{"id":4634,"date":"2025-10-17T09:22:51","date_gmt":"2025-10-17T13:22:51","guid":{"rendered":"https:\/\/aamac.ca\/?page_id=4634"},"modified":"2025-10-23T09:38:53","modified_gmt":"2025-10-23T13:38:53","slug":"volunteer-data-commitment-form","status":"publish","type":"page","link":"https:\/\/aamac.ca\/fr\/volunteer-data-commitment-form\/","title":{"rendered":"Formulaire de donn\u00e9es et d&rsquo;engagement des b\u00e9n\u00e9voles"},"content":{"rendered":"<p><div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_25_container\" data-token=\"b091ebedc96f74fb49d84ebcc9b2393c\" data-token=\"b091ebedc96f74fb49d84ebcc9b2393c\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form  frm_js_validate  frm_ajax_submit  frm_pro_form \" id=\"form_vg2bl2\" data-token=\"b091ebedc96f74fb49d84ebcc9b2393c\" data-token=\"b091ebedc96f74fb49d84ebcc9b2393c\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Volunteer form -- FR<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"25\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_25\" id=\"frm_hide_fields_25\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"vg2bl2\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_25\" name=\"frm_submit_entry_25\" value=\"15d6fcf7d8\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/fr\/wp-json\/wp\/v2\/pages\/4634\" \/><div id=\"frm_field_269_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6 frm_first\">\r\n\t<label for=\"field_1v3382\" id=\"field_1v3382_label\" class=\"frm_primary_label\">Pr\u00e9nom\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_1v3382\" name=\"item_meta[269]\" value=\"\"  data-reqmsg=\"Pr\u00e9nom cannot be blank.\" aria-required=\"true\" data-invmsg=\"Pr\u00e9nom is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_270_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n\t<label for=\"field_txrm2\" id=\"field_txrm2_label\" class=\"frm_primary_label\">Nom\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_txrm2\" name=\"item_meta[270]\" value=\"\"  data-reqmsg=\"Nom cannot be blank.\" aria-required=\"true\" data-invmsg=\"Nom is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_271_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio frm_other_container\">\r\n\t<label for=\"field_rjxar2\" id=\"field_rjxar2_label\" class=\"frm_primary_label\">Lien de parent\u00e9 avec le patient\u00a0: (cochez les cases applicables)\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_271-0\">\t\t\t<label  for=\"field_rjxar2-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[271][]\" id=\"field_rjxar2-0\" value=\"Patience\"  data-frmval=\"[&quot;Patient&quot;]\" data-reqmsg=\"Lien de parent\u00e9 avec le patient\u00a0: (cochez les cases applicables) cannot be blank.\" data-invmsg=\"Lien de parent\u00e9 avec le patient\u00a0: (cochez les cases applicables) is invalid\" aria-invalid=\"false\"   aria-required=\"true\"  \/> Patience<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_271-1\">\t\t\t<label  for=\"field_rjxar2-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[271][]\" id=\"field_rjxar2-1\" value=\"Relation\"  data-frmval=\"[&quot;Patient&quot;]\" data-reqmsg=\"Lien de parent\u00e9 avec le patient\u00a0: (cochez les cases applicables) cannot be blank.\" data-invmsg=\"Lien de parent\u00e9 avec le patient\u00a0: (cochez les cases applicables) is invalid\" aria-invalid=\"false\"   \/> Relation<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_271-3\">\t\t\t<label  for=\"field_rjxar2-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[271][]\" id=\"field_rjxar2-3\" value=\"Amie\"  data-frmval=\"[&quot;Patient&quot;]\" data-reqmsg=\"Lien de parent\u00e9 avec le patient\u00a0: (cochez les cases applicables) cannot be blank.\" data-invmsg=\"Lien de parent\u00e9 avec le patient\u00a0: (cochez les cases applicables) is invalid\" aria-invalid=\"false\"   \/> Amie<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_271-4\">\t\t\t<label  for=\"field_rjxar2-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[271][]\" id=\"field_rjxar2-4\" value=\"Non applicable\"  data-frmval=\"[&quot;Patient&quot;]\" data-reqmsg=\"Lien de parent\u00e9 avec le patient\u00a0: (cochez les cases applicables) cannot be blank.