{"id":1106,"date":"2025-12-15T11:31:30","date_gmt":"2025-12-15T10:31:30","guid":{"rendered":"https:\/\/atp79.info\/?page_id=1106"},"modified":"2026-08-25T16:07:44","modified_gmt":"2026-08-25T14:07:44","slug":"formulaire","status":"publish","type":"page","link":"https:\/\/atp79.info\/index.php\/formulaire\/","title":{"rendered":"Formulaire"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<meta charset=\"UTF-8\">\n<meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0\">\n<title>Formulaire de Contact &#8211; ATP79<\/title>\n<style>\n* { margin: 0; padding: 0; box-sizing: border-box; }\n\nbody {\n  font-family: 'Segoe UI', Tahoma, Geneva, Verdana, sans-serif;\n  background: #f4f6f9;\n  padding: 40px 20px;\n  min-height: 100vh;\n}\n\n.form-container {\n  max-width: 1400px;\n  margin: 0 auto;\n  background: white;\n  border-radius: 16px;\n  box-shadow: 0 4px 24px rgba(0, 0, 0, 0.08);\n  overflow: hidden;\n}\n\n.form-header {\n  background: #1a3a6b;\n  padding: 48px 50px;\n  text-align: center;\n  color: white;\n  position: relative;\n  overflow: hidden;\n}\n\n.form-header::before {\n  content: '';\n  position: absolute;\n  top: -50px; right: -50px;\n  width: 180px; height: 180px;\n  background: rgba(59, 130, 246, 0.15);\n  border-radius: 50%;\n}\n\n.form-header::after {\n  content: '';\n  position: absolute;\n  bottom: -40px; left: -40px;\n  width: 140px; height: 140px;\n  background: rgba(59, 130, 246, 0.1);\n  border-radius: 50%;\n}\n\n.form-header h1 {\n  font-size: 2.2em;\n  font-weight: 700;\n  letter-spacing: -0.02em;\n  margin-bottom: 10px;\n  position: relative;\n}\n\n.form-header h1 span {\n  color: #3b82f6;\n}\n\n.form-header p {\n  font-size: 1rem;\n  color: rgba(255,255,255,0.7);\n  position: relative;\n}\n\n.form-content {\n  padding: 48px 50px;\n}\n\n@media (max-width: 768px) {\n  .form-header { padding: 32px 24px; }\n  .form-header h1 { font-size: 1.6em; }\n  .form-content { padding: 28px 20px; }\n}\n<\/style>\n\n<div class=\"form-container\">\n  <div class=\"form-header\">\n    <h1>Fiche d&rsquo;<span>inscription<\/span><\/h1>\n    <p>Association Thouarsaise de Patinage \u00b7 Saison 2026-2027<\/p>\n  <\/div>\n  <div class=\"form-content\">\n    <div class=\"forminator-ui forminator-custom-form forminator-custom-form-1105 forminator-design--material  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-1105\" data-uid=\"6a9cf6a818518\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-1105\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-1105 forminator-design--material  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"1105\"\n\t\t\t\tenctype=\"multipart\/form-data\" data-color-option=\"theme\" data-design=\"material\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6a9cf6a818518\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-6a9cf6a818518-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-1-6a9cf6a818518-label\" class=\"forminator-label\">Discipline <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-1-1-6a9cf6a818518-label\" for=\"forminator-field-checkbox-1-1-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"Artistique\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-1-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-1-1-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Artistique<\/span><\/label><label id=\"forminator-field-checkbox-1-2-6a9cf6a818518-label\" for=\"forminator-field-checkbox-1-2-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"Loisirs adultes\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"two\" id=\"forminator-field-checkbox-1-2-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-1-2-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Loisirs adultes<\/span><\/label><label id=\"forminator-field-checkbox-1-3-6a9cf6a818518-label\" for=\"forminator-field-checkbox-1-3-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"Baby\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Baby\" id=\"forminator-field-checkbox-1-3-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-1-3-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Baby<\/span><\/label><label id=\"forminator-field-checkbox-1-4-6a9cf6a818518-label\" for=\"forminator-field-checkbox-1-4-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"Hockey\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Hockey\" id=\"forminator-field-checkbox-1-4-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-1-4-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hockey<\/span><\/label><label id=\"forminator-field-checkbox-1-5-6a9cf6a818518-label\" for=\"forminator-field-checkbox-1-5-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"Course\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Course\" id=\"forminator-field-checkbox-1-5-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-1-5-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Course<\/span><\/label><label id=\"forminator-field-checkbox-1-6-6a9cf6a818518-label\" for=\"forminator-field-checkbox-1-6-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"Freestyle\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Freestyle\" id=\"forminator-field-checkbox-1-6-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-1-6-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Freestyle<\/span><\/label><label id=\"forminator-field-checkbox-1-7-6a9cf6a818518-label\" for=\"forminator-field-checkbox-1-7-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"\u00c9cole