{"id":2,"date":"2019-12-10T13:13:13","date_gmt":"2019-12-10T12:13:13","guid":{"rendered":"http:\/\/site-fait-eric.fr\/?page_id=2"},"modified":"2020-03-25T15:06:39","modified_gmt":"2020-03-25T14:06:39","slug":"page-d-exemple","status":"publish","type":"page","link":"https:\/\/site-fait-eric.fr\/","title":{"rendered":"Renseignements fun\u00e9railles"},"content":{"rendered":"<div class=\"caldera-grid\" id=\"caldera_form_1\" data-cf-ver=\"1.9.7\" data-cf-form-id=\"CF5e73d213e986e\"><div id=\"caldera_notices_1\" data-spinner=\"https:\/\/site-fait-eric.fr\/wp-admin\/images\/spinner.gif\"><\/div><form data-instance=\"1\" class=\"CF5e73d213e986e caldera_forms_form\" method=\"POST\" enctype=\"multipart\/form-data\" id=\"CF5e73d213e986e_1\" data-form-id=\"CF5e73d213e986e\" aria-label=\"Renseignement obs&egrave;ques en ligne\">\r\n<input type=\"hidden\" id=\"_cf_verify_CF5e73d213e986e\" name=\"_cf_verify\" value=\"4b8f796bb2\"  data-nonce-time=\"1776593804\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/2\" \/><div id=\"cf2-CF5e73d213e986e_1\"><\/div><input type=\"hidden\" name=\"_cf_frm_id\" value=\"CF5e73d213e986e\">\r\n<input type=\"hidden\" name=\"_cf_frm_ct\" value=\"1\">\r\n<input type=\"hidden\" name=\"_cf_cr_pst\" value=\"2\">\r\n<span class=\"caldera-grid\"><ol class=\"breadcrumb\" data-form=\"caldera_form_1\" id=\"caldera-forms-breadcrumb_1\">\r\n<li class=\"active\"><a aria-controls=\"form_page_1_pg_1\" aria-expanded=\"true\" id=\"breadcrumb_1_pg_1\" href=\"?cf_pg=1\" data-page=\"1\" data-pagenav=\"caldera_form_1\" title=\"Aller \u00e0 POUVOIR\">POUVOIR<\/a><\/li>\r\n<li><a aria-controls=\"form_page_1_pg_2\" aria-expanded=\"false\" id=\"breadcrumb_1_pg_2\" href=\"?cf_pg=2\" data-page=\"2\" data-pagenav=\"caldera_form_1\" title=\"Aller \u00e0 DEFUNT\">DEFUNT<\/a><\/li>\r\n<li><a aria-controls=\"form_page_1_pg_3\" aria-expanded=\"false\" id=\"breadcrumb_1_pg_3\" href=\"?cf_pg=3\" data-page=\"3\" data-pagenav=\"caldera_form_1\" title=\"Aller \u00e0 VOLONTES\">VOLONTES<\/a><\/li>\r\n<li><a aria-controls=\"form_page_1_pg_4\" aria-expanded=\"false\" id=\"breadcrumb_1_pg_4\" href=\"?cf_pg=4\" data-page=\"4\" data-pagenav=\"caldera_form_1\" title=\"Aller \u00e0 DESTINATION\">DESTINATION<\/a><\/li>\r\n<\/ol><\/span>\r\n<div class=\"hide\" style=\"display:none; overflow:hidden;height:0;width:0;\">\r\n<label>Phone<\/label><input type=\"text\" name=\"phone\" value=\"\" autocomplete=\"off\">\r\n<\/div><div id=\"form_page_1_pg_1\" data-formpage=\"1\" class=\"caldera-form-page\" style=\"display:block;\" role=\"region\" aria-labelledby=\"breadcrumb_1_pg_1\" aria-hidden=\"false\"><div id=\"CF5e73d213e986e_1-row-1\"  class=\"row  first_row\"><div  class=\"col-sm-12  single\"><div class=\"\"><p>Formulaire &agrave; remplir par la personne qui a pouvoir aux fun&eacute;railles.<\/p>\n<p style=\"text-align: center;\"><span style=\"text-decoration: underline;\"><strong>Faites d&rsquo;abord <\/strong><\/span><\/p>\n<ol>\n<li>le <strong>choix du cercueil<\/strong> ( pour une <a href=\"https:\/\/site-fait-eric.fr\/index.php\/cercueils-inhumation\/\">inhumation ICI<\/a> ou pour une <a href=\"https:\/\/site-fait-eric.fr\/index.php\/cercueils-cremation\/\">cr&eacute;mation ICI<\/a> )et de son <a href=\"https:\/\/site-fait-eric.fr\/index.php\/capitons-2\/\">capiton ICI<\/a>,<\/li>\n<li>l&rsquo;<a href=\"https:\/\/site-fait-eric.fr\/index.php\/avis-journal\/\">avis de d&eacute;c&egrave;s en ligne<\/a> si vous le souhaitez,<\/li>\n<li>puis vous pouvez revenir <a href=\"https:\/\/site-fait-eric.fr\">sur cette page<\/a>, merci.<\/li>\n<\/ol>\n<\/div><\/div><\/div><div id=\"CF5e73d213e986e_1-row-2\"  class=\"row \"><div  class=\"col-sm-12  single\"><div class=\"\"><p>VOUS<\/p>\n<\/div><\/div><\/div><div id=\"CF5e73d213e986e_1-row-3\"  class=\"row \"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_6914774\" class=\"form-group\" id=\"fld_6914774_1-wrap\">\r\n\t<label id=\"fld_6914774Label\" for=\"fld_6914774_1\" class=\"control-label\">Nom <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input   required type=\"text\" data-field=\"fld_6914774\" class=\" form-control\" id=\"fld_6914774_1\" name=\"fld_6914774\" value=\"\" data-type=\"text\" aria-required=\"true\"   aria-labelledby=\"fld_6914774Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><div  class=\"col-sm-6  last_col\"><div data-field-wrapper=\"fld_2226689\" class=\"form-group\" id=\"fld_2226689_1-wrap\">\r\n\t<label id=\"fld_2226689Label\" for=\"fld_2226689_1\" class=\"control-label\">Pr\u00e9nom <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input   required type=\"text\" data-field=\"fld_2226689\" class=\" form-control\" id=\"fld_2226689_1\" name=\"fld_2226689\" value=\"\" data-type=\"text\" aria-required=\"true\"   aria-labelledby=\"fld_2226689Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-4\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_4033955\" class=\"form-group\" id=\"fld_4033955_1-wrap\">\r\n\t<label id=\"fld_4033955Label\" for=\"fld_4033955_1\" class=\"control-label\">Adresse <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input   required type=\"text\" data-field=\"fld_4033955\" class=\" form-control\" id=\"fld_4033955_1\" name=\"fld_4033955\" value=\"\" data-type=\"text\" aria-required=\"true\"   aria-labelledby=\"fld_4033955Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-5\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_9768045\" class=\"form-group\" id=\"fld_9768045_1-wrap\">\r\n\t<label id=\"fld_9768045Label\" for=\"fld_9768045_1\" class=\"control-label\">Code postal <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input   required type=\"number\" data-field=\"fld_9768045\" class=\" form-control\" id=\"fld_9768045_1\" name=\"fld_9768045\" value=\"\" data-type=\"number\" data-parsley-type=\"number\" aria-required=\"true\"   aria-labelledby=\"fld_9768045Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-6\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_7660300\" class=\"form-group\" id=\"fld_7660300_1-wrap\">\r\n\t<label id=\"fld_7660300Label\" for=\"fld_7660300_1\" class=\"control-label\">Ville <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input   required type=\"text\" data-field=\"fld_7660300\" class=\" form-control\" id=\"fld_7660300_1\" name=\"fld_7660300\" value=\"\" data-type=\"text\" aria-required=\"true\"   aria-labelledby=\"fld_7660300Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-7\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_2437338\" class=\"form-group\" id=\"fld_2437338_1-wrap\">\r\n\t<label id=\"fld_2437338Label\" for=\"fld_2437338_1\" class=\"control-label\">Lien de parent\u00e9 <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input   required type=\"text\" data-field=\"fld_2437338\" class=\" form-control\" id=\"fld_2437338_1\" name=\"fld_2437338\" value=\"\" data-type=\"text\" aria-required=\"true\"   aria-labelledby=\"fld_2437338Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-8\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_4054680\" class=\"form-group\" id=\"fld_4054680_1-wrap\">\r\n\t<label id=\"fld_4054680Label\" for=\"fld_4054680_1\" class=\"control-label\">T\u00e9l\u00e9phone fixe<\/label>\r\n\t<div class=\"\">\r\n\t\t<input  data-inputmask=\"'mask': '99-99-99-99-99'\"   type=\"phone\" data-field=\"fld_4054680\" class=\" form-control\" id=\"fld_4054680_1\" name=\"fld_4054680\" value=\"\" data-type=\"phone\"   aria-labelledby=\"fld_4054680Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_1004466\" class=\"form-group\" id=\"fld_1004466_1-wrap\">\r\n\t<label id=\"fld_1004466Label\" for=\"fld_1004466_1\" class=\"control-label\">T\u00e9l\u00e9phone portable<\/label>\r\n\t<div class=\"\">\r\n\t\t<input  data-inputmask=\"'mask': '99-99-99-99-99'\"   type=\"phone\" data-field=\"fld_1004466\" class=\" form-control\" id=\"fld_1004466_1\" name=\"fld_1004466\" value=\"\" data-type=\"phone\"   