\" data-invmsg=\"Lien de parent\u00e9 avec le patient\u00a0: (cochez les cases applicables) is invalid\" aria-invalid=\"false\"   \/> Non applicable<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_271-other_2\">\t\t\t<label  for=\"field_rjxar2-other_2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[271][other_2]\" id=\"field_rjxar2-other_2\" value=\"Autre\"  data-frmval=\"[&quot;Patient&quot;]\" data-reqmsg=\"Lien de parent\u00e9 avec le patient\u00a0: (cochez les cases applicables) cannot be blank.\" data-invmsg=\"Lien de parent\u00e9 avec le patient\u00a0: (cochez les cases applicables) is invalid\" aria-invalid=\"false\"   \/> Autre<\/label><label for=\"field_rjxar2-other_2-otext\" class=\"frm_screen_reader frm_hidden\">Autre<\/label><input type=\"text\" id=\"field_rjxar2-other_2-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][271][other_2]\" value=\"\" \/><\/div>\n\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_272_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio frm_other_container\">\r\n\t<label for=\"field_hiv7t2\" id=\"field_hiv7t2_label\" class=\"frm_primary_label\">Diagnostic\/Domaine d'int\u00e9r\u00eat\/Connaissances du b\u00e9n\u00e9vole\u00a0: (Cochez toutes les cases applicables)\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_272-0\">\t\t\t<label  for=\"field_hiv7t2-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[272][]\" id=\"field_hiv7t2-0\" value=\"An\u00e9mie aplastique\"  data-reqmsg=\"Diagnostic\/Domaine d&#039;int\u00e9r\u00eat\/Connaissances du b\u00e9n\u00e9vole\u00a0: (Cochez toutes les cases applicables) cannot be blank.\" data-invmsg=\"Diagnostic\/Domaine d&#039;int\u00e9r\u00eat\/Connaissances du b\u00e9n\u00e9vole\u00a0: (Cochez toutes les cases applicables) is invalid\" aria-invalid=\"false\"   aria-required=\"true\"  \/> An\u00e9mie aplastique<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_272-1\">\t\t\t<label  for=\"field_hiv7t2-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[272][]\" id=\"field_hiv7t2-1\" value=\"My\u00e9lodysplasie\"  data-reqmsg=\"Diagnostic\/Domaine d&#039;int\u00e9r\u00eat\/Connaissances du b\u00e9n\u00e9vole\u00a0: (Cochez toutes les cases applicables) cannot be blank.\" data-invmsg=\"Diagnostic\/Domaine d&#039;int\u00e9r\u00eat\/Connaissances du b\u00e9n\u00e9vole\u00a0: (Cochez toutes les cases applicables) is invalid\" aria-invalid=\"false\"   \/> My\u00e9lodysplasie<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_272-3\">\t\t\t<label  for=\"field_hiv7t2-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[272][]\" id=\"field_hiv7t2-3\" value=\"PNH\"  data-reqmsg=\"Diagnostic\/Domaine d&#039;int\u00e9r\u00eat\/Connaissances du b\u00e9n\u00e9vole\u00a0: (Cochez toutes les cases applicables) cannot be blank.\" data-invmsg=\"Diagnostic\/Domaine d&#039;int\u00e9r\u00eat\/Connaissances du b\u00e9n\u00e9vole\u00a0: (Cochez toutes les cases applicables) is invalid\" aria-invalid=\"false\"   \/> PNH<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_272-other_2\">\t\t\t<label  for=\"field_hiv7t2-other_2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[272][other_2]\" id=\"field_hiv7t2-other_2\" value=\"Autre, veuillez pr\u00e9ciser\"  data-reqmsg=\"Diagnostic\/Domaine d&#039;int\u00e9r\u00eat\/Connaissances du b\u00e9n\u00e9vole\u00a0: (Cochez toutes les cases applicables) cannot be blank.