de patinage\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"\u00c9cole-de-patinage\" id=\"forminator-field-checkbox-1-7-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-1-7-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">\u00c9cole de patinage<\/span><\/label><label id=\"forminator-field-checkbox-1-8-6a9cf6a818518-label\" for=\"forminator-field-checkbox-1-8-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"Roller Dance\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Roller-Dance\" id=\"forminator-field-checkbox-1-8-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-1-8-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Roller Dance<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-6 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-6a9cf6a818518-label\"><span id=\"forminator-radiogroup-radio-1-6a9cf6a818518-label\" class=\"forminator-label\">Souhaitez-vous louer du mat\u00e9riel ?<\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-6a9cf6a818518\" class=\"forminator-radio\" title=\"Oui\"><input type=\"radio\" name=\"radio-1\" value=\"one\" id=\"forminator-field-radio-1-1-6a9cf6a818518\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-6a9cf6a818518\" class=\"forminator-radio\" title=\"Non\"><input type=\"radio\" name=\"radio-1\" value=\"two\" id=\"forminator-field-radio-1-2-6a9cf6a818518\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><div id=\"checkbox-10\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-10-6a9cf6a818518-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-10-6a9cf6a818518-label\" class=\"forminator-label\">Le club propose de la location de materiel :<\/span><span id=\"forminator-field-checkbox-10-6a9cf6a818518-description\" class=\"forminator-description\">ch\u00e8que de caution de 150\u20ac pour la location (mat\u00e9riel restitu\u00e9 propre et en bon \u00e9tat).<\/span><label id=\"forminator-field-checkbox-10-1-6a9cf6a818518-label\" for=\"forminator-field-checkbox-10-1-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"30\u20ac annuels pour la section baby\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"one\" id=\"forminator-field-checkbox-10-1-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-10-1-6a9cf6a818518-label\" data-calculation=\"30\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-10-6a9cf6a818518-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">30\u20ac annuels pour la section baby<\/span><\/label><label id=\"forminator-field-checkbox-10-2-6a9cf6a818518-label\" for=\"forminator-field-checkbox-10-2-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"45\u20ac annuels pour les sections dance, \u00e9cole et adultes\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"two\" id=\"forminator-field-checkbox-10-2-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-10-2-6a9cf6a818518-label\" data-calculation=\"45\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-10-6a9cf6a818518-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">45\u20ac annuels pour les sections dance, \u00e9cole et adultes<\/span><\/label><label id=\"forminator-field-checkbox-10-3-6a9cf6a818518-label\" for=\"forminator-field-checkbox-10-3-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"60\u20ac annuels pour les sections artistique et hockey\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"annuels-pour-les-sections-artistique-et-hockey-|-60\" id=\"forminator-field-checkbox-10-3-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-10-3-6a9cf6a818518-label\" data-calculation=\"60\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-10-6a9cf6a818518-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">60\u20ac annuels pour les sections artistique et hockey<\/span><\/label><label id=\"forminator-field-checkbox-10-4-6a9cf6a818518-label\" for=\"forminator-field-checkbox-10-4-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"70\u20ac annuels pour la section course\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"annuels-pour-la-section-course-|-70\" id=\"forminator-field-checkbox-10-4-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-10-4-6a9cf6a818518-label\" data-calculation=\"70\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-10-6a9cf6a818518-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">70\u20ac annuels pour la section course<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-6a9cf6a818518-label\"><span id=\"forminator-radiogroup-radio-2-6a9cf6a818518-label\" class=\"forminator-label\">L&#039;inscription est pour une personne mineur <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-6a9cf6a818518\" class=\"forminator-radio\" title=\"Oui\"><input type=\"radio\" name=\"radio-2\" value=\"one\" id=\"forminator-field-radio-2-1-6a9cf6a818518\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Oui<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-6a9cf6a818518\" class=\"forminator-radio\" title=\"Non\"><input type=\"radio\" name=\"radio-2\" value=\"two\" id=\"forminator-field-radio-2-2-6a9cf6a818518\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-4\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Identit\u00e9 du licenci\u00e9<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Ajouter un \\u00e9l\\u00e9ment&quot;,&quot;remove_text&quot;:&quot;Retirer