{"id":2060,"date":"2019-08-13T15:26:03","date_gmt":"2019-08-13T14:26:03","guid":{"rendered":"http:\/\/grizzlysduhainaut.fr\/?page_id=2060"},"modified":"2024-08-27T09:19:55","modified_gmt":"2024-08-27T08:19:55","slug":"formulaire-inscription-adultes","status":"publish","type":"page","link":"https:\/\/grizzlysduhainaut.fr\/index.php\/formulaire-inscription-adultes\/","title":{"rendered":"Formulaire inscription adultes"},"content":{"rendered":"<div id=\"pl-2060\"  class=\"panel-layout\" ><div id=\"pg-2060-0\"  class=\"panel-grid panel-no-style\" ><div id=\"pgc-2060-0-0\"  class=\"panel-grid-cell\" ><div id=\"panel-2060-0-0-0\" class=\"so-panel widget widget_erforms-form-widget erforms-form-widget panel-first-child panel-last-child\" data-index=\"0\" ><h3 class=\"widget-title\">Formulaire d&rsquo;inscription<\/h3><div id=\"erf_form_container_3034\" class=\"erf-container erf-contact erf-label-top erf-layout-one-column erf-style-rounded-corner\">\n        \n    \n         \n                    <div class=\"erf-content-above\">\n                            <\/div>\n            <form method=\"post\" enctype=\"multipart\/form-data\" class=\"erf-form erf-front-form\" data-parsley-validate=\"\" novalidate=\"true\" data-erf-submission-id=\"0\" data-erf-form-id=\"3034\">\n                <div class=\"erf-form-html\" id=\"erf_form_3034\">\n                    <div class=\"rendered-form\">\n                        <div class=\"erf-text form-group field-text-345872939 erf-element-width-12\"><label for=\"text-345872939\" class=\"erf-text-label\">Nom<span class=\"erf-required\">*<\/span><\/label><input type='text' required='required' class='form-control' maxlength='50' name='text-345872939' data-ref-label='Nom' id='text-345872939'  \/><\/div><div class=\"erf-text form-group field-text-491022395 erf-element-width-12\"><label for=\"text-491022395\" class=\"erf-text-label\">Pr\u00e9nom<span class=\"erf-required\">*<\/span><\/label><input type='text' required='required' class='form-control' maxlength='50' name='text-491022395' data-ref-label='Prnom' id='text-491022395'  \/><\/div><div class=\"erf-email form-group field-text-38207731 erf-element-width-12\"><label for=\"text-38207731\" class=\"erf-email-label\">Email<span class=\"erf-required\">*<\/span><\/label><input type='email' required='required' class='form-control' name='text-38207731' data-ref-label='Email' id='text-38207731'  \/><\/div><div class=\"erf-text form-group field-date-1565703958436 erf-element-width-12\"><label for=\"date-1565703958436\" class=\"erf-text-label\">Date de naissance<span class=\"erf-required\">*<\/span><\/label><input type='text' required='required' data-date-format='mm\/dd\/yy' class='form-control erf-date-field' name='date-1565703958436' data-ref-label='Date_de_naissance' id='date-1565703958436'  \/><\/div><div class=\"erf-text form-group field-text-1565703986696 erf-element-width-12\"><label for=\"text-1565703986696\" class=\"erf-text-label\">Lieu de naissance<span class=\"erf-required\">*<\/span><\/label><input type='text' required='required' class='form-control' name='text-1565703986696' data-ref-label='Lieu_de_naissance' id='text-1565703986696'  \/><\/div><div class=\"erf-select form-group field-select-1565704108036 erf-element-width-12\"><label for=\"select-1565704108036\" class=\"erf-country-label\">Pays de naissance<span class=\"erf-required\">*<\/span><\/label><select required='required' name='select-1565704108036' class='form-control' data-ref-label='Pays_de_naissance' id='select-1565704108036'  ><option value=\"\"><\/option><\/select><\/div><div class=\"erf-separator erf-element-width-12\"><div data-non-input='1' custom-type='spacer' data-ref-id='ref-1oaijfpile6' data-ref-label='ref-hm53gf' class='spacer' >Separator<\/div><\/div><div class=\"erf-street1 form-group field-text-1565703047278 erf-element-width-12\"><label for=\"text-1565703047278\" class=\"erf-street1-label\">Adresse<span class=\"erf-required\">*<\/span><\/label><input type='street1' required='required' class='form-control' name='text-1565703047278' data-ref-label='Adresse' id='text-1565703047278'  \/><\/div><div class=\"erf-zip form-group field-text-1565703047431 