\" data-invmsg=\"Diagnostic\/Domaine d&#039;int\u00e9r\u00eat\/Connaissances du b\u00e9n\u00e9vole\u00a0: (Cochez toutes les cases applicables) is invalid\" aria-invalid=\"false\"   \/> Autre, veuillez pr\u00e9ciser<\/label><label for=\"field_hiv7t2-other_2-otext\" class=\"frm_screen_reader frm_hidden\">Autre, veuillez pr\u00e9ciser<\/label><input type=\"text\" id=\"field_hiv7t2-other_2-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][272][other_2]\" value=\"\" \/><\/div>\n\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_273_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n\t<label for=\"field_pq8fk2\" id=\"field_pq8fk2_label\" class=\"frm_primary_label\">Ann\u00e9e du diagnostic\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"text\" id=\"field_pq8fk2\" name=\"item_meta[273]\" value=\"\"  maxlength=\"10\" data-invmsg=\"Ann\u00e9e du diagnostic is invalid\" class=\"frm_date\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_274_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n\t<label for=\"field_grgcp2\" id=\"field_grgcp2_label\" class=\"frm_primary_label\">\u00c2ge au diagnostic\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"number\" id=\"field_grgcp2\" name=\"item_meta[274]\" value=\"\" data-invmsg=\"\u00c2ge au diagnostic is invalid\" aria-invalid=\"false\"   min=\"0\" max=\"120\" step=\"any\" \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_275_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_io3tb2\" id=\"field_io3tb2_label\" class=\"frm_primary_label\">Discours\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_io3tb2\" name=\"item_meta[275]\" value=\"\"  data-reqmsg=\"Discours cannot be blank.\" aria-required=\"true\" data-invmsg=\"Discours is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_276_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4 frm_first\">\r\n\t<label for=\"field_c0m7u2\" id=\"field_c0m7u2_label\" class=\"frm_primary_label\">Ville\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_c0m7u2\" name=\"item_meta[276]\" value=\"\"  data-reqmsg=\"Ville cannot be blank.\" aria-required=\"true\" data-invmsg=\"Ville is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_277_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4\">\r\n\t<label for=\"field_oi5av2\" id=\"field_oi5av2_label\" class=\"frm_primary_label\">Province\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_oi5av2\" name=\"item_meta[277]\" value=\"\"  data-reqmsg=\"Province cannot be blank.\" aria-required=\"true\" data-invmsg=\"Province is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_278_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4\">\r\n\t<label for=\"field_9htnb2\" id=\"field_9htnb2_label\" class=\"frm_primary_label\">Code postal\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_9htnb2\" name=\"item_meta[278]\" value=\"\"  data-reqmsg=\"Code postal cannot be blank.\" aria-required=\"true\" data-invmsg=\"Code postal is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_279_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4 frm_first\">\r\n\t<label for=\"field_v8iji2\" id=\"field_v8iji2_label\" class=\"frm_primary_label\">T\u00e9l\u00e9phone\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"tel\" id=\"field_v8iji2\" name=\"item_meta[279]\" value=\"\"  data-reqmsg=\"T\u00e9l\u00e9phone cannot be blank.\" aria-required=\"true\" data-invmsg=\"T\u00e9l\u00e9phone is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_280_container\" class=\"frm_form_field form-field  frm_top_container frm4\">\r\n\t<label for=\"field_zs7ph2\" id=\"field_zs7ph2_label\" class=\"frm_primary_label\">T\u00e9l\u00e9copieur\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input type=\"tel\" id=\"field_zs7ph2\" name=\"item_meta[280]\" value=\"\"  data-invmsg=\"T\u00e9l\u00e9copieur is invalid\" aria-invalid=\"false\" pattern=\"((\\+\\d{1,3}(-|.| )?\\(?\\d\\)?(-| |.)?\\d{1,5})|(\\(?\\d{2,6}\\)?))(-|.| )?(\\d{3,4})(-|.| )?(\\d{4})(( x| ext)\\d{1,5}){0,1}$\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_281_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm4\">\r\n\t<label for=\"field_f9w4b2\" id=\"field_f9w4b2_label\" class=\"frm_primary_label\">Courriel\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input type=\"email\" id=\"field_f9w4b2\" name=\"item_meta[281]\" value=\"\"  autocomplete=\"email\"  data-reqmsg=\"Courriel cannot be blank.