l\\u2018\\u00e9l\\u00e9ment&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"name-7\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-7_6a9cf6a818518\" id=\"forminator-field-name-7_6a9cf6a818518-label\" class=\"forminator-label\">Nom <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-7\" value=\"\" placeholder=\"\" id=\"forminator-field-name-7_6a9cf6a818518\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><div id=\"name-8\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-8_6a9cf6a818518\" id=\"forminator-field-name-8_6a9cf6a818518-label\" class=\"forminator-label\">Pr\u00e9nom <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-8\" value=\"\" placeholder=\"\" id=\"forminator-field-name-8_6a9cf6a818518\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-2\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-picker_6a9cf6a818518\" id=\"forminator-field-date-2-picker_6a9cf6a818518-label\" class=\"forminator-label\">Date de naissance <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-2\" value=\"\" placeholder=\"Choisissez une date\" id=\"forminator-field-date-2-picker_6a9cf6a818518\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"mm\/dd\/yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1926\" data-end-year=\"2126\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"name-6\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-6_6a9cf6a818518\" id=\"forminator-field-name-6_6a9cf6a818518-label\" class=\"forminator-label\">Nationalit\u00e9<\/label><input type=\"text\" name=\"name-6\" value=\"\" placeholder=\"\" id=\"forminator-field-name-6_6a9cf6a818518\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-2\" class=\"forminator-field-address forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-2-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-2-street_address_6a9cf6a818518\" id=\"forminator-field-address-2-street_address_6a9cf6a818518-label\" class=\"forminator-label\">Rue<\/label><input type=\"text\" name=\"address-2-street_address\" placeholder=\"\" id=\"forminator-field-address-2-street_address_6a9cf6a818518\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" autocomplete=\"address-line1\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-2-address_line\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-2-address_line_6a9cf6a818518\" id=\"forminator-field-address-2-address_line_6a9cf6a818518-label\" class=\"forminator-label\">Appartement, suite, etc.<\/label><input type=\"text\" name=\"address-2-address_line\" placeholder=\"\" id=\"forminator-field-address-2-address_line_6a9cf6a818518\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" autocomplete=\"address-line2\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-2-city\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-2-city_6a9cf6a818518\" id=\"forminator-field-address-2-city_6a9cf6a818518-label\" class=\"forminator-label\">Ville<\/label><input type=\"text\" name=\"address-2-city\" placeholder=\"\" id=\"forminator-field-address-2-city_6a9cf6a818518\" class=\"forminator-input\" data-required=\"\" aria-required=\"false\" autocomplete=\"address-level2\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-2-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-2-zip_6a9cf6a818518\" id=\"forminator-field-address-2-zip_6a9cf6a818518-label\" class=\"forminator-label\">Code postal<\/label><input type=\"text\" name=\"address-2-zip\" placeholder=\"\" id=\"forminator-field-address-2-zip_6a9cf6a818518\" class=\"forminator-input\" autocomplete=\"postal-code\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-4\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-4_6a9cf6a818518\" id=\"forminator-field-phone-4_6a9cf6a818518-label\" class=\"forminator-label\">T\u00e9l\u00e9phone<\/label><input type=\"text\" name=\"phone-4\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-4_6a9cf6a818518\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><div id=\"phone-5\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-5_6a9cf6a818518\" id=\"forminator-field-phone-5_6a9cf6a818518-label\" class=\"forminator-label\">Portable<\/label><input type=\"text\" name=\"phone-5\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-5_6a9cf6a818518\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-3\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-row-inside forminator-row-with-confirmation-email\"><div class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-email-3_6a9cf6a818518\" id=\"forminator-field-email-3_6a9cf6a818518-label\" class=\"forminator-label\">Adresse de messagerie <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-3\" value=\"\" placeholder=\"\" id=\"forminator-field-email-3_6a9cf6a818518\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><div class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-confirm_email-3_6a9cf6a818518\" id=\"forminator-field-confirm_email-3_6a9cf6a818518-label\" class=\"forminator-label\">Confirm Email Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"confirm_email-3\" value=\"\" placeholder=\"Re-type Email Address\" id=\"forminator-field-confirm_email-3_6a9cf6a818518\" class=\"forminator-input forminator-name--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-2\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">Responsable l\u00e9gal (si mineur)<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Ajouter un \\u00e9l\\u00e9ment&quot;,&quot;remove_text&quot;:&quot;Retirer