                            <span id='input_6_39_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_39.3' id='input_6_39_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_6_39_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_6_39_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_39.6' id='input_6_39_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_6_39_6' class='gform-field-label gform-field-label--type-sub '>Nom de famille<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_6_40\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_40'>Lien<\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_6_40' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_41\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_41'>T\u00e9l. (maison)<\/label><div class='ginput_container ginput_container_phone'><input name='input_41' id='input_6_41' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_42\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_42'>T\u00e9l. (travail)<\/label><div class='ginput_container ginput_container_phone'><input name='input_42' id='input_6_42' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_43\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_43'>Cellulaire :<\/label><div class='ginput_container ginput_container_phone'><input name='input_43' id='input_6_43' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_44\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_44'>Courriel<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_44' id='input_6_44' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_6_45\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Est-ce que la personne contact aimerait recevoir des mises \u00e0 jour et des communiqu\u00e9s de Popote roulante (Sudbury) par courriel?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_6_45'>\n\t\t\t<div class='gchoice gchoice_6_45_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='Oui' checked='checked' id='choice_6_45_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_45_0' id='label_6_45_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_45_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_45' type='radio' value='Non'  id='choice_6_45_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_45_1' id='label_6_45_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_6_46\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_46'>Gestionnaire de cas<\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_6_46' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_47\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_47'>Num\u00e9ro de t\u00e9l\u00e9phone du gestionnaire de cas<\/label><div class='ginput_container ginput_container_phone'><input name='input_47' id='input_6_47' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_48\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_48'>Num\u00e9ro de poste du gestionnaire de cas<\/label><div class='ginput_container ginput_container_text'><input name='input_48' id='input_6_48' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_6_85' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Page pr\u00e9c\u00e9dente'  \/> <input type='button' id='gform_next_button_6_85' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Page suivante'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_6_3' class='gform_page' data-js='page-field-id-85' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_6_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_6_49\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Pr\u00e9f\u00e9rences et allergies alimentaires<\/h3><\/div><fieldset id=\"field_6_50\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Allergies alimentaires<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_6_50'>\n\t\t\t<div class='gchoice gchoice_6_50_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='Oui'  id='choice_6_50_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_50_0' id='label_6_50_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_50_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='Non'  id='choice_6_50_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_50_1' id='label_6_50_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_6_51\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_51'>Allergie (n\u00e9cessite de la documentation)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_51' id='input_6_51' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_6_52\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Allergie au poisson<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_6_52'>\n\t\t\t<div class='gchoice gchoice_6_52_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='Oui'  id='choice_6_52_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_52_0' id='label_6_52_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_52_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_52' type='radio' value='Non'  id='choice_6_52_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_52_1' id='label_6_52_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_6_54\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Succ\u00e9dan\u00e9 du sucre<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_6_54'>\n\t\t\t<div class='gchoice gchoice_6_54_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Oui'  id='choice_6_54_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_54_0' id='label_6_54_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_54_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_54' type='radio' value='Non'  id='choice_6_54_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_54_1' id='label_6_54_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_6_55\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_55'>Boisson<\/label><div class='ginput_container ginput_container_text'><input name='input_55' id='input_6_55' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_6_86' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Page pr\u00e9c\u00e9dente'  \/> <input type='button' id='gform_next_button_6_86' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Page suivante'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_6_4' class='gform_page' data-js='page-field-id-86' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_6_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_6_56\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Service demand\u00e9<\/h3><\/div><fieldset id=\"field_6_57\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Horaire