erf-element-width-12\"><label for=\"text-1565703047431\" class=\"erf-zip-label\">Code postal<span class=\"erf-required\">*<\/span><\/label><input type='zip' required='required' class='form-control' name='text-1565703047431' data-ref-label='Code_postal' id='text-1565703047431'  \/><\/div><div class=\"erf-city form-group field-text-1565703047190 erf-element-width-12\"><label for=\"text-1565703047190\" class=\"erf-city-label\">Commune<span class=\"erf-required\">*<\/span><\/label><input type='city' required='required' class='form-control' name='text-1565703047190' data-ref-label='Commune' id='text-1565703047190'  \/><\/div><div class=\"erf-select form-group field-select-1565703046959 erf-element-width-12\"><label for=\"select-1565703046959\" class=\"erf-country-label\">Pays<span class=\"erf-required\">*<\/span><\/label><select required='required' name='select-1565703046959' class='form-control' data-ref-label='Pays' id='select-1565703046959'  ><option value=\"\"><\/option><\/select><\/div><div class=\"erf-file form-group field-file-1565704979069 erf-element-width-12\"><label for=\"file-1565704979069\" class=\"erf-file-label\">Photo d'identit\u00e9<span class=\"tooltip-element\" tooltip=\"Si nouvel(le) inscrit(e) ou changement de t\u00eate\"><i class=\"fa fa-info\" aria-hidden=\"true\"><\/i><\/span><\/label><input type='file' class='form-control' name='file-1565704979069' data-ref-label='Photo_didentit' id='file-1565704979069'  \/><\/div><div class=\"erf-richtext erf-element-width-12\"><div data-non-input='1' data-ref-label='RichText2' data-ref-id='richtext-x4j5t0lp' class='erf-rich-text' ><p>_____________________________________________________<\/p>\n<p><strong>Certificat m\u00e9dical :<\/strong><\/p>\n<p>Au choix, vous pouvez fournir :<\/p>\n<ul>\n<li>soit un certificat m\u00e9dical de moins de 3 mois indiquant la mention \"pas de contre-indication \u00e0 la pratique du floorball en comp\u00e9tition\".<\/li>\n<li>soit remplir, dater, signer et fournir le formulaire CERFA 15699*1, <strong>\u00e0 condition<\/strong> que vous avez un certificat m\u00e9dical pour le floorball de moins de 3 ans. Formulaire disponible ici : https:\/\/www.service-public.fr\/particuliers\/vosdroits\/R47821<\/li>\n<\/ul>\n<p>Dans les 2 cas, merci de remplir les donn\u00e9es relatives \u00e0 votre certificat m\u00e9dical (ancien ou r\u00e9cent) ci-dessous.\u00a0<\/p><\/div><\/div><div class=\"erf-text form-group field-date-1565704149094 erf-element-width-12\"><label for=\"date-1565704149094\" class=\"erf-text-label\">Date Certificat m\u00e9dical<\/label><input type='text' data-date-format='mm\/dd\/yy' class='form-control erf-date-field' name='date-1565704149094' data-ref-label='Date_Certificat_mdical' id='date-1565704149094'  \/><\/div><div class=\"erf-textarea form-group field-textarea-1565704178297 erf-element-width-12\"><label for=\"textarea-1565704178297\" class=\"erf-textarea-label\">Nom du m\u00e9decin<\/label><textarea class='form-control' name='textarea-1565704178297' data-ref-label='Nom_du_mdecin' id='textarea-1565704178297' ><\/textarea><\/div><div class=\"erf-text form-group field-text-1565704218358 erf-element-width-12\"><label for=\"text-1565704218358\" class=\"erf-text-label\">Num\u00e9ro de r\u00e9f\u00e9rence du m\u00e9decin<span class=\"tooltip-element\" tooltip=\"pr\u00e9sent sur le tampon du m\u00e9decin ou sur l\u2019ent\u00eate du certificat\"><i class=\"fa fa-info\" aria-hidden=\"true\"><\/i><\/span><\/label><input type='text' class='form-control' name='text-1565704218358' data-ref-label='Numro_de_rfrence_du_mdecin' id='text-1565704218358'  \/><\/div><div class=\"erf-file form-group field-file-1570455383042 erf-element-width-12\"><label for=\"file-1570455383042\" class=\"erf-file-label\">Certificat m\u00e9dical ou CERFA 15699*1<\/label><input type='file' class='form-control' name='file-1570455383042' data-ref-label='Certificat_medical' id='file-1570455383042'  \/><\/div><div class=\"erf-richtext erf-element-width-12\"><div data-non-input='1' data-ref-label='RichText3' data-ref-id='richtext-cmhqixi6' class='erf-rich-text' ><p>_____________________________________________________<\/p>\n<p><strong>Cotisation :<\/strong><\/p><\/div><\/div><div