aria-labelledby=\"fld_1004466Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-9\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_3454580\" class=\"form-group\" id=\"fld_3454580_1-wrap\">\r\n\t<label id=\"fld_3454580Label\" for=\"fld_3454580_1\" class=\"control-label\">Mail<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"email\" data-field=\"fld_3454580\" class=\" form-control\" id=\"fld_3454580_1\" name=\"fld_3454580\" value=\"\" data-type=\"email\"   aria-labelledby=\"fld_3454580Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-10\"  class=\"row \"><div  class=\"col-sm-12  first_col\"><div data-field-wrapper=\"fld_590335\" class=\"form-group\" id=\"fld_590335_1-wrap\">\r\n<div class=\"\">\r\n\t<input  class=\"btn btn-default cf-page-btn cf-page-btn-next\" type=\"button\" name=\"fld_590335\" id=\"fld_590335_1\" value=\"Page suivante\" data-field=\"fld_590335\" data-page=\"next\"  >\n<\/div>\r\n<\/div>\r\n\t<input class=\"button_trigger_1\" type=\"hidden\" name=\"fld_590335\" id=\"fld_590335_1_btn\" value=\"\" data-field=\"fld_590335\"  \/>\n<\/div><\/div><\/div><div id=\"form_page_1_pg_2\" data-formpage=\"2\" role=\"region\" aria-labelledby=\"breadcrumb_1_pg_2\" aria-hidden=\"true\" class=\"caldera-form-page\" style=\"display:none;\"><div id=\"CF5e73d213e986e_1-row-11\"  class=\"row \"><div  class=\"col-sm-12  single\"><div class=\"\"><p>DEFUNT<\/p>\n<\/div><\/div><\/div><div id=\"CF5e73d213e986e_1-row-12\"  class=\"row \"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_9472283\" class=\"form-group\" id=\"fld_9472283_1-wrap\">\r\n\t<label id=\"fld_9472283Label\" for=\"fld_9472283_1\" class=\"control-label\">Nom du d\u00e9funt <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input   required type=\"text\" data-field=\"fld_9472283\" class=\" form-control\" id=\"fld_9472283_1\" name=\"fld_9472283\" value=\"\" data-type=\"text\" aria-required=\"true\"   aria-labelledby=\"fld_9472283Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><div  class=\"col-sm-6  last_col\"><div data-field-wrapper=\"fld_8566827\" class=\"form-group\" id=\"fld_8566827_1-wrap\">\r\n\t<label id=\"fld_8566827Label\" for=\"fld_8566827_1\" class=\"control-label\">Pr\u00e9nom du d\u00e9funt <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input   required type=\"text\" data-field=\"fld_8566827\" class=\" form-control\" id=\"fld_8566827_1\" name=\"fld_8566827\" value=\"\" data-type=\"text\" aria-required=\"true\"   aria-labelledby=\"fld_8566827Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-13\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_1581991\" class=\"form-group\" id=\"fld_1581991_1-wrap\">\r\n\t<label id=\"fld_1581991Label\" for=\"fld_1581991_1\" class=\"control-label\">Nom de jeune fille<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_1581991\" class=\" form-control\" id=\"fld_1581991_1\" name=\"fld_1581991\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_1581991Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-14\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_1373842\" class=\"form-group\" id=\"fld_1373842_1-wrap\">\r\n\t<label id=\"fld_1373842Label\" for=\"fld_1373842_1\" class=\"control-label\">Adresse d\u00e9funt <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input   required type=\"text\" data-field=\"fld_1373842\" class=\" form-control\" id=\"fld_1373842_1\" name=\"fld_1373842\" value=\"\" data-type=\"text\" aria-required=\"true\"   aria-labelledby=\"fld_1373842Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-15\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_9431952\" class=\"form-group\" id=\"fld_9431952_1-wrap\">\r\n\t<label id=\"fld_9431952Label\" for=\"fld_9431952_1\" class=\"control-label\">Code postal <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input   required type=\"text\" data-field=\"fld_9431952\" class=\" form-control\" id=\"fld_9431952_1\" name=\"fld_9431952\" value=\"\" data-type=\"text\" aria-required=\"true\"   aria-labelledby=\"fld_9431952Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-16\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_8199291\" class=\"form-group\" id=\"fld_8199291_1-wrap\">\r\n\t<label id=\"fld_8199291Label\" for=\"fld_8199291_1\" class=\"control-label\">Ville d\u00e9funt <span aria-hidden=\"true\" role=\"presentation\" class=\"field_required\" style=\"color:#ee0000;\">*<\/span><\/label>\r\n\t<div class=\"\">\r\n\t\t<input   required type=\"text\" data-field=\"fld_8199291\" class=\" form-control\" id=\"fld_8199291_1\" name=\"fld_8199291\" value=\"\" data-type=\"text\" aria-required=\"true\"   aria-labelledby=\"fld_8199291Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-17\"  class=\"row \"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_9092174\" class=\"form-group\" id=\"fld_9092174_1-wrap\">\r\n\t<label id=\"fld_9092174Label\" for=\"fld_9092174_1\" class=\"control-label\">Date de naissance<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_9092174\" class=\" form-control\" id=\"fld_9092174_1\" name=\"fld_9092174\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_9092174Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><div  class=\"col-sm-6  last_col\"><div data-field-wrapper=\"fld_5782259\" class=\"form-group\" id=\"fld_5782259_1-wrap\">\r\n\t<label id=\"fld_5782259Label\" for=\"fld_5782259_1\" class=\"control-label\">Lieu de naissance<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_5782259\" class=\" form-control\" id=\"fld_5782259_1\" name=\"fld_5782259\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_5782259Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-18\"  class=\"row \"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_2417640\" class=\"form-group\" id=\"fld_2417640_1-wrap\">\r\n\t<label id=\"fld_2417640Label\" for=\"fld_2417640_1\" class=\"control-label\">Date du d\u00e9c\u00e8s<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_2417640\" class=\" form-control\" id=\"fld_2417640_1\" name=\"fld_2417640\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_2417640Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><div  class=\"col-sm-6  last_col\"><div data-field-wrapper=\"fld_7695917\" class=\"form-group\" id=\"fld_7695917_1-wrap\">\r\n\t<label id=\"fld_7695917Label\" for=\"fld_7695917_1\" class=\"control-label\">Heure du d\u00e9c\u00e8s<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_7695917\" class=\" form-control\" id=\"fld_7695917_1\" name=\"fld_7695917\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_7695917Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-19\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_173085\" class=\"form-group\" id=\"fld_173085_1-wrap\">\r\n\t<label id=\"fld_173085Label\" for=\"fld_173085_1\" class=\"control-label\">Lieu de d\u00e9c\u00e8s<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_173085\" class=\" form-control\" id=\"fld_173085_1\" name=\"fld_173085\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_173085Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-20\"  class=\"row \"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_2577736\" class=\"form-group\" id=\"fld_2577736_1-wrap\">\r\n\t<label id=\"fld_2577736Label\" for=\"fld_2577736_1\" class=\"control-label\">Situation familiale<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"checkbox\">\n\t\t\t\t\n                <label                         for=\"fld_2577736_1_opt1665471\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"C\u00e9libataire\"\n                                data-field=\"fld_2577736\"\n                                id=\"fld_2577736_1_opt1665471\"\n                                class=\"fld_2577736_1\"\n                                name=\"fld_2577736[opt1665471]\"\n                                value=\"C\u00e9libataire\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_2577736_1\"\n                                                                data-calc-value=\"C\u00e9libataire\"\n                            >\n                    C\u00e9libataire                <\/label>\n\n                \t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"checkbox\">\n\t\t\t\t\n                <label                         for=\"fld_2577736_1_opt1162679\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Epoux(se)\"\n                                data-field=\"fld_2577736\"\n                                id=\"fld_2577736_1_opt1162679\"\n                                class=\"fld_2577736_1\"\n                                name=\"fld_2577736[opt1162679]\"\n                                value=\"Epoux(se)\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_2577736_1\"\n                                                                data-calc-value=\"Epoux(se)\"\n                            >\n                    Epoux(se)                <\/label>\n\n                \t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"checkbox\">\n\t\t\t\t\n                <label                         for=\"fld_2577736_1_opt1521002\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Veuf(ve)\"\n                                data-field=\"fld_2577736\"\n                                id=\"fld_2577736_1_opt1521002\"\n                                class=\"fld_2577736_1\"\n                                name=\"fld_2577736[opt1521002]\"\n                                value=\"Veuf(ve)\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_2577736_1\"\n                                                                data-calc-value=\"Veuf(ve)\"\n                            >\n                    Veuf(ve)                <\/label>\n\n                \t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"checkbox\">\n\t\t\t\t\n                <label                         for=\"fld_2577736_1_opt1613500\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Divorc\u00e9(e)\"\n                                data-field=\"fld_2577736\"\n                                id=\"fld_2577736_1_opt1613500\"\n                                class=\"fld_2577736_1\"\n                                name=\"fld_2577736[opt1613500]\"\n                                value=\"Divorc\u00e9(e)\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_2577736_1\"\n                                                                data-calc-value=\"Divorc\u00e9(e)\"\n                            >\n                    Divorc\u00e9(e)                <\/label>\n\n                \t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n<\/div>\r\n<\/div><div  class=\"col-sm-6  last_col\"><div data-field-wrapper=\"fld_8435207\" class=\"form-group\" id=\"fld_8435207_1-wrap\">\r\n\t<label id=\"fld_8435207Label\" for=\"fld_8435207_1\" class=\"control-label\">De (nom,pr\u00e9nom)<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_8435207\" class=\" form-control\" id=\"fld_8435207_1\" name=\"fld_8435207\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_8435207Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-21\"  class=\"row \"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_5250013\" class=\"form-group\" id=\"fld_5250013_1-wrap\">\r\n\t<label id=\"fld_5250013Label\" for=\"fld_5250013_1\" class=\"control-label\">P\u00e8re du d\u00e9funt<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_5250013_1_opt1483788\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Vivant\"\n                                data-field=\"fld_5250013\"\n                                id=\"fld_5250013_1_opt1483788\"\n                                class=\"fld_5250013_1\"\n                                name=\"fld_5250013[opt1483788]\"\n                                value=\"Vivant\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_5250013_1\"\n                                                                data-calc-value=\"Vivant\"\n                            >\n                    Vivant                <\/label>\n\n                \t\t\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_5250013_1_opt2020135\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"D\u00e9c\u00e9d\u00e9\"\n                                data-field=\"fld_5250013\"\n                                id=\"fld_5250013_1_opt2020135\"\n                                class=\"fld_5250013_1\"\n                                name=\"fld_5250013[opt2020135]\"\n                                value=\"D\u00e9c\u00e9d\u00e9\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_5250013_1\"\n                                                                data-calc-value=\"D\u00e9c\u00e9d\u00e9\"\n                            >\n                    D\u00e9c\u00e9d\u00e9                <\/label>\n\n                \t\t\t\t\t\t\t<\/div>\r\n<\/div>\r\n<\/div><div  class=\"col-sm-6  last_col\"><div data-field-wrapper=\"fld_5701876\" class=\"form-group\" id=\"fld_5701876_1-wrap\">\r\n\t<label id=\"fld_5701876Label\" for=\"fld_5701876_1\" class=\"control-label\">P\u00e8re du d\u00e9funt<\/label>\r\n\t<div class=\"\">\r\n\t\t<input placeholder=\"nom,pr\u00e9nom\"   type=\"text\" data-field=\"fld_5701876\" class=\" form-control\" id=\"fld_5701876_1\" name=\"fld_5701876\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_5701876Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-22\"  class=\"row \"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_9049267\" class=\"form-group\" id=\"fld_9049267_1-wrap\">\r\n\t<label id=\"fld_9049267Label\" for=\"fld_9049267_1\" class=\"control-label\">M\u00e8re du d\u00e9funt<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_9049267_1_opt1301891\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Vivante\"\n                                data-field=\"fld_9049267\"\n                                id=\"fld_9049267_1_opt1301891\"\n                                class=\"fld_9049267_1\"\n                                name=\"fld_9049267[opt1301891]\"\n                                value=\"Vivante\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_9049267_1\"\n                                                                data-calc-value=\"Vivante\"\n                            >\n                    Vivante                <\/label>\n\n                \t\t\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_9049267_1_opt1908145\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"D\u00e9c\u00e9d\u00e9e\"\n                                data-field=\"fld_9049267\"\n                                id=\"fld_9049267_1_opt1908145\"\n                                class=\"fld_9049267_1\"\n                                name=\"fld_9049267[opt1908145]\"\n                                value=\"D\u00e9c\u00e9d\u00e9e\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_9049267_1\"\n                                                                data-calc-value=\"D\u00e9c\u00e9d\u00e9e\"\n                            >\n                    D\u00e9c\u00e9d\u00e9e                <\/label>\n\n                \t\t\t\t\t\t\t<\/div>\r\n<\/div>\r\n<\/div><div  class=\"col-sm-6  last_col\"><div data-field-wrapper=\"fld_4400134\" class=\"form-group\" id=\"fld_4400134_1-wrap\">\r\n\t<label id=\"fld_4400134Label\" for=\"fld_4400134_1\" class=\"control-label\">M\u00e8re du d\u00e9funt<\/label>\r\n\t<div class=\"\">\r\n\t\t<input placeholder=\"nom,pr\u00e9nom\"   type=\"text\" data-field=\"fld_4400134\" class=\" form-control\" id=\"fld_4400134_1\" name=\"fld_4400134\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_4400134Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-23\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_9724210\" class=\"form-group\" id=\"fld_9724210_1-wrap\">\r\n\t<label id=\"fld_9724210Label\" for=\"fld_9724210_1\" class=\"control-label\">Activit\u00e9<\/label>\r\n\t<div class=\"\">\r\n\t\t<input placeholder=\"employ\u00e9,en retraite etc...