des repas<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_6_57'><div class='gchoice gchoice_6_57_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.1' type='checkbox'  value='Lundi'  id='choice_6_57_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_57_1' id='label_6_57_1' class='gform-field-label gform-field-label--type-inline'>Lundi<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_57_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.2' type='checkbox'  value='Mardi'  id='choice_6_57_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_57_2' id='label_6_57_2' class='gform-field-label gform-field-label--type-inline'>Mardi<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_57_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.3' type='checkbox'  value='Mercredi'  id='choice_6_57_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_57_3' id='label_6_57_3' class='gform-field-label gform-field-label--type-inline'>Mercredi<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_57_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.4' type='checkbox'  value='Jeudi'  id='choice_6_57_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_57_4' id='label_6_57_4' class='gform-field-label gform-field-label--type-inline'>Jeudi<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_57_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.5' type='checkbox'  value='Vendredi'  id='choice_6_57_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_57_5' id='label_6_57_5' class='gform-field-label gform-field-label--type-inline'>Vendredi<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_6_58\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_58'>Date de d\u00e9but<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_58' id='input_6_58' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/jj\/aaaa' aria-describedby=\"input_6_58_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_6_58_date_format' class='screen-reader-text'>MM slash JJ slash AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_6_58' class='gform_hidden' value='https:\/\/sudburymeals.org\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_6_59\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_59'>Date de fin<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_59' id='input_6_59' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/jj\/aaaa' aria-describedby=\"input_6_59_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_6_59_date_format' class='screen-reader-text'>MM slash JJ slash AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_6_59' class='gform_hidden' value='https:\/\/sudburymeals.org\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_6_60\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Information sur la provenance de la demande<\/h3><\/div><fieldset id=\"field_6_61\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Raison de la demande<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_6_61'><div class='gchoice gchoice_6_61_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.1' type='checkbox'  value='Personne \u00e2g\u00e9e'  id='choice_6_61_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_61_1' id='label_6_61_1' class='gform-field-label gform-field-label--type-inline'>Personne \u00e2g\u00e9e<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_61_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.2' type='checkbox'  value='Personne physiquement malade'  id='choice_6_61_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_61_2' id='label_6_61_2' class='gform-field-label gform-field-label--type-inline'>Personne physiquement malade<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_61_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.3' type='checkbox'  value='Personne en phase terminale'  id='choice_6_61_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_61_3' id='label_6_61_3' class='gform-field-label gform-field-label--type-inline'>Personne en phase terminale<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_61_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.4' type='checkbox'  value='Personne ayant une maladie chronique'  id='choice_6_61_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_61_4' id='label_6_61_4' class='gform-field-label gform-field-label--type-inline'>Personne ayant une maladie chronique<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_61_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.5' type='checkbox'  value='Personne en convalescence'  id='choice_6_61_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_61_5' id='label_6_61_5' class='gform-field-label gform-field-label--type-inline'>Personne en convalescence<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_61_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.6' type='checkbox'  value='Nouvelle m\u00e8re'  id='choice_6_61_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_61_6' id='label_6_61_6' class='gform-field-label gform-field-label--type-inline'>Nouvelle m\u00e8re<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_61_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.7' type='checkbox'  value='Proche aidant'  id='choice_6_61_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_61_7' id='label_6_61_7' class='gform-field-label gform-field-label--type-inline'>Proche aidant<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_6_62\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_62'>Facteurs \u00e9nonc\u00e9s (Pourquoi la personne a-t-elle besoin des services de Popote roulante?)