{"id":409,"date":"2022-11-11T12:52:36","date_gmt":"2022-11-11T12:52:36","guid":{"rendered":"http:\/\/127.0.0.1\/OMI%20HAITI\/?page_id=409"},"modified":"2023-01-02T17:09:51","modified_gmt":"2023-01-02T17:09:51","slug":"formulaire-de-preinscription","status":"publish","type":"page","link":"https:\/\/omihaiti.org\/index.php\/formulaire-de-preinscription\/","title":{"rendered":"Formulaire de pr\u00e9inscription"},"content":{"rendered":"<hr>\n<form method=\"post\" action=\"https:\/\/omihaiti.org\/form\/preinscription_php.php\" enctype=\"multipart\/form-data\">\n<h3>Informations personnels<\/h3>\n<table>\n<tbody>\n<tr>\n<td>* Nom<\/td>\n<td><input type=\"text\" name=\"nomPerso\" placeholder=\"nom\" required=\"required\"><\/td>\n<\/tr>\n<tr>\n<td>* Prenom<\/td>\n<td><input type=\"text\" name=\"prenomPerso\" placeholder=\"prenom\" required=\"required\"><\/td>\n<\/tr>\n<tr>\n<td>* NIF<\/td>\n<td><input type=\"text\" name=\"nif\" placeholder=\"nif chiffres et - seulement\" pattern=\"[0-9]{3}-[0-9]{3}-[0-9]{3}-[0-9]{1}\" maxlength=\"13\" required=\"required\"><\/td>\n<\/tr>\n<tr>\n<td>* NIU<\/td>\n<td><input type=\"text\" name=\"niu\" maxlength=\"10\" placeholder=\"Numero Identification Unique\" required=\"required\"><\/td>\n<\/tr>\n<tr>\n<td>* \u00c9tat civil<\/td>\n<td>\n<select name=\"civilite\" required=\"required\"><option disabled=\"\" selected=\"\">&#8211; \u00c9tat civil &#8211;<\/option><option value=\"C\u00e9libataire\">C\u00e9libataire<\/option><option value=\"Mari\u00e9(e)\">Mari\u00e9(e)<\/option><option value=\"Divors\u00e9(e\">Autre<\/option><\/select><\/td>\n<\/tr>\n<tr>\n<td>* Date de nassaince<\/td>\n<td><input type=\"date\" name=\"dobPerso\" placeholder=\"date de naissance\" required=\"required\"><\/td>\n<\/tr>\n<tr>\n<td>* Lieu de nassaince<\/td>\n<td><select name=\"Lieu_de_naissance\"><option disabled=\"\" selected=\"\">&#8211; Lieu de Naissance &#8211;<\/option><option>Abricots<\/option><option>Acul Du Nord<\/option><option>Anse \u00e0 Foleur<\/option><option>Anse \u00e0 Galets (la gon\u00e2ve)<\/option><option>Anse \u00e0 Pitres<\/option><option>Anse \u00e0 Veau<\/option><option>Anse d&#8217;Ainault<\/option><option>anse rouge<\/option><option>Aquin<\/option><option>Arcahaie<\/option><option>Arnaud<\/option><option>Arniquet<\/option><option>Bahon<\/option><option>Baie de Henn<\/option><option>Bainet<\/option><option>Barad\u00e8res<\/option><option>Bas limb\u00e9<\/option><option>Bassin bleu<\/option><option>Beaumont<\/option><option>Bellad\u00e8re<\/option><option>Belle Anse<\/option><option>Bombardopolis<\/option><option>Bonbon<\/option><option>Borgne<\/option><option>Boucan carr\u00e9<\/option><option>Cabaret<\/option><option>Camp-perrin<\/option><option>Cap-haitien<\/option><option>Capotille<\/option><option>Caracol<\/option><option>Carice<\/option><option>Carrefour<\/option><option>Cavaillon<\/option><option>Cayes<\/option><option>Cayes Jacmel<\/option><option>Cerca Carvajal<\/option><option>Cerca la Source<\/option><option>Chambellan<\/option><option>Chansolme<\/option><option>Chantal<\/option><option>Chardonni\u00e8res<\/option><option>Cit\u00e9 Soleil<\/option><option>Corail<\/option><option>Cornillon<\/option><option>Coteaux<\/option><option>Coteferrais<\/option><option>C\u00f4tes de Fer<\/option><option>Croix-des-Bouquets<\/option><option>Dame