{"id":5527,"date":"2021-01-04T20:25:13","date_gmt":"2021-01-04T23:25:13","guid":{"rendered":"https:\/\/tolhuinexpeditions.com\/fiche-dinscription-et-etat-de-sante\/"},"modified":"2023-10-24T14:31:39","modified_gmt":"2023-10-24T17:31:39","slug":"formulaire-denregistrement-et-declaration-de-sante","status":"publish","type":"page","link":"https:\/\/tolhuinexpeditions.com\/fr\/formulaire-denregistrement-et-declaration-de-sante\/","title":{"rendered":"FICHE D\u2019INSCRIPTION ET \u00c9TAT DE SANT\u00c9"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"5527\" class=\"elementor elementor-5527 elementor-1436\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"has_ma_el_bg_slider elementor-section elementor-top-section elementor-element elementor-element-4566257 elementor-section-full_width elementor-section-height-min-height elementor-section-stretched elementor-section-height-default elementor-section-items-middle jltma-glass-effect-no\" data-id=\"4566257\" data-element_type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;jet_parallax_layout_list&quot;:[{&quot;jet_parallax_layout_image&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;_id&quot;:&quot;3ce43fa&quot;,&quot;jet_parallax_layout_image_tablet&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_image_mobile&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_speed&quot;:{&quot;unit&quot;:&quot;%&quot;,&quot;size&quot;:50,&quot;sizes&quot;:[]},&quot;jet_parallax_layout_type&quot;:&quot;scroll&quot;,&quot;jet_parallax_layout_direction&quot;:null,&quot;jet_parallax_layout_fx_direction&quot;:null,&quot;jet_parallax_layout_z_index&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x&quot;:50,&quot;jet_parallax_layout_bg_x_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y&quot;:50,&quot;jet_parallax_layout_bg_y_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size&quot;:&quot;auto&quot;,&quot;jet_parallax_layout_bg_size_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_animation_prop&quot;:&quot;transform&quot;,&quot;jet_parallax_layout_on&quot;:[&quot;desktop&quot;,&quot;tablet&quot;]}],&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_ma_el_bg_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-dac5294 jltma-glass-effect-no\" data-id=\"dac5294\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_ma_el_bg_slider elementor-section elementor-top-section elementor-element elementor-element-f59a4df elementor-section-boxed elementor-section-height-default elementor-section-height-default jltma-glass-effect-no\" data-id=\"f59a4df\" data-element_type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[{&quot;jet_parallax_layout_image&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;_id&quot;:&quot;00edf3c&quot;,&quot;jet_parallax_layout_image_tablet&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_image_mobile&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_speed&quot;:{&quot;unit&quot;:&quot;%&quot;,&quot;size&quot;:50,&quot;sizes&quot;:[]},&quot;jet_parallax_layout_type&quot;:&quot;scroll&quot;,&quot;jet_parallax_layout_direction&quot;:null,&quot;jet_parallax_layout_fx_direction&quot;:null,&quot;jet_parallax_layout_z_index&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x&quot;:50,&quot;jet_parallax_layout_bg_x_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y&quot;:50,&quot;jet_parallax_layout_bg_y_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size&quot;:&quot;auto&quot;,&quot;jet_parallax_layout_bg_size_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_animation_prop&quot;:&quot;transform&quot;,&quot;jet_parallax_layout_on&quot;:[&quot;desktop&quot;,&quot;tablet&quot;]}]}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_ma_el_bg_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-0be817f jltma-glass-effect-no\" data-id=\"0be817f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e25489d jltma-glass-effect-no elementor-widget elementor-widget-heading\" data-id=\"e25489d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">CARTE D\u2019INSCRIPTION ET DE SANT\u00c9<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_ma_el_bg_slider elementor-section elementor-top-section elementor-element elementor-element-cae1e97 elementor-section-boxed elementor-section-height-default elementor-section-height-default