\" aria-required=\"true\" data-invmsg=\"Courriel is invalid\" aria-invalid=\"false\"  \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_282_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n\t<label for=\"field_wd94v2\" id=\"field_wd94v2_label\" class=\"frm_primary_label\">Combien d'heures \u00eates-vous disponibles par mois\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_wd94v2\" name=\"item_meta[282]\" value=\"\"  data-reqmsg=\"Combien d&#039;heures \u00eates-vous disponibles par mois cannot be blank.\" aria-required=\"true\" data-invmsg=\"Combien d&#039;heures \u00eates-vous disponibles par mois is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_283_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n\t<div  id=\"field_1g6yy2_label\" class=\"frm_primary_label\">Choisissez les jours de la semaine o\u00f9 vous \u00eates disponible\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_1g6yy2_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_283-0\">\t\t\t<label  for=\"field_1g6yy2-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[283][]\" id=\"field_1g6yy2-0\" value=\"Lundi\"  data-reqmsg=\"Choisissez les jours de la semaine o\u00f9 vous \u00eates disponible cannot be blank.\" data-invmsg=\"Choisissez les jours de la semaine o\u00f9 vous \u00eates disponible is invalid\" aria-invalid=\"false\"   aria-required=\"true\"  \/> Lundi<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_283-1\">\t\t\t<label  for=\"field_1g6yy2-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[283][]\" id=\"field_1g6yy2-1\" value=\"Mardi\"  data-reqmsg=\"Choisissez les jours de la semaine o\u00f9 vous \u00eates disponible cannot be blank.\" data-invmsg=\"Choisissez les jours de la semaine o\u00f9 vous \u00eates disponible is invalid\" aria-invalid=\"false\"   \/> Mardi<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_283-2\">\t\t\t<label  for=\"field_1g6yy2-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[283][]\" id=\"field_1g6yy2-2\" value=\"Mercredi\"  data-reqmsg=\"Choisissez les jours de la semaine o\u00f9 vous \u00eates disponible cannot be blank.\" data-invmsg=\"Choisissez les jours de la semaine o\u00f9 vous \u00eates disponible is invalid\" aria-invalid=\"false\"   \/> Mercredi<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_283-3\">\t\t\t<label  for=\"field_1g6yy2-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[283][]\" id=\"field_1g6yy2-3\" value=\"Jeudi\"  data-reqmsg=\"Choisissez les jours de la semaine o\u00f9 vous \u00eates disponible cannot be blank.\" data-invmsg=\"Choisissez les jours de la semaine o\u00f9 vous \u00eates disponible is invalid\" aria-invalid=\"false\"   \/> Jeudi<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_283-4\">\t\t\t<label  for=\"field_1g6yy2-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[283][]\" id=\"field_1g6yy2-4\" value=\"Vendredi\"  data-reqmsg=\"Choisissez les jours de la semaine o\u00f9 vous \u00eates disponible cannot be blank.\" data-invmsg=\"Choisissez les jours de la semaine o\u00f9 vous \u00eates disponible is invalid\" aria-invalid=\"false\"   \/> Vendredi<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_283-5\">\t\t\t<label  for=\"field_1g6yy2-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[283][]\" id=\"field_1g6yy2-5\" value=\"Samedi\"  data-reqmsg=\"Choisissez les jours de la semaine o\u00f9 vous \u00eates disponible cannot be blank.\" data-invmsg=\"Choisissez les jours de la semaine o\u00f9 vous \u00eates disponible is invalid\" aria-invalid=\"false\"   \/> Samedi<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_283-6\">\t\t\t<label  for=\"field_1g6yy2-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[283][]\" id=\"field_1g6yy2-6\" value=\"Dimanche\"  data-reqmsg=\"Choisissez les jours de la semaine o\u00f9 vous \u00eates disponible cannot be blank.