l\\u2018\\u00e9l\\u00e9ment&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"name-4\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-4_6a9cf6a818518\" id=\"forminator-field-name-4_6a9cf6a818518-label\" class=\"forminator-label\">Nom responsable l\u00e9gal<\/label><input type=\"text\" name=\"name-4\" value=\"\" placeholder=\"\" id=\"forminator-field-name-4_6a9cf6a818518\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-5\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-5_6a9cf6a818518\" id=\"forminator-field-name-5_6a9cf6a818518-label\" class=\"forminator-label\">Pr\u00e9nom<\/label><input type=\"text\" name=\"name-5\" value=\"\" placeholder=\"\" id=\"forminator-field-name-5_6a9cf6a818518\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-3\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-3_6a9cf6a818518\" id=\"forminator-field-phone-3_6a9cf6a818518-label\" class=\"forminator-label\">T\u00e9l\u00e9phone<\/label><input type=\"text\" name=\"phone-3\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-3_6a9cf6a818518\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-2\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-row-inside forminator-row-with-confirmation-email\"><div class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-email-2_6a9cf6a818518\" id=\"forminator-field-email-2_6a9cf6a818518-label\" class=\"forminator-label\">Email <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-2\" value=\"\" placeholder=\"\" id=\"forminator-field-email-2_6a9cf6a818518\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><div class=\"forminator-col forminator-col-6\"><div class=\"forminator-field\"><label for=\"forminator-field-confirm_email-2_6a9cf6a818518\" id=\"forminator-field-confirm_email-2_6a9cf6a818518-label\" class=\"forminator-label\">Confirm Email Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"confirm_email-2\" value=\"\" placeholder=\"Re-type Email Address\" id=\"forminator-field-confirm_email-2_6a9cf6a818518\" class=\"forminator-input forminator-name--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-3\" class=\"forminator-field-group forminator-col forminator-col-12 \"><label class=\"forminator-label forminator-repeater-label\">PI\u00c8CES OBLIGATOIRES \u00c0 FOURNIR<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Ajouter un \\u00e9l\\u00e9ment&quot;,&quot;remove_text&quot;:&quot;Retirer l\\u2018\\u00e9l\\u00e9ment&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"checkbox-4\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-4-6a9cf6a818518-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-4-6a9cf6a818518-label\" class=\"forminator-label\">Cocher les pi\u00e8ces transmises <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-4-1-6a9cf6a818518-label\" for=\"forminator-field-checkbox-4-1-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"Une photo d\u2019identit\u00e9 (pour les nouvelles licences).\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"one\" id=\"forminator-field-checkbox-4-1-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-4-1-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Une photo d\u2019identit\u00e9 (pour les nouvelles licences).<\/span><\/label><label id=\"forminator-field-checkbox-4-2-6a9cf6a818518-label\" for=\"forminator-field-checkbox-4-2-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"Certificat m\u00e9dical pour les majeurs en comp\u00e9tition (avec la mention \u00ab apte au roller en comp\u00e9tition \u00bb) s\u2019il a plus de 3 ans\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"two\" id=\"forminator-field-checkbox-4-2-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-4-2-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Certificat m\u00e9dical pour les majeurs en comp\u00e9tition (avec la mention \u00ab apte au roller en comp\u00e9tition \u00bb) s\u2019il a plus de 3 ans<\/span><\/label><label id=\"forminator-field-checkbox-4-3-6a9cf6a818518-label\" for=\"forminator-field-checkbox-4-3-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"Code PASS\u2019SPORT\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Code-PASS\u2019SPORT\" id=\"forminator-field-checkbox-4-3-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-4-3-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Code PASS\u2019SPORT<\/span><\/label><\/div><\/div><div id=\"upload-1\" class=\"forminator-field-upload forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-1_6a9cf6a818518\" id=\"forminator-field-upload-1_6a9cf6a818518-label\" class=\"forminator-label\">Pi\u00e8ces \u00e0 fournir<\/label><span id=\"forminator-field-upload-1_6a9cf6a818518-description\" class=\"forminator-description\">Photo d\u2019identit\u00e9 (jpeg, jpg, png)  Certificat m\u00e9dical (PDF)  Autre document (PDF)<\/span><div class=\"forminator-multi-upload \" data-element=\"upload-1_6a9cf6a818518\" aria-describedby=\"forminator-field-upload-1_6a9cf6a818518-description\"><input type=\"file\" name=\"upload-1[]\" id=\"forminator-field-upload-1_6a9cf6a818518\" class=\"forminator-input-file forminator-field-upload-1_6a9cf6a818518-1105\" multiple=\"multiple\" data-method=\"ajax\" accept=\".avif,.heif,.heics,.heifs,.jpg,.jpeg,.jpe,.png,.pdf,image\/avif,image\/heif,image\/heic-sequence,image\/heif-sequence,image\/jpeg,image\/png,application\/pdf\" data-size=\"104857600\" data-size-message=\"Maximum file size allowed is 100 MB. \" data-filetype=\"avif|heif|heics|heifs|jpg|jpeg|jpe|png|pdf\" data-filetype-message=\"l\u2019extension de fichier n\u2019est pas autoris\u00e9e.