jltma-glass-effect-no\" data-id=\"cae1e97\" data-element_type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[{&quot;jet_parallax_layout_image&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;_id&quot;:&quot;9c0653f&quot;,&quot;jet_parallax_layout_image_tablet&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_image_mobile&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_speed&quot;:{&quot;unit&quot;:&quot;%&quot;,&quot;size&quot;:50,&quot;sizes&quot;:[]},&quot;jet_parallax_layout_type&quot;:&quot;scroll&quot;,&quot;jet_parallax_layout_direction&quot;:null,&quot;jet_parallax_layout_fx_direction&quot;:null,&quot;jet_parallax_layout_z_index&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x&quot;:50,&quot;jet_parallax_layout_bg_x_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y&quot;:50,&quot;jet_parallax_layout_bg_y_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size&quot;:&quot;auto&quot;,&quot;jet_parallax_layout_bg_size_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_animation_prop&quot;:&quot;transform&quot;,&quot;jet_parallax_layout_on&quot;:[&quot;desktop&quot;,&quot;tablet&quot;]}]}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_ma_el_bg_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-662c046 jltma-glass-effect-no\" data-id=\"662c046\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-b3ca989 jltma-glass-effect-no elementor-widget elementor-widget-heading\" data-id=\"b3ca989\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">DONN\u00c9ES PERSONNELLES ET DOCUMENT D\u2019IDENTIFICATION<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_ma_el_bg_slider elementor-section elementor-top-section elementor-element elementor-element-165228b elementor-section-boxed elementor-section-height-default elementor-section-height-default jltma-glass-effect-no\" data-id=\"165228b\" data-element_type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[{&quot;jet_parallax_layout_image&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;_id&quot;:&quot;86cda70&quot;,&quot;jet_parallax_layout_image_tablet&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_image_mobile&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_speed&quot;:{&quot;unit&quot;:&quot;%&quot;,&quot;size&quot;:50,&quot;sizes&quot;:[]},&quot;jet_parallax_layout_type&quot;:&quot;scroll&quot;,&quot;jet_parallax_layout_direction&quot;:null,&quot;jet_parallax_layout_fx_direction&quot;:null,&quot;jet_parallax_layout_z_index&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x&quot;:50,&quot;jet_parallax_layout_bg_x_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y&quot;:50,&quot;jet_parallax_layout_bg_y_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size&quot;:&quot;auto&quot;,&quot;jet_parallax_layout_bg_size_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_animation_prop&quot;:&quot;transform&quot;,&quot;jet_parallax_layout_on&quot;:[&quot;desktop&quot;,&quot;tablet&quot;]}]}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_ma_el_bg_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-3af8875 jltma-glass-effect-no\" data-id=\"3af8875\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-bc5ae20 jltma-glass-effect-no elementor-widget elementor-widget-shortcode\" data-id=\"bc5ae20\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-1435\"><form id=\"wpforms-form-1435\" class=\"wpforms-validate wpforms-form\" data-formid=\"1435\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/fr\/wp-json\/wp\/v2\/pages\/5527\" data-token=\"c929be13fa9be8950a976594b808b7da\" data-token-time=\"1779069235\"><noscript class=\"wpforms-error-noscript\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-1435-field_1-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_1\">DATE<\/label><input type=\"text\" id=\"wpforms-1435-field_1\" class=\"wpforms-field-large\" name=\"wpforms[fields][1]\" ><\/div><div id=\"wpforms-1435-field_2-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_2\">PR\u00c9NOM<\/label><input type=\"text\" id=\"wpforms-1435-field_2\" class=\"wpforms-field-large\" name=\"wpforms[fields][2]\" ><\/div><div id=\"wpforms-1435-field_4-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_4\">NOM<\/label><input type=\"text\" id=\"wpforms-1435-field_4\" class=\"wpforms-field-large\" name=\"wpforms[fields][4]\" ><\/div><div id=\"wpforms-1435-field_5-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_5\">\u00c2GE<\/label><input