\" data-invmsg=\"Choisissez les jours de la semaine o\u00f9 vous \u00eates disponible is invalid\" aria-invalid=\"false\"   \/> Dimanche<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_284_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_1x0nn2\" id=\"field_1x0nn2_label\" class=\"frm_primary_label\">S'il vous pla\u00eet ne m'appelez pas aux heures suivantes\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_1x0nn2\" name=\"item_meta[284]\" value=\"\"  data-invmsg=\"S&#039;il vous pla\u00eet ne m&#039;appelez pas aux heures suivantes is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_285_container\" class=\"frm_form_field form-field  frm_top_container vertical_radio frm_other_container\">\r\n\t<div  id=\"field_tn4hc2_label\" class=\"frm_primary_label\">Je suis disponible pour (cochez toutes les cases applicables)\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_tn4hc2_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_285-0\">\t\t\t<label  for=\"field_tn4hc2-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[285][]\" id=\"field_tn4hc2-0\" value=\"Correspondre avec les patients par courriel\"  data-invmsg=\"Je suis disponible pour (cochez toutes les cases applicables) is invalid\" aria-invalid=\"false\"   \/> Correspondre avec les patients par courriel<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_285-1\">\t\t\t<label  for=\"field_tn4hc2-1\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[285][]\" id=\"field_tn4hc2-1\" value=\"Parler aux patients par t\u00e9l\u00e9phone\"  data-invmsg=\"Je suis disponible pour (cochez toutes les cases applicables) is invalid\" aria-invalid=\"false\"   \/> Parler aux patients par t\u00e9l\u00e9phone<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_285-2\">\t\t\t<label  for=\"field_tn4hc2-2\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[285][]\" id=\"field_tn4hc2-2\" value=\"Aider les groupes de soutien\"  data-invmsg=\"Je suis disponible pour (cochez toutes les cases applicables) is invalid\" aria-invalid=\"false\"   \/> Aider les groupes de soutien<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_285-3\">\t\t\t<label  for=\"field_tn4hc2-3\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[285][]\" id=\"field_tn4hc2-3\" value=\"Participer aux activit\u00e9s de sensibilisation\"  data-invmsg=\"Je suis disponible pour (cochez toutes les cases applicables) is invalid\" aria-invalid=\"false\"   \/> Participer aux activit\u00e9s de sensibilisation<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_285-4\">\t\t\t<label  for=\"field_tn4hc2-4\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[285][]\" id=\"field_tn4hc2-4\" value=\"R\u00e9diger, rechercher ou relire des documents d&#039;information et des bulletins d&#039;information\"  data-invmsg=\"Je suis disponible pour (cochez toutes les cases applicables) is invalid\" aria-invalid=\"false\"   \/> R\u00e9diger, rechercher ou relire des documents d'information et des bulletins d'information<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_285-5\">\t\t\t<label  for=\"field_tn4hc2-5\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[285][]\" id=\"field_tn4hc2-5\" value=\"Si\u00e9ger au conseil d&#039;administration de l&#039;AAMAC\"  data-invmsg=\"Je suis disponible pour (cochez toutes les cases applicables) is invalid\" aria-invalid=\"false\"   \/> Si\u00e9ger au conseil d'administration de l'AAMAC<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_285-6\">\t\t\t<label  for=\"field_tn4hc2-6\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[285][]\" id=\"field_tn4hc2-6\" value=\"Collecter des fonds\"  data-invmsg=\"Je suis disponible pour (cochez toutes les cases applicables) is invalid\" aria-invalid=\"false\"   \/> Collecter des fonds<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_285-7\">\t\t\t<label  for=\"field_tn4hc2-7\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[285][]\" id=\"field_tn4hc2-7\" value=\"Offrir du soutien lors d&#039;\u00e9v\u00e9nements de financement\"  data-invmsg=\"Je suis disponible pour (cochez toutes les cases applicables) is invalid\" aria-invalid=\"false\"   \/> Offrir du soutien lors d'\u00e9v\u00e9nements de