\"><div class=\"forminator-multi-upload-message\" aria-hidden=\"true\"><span class=\"forminator-icon-upload\" aria-hidden=\"true\"><\/span><p>Glissez et d\u00e9posez (ou) <a class=\"forminator-upload-file--forminator-field-upload-1_6a9cf6a818518\" href=\"#\" onclick=\"return false;\">Choisissez des fichiers<\/a><\/p><\/div><\/div><ul class=\"forminator-uploaded-files upload-container-upload-1_6a9cf6a818518\"><\/ul><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-2\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-2-6a9cf6a818518-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-2-6a9cf6a818518-label\" class=\"forminator-label\">Questionnaire de sant\u00e9 <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-2-1-6a9cf6a818518-label\" for=\"forminator-field-checkbox-2-1-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"J\u2019atteste avoir compl\u00e9t\u00e9 le questionnaire de sant\u00e9 QS-SPORT et avoir r\u00e9pondu NON \u00e0 toutes les rubriques.\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"one\" id=\"forminator-field-checkbox-2-1-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-2-1-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">J\u2019atteste avoir compl\u00e9t\u00e9 le questionnaire de sant\u00e9 QS-SPORT et avoir r\u00e9pondu NON \u00e0 toutes les rubriques.<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-5\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-5-6a9cf6a818518-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-5-6a9cf6a818518-label\" class=\"forminator-label\">Autorisations parentales: <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-5-1-6a9cf6a818518-label\" for=\"forminator-field-checkbox-5-1-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"J\u2019autorise l&#039;ATP 79 \u00e0 prendre toutes les mesures m\u00e9dicales n\u00e9cessaires en cas d&#039;urgence pour mon enfant, y compris les examens m\u00e9dicaux invasifs (prise de sang, \u2026 )\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"one\" id=\"forminator-field-checkbox-5-1-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-5-1-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">J\u2019autorise l&rsquo;ATP 79 \u00e0 prendre toutes les mesures m\u00e9dicales n\u00e9cessaires en cas d&rsquo;urgence pour mon enfant, y compris les examens m\u00e9dicaux invasifs (prise de sang, \u2026 )<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-14\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-14-6a9cf6a818518-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-14-6a9cf6a818518-label\" class=\"forminator-label\">Pathologies (asthme, allergie, etc \u2026\u2026.) <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-14-1-6a9cf6a818518-label\" for=\"forminator-field-checkbox-14-1-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"Je d\u00e9gage de toutes responsabilit\u00e9s le club ATP 79 ainsi que ses b\u00e9n\u00e9voles lors des d\u00e9placements effectu\u00e9s pour toute manifestation pendant la saison en cours.\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"two\" id=\"forminator-field-checkbox-14-1-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-14-1-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Je d\u00e9gage de toutes responsabilit\u00e9s le club ATP 79 ainsi que ses b\u00e9n\u00e9voles lors des d\u00e9placements effectu\u00e9s pour toute manifestation pendant la saison en cours.<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-15\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-15-6a9cf6a818518-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-15-6a9cf6a818518-label\" class=\"forminator-label\">Votre enfant a t&#039;il une pathologie a ce jour?<\/span><label id=\"forminator-field-checkbox-15-1-6a9cf6a818518-label\" for=\"forminator-field-checkbox-15-1-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"Oui\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"one\" id=\"forminator-field-checkbox-15-1-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-15-1-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Oui<\/span><\/label><label id=\"forminator-field-checkbox-15-2-6a9cf6a818518-label\" for=\"forminator-field-checkbox-15-2-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"Non\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"two\" id=\"forminator-field-checkbox-15-2-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-15-2-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6a9cf6a818518\" id=\"forminator-field-textarea-2_6a9cf6a818518-label\" class=\"forminator-label\">Indiquer la pathologie<\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_6a9cf6a818518\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-6\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-6-6a9cf6a818518-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-6-6a9cf6a818518-label\" class=\"forminator-label\">Droit \u00e0 l\u2019image : <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-6-1-6a9cf6a818518-label\" for=\"forminator-field-checkbox-6-1-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"J\u2019autorise le club, la f\u00e9d\u00e9ration ou ses organes d\u00e9concentr\u00e9s (ligue ou comit\u00e9 d\u00e9partemental), \u00e0 utiliser sur ses supports de communication, ma photo d\u2019identit\u00e9 ins\u00e9r\u00e9e sur la licence, \u00e0 des fins exclusives de promotion de ses activit\u00e9s et \u00e0 des fins non commerciales. Je reconnais que cette cession de droit est effectu\u00e9e \u00e0 titre gratuit et valable pour la dur\u00e9e de la saison sportive en cours.