type=\"text\" id=\"wpforms-1435-field_5\" class=\"wpforms-field-large\" name=\"wpforms[fields][5]\" ><\/div><div id=\"wpforms-1435-field_6-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_6\">SEXE<\/label><input type=\"text\" id=\"wpforms-1435-field_6\" class=\"wpforms-field-large\" name=\"wpforms[fields][6]\" ><\/div><div id=\"wpforms-1435-field_7-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_7\">T\u00c9L\u00c9PHONE<\/label><input type=\"text\" id=\"wpforms-1435-field_7\" class=\"wpforms-field-large\" name=\"wpforms[fields][7]\" ><\/div><div id=\"wpforms-1435-field_9-container\" class=\"wpforms-field wpforms-field-email wpforms-one-half\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_9\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1435-field_9\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][9]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-1435-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_10\">ADRESSE<\/label><input type=\"text\" id=\"wpforms-1435-field_10\" class=\"wpforms-field-large\" name=\"wpforms[fields][10]\" ><\/div><div id=\"wpforms-1435-field_11-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_11\">VILLE<\/label><input type=\"text\" id=\"wpforms-1435-field_11\" class=\"wpforms-field-large\" name=\"wpforms[fields][11]\" ><\/div><div id=\"wpforms-1435-field_12-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_12\">PAYS<\/label><input type=\"text\" id=\"wpforms-1435-field_12\" class=\"wpforms-field-large\" name=\"wpforms[fields][12]\" ><\/div><div id=\"wpforms-1435-field_13-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_13\">NATIONALIT\u00c9<\/label><input type=\"text\" id=\"wpforms-1435-field_13\" class=\"wpforms-field-medium\" name=\"wpforms[fields][13]\" ><\/div><div id=\"wpforms-1435-field_15-container\" class=\"wpforms-field wpforms-field-select wpforms-one-half wpforms-first wpforms-field-select-style-classic\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_15\">TYPE DE DOCUMENT<\/label><select id=\"wpforms-1435-field_15\" class=\"wpforms-field-large\" name=\"wpforms[fields][15]\"><option value=\"PASSEPORT\" >PASSEPORT<\/option><option value=\"NACIONAL (SOLO PARA SURAMERICA)\" >NACIONAL (SOLO PARA SURAMERICA)<\/option><\/select><\/div><div id=\"wpforms-1435-field_18-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_18\">N\u00ba DE DOCUMENT<\/label><input type=\"text\" id=\"wpforms-1435-field_18\" class=\"wpforms-field-large\" name=\"wpforms[fields][18]\" ><\/div><div id=\"wpforms-1435-field_19-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_19\">DATE D&#039;\u00c9MISSION<\/label><input type=\"text\" id=\"wpforms-1435-field_19\" class=\"wpforms-field-medium\" name=\"wpforms[fields][19]\" ><\/div><div id=\"wpforms-1435-field_20-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_20\">DATE D&#039;EXPIRATION<\/label><input type=\"text\" id=\"wpforms-1435-field_20\" class=\"wpforms-field-medium\" name=\"wpforms[fields][20]\" ><\/div><div id=\"wpforms-1435-field_21-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_21\">EMIS PAR<\/label><input type=\"text\" id=\"wpforms-1435-field_21\" class=\"wpforms-field-medium\" name=\"wpforms[fields][21]\" ><\/div><div id=\"wpforms-1435-field_25-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-one-third wpforms-first wpforms-list-inline\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_25\">Exp\u00e9riences dans des activit\u00e9s similaires<\/label><ul id=\"wpforms-1435-field_25\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1435-field_25_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][25][]\" value=\"OUI\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1435-field_25_1\">OUI<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1435-field_25_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][25][]\" value=\"NON\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1435-field_25_2\">NON<\/label><\/li><\/ul><\/div><div id=\"wpforms-1435-field_26-container\" class=\"wpforms-field wpforms-field-text wpforms-two-thirds\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_26\">Si vous avez r\u00e9pondu \u00aboui\u00bb, pr\u00e9cisez o\u00f9, quand et l&#039;altitude maximale atteinte<\/label><input type=\"text\" id=\"wpforms-1435-field_26\" class=\"wpforms-field-large\" name=\"wpforms[fields][26]\" ><\/div><div