financement<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_285-8\">\t\t\t<label  for=\"field_tn4hc2-8\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[285][]\" id=\"field_tn4hc2-8\" value=\"Aider aux t\u00e2ches administratives\"  data-invmsg=\"Je suis disponible pour (cochez toutes les cases applicables) is invalid\" aria-invalid=\"false\"   \/> Aider aux t\u00e2ches administratives<\/label><\/div>\n\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_285-other_9\">\t\t\t<label  for=\"field_tn4hc2-other_9\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[285][other_9]\" id=\"field_tn4hc2-other_9\" value=\"Autre, veuillez pr\u00e9ciser\"  data-invmsg=\"Je suis disponible pour (cochez toutes les cases applicables) is invalid\" aria-invalid=\"false\"   \/> Autre, veuillez pr\u00e9ciser<\/label><label for=\"field_tn4hc2-other_9-otext\" class=\"frm_screen_reader frm_hidden\">Autre, veuillez pr\u00e9ciser<\/label><input type=\"text\" id=\"field_tn4hc2-other_9-otext\" class=\"frm_other_input frm_pos_none\"  name=\"item_meta[other][285][other_9]\" value=\"\" \/><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_286_container\" class=\"frm_form_field form-field  frm_top_container frm6 frm_first\">\r\n\t<label for=\"field_mcdth2\" id=\"field_mcdth2_label\" class=\"frm_primary_label\">Comp\u00e9tences linguistiques (parler)\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_mcdth2\" name=\"item_meta[286]\" value=\"\"  data-invmsg=\"Comp\u00e9tences linguistiques (parler) is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_287_container\" class=\"frm_form_field form-field  frm_top_container frm6\">\r\n\t<label for=\"field_4g5la2\" id=\"field_4g5la2_label\" class=\"frm_primary_label\">Comp\u00e9tences linguistiques (\u00e9crire)\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<input  type=\"text\" id=\"field_4g5la2\" name=\"item_meta[287]\" value=\"\"  data-invmsg=\"Comp\u00e9tences linguistiques (\u00e9crire) is invalid\" aria-invalid=\"false\"   \/>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_288_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_m9p7y2\" id=\"field_m9p7y2_label\" class=\"frm_primary_label\">Autres exp\u00e9riences personnelles\/m\u00e9dicales\/psychosociales\/techniques\/connaissances qui pourraient \u00eatre utiles aux patients\/familles\/amis de l'AAMAC\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[288]\" id=\"field_m9p7y2\" rows=\"5\"  data-invmsg=\"Autres exp\u00e9riences personnelles\/m\u00e9dicales\/psychosociales\/techniques\/connaissances qui pourraient \u00eatre utiles aux patients\/familles\/amis de l&#039;AAMAC is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_289_container\" class=\"frm_form_field  frm_html_container form-field\">\n<p><strong>Veuillez noter\u00a0: L'Association canadienne de l'an\u00e9mie aplasique et des my\u00e9lodysplasies a adopt\u00e9 une politique de confidentialit\u00e9 que tous les b\u00e9n\u00e9voles doivent respecter. Vous pouvez en obtenir une copie avant de signer ce formulaire.<\/strong><\/p>\n<p>J\u2019accepte d\u2019\u00eatre li\u00e9 par la politique de confidentialit\u00e9 de l\u2019AAMAC. Je reconnais que l\u2019AAMAC mettra tout en \u0153uvre pour pr\u00e9server la confidentialit\u00e9 des renseignements personnels, y compris les num\u00e9ros de t\u00e9l\u00e9phone, les diagnostics, etc.<\/p>\n<\/div>\n<div id=\"frm_field_290_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_aa5te2\" id=\"field_aa5te2_label\" class=\"frm_primary_label\">Signature\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<div class=\"sigPad\" id='sigPad290' style=\"max-width:400px;\">\n\t<div class=\"sig sigWrapper\" style=\"height:150px;border-color:#d6d6d6;--bg-color:#;--active:#008ec2;--inactive:#dddddd;--active-text:#ffffff;--inactive-text:#ffffff;--button-margin:22px;--button-size:20px;--button-padding:10px;--button-side-margin:22px;--icon:20px\">\n\n\t\t<ul class=\"sigNav\">\n\t\t\t\t<li class=\"drawIt\">\n\t\t\t\t\t<a href=\"#\" class=\"frm-active-sig-type\" title=\"Draw