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_62' id='input_6_62' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_6_63\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Source de la demande de service<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_6_63'><div class='gchoice gchoice_6_63_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.1' type='checkbox'  value='Services de soutien \u00e0 domicile et en milieu communautaire'  id='choice_6_63_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_63_1' id='label_6_63_1' class='gform-field-label gform-field-label--type-inline'>Services de soutien \u00e0 domicile et en milieu communautaire<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_63_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.2' type='checkbox'  value='D\u00e9pliants'  id='choice_6_63_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_63_2' id='label_6_63_2' class='gform-field-label gform-field-label--type-inline'>D\u00e9pliants<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_63_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.3' type='checkbox'  value='M\u00e9dias'  id='choice_6_63_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_63_3' id='label_6_63_3' class='gform-field-label gform-field-label--type-inline'>M\u00e9dias<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_63_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.4' type='checkbox'  value='Services sociaux'  id='choice_6_63_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_63_4' id='label_6_63_4' class='gform-field-label gform-field-label--type-inline'>Services sociaux<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_63_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.5' type='checkbox'  value='Famille'  id='choice_6_63_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_63_5' id='label_6_63_5' class='gform-field-label gform-field-label--type-inline'>Famille<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_63_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.6' type='checkbox'  value='Ami'  id='choice_6_63_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_63_6' id='label_6_63_6' class='gform-field-label gform-field-label--type-inline'>Ami<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_63_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.7' type='checkbox'  value='Pr\u00e9sentations'  id='choice_6_63_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_63_7' id='label_6_63_7' class='gform-field-label gform-field-label--type-inline'>Pr\u00e9sentations<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_63_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.8' type='checkbox'  value='M\u00e9decin'  id='choice_6_63_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_63_8' id='label_6_63_8' class='gform-field-label gform-field-label--type-inline'>M\u00e9decin<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_63_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.9' type='checkbox'  value='Client(e)'  id='choice_6_63_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_63_9' id='label_6_63_9' class='gform-field-label gform-field-label--type-inline'>Client(e)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_63_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.11' type='checkbox'  value='H\u00f4pital'  id='choice_6_63_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_63_11' id='label_6_63_11' class='gform-field-label gform-field-label--type-inline'>H\u00f4pital<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_63_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_63.12' type='checkbox'  value='Autre'  id='choice_6_63_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_63_12' id='label_6_63_12' class='gform-field-label gform-field-label--type-inline'>Autre<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_6_64\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_64'>Autre<\/label><div class='ginput_container ginput_container_text'><input name='input_64' id='input_6_64' type='text' value='' class='large'  aria-describedby=\"gfield_description_6_64\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_6_64'>Source de la demande de service<\/div><\/div><div id=\"field_6_65\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_65'>D\u00e9tails de la demande de service<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_65' id='input_6_65' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_6_66\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Source de paiement<\/h3><\/div><fieldset id=\"field_6_67\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Source de paiement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_6_67'>\n\t\t\t<div class='gchoice gchoice_6_67_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='Client(e)'  id='choice_6_67_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_67_0' id='label_6_67_0' class='gform-field-label gform-field-label--type-inline'>Client(e)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_67_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='Subvention'  id='choice_6_67_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_67_1' id='label_6_67_1' class='gform-field-label gform-field-label--type-inline'>Subvention<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_67_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='Famille\/ami'  id='choice_6_67_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_67_2' id='label_6_67_2' class='gform-field-label gform-field-label--type-inline'>Famille\/ami<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_67_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='Anciens Combattants Canada (ACC)'  id='choice_6_67_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_67_3' id='label_6_67_3' class='gform-field-label gform-field-label--type-inline'>Anciens Combattants Canada (ACC)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_67_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='WSIB'  id='choice_6_67_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_67_4' id='label_6_67_4' class='gform-field-label gform-field-label--type-inline'>WSIB<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_67_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_67' type='radio' value='Tuteur et curateur public (TCP)'  id='choice_6_67_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_67_5' id='label_6_67_5' class='gform-field-label gform-field-label--type-inline'>Tuteur et curateur public (TCP)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_6_68\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Adresse de famille\/ami<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_6_68' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_6_68_1_container' >\n                                        <input type='text' name='input_68.1' id='input_6_68_1' value=''    aria-required='false'    \/>\n                                        <label for='input_6_68_1' id='input_6_68_1_label' class='gform-field-label gform-field-label--type-sub '>Adresse postale<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_6_68_2_container' >\n                                        <input type='text' name='input_68.2' id='input_6_68_2' value=''     aria-required='false'   \/>\n                                        <label