id=\"wpforms-1435-field_27-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-one-third wpforms-first wpforms-list-inline\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_27\">Allrgies<\/label><ul id=\"wpforms-1435-field_27\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1435-field_27_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][27][]\" value=\"OUI\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1435-field_27_1\">OUI<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1435-field_27_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][27][]\" value=\"NON\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1435-field_27_2\">NON<\/label><\/li><\/ul><\/div><div id=\"wpforms-1435-field_28-container\" class=\"wpforms-field wpforms-field-text wpforms-two-thirds\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_28\">Si vous avez r\u00e9pondu \u00aboui\u00bb, pr\u00e9cisez lesquels<\/label><input type=\"text\" id=\"wpforms-1435-field_28\" class=\"wpforms-field-large\" name=\"wpforms[fields][28]\" ><\/div><div id=\"wpforms-1435-field_29-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-one-third wpforms-first wpforms-list-inline\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_29\">Maladies chroniques (hypertension, diab\u00e8te, convulsions, asthme, probl\u00e8mes cardiaques, probl\u00e8mes sanguins, etc ...)<\/label><ul id=\"wpforms-1435-field_29\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1435-field_29_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][29][]\" value=\"OUI\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1435-field_29_1\">OUI<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1435-field_29_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][29][]\" value=\"NON\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1435-field_29_2\">NON<\/label><\/li><\/ul><\/div><div id=\"wpforms-1435-field_30-container\" class=\"wpforms-field wpforms-field-text wpforms-two-thirds\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_30\">Si vous avez r\u00e9pondu \u00aboui\u00bb, pr\u00e9cisez lesquels<\/label><input type=\"text\" id=\"wpforms-1435-field_30\" class=\"wpforms-field-large\" name=\"wpforms[fields][30]\" ><\/div><div id=\"wpforms-1435-field_31-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-one-third wpforms-first wpforms-list-inline\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_31\">Tu prends des m\u00e9dicaments?<\/label><ul id=\"wpforms-1435-field_31\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1435-field_31_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][31][]\" value=\"OUI\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1435-field_31_1\">OUI<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1435-field_31_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][31][]\" value=\"NON\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1435-field_31_2\">NON<\/label><\/li><\/ul><\/div><div id=\"wpforms-1435-field_32-container\" class=\"wpforms-field wpforms-field-text wpforms-two-thirds\" data-field-id=\"32\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_32\">Si vous avez r\u00e9pondu \u00aboui\u00bb, pr\u00e9cisez lesquels<\/label><input type=\"text\" id=\"wpforms-1435-field_32\" class=\"wpforms-field-large\" name=\"wpforms[fields][32]\" ><\/div><div id=\"wpforms-1435-field_33-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-one-third wpforms-first wpforms-list-inline\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_33\">Chirurgies r\u00e9centes<\/label><ul id=\"wpforms-1435-field_33\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1435-field_33_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][33][]\" value=\"OUI\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1435-field_33_1\">OUI<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1435-field_33_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][33][]\" value=\"NON\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1435-field_33_2\">NON<\/label><\/li><\/ul><\/div><div id=\"wpforms-1435-field_34-container\" class=\"wpforms-field wpforms-field-text wpforms-two-thirds\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_34\">Si vous avez r\u00e9pondu \u00aboui\u00bb, pr\u00e9cisez depuis combien de temps et les d\u00e9tails de la chirurgie<\/label><input type=\"text\" id=\"wpforms-1435-field_34\" class=\"wpforms-field-large\" name=\"wpforms[fields][34]\" ><\/div><div