It\" aria-label=\"Draw It\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>signature<\/title>\n\t<path d=\"M19.7 2.2A3.5 3.5 0 0 0 14 1.1L1.7 13.4a1 1 0 0 0-.3.4l-1.3 5a.9.9 0 0 0 0 .5 1 1 0 0 0 1 .6l5-1.3c.2 0 .4-.1.5-.3L18.9 6a3.5 3.5 0 0 0 .7-3.8zm-6.8 2.6L15.2 7l-8.6 8.7-2.4-2.4zm-10.7 13l1-3.3L5.4 17zM18 4.2l-.4.5L16.3 6 14 3.7l1.3-1.3A1.7 1.7 0 0 1 18 3.6l-.1.6zM9 17.9h11v1H9v-1z\"><\/path>\n\n<\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t\t\t<li class=\"typeIt\">\n\t\t\t\t\t<a href=\"#\" class=\"\" title=\"Type It\" aria-label=\"Type It\">\n\t\t\t\t\t\t<svg  viewBox=\"0 0 22 20\" class=\"frmsvg\">\n\t<title>keyboard<\/title>\n\t<path d=\"M20.6 2.5H2c-1 0-1.9.8-1.9 1.9v11.2c0 1 .8 1.9 1.9 1.9h18.7c1 0 1.9-.8 1.9-1.9V4.4c0-1-.8-1.9-1.9-1.9zm.3 13.1c0 .2-.1.3-.3.3H2a.3.3 0 0 1-.3-.3V4.4c0-.2.1-.3.3-.3h18.7c.2 0 .3.1.3.3v11.2zm-14.3-5V9.4c0-.3-.2-.5-.4-.5H5c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5H9c-.3 0-.5.2-.5.5v1c0 .3.2.5.4.5H10c.3 0 .5-.2.5-.5zm3.7 0V9.4c0-.3-.2-.5-.4-.5h-1.1c-.3 0-.5.2-.5.5v1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0V9.4c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.5v1c0 .3.2.5.4.5h1.1c.3 0 .5-.2.5-.5zM4.8 7.2v-1c0-.3-.2-.5-.5-.5H3.2c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm3.7 0v-1c0-.3-.2-.5-.5-.5H7c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0v-1c0-.3-.2-.5-.5-.5h-1.1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm3.7 0v-1c0-.3-.2-.5-.5-.5h-1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1c.3 0 .5-.2.5-.5zm3.8 0v-1c0-.3-.2-.5-.5-.5h-1.1c-.3 0-.5.2-.5.4v1.1c0 .3.2.5.5.5h1.1c.3 0 .5-.2.5-.5zm-2 6.2V13c0-.3-.2-.5-.6-.5h-12c-.3 0-.6.2-.6.5v.6c0 .3.3.5.7.5h12c.3 0 .6-.2.6-.5z\"><\/path>\n<\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/li>\n\t\t<\/ul>\n\n\t\t<span class=\"frm-typed-drawline\"><\/span>\n\n\t\t<div class=\"typed\">\n\t\t\t<input type=\"text\" name=\"item_meta[290][typed]\" class=\"name\" id=\"field_aa5te2\" autocomplete=\"off\" value=\"\"  style=\"width:400px\" maxlength=\"150\" class=\"auto_width\" aria-invalid=\"false\"   \/>\n\t\t<\/div>\n\n\t\t<canvas class=\"pad\" data-fieldid=\"290\" data-fieldname=\"item_meta[290]\" width=\"396\" height=\"150\"><\/canvas>\n\t\t<div class=\"clearButton\"><a href=\"#clear\">Clear<\/a><\/div>\n\n\t\t<input type=\"hidden\" name=\"item_meta[290][output]\" class=\"output\" value=\"\" \/>\n\t<\/div>\n<\/div>\n\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_291_container\" class=\"frm_form_field form-field  frm_none_container vertical_radio\">\r\n\t<div  id=\"field_busu52_label\" class=\"frm_primary_label\">Contact with patients check\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/div>\r\n\t<div class=\"frm_opt_container\" aria-labelledby=\"field_busu52_label\" role=\"group\">\t\t<div class=\"frm_checkbox\" id=\"frm_checkbox_291-0\">\t\t\t<label  for=\"field_busu52-0\">\n\t\t\t<input type=\"checkbox\" name=\"item_meta[291][]\" id=\"field_busu52-0\" value=\"Si vous souhaitez avoir des contacts avec des patients, veuillez remplir cette section.\"  data-invmsg=\"Contact with patients check is invalid\" aria-invalid=\"false\"   \/> Si vous souhaitez avoir des contacts avec des patients, veuillez remplir cette section.<\/label><\/div>\n<\/div>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_292_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_k92zf2\" id=\"field_k92zf2_label\" class=\"frm_primary_label\">Veuillez d\u00e9crire votre exp\u00e9rience. Veuillez indiquer le traitement, les dates de traitement, les m\u00e9dicaments utilis\u00e9s, votre \u00e9tat de sant\u00e9 actuel, etc.\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[292]\" id=\"field_k92zf2\" rows=\"5\"  data-invmsg=\"Veuillez d\u00e9crire votre exp\u00e9rience. Veuillez indiquer le traitement, les dates de traitement, les m\u00e9dicaments utilis\u00e9s, votre \u00e9tat de sant\u00e9 actuel, etc. is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_293_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_c9t152\" id=\"field_c9t152_label\" class=\"frm_primary_label\">Selon vous, qui pourriez-vous aider le plus (par exemple, les parents de jeunes enfants atteints d\u2019an\u00e9mie aplasique, tout patient atteint de SMD, etc.) ?