\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"one\" id=\"forminator-field-checkbox-6-1-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-6-1-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">J\u2019autorise le club, la f\u00e9d\u00e9ration ou ses organes d\u00e9concentr\u00e9s (ligue ou comit\u00e9 d\u00e9partemental), \u00e0 utiliser sur ses supports de communication, ma photo d\u2019identit\u00e9 ins\u00e9r\u00e9e sur la licence, \u00e0 des fins exclusives de promotion de ses activit\u00e9s et \u00e0 des fins non commerciales. Je reconnais que cette cession de droit est effectu\u00e9e \u00e0 titre gratuit et valable pour la dur\u00e9e de la saison sportive en cours.<\/span><\/label><label id=\"forminator-field-checkbox-6-2-6a9cf6a818518-label\" for=\"forminator-field-checkbox-6-2-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"J&#039;autorise l&#039;ATP79 \u00e0 prendre des photos ou vid\u00e9o lors de ces diff\u00e9rentes manifestations et des les diffuser \u00e0 la presse ou sur ces divers supports de communication.\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"two\" id=\"forminator-field-checkbox-6-2-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-6-2-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">J&rsquo;autorise l&rsquo;ATP79 \u00e0 prendre des photos ou vid\u00e9o lors de ces diff\u00e9rentes manifestations et des les diffuser \u00e0 la presse ou sur ces divers supports de communication.<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-7\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-7-6a9cf6a818518-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-7-6a9cf6a818518-label\" class=\"forminator-label\">Assurances : <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-field-checkbox-7-6a9cf6a818518-description\" class=\"forminator-description\">L\u2019adh\u00e9sion \u00e0 l\u2019ATP79 implique votre adh\u00e9sion de fait \u00e0 la F\u00e9d\u00e9ration Fran\u00e7aise de Roller Sport (FFRS) ainsi que l\u2019adh\u00e9sion au contrat d\u2019assurance facultatif \u00ab Garanties de base individuelle accident (ou dommages corporels) contrat n\u00b0101 625 000 (voir document joint ou sur le site www.ffrs.asso.fr). L\u2019ATP79 vous informe que vous avez la possibilit\u00e9 de souscrire directement aupr\u00e8s de l\u2019assureur MMA des garanties compl\u00e9mentaires (contrat 102 742 500 sur le site http:\/\/ffroller.fr\/creer-mon-club\/assurance\/)<\/span><label id=\"forminator-field-checkbox-7-1-6a9cf6a818518-label\" for=\"forminator-field-checkbox-7-1-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"Je soussign\u00e9 d\u00e9clare avoir pris connaissance par l\u2019interm\u00e9diaire de mon club des informations relatives \u00e0 la notice d\u2019assurance \u00ab dommages corporels \u00bb de base et des garanties compl\u00e9mentaires propos\u00e9es par la FFRS (disponibles ci-jointes, ainsi que sur le site www.ffroller.fr et dans l\u2019espace licenci\u00e9 sur Rol\u2019Skanet).\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"one\" id=\"forminator-field-checkbox-7-1-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-7-1-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-7-6a9cf6a818518-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Je soussign\u00e9 d\u00e9clare avoir pris connaissance par l\u2019interm\u00e9diaire de mon club des informations relatives \u00e0 la notice d\u2019assurance \u00ab dommages corporels \u00bb de base et des garanties compl\u00e9mentaires propos\u00e9es par la FFRS (disponibles ci-jointes, ainsi que sur le site www.ffroller.fr et dans l\u2019espace licenci\u00e9 sur Rol\u2019Skanet).<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-8\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-8-6a9cf6a818518-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-8-6a9cf6a818518-label\" class=\"forminator-label\">Donn\u00e9es personnelles<\/span><span id=\"forminator-field-checkbox-8-6a9cf6a818518-description\" class=\"forminator-description\">Donn\u00e9es personnelles Les donn\u00e9es \u00e0 caract\u00e8re personnel vous concernant sont indispensables \u00e0 la gestion de votre licence par la FFRS. \u00c0 d\u00e9faut, votre demande de licence ou de renouvellement de licence ne pourra \u00eatre prise en consid\u00e9ration. Vous autorisez express\u00e9ment la FF Roller \u00e0 traiter et conserver par informatique les donn\u00e9es vous concernant. Vous disposez d\u2019un droit d\u2019acc\u00e8s, en application des art. 39 et suivants de la loi du 6 juillet 1978 modifi\u00e9e, de rectification et de mise \u00e0 jour des donn\u00e9es vous concernant aupr\u00e8s du service \u00ab vie f\u00e9d\u00e9rale \u00bb de la FF Roller ou sur votre espace licenci\u00e9 de la base de donn\u00e9es Rolskanet. Ces informations sont destin\u00e9es \u00e0 la FF Roller et peuvent \u00eatre communiqu\u00e9es \u00e0 des tiers. Vous pouvez choisir de la part de qui vous pouvez recevoir des informations :<\/span><label