id=\"wpforms-1435-field_35-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-one-third wpforms-first wpforms-list-inline\" data-field-id=\"35\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_35\">R\u00e9gime sp\u00e9cial<\/label><ul id=\"wpforms-1435-field_35\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1435-field_35_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][35][]\" value=\"OUI\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1435-field_35_1\">OUI<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1435-field_35_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][35][]\" value=\"NON\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1435-field_35_2\">NON<\/label><\/li><\/ul><\/div><div id=\"wpforms-1435-field_36-container\" class=\"wpforms-field wpforms-field-text wpforms-two-thirds\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_36\">si vous avez des restrictions alimentaires; intol\u00e9rance, allergie ou effet n\u00e9gatif<\/label><input type=\"text\" id=\"wpforms-1435-field_36\" class=\"wpforms-field-large\" name=\"wpforms[fields][36]\" ><\/div><div id=\"wpforms-1435-field_37-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-id=\"37\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_37\">Enceinte<\/label><ul id=\"wpforms-1435-field_37\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1435-field_37_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][37][]\" value=\"OUI\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1435-field_37_1\">OUI<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1435-field_37_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][37][]\" value=\"NON\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1435-field_37_2\">NON<\/label><\/li><\/ul><\/div><div id=\"wpforms-1435-field_39-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-one-third wpforms-first wpforms-list-inline\" data-field-id=\"39\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_39\">Autres<\/label><ul id=\"wpforms-1435-field_39\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1435-field_39_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][39][]\" value=\"OUI\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1435-field_39_1\">OUI<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1435-field_39_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][39][]\" value=\"NON\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1435-field_39_2\">NON<\/label><\/li><\/ul><\/div><div id=\"wpforms-1435-field_40-container\" class=\"wpforms-field wpforms-field-text wpforms-two-thirds\" data-field-id=\"40\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_40\">Pr\u00e9ciser si la r\u00e9ponse est affirmative<\/label><input type=\"text\" id=\"wpforms-1435-field_40\" class=\"wpforms-field-large\" name=\"wpforms[fields][40]\" ><\/div><div id=\"wpforms-1435-field_41-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"41\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_41\">PR\u00c9NOM ET NOM DU CONTACT EN CAS D&#039;URGENCE<\/label><input type=\"text\" id=\"wpforms-1435-field_41\" class=\"wpforms-field-large\" name=\"wpforms[fields][41]\" ><\/div><div id=\"wpforms-1435-field_42-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-first\" data-field-id=\"42\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_42\">T\u00c9L\u00c9PHONE<\/label><input type=\"text\" id=\"wpforms-1435-field_42\" class=\"wpforms-field-large\" name=\"wpforms[fields][42]\" ><\/div><div id=\"wpforms-1435-field_45-container\" class=\"wpforms-field wpforms-field-email wpforms-one-half\" data-field-id=\"45\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_45\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1435-field_45\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][45]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-1435-field_46-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"46\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_46\">ADRESSE COMPL\u00c8TE<\/label><input type=\"text\" id=\"wpforms-1435-field_46\" class=\"wpforms-field-large\" name=\"wpforms[fields][46]\" ><\/div><div id=\"wpforms-1435-field_48-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-id=\"48\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_48\">ASSURANCE D&#039;ASSISTANCE M\u00c9DICALE INTERNATIONALE<\/label><ul