for='input_6_68_2' id='input_6_68_2_label' class='gform-field-label gform-field-label--type-sub '>Adresse ligne 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_6_68_3_container' >\n                                    <input type='text' name='input_68.3' id='input_6_68_3' value=''    aria-required='false'    \/>\n                                    <label for='input_6_68_3' id='input_6_68_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_6_68_4_container' >\n                                        <select name='input_68.4' id='input_6_68_4'     aria-required='false'    ><option value='' ><\/option><option value='Alberta' >Alberta<\/option><option value='Colombie-Britannique' >Colombie-Britannique<\/option><option value='Manitoba' >Manitoba<\/option><option value='Nouveau-Brunswick' >Nouveau-Brunswick<\/option><option value='Terre-Neuve-et-Labrador' >Terre-Neuve-et-Labrador<\/option><option value='Territoires du Nord-Ouest' >Territoires du Nord-Ouest<\/option><option value='Nouvelle-\u00c9cosse' >Nouvelle-\u00c9cosse<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' selected='selected'>Ontario<\/option><option value='\u00cele du Prince-\u00c9douard' >\u00cele du Prince-\u00c9douard<\/option><option value='Qu\u00e9bec' >Qu\u00e9bec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><\/select>\n                                        <label for='input_6_68_4' id='input_6_68_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_6_68_5_container' >\n                                    <input type='text' name='input_68.5' id='input_6_68_5' value=''    aria-required='false'    \/>\n                                    <label for='input_6_68_5' id='input_6_68_5_label' class='gform-field-label gform-field-label--type-sub '>Code postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_68.6' id='input_6_68_6' value='Canada' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_6_72\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_72'>Anciens Combattants Canada (ACC) no.<\/label><div class='ginput_container ginput_container_number'><input name='input_72' id='input_6_72' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_6_70\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_70'>Contact de Anciens Combattants Canada (ACC)<\/label><div class='ginput_container ginput_container_text'><input name='input_70' id='input_6_70' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_69\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_69'>WSIB #<\/label><div class='ginput_container ginput_container_number'><input name='input_69' id='input_6_69' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_6_73\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_73'>Contact de WSIB<\/label><div class='ginput_container ginput_container_text'><input name='input_73' id='input_6_73' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_74\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_74'>Tuteur et curateur public (TCP) no.<\/label><div class='ginput_container ginput_container_number'><input name='input_74' id='input_6_74' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_6_75\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_75'>Contact de Tuteur et curateur public (TCP)<\/label><div class='ginput_container ginput_container_text'><input name='input_75' id='input_6_75' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_6_71\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Adresse de facturation<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_6_71' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_6_71_1_container' >\n                                        <input type='text' name='input_71.1' id='input_6_71_1' value=''    aria-required='false'    \/>\n                                        <label for='input_6_71_1' id='input_6_71_1_label' class='gform-field-label gform-field-label--type-sub '>Adresse postale<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_6_71_2_container' >\n                                        <input type='text' name='input_71.2' id='input_6_71_2' value=''     aria-required='false'   \/>\n                                        <label for='input_6_71_2' id='input_6_71_2_label' class='gform-field-label gform-field-label--type-sub '>Adresse ligne 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_6_71_3_container' >\n                                    <input type='text' name='input_71.3' id='input_6_71_3' value=''    aria-required='false'    \/>\n                                    <label for='input_6_71_3' id='input_6_71_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_6_71_4_container' >\n                                        <select name='input_71.4' id='input_6_71_4'     aria-required='false'    ><option value='' ><\/option><option value='Alberta' >Alberta<\/option><option value='Colombie-Britannique' >Colombie-Britannique<\/option><option value='Manitoba' >Manitoba<\/option><option value='Nouveau-Brunswick' >Nouveau-Brunswick<\/option><option value='Terre-Neuve-et-Labrador' >Terre-Neuve-et-Labrador<\/option><option value='Territoires du Nord-Ouest' >Territoires du Nord-Ouest<\/option><option value='Nouvelle-\u00c9cosse' >Nouvelle-\u00c9cosse<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' selected='selected'>Ontario<\/option><option value='\u00cele du Prince-\u00c9douard' >\u00cele du Prince-\u00c9douard<\/option><option value='Qu\u00e9bec' >Qu\u00e9bec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><\/select>\n                                        <label for='input_6_71_4' id='input_6_71_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_6_71_5_container' >\n                                    <input type='text' name='input_71.5' id='input_6_71_5' value=''    aria-required='false'    \/>\n                                    <label for='input_6_71_5' id='input_6_71_5_label' class='gform-field-label gform-field-label--type-sub '>Code postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_71.6' id='input_6_71_6' value='Canada' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_6_76\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Engagement \u00e0 respecter les pratiques de l&#039;organisme<\/h3><\/div><fieldset id=\"field_6_77\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Pratique \u2013 mauvais temps<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_6_77'>\n\t\t\t<div class='gchoice gchoice_6_77_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_77' type='radio' value='Oui'  