id=\"forminator-field-checkbox-8-1-6a9cf6a818518-label\" for=\"forminator-field-checkbox-8-1-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"Aucun mailing\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"Aucun-mailing\" id=\"forminator-field-checkbox-8-1-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-8-1-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-8-6a9cf6a818518-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Aucun mailing<\/span><\/label><label id=\"forminator-field-checkbox-8-2-6a9cf6a818518-label\" for=\"forminator-field-checkbox-8-2-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"Tout mailing (f\u00e9d\u00e9ral et commercial)\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"two\" id=\"forminator-field-checkbox-8-2-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-8-2-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-8-6a9cf6a818518-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Tout mailing (f\u00e9d\u00e9ral et commercial)<\/span><\/label><label id=\"forminator-field-checkbox-8-3-6a9cf6a818518-label\" for=\"forminator-field-checkbox-8-3-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"Mailing interne\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"one\" id=\"forminator-field-checkbox-8-3-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-8-3-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-8-6a9cf6a818518-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mailing interne<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-9\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-9-6a9cf6a818518-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-9-6a9cf6a818518-label\" class=\"forminator-label\">1er inscription dans le foyer pour cette ann\u00e9e?<\/span><label id=\"forminator-field-checkbox-9-1-6a9cf6a818518-label\" for=\"forminator-field-checkbox-9-1-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"Oui\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"one\" id=\"forminator-field-checkbox-9-1-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-9-1-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Oui<\/span><\/label><label id=\"forminator-field-checkbox-9-2-6a9cf6a818518-label\" for=\"forminator-field-checkbox-9-2-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"Non nous avons d\u00e9j\u00e0 une personne inscrit dans le club cette ann\u00e9e\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"two\" id=\"forminator-field-checkbox-9-2-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-9-2-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Non nous avons d\u00e9j\u00e0 une personne inscrit dans le club cette ann\u00e9e<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-11\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-11-6a9cf6a818518-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-11-6a9cf6a818518-label\" class=\"forminator-label\">Tarif adh\u00e9sion <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-11-1-6a9cf6a818518-label\" for=\"forminator-field-checkbox-11-1-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"Le r\u00e8glement de 100\u20ac (80\u20ac de licence + 20\u20ac de tickets de tombola)\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"one\" id=\"forminator-field-checkbox-11-1-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-11-1-6a9cf6a818518-label\" data-calculation=\"100\" checked=\"checked\"  data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Le r\u00e8glement de 100\u20ac (80\u20ac de licence + 20\u20ac de tickets de tombola)<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-12\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-12-6a9cf6a818518-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-12-6a9cf6a818518-label\" class=\"forminator-label\">Tarif adh\u00e9sion 2 <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-field-checkbox-12-6a9cf6a818518-description\" class=\"forminator-description\">si 2 personnes ou plus sont incrite dans un meme foyer<\/span><label id=\"forminator-field-checkbox-12-1-6a9cf6a818518-label\" for=\"forminator-field-checkbox-12-1-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"Le r\u00e8glement de 80\u20ac (80\u20ac de licence - 20\u20ac de tickets de tombola d\u00e9j\u00e0 pris sur l\u2019inscription de la 1er personne du m\u00eame foyer)\"><input type=\"checkbox\" name=\"checkbox-12[]\" value=\"one\" id=\"forminator-field-checkbox-12-1-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-12-1-6a9cf6a818518-label\" data-calculation=\"80\" checked=\"checked\"  data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-12-6a9cf6a818518-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Le r\u00e8glement de 80\u20ac (80\u20ac de licence &#8211; 20\u20ac de tickets de tombola d\u00e9j\u00e0 pris sur l\u2019inscription de la 1er personne du m\u00eame foyer)<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-13\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-13-6a9cf6a818518-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-13-6a9cf6a818518-label\" class=\"forminator-label\">Avez vous un Code PASS&#039;SPORT<\/span><span id=\"forminator-field-checkbox-13-6a9cf6a818518-description\" class=\"forminator-description\">Aide financer une inscription dans un club ou une association sportive.