\"   type=\"text\" data-field=\"fld_9724210\" class=\" form-control\" id=\"fld_9724210_1\" name=\"fld_9724210\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_9724210Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-24\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_6059048\" class=\"form-group\" id=\"fld_6059048_1-wrap\">\r\n\t<label id=\"fld_6059048Label\" for=\"fld_6059048_1\" class=\"control-label\">Contrat obs\u00e8ques<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_6059048_1_opt1824289\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Oui\"\n                                data-field=\"fld_6059048\"\n                                id=\"fld_6059048_1_opt1824289\"\n                                class=\"fld_6059048_1\"\n                                name=\"fld_6059048[opt1824289]\"\n                                value=\"Oui\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_6059048_1\"\n                                                                data-calc-value=\"Oui\"\n                            >\n                    Oui                <\/label>\n\n                \t\t\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_6059048_1_opt2045409\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Non\"\n                                data-field=\"fld_6059048\"\n                                id=\"fld_6059048_1_opt2045409\"\n                                class=\"fld_6059048_1\"\n                                name=\"fld_6059048[opt2045409]\"\n                                value=\"Non\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_6059048_1\"\n                                                                data-calc-value=\"Non\"\n                            >\n                    Non                <\/label>\n\n                \t\t\t\t\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-25\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_8434066\" class=\"form-group\" id=\"fld_8434066_1-wrap\">\r\n\t<label id=\"fld_8434066Label\" for=\"fld_8434066_1\" class=\"control-label\">Corpulence (taille,poids)<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_8434066\" class=\" form-control\" id=\"fld_8434066_1\" name=\"fld_8434066\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_8434066Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-26\"  class=\"row \"><div  class=\"col-sm-12  first_col\"><div data-field-wrapper=\"fld_8138673\" class=\"form-group\" id=\"fld_8138673_1-wrap\">\r\n<div class=\"\">\r\n\t<input  class=\"btn btn-default cf-page-btn cf-page-btn-next\" type=\"button\" name=\"fld_8138673\" id=\"fld_8138673_1\" value=\"Suivant\" data-field=\"fld_8138673\" data-page=\"next\"  >\n<\/div>\r\n<\/div>\r\n\t<input class=\"button_trigger_1\" type=\"hidden\" name=\"fld_8138673\" id=\"fld_8138673_1_btn\" value=\"\" data-field=\"fld_8138673\"  \/>\n<\/div><\/div><\/div><div id=\"form_page_1_pg_3\" data-formpage=\"3\" role=\"region\" aria-labelledby=\"breadcrumb_1_pg_3\" aria-hidden=\"true\" class=\"caldera-form-page\" style=\"display:none;\"><div id=\"CF5e73d213e986e_1-row-27\"  class=\"row \"><div  class=\"col-sm-12  single\"><div class=\"\"><p>VOLONTES<\/p>\n<\/div><\/div><\/div><div id=\"CF5e73d213e986e_1-row-28\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_6506351\" class=\"form-group\" id=\"fld_6506351_1-wrap\">\r\n\t<label id=\"fld_6506351Label\" for=\"fld_6506351_1\" class=\"control-label\">Transport avant mise en bi\u00e8re<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"checkbox\">\n\t\t\t\t\n                <label                         for=\"fld_6506351_1_opt2026368\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Oui (chambre fun\u00e9raire)\"\n                                data-field=\"fld_6506351\"\n                                id=\"fld_6506351_1_opt2026368\"\n                                class=\"fld_6506351_1\"\n                                name=\"fld_6506351[opt2026368]\"\n                                value=\"Oui (chambre fun\u00e9raire)\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_6506351_1\"\n                                                                data-calc-value=\"Oui (chambre fun\u00e9raire)\"\n                            >\n                    Oui (chambre fun\u00e9raire)                <\/label>\n\n                \t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"checkbox\">\n\t\t\t\t\n                <label                         for=\"fld_6506351_1_opt1274914\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Non\"\n                                data-field=\"fld_6506351\"\n                                id=\"fld_6506351_1_opt1274914\"\n                                class=\"fld_6506351_1\"\n                                name=\"fld_6506351[opt1274914]\"\n                                value=\"Non\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_6506351_1\"\n                                                                data-calc-value=\"Non\"\n                            >\n                    Non                <\/label>\n\n                \t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-29\"  class=\"row \"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_8062186\" class=\"form-group\" id=\"fld_8062186_1-wrap\">\r\n\t<label id=\"fld_8062186Label\" for=\"fld_8062186_1\" class=\"control-label\">Chambre fun\u00e9raire de (lieu)<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_8062186\" class=\" form-control\" id=\"fld_8062186_1\" name=\"fld_8062186\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_8062186Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><div  class=\"col-sm-6  last_col\"><div data-field-wrapper=\"fld_7735238\" class=\"form-group\" id=\"fld_7735238_1-wrap\">\r\n\t<label id=\"fld_7735238Label\" for=\"fld_7735238_1\" class=\"control-label\">Chambre fun\u00e9raire<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_7735238_1_opt1281827\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Pr\u00e9sentation en salon\"\n                                data-field=\"fld_7735238\"\n                                id=\"fld_7735238_1_opt1281827\"\n                                class=\"fld_7735238_1\"\n                                name=\"fld_7735238[opt1281827]\"\n                                value=\"Pr\u00e9sentation en salon\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_7735238_1\"\n                                                                data-calc-value=\"Pr\u00e9sentation en salon\"\n                            >\n                    Pr\u00e9sentation en salon                <\/label>\n\n                \t\t\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_7735238_1_opt1518604\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Pas de pr\u00e9sentation\"\n                                data-field=\"fld_7735238\"\n                                id=\"fld_7735238_1_opt1518604\"\n                                class=\"fld_7735238_1\"\n                                name=\"fld_7735238[opt1518604]\"\n                                value=\"Pas de pr\u00e9sentation\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_7735238_1\"\n                                                                data-calc-value=\"Pas de pr\u00e9sentation\"\n                            >\n                    Pas de pr\u00e9sentation                <\/label>\n\n                \t\t\t\t\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-30\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_326827\" class=\"form-group\" id=\"fld_326827_1-wrap\">\r\n\t<label id=\"fld_326827Label\" for=\"fld_326827_1\" class=\"control-label\">Soins de conservation<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_326827_1_opt1546636\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Oui\"\n                                data-field=\"fld_326827\"\n                                id=\"fld_326827_1_opt1546636\"\n                                class=\"fld_326827_1\"\n                                