id=\"wpforms-1435-field_48\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1435-field_48_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][48][]\" value=\"J&#039;ai une assurance m\u00e9dicale souscrite aupr\u00e8s de TOLHUIN EXPEDITIONS AND LODGES\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1435-field_48_1\">J'ai une assurance m\u00e9dicale souscrite aupr\u00e8s de TOLHUIN EXPEDITIONS AND LODGES<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1435-field_48_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][48][]\" value=\"J&#039;ai une assurance m\u00e9dicale souscrite aupr\u00e8s de TOLHUIN EXPEDITIONS AND LODGES et ASSURANCE COMPL\u00c9MENTAIRE\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1435-field_48_2\">J'ai une assurance m\u00e9dicale souscrite aupr\u00e8s de TOLHUIN EXPEDITIONS AND LODGES et ASSURANCE COMPL\u00c9MENTAIRE<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-1435-field_48_3\" data-rule-check-limit=\"true\" name=\"wpforms[fields][48][]\" value=\"Je n&#039;ai pas d&#039;assurance souscrite aupr\u00e8s de TOLHUIN EXPEDITIONS AND LODGES, MAIS j&#039;ai une assurance compl\u00e9mentaire\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1435-field_48_3\">Je n'ai pas d'assurance souscrite aupr\u00e8s de TOLHUIN EXPEDITIONS AND LODGES, MAIS j'ai une assurance compl\u00e9mentaire<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-1435-field_48_4\" data-rule-check-limit=\"true\" name=\"wpforms[fields][48][]\" value=\"Je n&#039;ai PAS encore souscrit d&#039;assurance, mais lorsque je le ferai, j&#039;enverrai imm\u00e9diatement les informations en attente\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1435-field_48_4\">Je n'ai PAS encore souscrit d'assurance, mais lorsque je le ferai, j'enverrai imm\u00e9diatement les informations en attente<\/label><\/li><\/ul><\/div><div id=\"wpforms-1435-field_49-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"49\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_49\">ASSURANCE D&#039;ASSISTANCE M\u00c9DICALE INTERNATIONALE COMPL\u00c9MENTAIRE<\/label><input type=\"text\" id=\"wpforms-1435-field_49\" class=\"wpforms-field-medium\" name=\"wpforms[fields][49]\" placeholder=\"(\u00e0 remplir ci-dessous uniquement si vous avez souscrit une assurance compl\u00e9mentaire assistance m\u00e9dicale internationale)\" ><\/div><div id=\"wpforms-1435-field_50-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"50\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_50\">Nom de l&#039;entreprise de prestation<\/label><input type=\"text\" id=\"wpforms-1435-field_50\" class=\"wpforms-field-medium\" name=\"wpforms[fields][50]\" ><\/div><div id=\"wpforms-1435-field_51-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-first\" data-field-id=\"51\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_51\">N\u00ba de Police<\/label><input type=\"text\" id=\"wpforms-1435-field_51\" class=\"wpforms-field-large\" name=\"wpforms[fields][51]\" ><\/div><div id=\"wpforms-1435-field_52-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third\" data-field-id=\"52\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_52\">Date d&#039;\u00e9mission<\/label><input type=\"text\" id=\"wpforms-1435-field_52\" class=\"wpforms-field-large\" name=\"wpforms[fields][52]\" ><\/div><div id=\"wpforms-1435-field_53-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third\" data-field-id=\"53\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_53\">Date d&#039;expiration<\/label><input type=\"text\" id=\"wpforms-1435-field_53\" class=\"wpforms-field-large\" name=\"wpforms[fields][53]\" ><\/div><div id=\"wpforms-1435-field_54-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_54\">T\u00e9l\u00e9phone d&#039;urgence<\/label><input type=\"text\" id=\"wpforms-1435-field_54\" class=\"wpforms-field-medium\" name=\"wpforms[fields][54]\" ><\/div><div id=\"wpforms-1435-field_56-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"56\"><label class=\"wpforms-field-label\" for=\"wpforms-1435-field_56\">ACCEPTER ET CONFIRMER <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-1435-field_56\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1435-field_56_1\" name=\"wpforms[fields][56]\" value=\"JE D\u00c9CLARE sous serment ou promets la v\u00e9racit\u00e9 des informations fournies et j&#039;assume sous toute responsabilit\u00e9 toute erreur ou omission des informations requises. De plus, je confirme avoir et je m&#039;engage \u00e0 pr\u00e9senter tous les documents originaux n\u00e9cessaires pour valider les informations fournies ici.