<\/span><label id=\"forminator-field-checkbox-13-1-6a9cf6a818518-label\" for=\"forminator-field-checkbox-13-1-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"Oui\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"one\" id=\"forminator-field-checkbox-13-1-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-13-1-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-13-6a9cf6a818518-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Oui<\/span><\/label><label id=\"forminator-field-checkbox-13-2-6a9cf6a818518-label\" for=\"forminator-field-checkbox-13-2-6a9cf6a818518\" class=\"forminator-checkbox\" title=\"Non\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"two\" id=\"forminator-field-checkbox-13-2-6a9cf6a818518\" aria-labelledby=\"forminator-field-checkbox-13-2-6a9cf6a818518-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-checkbox-13-6a9cf6a818518-description\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Non<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-1\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-1_6a9cf6a818518\" id=\"forminator-field-number-1_6a9cf6a818518-label\" class=\"forminator-label\">Montant du PASS&#039;SPORT<\/label><input name=\"number-1\" value=\"\" placeholder=\"merci de mettre le montant de votre PASS&#039;SPORT sans le symbole \u20ac exemple: 70\" id=\"forminator-field-number-1_6a9cf6a818518\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"150\" \/><\/div><\/div><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6a9cf6a818518\" id=\"forminator-field-textarea-1_6a9cf6a818518-label\" class=\"forminator-label\">Code PASS&#039;SPORT<\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_6a9cf6a818518\" class=\"forminator-textarea\" style=\"--forminator-textarea-min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"calculation-1\" class=\"forminator-field-calculation forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"calculation-1-field_6a9cf6a818518\" id=\"calculation-1-field_6a9cf6a818518-label\" class=\"forminator-label\">Total adh\u00e9sion :<\/label><span id=\"calculation-1-field_6a9cf6a818518-description\" class=\"forminator-description\">Montant a payer pour votre adh\u00e9sion<\/span><div class=\"forminator-input forminator-input-with-prefix\"><span class=\"forminator-prefix\">\u20ac<\/span><input type=\"text\" name=\"calculation-1\" value=\"\" id=\"calculation-1-field_6a9cf6a818518\" class=\"forminator-calculation\" data-formula=\"{checkbox-10} + {checkbox-11} + {checkbox-12} - {number-1}\" data-required=\"\" data-decimal-point=\"\" data-precision=\"0\" data-is-hidden=\"\" disabled=\"disabled\" data-decimals=\"0\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" readonly=\"readonly\" data-hidden-behavior=\"zero\" aria-describedby=\"calculation-1-field_6a9cf6a818518-description\" \/><span class=\"forminator-suffix\"><\/span><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-form-1105__field--select-1_6a9cf6a818518\" id=\"forminator-form-1105__field--select-1_6a9cf6a818518-label\" class=\"forminator-label\">S\u00e9lectionner <span class=\"forminator-required\">*<\/span><\/label><select  id=\"forminator-form-1105__field--select-1_6a9cf6a818518\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-1\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Mode de paiement\" data-search=\"false\" data-search-placeholder=\"Mode de paiement\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-1105__field--select-1_6a9cf6a818518-label\"><option value=\"\"  >Mode de paiement<\/option><option value=\"one\"  data-calculation=\"0\">HelloAsso (carte bancaire)<\/option><option value=\"Cheques\"  data-calculation=\"0\">Cheques<\/option><option value=\"Esp\u00e8ces\"  data-calculation=\"0\">Esp\u00e8ces<\/option><\/select><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\"><span>Envoyer<\/span><span aria-hidden=\"true\"><\/span><\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"48cf57d029\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/1106\" \/><input type=\"hidden\" name=\"form_id\" value=\"1105\"><input type=\"hidden\" name=\"page_id\" value=\"1106\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/atp79.info\/index.php\/formulaire\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"forminator-multifile-hidden\" class=\"forminator-multifile-hidden\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form>\n  <\/div>\n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Formulaire de Contact &#8211; ATP79 Fiche d&rsquo;inscription Association Thouarsaise de Patinage \u00b7 Saison 2026-2027<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":"","_members_access_role":[],"_members_access_error":""},"class_list":["post-1106","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/atp79.info\/index.php\/wp-json\/wp\/v2\/pages\/1106","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/atp79.info\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/atp79.info\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/atp79.info\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/atp79.info\/index.php\/wp-json\/wp\/v2\/comments?post=1106"}],"version-history":[{"count":10,"href":"https:\/\/atp79.info\/index.php\/wp-json\/wp\/v2\/pages\/1106\/revisions"}],"predecessor-version":[{"id":1155,"href":"https:\/\/atp79.info\/index.php\/wp-json\/wp\/v2\/pages\/1106\/revisions\/1155"}],"wp:attachment":[{"href":"https:\/\/atp79.info\/index.php\/wp-json\/wp\/v2\/media?parent=1106"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}