name=\"fld_326827[opt1546636]\"\n                                value=\"Oui\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_326827_1\"\n                                                                data-calc-value=\"Oui\"\n                            >\n                    Oui                <\/label>\n\n                \t\t\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_326827_1_opt1289998\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Non\"\n                                data-field=\"fld_326827\"\n                                id=\"fld_326827_1_opt1289998\"\n                                class=\"fld_326827_1\"\n                                name=\"fld_326827[opt1289998]\"\n                                value=\"Non\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_326827_1\"\n                                                                data-calc-value=\"Non\"\n                            >\n                    Non                <\/label>\n\n                \t\t\t\t\t\t<span id=\"fld_326827Caption\" class=\"help-block\">Vu les circonstances actuelles, nous ne proposons plus de soins<\/span>\r\n\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-31\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_237374\" class=\"form-group\" id=\"fld_237374_1-wrap\">\r\n\t<label id=\"fld_237374Label\" for=\"fld_237374_1\" class=\"control-label\">Pile cardiaque<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_237374_1_opt1669999\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Oui\"\n                                data-field=\"fld_237374\"\n                                id=\"fld_237374_1_opt1669999\"\n                                class=\"fld_237374_1\"\n                                name=\"fld_237374[opt1669999]\"\n                                value=\"Oui\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_237374_1\"\n                                                                data-calc-value=\"Oui\"\n                            >\n                    Oui                <\/label>\n\n                \t\t\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_237374_1_opt1125507\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Non\"\n                                data-field=\"fld_237374\"\n                                id=\"fld_237374_1_opt1125507\"\n                                class=\"fld_237374_1\"\n                                name=\"fld_237374[opt1125507]\"\n                                value=\"Non\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_237374_1\"\n                                                                data-calc-value=\"Non\"\n                            >\n                    Non                <\/label>\n\n                \t\t\t\t\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-32\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_4412805\" class=\"form-group\" id=\"fld_4412805_1-wrap\">\r\n\t<label id=\"fld_4412805Label\" for=\"fld_4412805_1\" class=\"control-label\">Bijoux<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_4412805_1_opt1750570\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Oui\"\n                                data-field=\"fld_4412805\"\n                                id=\"fld_4412805_1_opt1750570\"\n                                class=\"fld_4412805_1\"\n                                name=\"fld_4412805[opt1750570]\"\n                                value=\"Oui\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_4412805_1\"\n                                                                data-calc-value=\"Oui\"\n                            >\n                    Oui                <\/label>\n\n                \t\t\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_4412805_1_opt1296051\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Non\"\n                                data-field=\"fld_4412805\"\n                                id=\"fld_4412805_1_opt1296051\"\n                                class=\"fld_4412805_1\"\n                                name=\"fld_4412805[opt1296051]\"\n                                value=\"Non\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_4412805_1\"\n                                                                data-calc-value=\"Non\"\n                            >\n                    Non                <\/label>\n\n                \t\t\t\t\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-33\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_1650673\" class=\"form-group\" id=\"fld_1650673_1-wrap\">\r\n\t<label id=\"fld_1650673Label\" for=\"fld_1650673_1\" class=\"control-label\">Volont\u00e9s<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_1650673_1_opt1766965\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Inhumation\"\n                                data-field=\"fld_1650673\"\n                                id=\"fld_1650673_1_opt1766965\"\n                                class=\"fld_1650673_1\"\n                                name=\"fld_1650673[opt1766965]\"\n                                value=\"Inhumation\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_1650673_1\"\n                                                                data-calc-value=\"Inhumation\"\n                            >\n                    Inhumation                <\/label>\n\n                \t\t\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_1650673_1_opt1818441\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Cr\u00e9mation\"\n                                data-field=\"fld_1650673\"\n                                id=\"fld_1650673_1_opt1818441\"\n                                class=\"fld_1650673_1\"\n                                name=\"fld_1650673[opt1818441]\"\n                                value=\"Cr\u00e9mation\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_1650673_1\"\n                                                                data-calc-value=\"Cr\u00e9mation\"\n                            >\n                    Cr\u00e9mation                <\/label>\n\n                \t\t\t\t\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-34\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_6300078\" class=\"form-group\" id=\"fld_6300078_1-wrap\">\r\n\t<label id=\"fld_6300078Label\" for=\"fld_6300078_1\" class=\"control-label\">C\u00e9r\u00e9monie<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_6300078_1_opt1295834\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Religieuse\"\n                                data-field=\"fld_6300078\"\n                                id=\"fld_6300078_1_opt1295834\"\n                                class=\"fld_6300078_1\"\n                                name=\"fld_6300078[opt1295834]\"\n                                value=\"Religieuse\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_6300078_1\"\n                                                                data-calc-value=\"Religieuse\"\n                            >\n                    Religieuse                <\/label>\n\n                \t\t\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_6300078_1_opt1190221\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Civile\"\n                                data-field=\"fld_6300078\"\n                                id=\"fld_6300078_1_opt1190221\"\n                                class=\"fld_6300078_1\"\n                                name=\"fld_6300078[opt1190221]\"\n                                value=\"Civile\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_6300078_1\"\n                                                                data-calc-value=\"Civile\"\n                            >\n                    Civile                <\/label>\n\n                \t\t\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_6300078_1_opt1074593\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Intimit\u00e9\"\n                                