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1435-field_56_1\">JE D\u00c9CLARE sous serment ou promets la v\u00e9racit\u00e9 des informations fournies et j'assume sous toute responsabilit\u00e9 toute erreur ou omission des informations requises. De plus, je confirme avoir et je m'engage \u00e0 pr\u00e9senter tous les documents originaux n\u00e9cessaires pour valider les informations fournies ici.<\/label><\/li><\/ul><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"1435\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/tolhuinexpeditions.com\/fr\/wp-json\/wp\/v2\/pages\/5527\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1435\" class=\"wpforms-submit\" data-alt-text=\"en cours d&#039;envoi....\" data-submit-text=\"ENVOYER\" aria-live=\"assertive\" value=\"wpforms-submit\">ENVOYER<\/button><\/div><\/form><\/div>  <!-- .wpforms-container --><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>CARTE D\u2019INSCRIPTION ET DE SANT\u00c9 DONN\u00c9ES PERSONNELLES ET DOCUMENT D\u2019IDENTIFICATION<\/p>\n","protected":false},"author":2,"featured_media":5528,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"ocean_post_layout":"full-screen","ocean_both_sidebars_style":"","ocean_both_sidebars_content_width":0,"ocean_both_sidebars_sidebars_width":0,"ocean_sidebar":"0","ocean_second_sidebar":"0","ocean_disable_margins":"enable","ocean_add_body_class":"","ocean_shortcode_before_top_bar":"","ocean_shortcode_after_top_bar":"","ocean_shortcode_before_header":"","ocean_shortcode_after_header":"","ocean_has_shortcode":"","ocean_shortcode_after_title":"","ocean_shortcode_before_footer_widgets":"","ocean_shortcode_after_footer_widgets":"","ocean_shortcode_before_footer_bottom":"","ocean_shortcode_after_footer_bottom":"","ocean_display_top_bar":"default","ocean_display_header":"default","ocean_header_style":"","ocean_center_header_left_menu":"0","ocean_custom_header_template":"0","ocean_custom_logo":0,"ocean_custom_retina_logo":0,"ocean_custom_logo_max_width":0,"ocean_custom_logo_tablet_max_width":0,"ocean_custom_logo_mobile_max_width":0,"ocean_custom_logo_max_height":0,"ocean_custom_logo_tablet_max_height":0,"ocean_custom_logo_mobile_max_height":0,"ocean_header_custom_menu":"0","ocean_menu_typo_font_family":"0","ocean_menu_typo_font_subset":"","ocean_menu_typo_font_size":0,"ocean_menu_typo_font_size_tablet":0,"ocean_menu_typo_font_size_mobile":0,"ocean_menu_typo_font_size_unit":"px","ocean_menu_typo_font_weight":"","ocean_menu_typo_font_weight_tablet":"","ocean_menu_typo_font_weight_mobile":"","ocean_menu_typo_transform":"","ocean_menu_typo_transform_tablet":"","ocean_menu_typo_transform_mobile":"","ocean_menu_typo_line_height":0,"ocean_menu_typo_line_height_tablet":0,"ocean_menu_typo_line_height_mobile":0,"ocean_menu_typo_line_height_unit":"","ocean_menu_typo_spacing":0,"ocean_menu_typo_spacing_tablet":0,"ocean_menu_typo_spacing_mobile":0,"ocean_menu_typo_spacing_unit":"","ocean_menu_link_color":"","ocean_menu_link_color_hover":"","ocean_menu_link_color_active":"","ocean_menu_link_background":"","ocean_menu_link_hover_background":"","ocean_menu_link_active_background":"","ocean_menu_social_links_bg":"","ocean_menu_social_hover_links_bg":"","ocean_menu_social_links_color":"","ocean_menu_social_hover_links_color":"","ocean_disable_title":"default","ocean_disable_heading":"default","ocean_post_title":"","ocean_post_subheading":"","ocean_post_title_style":"","ocean_post_title_background_color":"","ocean_post_title_background":0,"ocean_post_title_bg_image_position":"","ocean_post_title_bg_image_attachment":"","ocean_post_title_bg_image_repeat":"","ocean_post_title_bg_image_size":"","ocean_post_title_height":0,"ocean_post_title_bg_overlay":0.5,"ocean_post_title_bg_overlay_color":"","ocean_disable_breadcrumbs":"default","ocean_breadcrumbs_color":"","ocean_breadcrumbs_separator_color":"","ocean_breadcrumbs_links_color":"","ocean_breadcrumbs_links_hover_color":"","ocean_display_footer_widgets":"default","ocean_display_footer_bottom":"default","ocean_custom_footer_template":"0","footnotes":""},"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.0 - 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