id='choice_6_77_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_77_0' id='label_6_77_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_77_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_77' type='radio' value='Non'  id='choice_6_77_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_77_1' id='label_6_77_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_6_78\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Pratique \u2013 cercle de soins<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_6_78'>\n\t\t\t<div class='gchoice gchoice_6_78_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_78' type='radio' value='Oui'  id='choice_6_78_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_78_0' id='label_6_78_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_78_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_78' type='radio' value='Non'  id='choice_6_78_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_78_1' id='label_6_78_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_6_79\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Pratique \u2013 annulation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_6_79'>\n\t\t\t<div class='gchoice gchoice_6_79_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='Oui'  id='choice_6_79_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_79_0' id='label_6_79_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_79_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_79' type='radio' value='Non'  id='choice_6_79_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_79_1' id='label_6_79_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_6_80\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Politique de paiement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_6_80'>Y compris la d\u00e9claration indiquant que les b\u00e9n\u00e9voles n\u2019acceptent pas d\u2019argent comptant ou de messages<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_6_80'>\n\t\t\t<div class='gchoice gchoice_6_80_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='Oui'  id='choice_6_80_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_6_80\"   \/>\n\t\t\t\t\t<label for='choice_6_80_0' id='label_6_80_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_80_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='Non'  id='choice_6_80_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_80_1' id='label_6_80_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_6_81\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Vie priv\u00e9e et confidentialit\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_6_81'>Y compris la d\u00e9claration indiquant que les renseignements personnels ne sont communiqu\u00e9s qu\u2019aux membres du personnel qui en ont besoin<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_6_81'>\n\t\t\t<div class='gchoice gchoice_6_81_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='Oui'  id='choice_6_81_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_6_81\"   \/>\n\t\t\t\t\t<label for='choice_6_81_0' id='label_6_81_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_81_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='Non'  id='choice_6_81_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_81_1' id='label_6_81_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_6_82\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_82'>Autres documents pertinents<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_82' id='input_6_82' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_6_83\" class=\"gfield gfield--type-captcha gfield--input-type-captcha gfield--width-full field_sublabel_below gfield--no-description field_description_below 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Nous sommes fiers de respecter l\u2019individualit\u00e9 des clients. Nos services visent une client\u00e8le vari\u00e9e : A\u00een\u00e9s de 65 ans ou plus Personnes ayant une maladie chronique Personnes en phase terminale Personnes en convalescence (r\u00e9tablissement) Personnes handicap\u00e9es Personnes atteintes d\u2019une maladie mentale Proches aidants Nouvelles m\u00e8res ou nouveaux parents Popote roulante (Sudbury) offre un programme de subvention aux personnes admissibles. Si nos programmes de repas vous int\u00e9ressent, mais que vous ne croyez pas pouvoir en payer les co\u00fbts, communiquez avec notre bureau au 705 525-4554 pour en savoir plus. Si vous \u00eates un fournisseur de services de sant\u00e9, allez \u00e0 la page :Comment demander des services<div class=\"et_pb_module dsm_card dsm_card_0 et_pb_bg_layout_light  dsm_card_layout_stacked\">\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t<div class=\"et_pb_module_inner\">\n\t\t\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t<div class=\"et_pb_module dsm_card_wrapper et_pb_text_align_left\">\n\t\t\t\t\t\n\t\t\t\t\t<h3 class=\"dsm_card_title et_pb_module_header\">\u00c9TAPE N\u00b0 1<\/h3>\n\t\t\t\t\t<div class=\"dsm_card_subtitle\">Communiquer avec Popote roulante (Sudbury)<\/div>\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t<\/div>\n\t\t\t\n\t\t\t\t<\/div>\n\t\t\t<\/div>Vous, votre m\u00e9decin, l\u2019infirmi\u00e8re qui s\u2019occupe de votre sortie de l\u2019h\u00f4pital, l\u2019\u00e9quipe Sant\u00e9 Ontario de votre r\u00e9gion, votre famille ou votre proche aidant pouvez communiquer avec Popote roulante (Sudbury) pour demander nos services. Toutes les portes sont bonnes. Vous pouvez nous joindre en personne, par t\u00e9l\u00e9phone, par courriel, par t\u00e9l\u00e9copieur [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-964","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/sudburymeals.org\/fr\/wp-json\/wp\/v2\/pages\/964","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sudburymeals.org\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/sudburymeals.org\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/sudburymeals.org\/fr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/sudburymeals.org\/fr\/wp-json\/wp\/v2\/comments?post=964"}],"version-history":[{"count":14,"href":"https:\/\/sudburymeals.org\/fr\/wp-json\/wp\/v2\/pages\/964\/revisions"}],"predecessor-version":[{"id":1376,"href":"https:\/\/sudburymeals.org\/fr\/wp-json\/wp\/v2\/pages\/964\/revisions\/1376"}],"wp:attachment":[{"href":"https:\/\/sudburymeals.org\/fr\/wp-json\/wp\/v2\/media?parent=964"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}