Marie<\/option><option>Delmas<\/option><option>Desdunes<\/option><option>Dessalines<\/option><option>Dondon<\/option><option>Ennery<\/option><option>Ferrier<\/option><option>Fonds des N\u00e8gres<\/option><option>Fonds Verrettes<\/option><option>Fort Libert\u00e9<\/option><option>Ganthier<\/option><option>Gonaives<\/option><option>Grand boucan<\/option><option>Grand Go\u00e2ve<\/option><option>Grand Gosier<\/option><option>Grande Rivi\u00e8re du Nord<\/option><option>Grande Saline<\/option><option>Gressier <\/option><option>Gros Morne<\/option><option>Hinche<\/option><option>Irois<\/option><option>Jacmel<\/option><option>Jean Rabel<\/option><option>J\u00e9r\u00e9mie<\/option><option>Kenscoff<\/option><option>l&#8217;Asile<\/option><option>l&#8217;Est\u00e8re<\/option><option>l&#8217;ile de la Tortue<\/option><option>l&#8217;\u00eele \u00e0 Vaches<\/option><option>La Chapelle<\/option><option>La Vall\u00e9e<\/option><option>La Victoire<\/option><option>Lascahobas<\/option><option>Les Anglais<\/option><option>L\u00e9og\u00e2ne<\/option><option>Limb\u00e9<\/option><option>Limonade<\/option><option>Ma\u00efssade<\/option><option>Maniche<\/option><option>Marigot<\/option><option>Marmelade<\/option><option>Milot<\/option><option>Mirago\u00e2ne<\/option><option>Mirebalais<\/option><option>Mombin Crochu<\/option><option>Mont-Organis\u00e9<\/option><option>Moron<\/option><option>M\u00f4le St Nicolas<\/option><option>Ouanaminthe<\/option><option>Paillant<\/option><option>Perches<\/option><option>Pestel<\/option><option>Petit Go\u00e2ve<\/option><option>Petit-Trou-de-Nippes<\/option><option>Petite Rivi\u00e8re de l&#8217;Artibonite<\/option><option>Petite Rivi\u00e8re de N<\/option><option>P\u00e9tion-Ville<\/option><option>Pignon<\/option><option>Pilate<\/option><option>Plaine du  Nord<\/option><option>Plaisance<\/option><option>Pointe \u00e0 Raquette<\/option><option>Port Magot<\/option><option>Port-au-Prince<\/option><option>Port-\u00e0-Piment<\/option><option>Port-de-Paix<\/option><option>Port-Salut<\/option><option>Quartier Morin<\/option><option>Ranquitte<\/option><option>Roche \u00e0 Bateaux<\/option><option>Roseaux<\/option><option>Saint Louis du Nord<\/option><option>Saint Louis du Sud<\/option><option>Saint Marc<\/option><option>Saint Michel<\/option><option>Saint Rapha\u00ebl<\/option><option>Saint Suzanne<\/option><option>Saut d&#8217;Eau<\/option><option>Savanette<\/option><option>St Jean du Sud<\/option><option>Tabarre<\/option><option>Terre Neuve<\/option><option>Terrier Rouge<\/option><option>Thiotte<\/option><option>Thomassique<\/option><option>Thomazeau<\/option><option>Thomonde<\/option><option>Tiburon<\/option><option>Torbeck<\/option><option>Trou du nord<\/option><option>Trounippois<\/option><option>Valli\u00e8res<\/option><option>Verrettes<\/option><\/select><\/td>\n<\/tr>\n<tr>\n<td>* Sexe<\/td>\n<td>\t\t\t\t\t\t\t\t\t\t\t\t <select name=\"sexe\" required=\"required\"><option disabled=\"\" selected=\"\">&#8211; Sexe &#8211;<\/option><option value=\"Masculin\">Masculin<\/option><option value=\"Feminin\">F\u00e9minin<\/option><\/select><\/td>\n<\/tr>\n<tr>\n<td>* Nationalit\u00e9<\/td>\n<td><input type=\"text\" name=\"nationalite\" placeholder=\"Nationalit\u00e9\" required=\"required\"><\/td>\n<\/tr>\n<tr>\n<td>* Confession religieuse<\/td>\n<td><input