class=\"erf-select form-group field-field-UPovQuil88aqCo7 erf-element-width-12\"><label for=\"field-UPovQuil88aqCo7\" class=\"erf-select-label\">Type de cotisation \u00e0 payer (choisir dans la liste)<span class=\"erf-required\">*<\/span><\/label><select class='form-control' name='field-UPovQuil88aqCo7' required='required' data-ref-label='Type_de_cotisation__payer_choisir_dans_l' id='field-UPovQuil88aqCo7'  ><option value=\"100\u20ac\">Adulte comp\u00e9tition - 100\u20ac<\/option><option value=\"80\u20ac\">Adulte loisir - 80\u20ac<\/option><option value=\"50\u20ac\">Tarif r\u00e9duit [\u00e9tudiant, demandeur d&#039;emploi] - 50\u20ac<\/option><\/select><\/div><div class=\"erf-richtext erf-element-width-12\"><div data-non-input='1' data-ref-label='ref-iVq3yCnt' data-ref-id='ref-V9AgfqfM' class='erf-rich-text' ><p>Paiement \u00e0 effectuer au club soit :<\/p>\n<ul>\n<li>par ch\u00e8que (ordre : Unihockey Club Les Grizzlys du Hainaut),<\/li>\n<li>en liquide,<\/li>\n<li>par carte bancaire (terminal de paiement disponible au club),<\/li>\n<li>par virement (IBAN : FR45 2004 1010 0513 4145 4X02 672 \/ BIC : PSSTFRPPLIL) . <strong>MENTIONNER LORS DU VIREMENT \"inscr. floorball + nom de(s) l'inscrit(s)\"<\/strong><\/li>\n<\/ul>\n<p>\u00a0<\/p><\/div><\/div><div class=\"erf-select form-group field-select-1565708283395 erf-element-width-12\"><label for=\"select-1565708283395\" class=\"erf-select-label\">Type de paiement (choisir dans la liste)<span class=\"erf-required\">*<\/span><\/label><select required='required' name='select-1565708283395' class='form-control' data-ref-label='Type_de_paiement_choisir_dans_la_liste' id='select-1565708283395'  ><option value=\"option-1\">Par virement<\/option><option value=\"option-2\">Par ch\u00e8que<\/option><option value=\"option-3\">En liquide<\/option><option value=\"option-4\">Par carte bancaire<\/option><\/select><\/div><div class=\"erf-button form-group field-button-1308105220 erf-element-width-12\"><button type='submit'class='btn btn-default'name='button-1308105220'data-erf-btn-pos='left'data-ref-label='Send'id='button-1308105220'>Send<\/button><\/div>                    <\/div> \n                <\/div>    \n\n                <div class=\"erf-external-form-elements\">\n                    \n                    \n                    \n\n                    \n                                        <div class=\"erf-errors\" style=\"display:none\">\n                        <span class=\"erf-errors-head erf-error-row\">Error occured. Please confirm your data and submit again:<\/span>\n                        <div class=\"erf-errors-body\">\n                                                    <\/div> \n                    <\/div>\n\n                <\/div>\n                <!-- Contains multipage Next,Previous buttons -->\n                <div class=\"erf-form-nav clearfix\"><\/div> \n\n                <!-- Single page form button -->\n                <div class=\"erf-submit-button clearfix\"><\/div>\n\n\n                <input type=\"hidden\" name=\"erform_id\" value=\"3034\" \/>\n                <input type=\"hidden\" id=\"erform_submission_nonce\" name=\"erform_submission_nonce\" value=\"4592804be9\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/2060\" \/>                <input type=\"hidden\" name=\"action\" value=\"erf_submit_form\" \/>\n\n            <\/form>\n            \n<\/div>\n<\/div><\/div><\/div><\/div>","protected":false},"excerpt":{"rendered":"<p>Formulaire d&rsquo;inscription Nom*Pr\u00e9nom*Email*Date de naissance*Lieu de naissance*Pays de naissance*SeparatorAdresse*Code postal*Commune*Pays*Photo d&rsquo;identit\u00e9_____________________________________________________ Certificat m\u00e9dical : Au choix, vous pouvez fournir : soit un certificat m\u00e9dical de moins de 3 mois indiquant la mention \u00ab\u00a0pas de contre-indication \u00e0 la pratique du floorball en comp\u00e9tition\u00a0\u00bb. soit remplir, dater, signer et fournir le formulaire CERFA 15699*1, \u00e0 condition que [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2060","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.5 - 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