data-field=\"fld_6300078\"\n                                id=\"fld_6300078_1_opt1074593\"\n                                class=\"fld_6300078_1\"\n                                name=\"fld_6300078[opt1074593]\"\n                                value=\"Intimit\u00e9\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_6300078_1\"\n                                                                data-calc-value=\"Intimit\u00e9\"\n                            >\n                    Intimit\u00e9                <\/label>\n\n                \t\t\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_6300078_1_opt1370174\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Aucune\"\n                                data-field=\"fld_6300078\"\n                                id=\"fld_6300078_1_opt1370174\"\n                                class=\"fld_6300078_1\"\n                                name=\"fld_6300078[opt1370174]\"\n                                value=\"Aucune\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_6300078_1\"\n                                                                data-calc-value=\"Aucune\"\n                            >\n                    Aucune                <\/label>\n\n                \t\t\t\t\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-35\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_3908925\" class=\"form-group\" id=\"fld_3908925_1-wrap\">\r\n\t<label id=\"fld_3908925Label\" for=\"fld_3908925_1\" class=\"control-label\">Lieu de c\u00e9r\u00e9monie<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_3908925\" class=\" form-control\" id=\"fld_3908925_1\" name=\"fld_3908925\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_3908925Label\" aria-describedby=\"fld_3908925Caption\" >\t\t<span id=\"fld_3908925Caption\" class=\"help-block\">Actuellement, recueillement au cimeti\u00e8re uniquement, 20 personnes maximum<\/span>\r\n\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-36\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_8398854\" class=\"form-group\" id=\"fld_8398854_1-wrap\">\r\n\t<label id=\"fld_8398854Label\" for=\"fld_8398854_1\" class=\"control-label\">Choix du cercueil<\/label>\r\n\t<div class=\"\">\r\n\t\t<input placeholder=\"Attention, cercueil V\u00e9nus indisponible\"   type=\"text\" data-field=\"fld_8398854\" class=\" form-control\" id=\"fld_8398854_1\" name=\"fld_8398854\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_8398854Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_8514349\" class=\"form-group\" id=\"fld_8514349_1-wrap\">\r\n\t<label id=\"fld_8514349Label\" for=\"fld_8514349_1\" class=\"control-label\">Capiton<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_8514349\" class=\" form-control\" id=\"fld_8514349_1\" name=\"fld_8514349\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_8514349Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_5537730\" class=\"form-group\" id=\"fld_5537730_1-wrap\">\r\n\t<label id=\"fld_5537730Label\" for=\"fld_5537730_1\" class=\"control-label\">Presse<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_5537730_1_opt1820829\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Oui\"\n                                data-field=\"fld_5537730\"\n                                id=\"fld_5537730_1_opt1820829\"\n                                class=\"fld_5537730_1\"\n                                name=\"fld_5537730[opt1820829]\"\n                                value=\"Oui\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_5537730_1\"\n                                                                data-calc-value=\"Oui\"\n                            >\n                    Oui                <\/label>\n\n                \t\t\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_5537730_1_opt1892158\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Non\"\n                                data-field=\"fld_5537730\"\n                                id=\"fld_5537730_1_opt1892158\"\n                                class=\"fld_5537730_1\"\n                                name=\"fld_5537730[opt1892158]\"\n                                value=\"Non\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_5537730_1\"\n                                                                data-calc-value=\"Non\"\n                            >\n                    Non                <\/label>\n\n                \t\t\t\t\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-37\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_67054\" class=\"form-group\" id=\"fld_67054_1-wrap\">\r\n\t<label id=\"fld_67054Label\" for=\"fld_67054_1\" class=\"control-label\">Texte de l&rsquo;avis de d\u00e9c\u00e8s<\/label>\r\n\t<div class=\"\">\r\n\t\t<textarea name=\"fld_67054\" value=\"\" data-field=\"fld_67054\" class=\"form-control\" id=\"fld_67054_1\" rows=\"4\"    aria-labelledby=\"fld_67054Label\" ><\/textarea>\n\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_7619428\" class=\"form-group\" id=\"fld_7619428_1-wrap\">\r\n\t<label id=\"fld_7619428Label\" for=\"fld_7619428_1\" class=\"control-label\">Registre<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_7619428_1_opt1485878\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Oui\"\n                                data-field=\"fld_7619428\"\n                                id=\"fld_7619428_1_opt1485878\"\n                                class=\"fld_7619428_1\"\n                                name=\"fld_7619428[opt1485878]\"\n                                value=\"Oui\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_7619428_1\"\n                                                                data-calc-value=\"Oui\"\n                            >\n                    Oui                <\/label>\n\n                \t\t\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_7619428_1_opt1545066\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Non\"\n                                data-field=\"fld_7619428\"\n                                id=\"fld_7619428_1_opt1545066\"\n                                class=\"fld_7619428_1\"\n                                name=\"fld_7619428[opt1545066]\"\n                                value=\"Non\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_7619428_1\"\n                                                                data-calc-value=\"Non\"\n                            >\n                    Non                <\/label>\n\n                \t\t\t\t\t\t<span id=\"fld_7619428Caption\" class=\"help-block\">Pas de registre pendant le confinement, merci<\/span>\r\n\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-38\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_3935793\" class=\"form-group\" id=\"fld_3935793_1-wrap\">\r\n\t<label id=\"fld_3935793Label\" for=\"fld_3935793_1\" class=\"control-label\">Urne<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_3935793_1_opt1178500\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Inhumation\"\n                                data-field=\"fld_3935793\"\n                                id=\"fld_3935793_1_opt1178500\"\n                                class=\"fld_3935793_1\"\n                                name=\"fld_3935793[opt1178500]\"\n                                value=\"Inhumation\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_3935793_1\"\n                                                                data-calc-value=\"Inhumation\"\n                            >\n                    Inhumation                <\/label>\n\n                \t\t\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_3935793_1_opt1490754\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Scellement\"\n                                data-field=\"fld_3935793\"\n                                id=\"fld_3935793_1_opt1490754\"\n                                class=\"fld_3935793_1\"\n                                