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[293]\" id=\"field_c9t152\" rows=\"5\"  data-invmsg=\"Selon vous, qui pourriez-vous aider le plus (par exemple, les parents de jeunes enfants atteints d\u2019an\u00e9mie aplasique, tout patient atteint de SMD, etc.) ? is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_294_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n\t<label for=\"field_w4qns2\" id=\"field_w4qns2_label\" class=\"frm_primary_label\">\u00cates-vous pr\u00eat \u00e0 parler \u00e0 des patients de partout au Canada, seulement de votre province ou seulement de votre ville ?\r\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n\t<\/label>\r\n\t<textarea name=\"item_meta[294]\" id=\"field_w4qns2\" rows=\"5\"  data-invmsg=\"\u00cates-vous pr\u00eat \u00e0 parler \u00e0 des patients de partout au Canada, seulement de votre province ou seulement de votre ville ? is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n\t\r\n\t\r\n<\/div>\n<div id=\"frm_field_299_container\" class=\"frm_form_field form-field  frm_none_container\">\n\t<label for=\"g-recaptcha-response\" id=\"field_6ga5k_label\" class=\"frm_primary_label\">Captcha\n\t\t<span class=\"frm_required\" aria-hidden=\"true\"><\/span>\n\t<\/label>\n\t<div  id=\"field_6ga5k\" class=\"frm-g-recaptcha\" data-sitekey=\"6Ld55vorAAAAAOwDfLs42sJMlMJnIPgDz-299Yye\" data-size=\"invisible\" data-theme=\"light\"><\/div>\n\t\n\t\n<\/div>\n<div id=\"frm_field_295_container\" class=\"frm_form_field form-field  frm12\">\r\n\t<div class=\"frm_submit frm_flex\">\r\n<button class=\"frm_button_submit frm_final_submit\" type=\"submit\"   formnovalidate=\"formnovalidate\">Submit<\/button>\r\n\r\n\r\n\r\n<\/div>\r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t<div id=\"frm_field_311_container\">\n\t\t\t<label for=\"field_c4pnx\" >\n\t\t\t\tSi vous \u00eates un humain, ne remplissez pas ce champ.\t\t\t<\/label>\n\t\t\t<input  id=\"field_c4pnx\" type=\"text\" class=\"frm_form_field form-field frm_verify\" name=\"item_meta[311]\" value=\"\"  \/>\n\t\t<\/div>\n\t\t<input name=\"frm_state\" type=\"hidden\" value=\"o0SmQgc+HgerWGf9VQwl\/J2cj8fvMto4Ijwhcilsi6vOHs8hGl8\/Imb+g94upTxQ\" \/><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n<script>\nvar frmSigs=[{\"bgColour\":\"rgba(0,0,0,0)\",\"id\":\"262\",\"width\":\"400\",\"height\":\"150\",\"line_top\":105.5,\"line_margin\":20,\"line_color\":\"#d6d6d6\",\"line_width\":1,\"default_tab\":\"drawIt\",\"text_color\":\"#333333\",\"border_color\":\"#d6d6d6\"},{\"bgColour\":\"rgba(0,0,0,0)\",\"id\":\"290\",\"width\":\"400\",\"height\":\"150\",\"line_top\":105.5,\"line_margin\":20,\"line_color\":\"#d6d6d6\",\"line_width\":1,\"default_tab\":\"drawIt\",\"text_color\":\"#333333\",\"border_color\":\"#d6d6d6\"}];\nif(typeof __FRMSIG === 'undefined'){__FRMSIG=frmSigs;}else{__FRMSIG=jQuery.extend(__FRMSIG,frmSigs);}\n<\/script>\n<\/p>","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"inline_featured_image":false,"footnotes":""},"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/aamac.ca\/fr\/wp-json\/wp\/v2\/pages\/4634"}],"collection":[{"href":"https:\/\/aamac.ca\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/aamac.ca\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/aamac.ca\/fr\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/aamac.ca\/fr\/wp-json\/wp\/v2\/comments?post=4634"}],"version-history":[{"count":6,"href":"https:\/\/aamac.ca\/fr\/wp-json\/wp\/v2\/pages\/4634\/revisions"}],"predecessor-version":[{"id":4644,"href":"https:\/\/aamac.ca\/fr\/wp-json\/wp\/v2\/pages\/4634\/revisions\/4644"}],"wp:attachment":[{"href":"https:\/\/aamac.ca\/fr\/wp-json\/wp\/v2\/media?parent=4634"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}