type=\"text\" name=\"Confession\" placeholder=\"Confession religieuse\" required=\"required\"><\/td>\n<\/tr>\n<tr>\n<td>* Adresse<\/td>\n<td><input type=\"text\" name=\"adrPerso\" placeholder=\"Adresse\" required=\"required\"><\/td>\n<\/tr>\n<tr>\n<td>* Code postal<\/td>\n<td><input type=\"text\" name=\"postal\" placeholder=\"Code postal\" required=\"required\"><\/td>\n<\/tr>\n<tr>\n<td>* T\u00e9l\u00e9phone<\/td>\n<td><input type=\"number\" name=\"phone\" maxlength=\"13\" minlength=\"8\" placeholder=\"T\u00e9l\u00e9phone\" required=\"required\"><\/td>\n<\/tr>\n<tr>\n<td> Mail<\/td>\n<td><input type=\"email\" name=\"mailPerso\" placeholder=\"EMail\"><\/td>\n<\/tr>\n<tr>\n<td> Derni\u00e8re \u00e9cole fr\u00e9quent\u00e9e<\/td>\n<td><input type=\"text\" name=\"dernecole\" placeholder=\"Derni\u00e8re \u00e9cole fr\u00e9quent\u00e9e \"><\/td>\n<\/tr>\n<tr>\n<td> Personne responsable<\/td>\n<td><input type=\"text\" name=\"responsable\" placeholder=\"Personne responsable \"><\/td>\n<\/tr>\n<tr>\n<td> T\u00e9l\u00e9phone<\/td>\n<td><input type=\"number\" name=\"telres\" maxlength=\"13\" minlength=\"8\" placeholder=\"T\u00e9l\u00e9phone \"><\/td>\n<\/tr>\n<tr>\n<td> Adresse responsable<\/td>\n<td><input type=\"text\" name=\"addresponsable\" placeholder=\"Adresse responsable\"><\/td>\n<\/tr>\n<tr>\n<td> Pourquoi avez-vous fait le choix du CRUNITEHC ?<\/td>\n<td><textarea name=\"choixcrunitehc\" maxlength=\"60\"><\/textarea><\/td>\n<\/tr>\n<tr>\n<td>Photo<\/td>\n<td>\t\t\t\t\t\t\t\t\t\t\t\t<input type=\"file\" name=\"photo\" accept=\".png, .jpg, .jpeg\"><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><input type=\"submit\" value=\"Inscrire\"><br \/>\n<\/form>\n","protected":false},"excerpt":{"rendered":"<p>Informations personnels * Nom * Prenom * NIF * NIU * \u00c9tat civil &#8211; \u00c9tat civil &#8211;C\u00e9libataireMari\u00e9(e)Autre * Date de nassaince * Lieu de nassaince &#8211; Lieu de Naissance &#8211;AbricotsAcul Du NordAnse \u00e0 FoleurAnse \u00e0 Galets (la gon\u00e2ve)Anse \u00e0 PitresAnse \u00e0 VeauAnse d&#8217;Ainaultanse rougeAquinArcahaieArnaudArniquetBahonBaie de HennBainetBarad\u00e8resBas limb\u00e9Bassin bleuBeaumontBellad\u00e8reBelle AnseBombardopolisBonbonBorgneBoucan carr\u00e9CabaretCamp-perrinCap-haitienCapotilleCaracolCariceCarrefourCavaillonCayesCayes JacmelCerca CarvajalCerca la SourceChambellanChansolmeChantalChardonni\u00e8resCit\u00e9 SoleilCorailCornillonCoteauxCoteferraisC\u00f4tes [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-409","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/omihaiti.org\/index.php\/wp-json\/wp\/v2\/pages\/409","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/omihaiti.org\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/omihaiti.org\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/omihaiti.org\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/omihaiti.org\/index.php\/wp-json\/wp\/v2\/comments?post=409"}],"version-history":[{"count":32,"href":"https:\/\/omihaiti.org\/index.php\/wp-json\/wp\/v2\/pages\/409\/revisions"}],"predecessor-version":[{"id":596,"href":"https:\/\/omihaiti.org\/index.php\/wp-json\/wp\/v2\/pages\/409\/revisions\/596"}],"wp:attachment":[{"href":"https:\/\/omihaiti.org\/index.php\/wp-json\/wp\/v2\/media?parent=409"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}