name=\"fld_3935793[opt1490754]\"\n                                value=\"Scellement\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_3935793_1\"\n                                                                data-calc-value=\"Scellement\"\n                            >\n                    Scellement                <\/label>\n\n                \t\t\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_3935793_1_opt1109756\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Dispersion\"\n                                data-field=\"fld_3935793\"\n                                id=\"fld_3935793_1_opt1109756\"\n                                class=\"fld_3935793_1\"\n                                name=\"fld_3935793[opt1109756]\"\n                                value=\"Dispersion\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_3935793_1\"\n                                                                data-calc-value=\"Dispersion\"\n                            >\n                    Dispersion                <\/label>\n\n                \t\t\t\t\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-39\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_9771483\" class=\"form-group\" id=\"fld_9771483_1-wrap\">\r\n<div class=\"\">\r\n\t<input  class=\"btn btn-default cf-page-btn cf-page-btn-next\" type=\"button\" name=\"fld_9771483\" id=\"fld_9771483_1\" value=\"Suivant\" data-field=\"fld_9771483\" data-page=\"next\"  >\n<\/div>\r\n<\/div>\r\n\t<input class=\"button_trigger_1\" type=\"hidden\" name=\"fld_9771483\" id=\"fld_9771483_1_btn\" value=\"\" data-field=\"fld_9771483\"  \/>\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-40\"  class=\"row \"><div  class=\"col-sm-12  first_col\"><\/div><\/div><\/div><div id=\"form_page_1_pg_4\" data-formpage=\"4\" role=\"region\" aria-labelledby=\"breadcrumb_1_pg_4\" aria-hidden=\"true\" class=\"caldera-form-page\" style=\"display:none;\"><div id=\"CF5e73d213e986e_1-row-41\"  class=\"row \"><div  class=\"col-sm-12  single\"><div class=\"\"><p>DESTINATION<\/p>\n<\/div><\/div><\/div><div id=\"CF5e73d213e986e_1-row-42\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_2535205\" class=\"form-group\" id=\"fld_2535205_1-wrap\">\r\n\t<label id=\"fld_2535205Label\" for=\"fld_2535205_1\" class=\"control-label\">Cimeti\u00e8re (lieu)<\/label>\r\n\t<div class=\"\">\r\n\t\t<input    type=\"text\" data-field=\"fld_2535205\" class=\" form-control\" id=\"fld_2535205_1\" name=\"fld_2535205\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_2535205Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-43\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_9846499\" class=\"form-group\" id=\"fld_9846499_1-wrap\">\r\n\t<label id=\"fld_9846499Label\" for=\"fld_9846499_1\" class=\"control-label\">Destination<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"checkbox\">\n\t\t\t\t\n                <label                         for=\"fld_9846499_1_opt1147409\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Jardin du souvenir\"\n                                data-field=\"fld_9846499\"\n                                id=\"fld_9846499_1_opt1147409\"\n                                class=\"fld_9846499_1\"\n                                name=\"fld_9846499[opt1147409]\"\n                                value=\"Jardin du souvenir\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_9846499_1\"\n                                                                data-calc-value=\"Jardin du souvenir\"\n                            >\n                    Jardin du souvenir                <\/label>\n\n                \t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"checkbox\">\n\t\t\t\t\n                <label                         for=\"fld_9846499_1_opt1319466\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Dispersion dans la nature\"\n                                data-field=\"fld_9846499\"\n                                id=\"fld_9846499_1_opt1319466\"\n                                class=\"fld_9846499_1\"\n                                name=\"fld_9846499[opt1319466]\"\n                                value=\"Dispersion dans la nature\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_9846499_1\"\n                                                                data-calc-value=\"Dispersion dans la nature\"\n                            >\n                    Dispersion dans la nature                <\/label>\n\n                \t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-44\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_6118567\" class=\"form-group\" id=\"fld_6118567_1-wrap\">\r\n\t<label id=\"fld_6118567Label\" for=\"fld_6118567_1\" class=\"control-label\">Type de concession<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"checkbox\">\n\t\t\t\t\n                <label                         for=\"fld_6118567_1_opt1767407\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Caveau\"\n                                data-field=\"fld_6118567\"\n                                id=\"fld_6118567_1_opt1767407\"\n                                class=\"fld_6118567_1\"\n                                name=\"fld_6118567[opt1767407]\"\n                                value=\"Caveau\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_6118567_1\"\n                                                                data-calc-value=\"Caveau\"\n                            >\n                    Caveau                <\/label>\n\n                \t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"checkbox\">\n\t\t\t\t\n                <label                         for=\"fld_6118567_1_opt1052387\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Pleine terre\"\n                                data-field=\"fld_6118567\"\n                                id=\"fld_6118567_1_opt1052387\"\n                                class=\"fld_6118567_1\"\n                                name=\"fld_6118567[opt1052387]\"\n                                value=\"Pleine terre\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_6118567_1\"\n                                                                data-calc-value=\"Pleine terre\"\n                            >\n                    Pleine terre                <\/label>\n\n                \t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"checkbox\">\n\t\t\t\t\n                <label                         for=\"fld_6118567_1_opt1132989\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Dalle + terre\"\n                                data-field=\"fld_6118567\"\n                                id=\"fld_6118567_1_opt1132989\"\n                                class=\"fld_6118567_1\"\n                                name=\"fld_6118567[opt1132989]\"\n                                value=\"Dalle + terre\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_6118567_1\"\n                                                                data-calc-value=\"Dalle + terre\"\n                            >\n                    Dalle + terre                <\/label>\n\n                \t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"checkbox\">\n\t\t\t\t\n                <label                         for=\"fld_6118567_1_opt1093505\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Colombarium\"\n                                data-field=\"fld_6118567\"\n                                id=\"fld_6118567_1_opt1093505\"\n                                class=\"fld_6118567_1\"\n                                name=\"fld_6118567[opt1093505]\"\n                                value=\"Colombarium\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_6118567_1\"\n                                                                data-calc-value=\"Colombarium\"\n                            >\n                    Colombarium                <\/label>\n\n                \t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-45\"  class=\"row \"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_4453894\" class=\"form-group\" id=\"fld_4453894_1-wrap\">\r\n\t<label id=\"fld_4453894Label\" for=\"fld_4453894_1\" class=\"control-label\">Derni\u00e8re personne inhum\u00e9e<\/label>\r\n\t<div class=\"\">\r\n\t\t<input placeholder=\"pr\u00e9nom,nom,ann\u00e9e\"   type=\"text\" data-field=\"fld_4453894\" class=\" form-control\" id=\"fld_4453894_1\" name=\"fld_4453894\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_4453894Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><div  class=\"col-sm-6  last_col\"><div data-field-wrapper=\"fld_8919193\" class=\"form-group\" id=\"fld_8919193_1-wrap\">\r\n\t<label id=\"fld_8919193Label\" for=\"fld_8919193_1\" class=\"control-label\">Concessionnaire<\/label>\r\n\t<div class=\"\">\r\n\t\t<input placeholder=\"Nom famille(s) inscrit sur la st\u00e8le\"   type=\"text\" data-field=\"fld_8919193\" class=\" form-control\" id=\"fld_8919193_1\" name=\"fld_8919193\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_8919193Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-46\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_1841263\" class=\"form-group\" id=\"fld_1841263_1-wrap\">\r\n\t<label id=\"fld_1841263Label\" for=\"fld_1841263_1\" class=\"control-label\">Emplacement-situation<\/label>\r\n\t<div class=\"\">\r\n\t\t<textarea name=\"fld_1841263\" value=\"\" data-field=\"fld_1841263\" class=\"form-control\" id=\"fld_1841263_1\" rows=\"4\" placeholder=\"Ex: au portail \u00e0 gauche,2\u00e8me all\u00e9e \u00e0 droite\"    aria-labelledby=\"fld_1841263Label\" ><\/textarea>\n\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-47\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_7849469\" class=\"form-group\" id=\"fld_7849469_1-wrap\">\r\n\t<label id=\"fld_7849469Label\" for=\"fld_7849469_1\" class=\"control-label\">Places restantes<\/label>\r\n\t<div class=\"\">\r\n\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_7849469_1_opt1641310\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Oui\"\n                                data-field=\"fld_7849469\"\n                                id=\"fld_7849469_1_opt1641310\"\n                                class=\"fld_7849469_1\"\n                                name=\"fld_7849469[opt1641310]\"\n                                value=\"Oui\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_7849469_1\"\n                                                                data-calc-value=\"Oui\"\n                            >\n                    Oui                <\/label>\n\n                \t\t\t\t\t\t\t\t\n                <label  class=\"checkbox-inline\"                        for=\"fld_7849469_1_opt1507944\"\n                >\n                            <input\n                                                                type=\"checkbox\"\n                                data-label=\"Non\"\n                                data-field=\"fld_7849469\"\n                                id=\"fld_7849469_1_opt1507944\"\n                                class=\"fld_7849469_1\"\n                                name=\"fld_7849469[opt1507944]\"\n                                value=\"Non\"\n                                                                data-type=\"checkbox\"\n                                data-checkbox-field=\"fld_7849469_1\"\n                                                                data-calc-value=\"Non\"\n                            >\n                    Non                <\/label>\n\n                \t\t\t\t\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-48\"  class=\"row \"><div  class=\"col-sm-12  single\"><div data-field-wrapper=\"fld_4848071\" class=\"form-group\" id=\"fld_4848071_1-wrap\">\r\n\t<label id=\"fld_4848071Label\" for=\"fld_4848071_1\" class=\"control-label\">Gravure sur la st\u00e8le<\/label>\r\n\t<div class=\"\">\r\n\t\t<input placeholder=\"essai exemple 19xx-20xx\"   type=\"text\" data-field=\"fld_4848071\" class=\" form-control\" id=\"fld_4848071_1\" name=\"fld_4848071\" value=\"\" data-type=\"text\"   aria-labelledby=\"fld_4848071Label\" >\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-49\"  class=\"row \"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_4809507\" class=\"form-group\" id=\"fld_4809507_1-wrap\">\r\n\t<label id=\"fld_4809507Label\" for=\"fld_4809507_1\" class=\"control-label\">Documents (livret de famille,contrat etc&#8230;.)<\/label>\r\n\t<div class=\"file-prevent-overflow\">\r\n\t\t<div id=\"fld_4809507_1_file_list\" class=\"cf-multi-uploader-list\"><\/div>\n\t\t\t\t\t<button type=\"button\" class=\"btn btn-block cf-uploader-trigger\" data-parent=\"fld_4809507_1\">Ajouter des fichiers<\/button>\n\t\t\t\t<input type=\"file\" name=\"fld_4809507\" value=\"\" data-field=\"fld_4809507\" class=\"\" id=\"fld_4809507_1\" data-controlid=\"trupl69e4ab8c48783\" data-required=\"true\"      aria-labelledby=\"fld_4809507Label\">\n\t\t<input type=\"hidden\" name=\"fld_4809507\" value=\"trupl69e4ab8c48783\">\n\t\t\t<\/div>\r\n<\/div>\r\n<\/div><div  class=\"col-sm-6  last_col\"><div data-field-wrapper=\"fld_2782330\" class=\"form-group\" id=\"fld_2782330_1-wrap\">\r\n\t<label id=\"fld_2782330Label\" for=\"fld_2782330_1\" class=\"control-label\">Votre commentaire<\/label>\r\n\t<div class=\"\">\r\n\t\t<textarea name=\"fld_2782330\" value=\"\" data-field=\"fld_2782330\" class=\"form-control\" id=\"fld_2782330_1\" rows=\"4\"    aria-labelledby=\"fld_2782330Label\" ><\/textarea>\n\t\t\t<\/div>\r\n<\/div>\r\n<\/div><\/div><div id=\"CF5e73d213e986e_1-row-50\"  class=\"row \"><div  class=\"col-sm-6  first_col\"><div data-field-wrapper=\"fld_1489336\" class=\"form-group\" id=\"fld_1489336_1-wrap\">\r\n\t<label id=\"fld_1489336Label\" for=\"fld_1489336_1\" class=\"control-label\">Si vous le souhaitez, faites-nous parvenir la photo du d\u00e9funt et nous pourrons l&rsquo;imprimer afin qu&rsquo;elle soit pr\u00e9sente sur le cercueil<\/label>\r\n\t<div class=\"file-prevent-overflow\">\r\n\t\t<div id=\"fld_1489336_1_file_list\" class=\"cf-multi-uploader-list\"><\/div>\n\t\t\t\t<input type=\"file\" name=\"fld_1489336\" value=\"\" data-field=\"fld_1489336\" class=\"\" id=\"fld_1489336_1\" data-controlid=\"trupl69e4ab8c48911\"      aria-labelledby=\"fld_1489336Label\">\n\t\t<input type=\"hidden\" name=\"fld_1489336\" value=\"trupl69e4ab8c48911\">\n\t\t\t<\/div>\r\n<\/div>\r\n<div data-field-wrapper=\"fld_8766637\" class=\"form-group\" id=\"fld_8766637_1-wrap\">\r\n<div class=\"\">\r\n\t<input  class=\"btn btn-default\" type=\"submit\" name=\"fld_8766637\" id=\"fld_8766637_1\" value=\"Valider et envoyer\" data-field=\"fld_8766637\"  >\n<\/div>\r\n<\/div>\r\n\t<input class=\"button_trigger_1\" type=\"hidden\" name=\"fld_8766637\" id=\"fld_8766637_1_btn\" value=\"\" data-field=\"fld_8766637\"  \/>\n<\/div><div  class=\"col-sm-6  last_col\"><\/div><\/div><div id=\"CF5e73d213e986e_1-row-51\"  class=\"row  last_row\"><div  class=\"col-sm-12  first_col\"><\/div><\/div><\/div><\/form>\r\n<\/div>\r\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"open","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/site-fait-eric.fr\/index.php\/wp-json\/wp\/v2\/pages\/2"}],"collection":[{"href":"https:\/\/site-fait-eric.fr\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/site-fait-eric.fr\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/site-fait-eric.fr\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/site-fait-eric.fr\/index.php\/wp-json\/wp\/v2\/comments?post=2"}],"version-history":[{"count":9,"href":"https:\/\/site-fait-eric.fr\/index.php\/wp-json\/wp\/v2\/pages\/2\/revisions"}],"predecessor-version":[{"id":215,"href":"https:\/\/site-fait-eric.fr\/index.php\/wp-json\/wp\/v2\/pages\/2\/revisions\/215"}],"wp:attachment":[{"href":"https:\/\/site-fait-eric.fr\/index.php\/wp-json\/wp\/v2\/media?parent=2"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}