{"id":30,"date":"2025-12-13T21:30:14","date_gmt":"2025-12-13T20:30:14","guid":{"rendered":"https:\/\/croixblanchesyl.org\/?page_id=30"},"modified":"2026-02-02T14:20:59","modified_gmt":"2026-02-02T13:20:59","slug":"formulaire-contact","status":"publish","type":"page","link":"https:\/\/croixblanchesyl.org\/index.php\/formulaire-contact\/","title":{"rendered":"formulaire contact"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"30\" class=\"elementor elementor-30\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b0d1f7b e-flex e-con-boxed e-con e-parent\" data-id=\"b0d1f7b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ea5658c elementor-widget elementor-widget-html\" data-id=\"ea5658c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div id=\"bitforms_1_30_1\" class=\"b1-bit-form bAV1 _frm-bg-b1 bit-form bf-form-wrapper\">\n      \n          <form novalidate id=\"form-bitforms_1_30_1\" class=\"bAT1 bAU1 _frm-b1 bf-form\" method=\"post\">\n              <input type=\"text\" class=\"d-none\" name=\"csrf\" value=\"yhiVSHvxaF4K8za8Sck2s1AuxknGNfO8nFjwungC9l8=\">\n              <input type=\"text\" class=\"d-none\" name=\"t_identity\" value=\"jnmHTZlkvGOnIu\/YTier6aE20\/4Ncr0cL57Yo+x155k=\">\n              \n        <input type=\"text\" class=\"d-none\" name=\"b_h_t\" value=\"WDJKcGRHWnZjbTF6WHpGZk1UYzROemMyTURFeU5WOD0=\">\n        <input type=\"text\" class=\"d-none\" name=\"WDJKcGRHWnZjbTF6WHpGZk1UYzROemMyTURFeU5WOD0=\" required>\n      \n              <input type=\"text\" class=\"d-none\" name=\"bitforms_id\" value=\"bitforms_1\">\n                  <div class=\"btcd-fld-itm b1-7 \"><div class=\"bA1 bD1 bP1  b1-7-fld-wrp b1-fld-wrp bf-fld-wrp bf-field-wrapper \">\n    <\/div><\/div><div class=\"btcd-fld-itm b1-6 \"><div class=\"bA1 bD1 bG1 bBG1  b1-6-fld-wrp b1-fld-wrp bf-fld-wrp bf-field-wrapper \">\n     \n      <div class=\"bBJ1  b1-6-titl-wrp b1-titl-wrp bf-titl-wrp bf-title-wrapper \">\n              <h1 class=\"bA1 bD1 bAO1 bAP1 bBK1  b1-6-title b1-title bf-title bf-title \">\n      <img decoding=\"async\" class=\"bAO1 bAR1 bAS1 bBL1  b1-6-title-pre-i b1-title-pre-i bf-title-pre-i bf-title-prefix-icon \" src=\"https:\/\/croixblanchesyl.org\/wp-content\/uploads\/bitforms\/icons\/font-awesome-comment-dots.svg\" alt=\"Title Prefix Icon\" \/>\n      Un message, une action.\n      \n      <\/h1>\n              <h5 class=\"bA1 bD1 bG1 bAO1 bAP1 bAQ1 bBI1  b1-6-sub-titl b1-sub-titl bf-sub-titl bf-subtitle \">\n      \n      Un besoin, une id\u00e9e, une envie d'aider ? \u00c9cris nous. On te r\u00e9pond.\n      \n      <\/h5>\n      <\/div>\n    <\/div><\/div><div class=\"btcd-fld-itm b1-13 \"><div class=\"bA1 bD1 bP1  b1-13-fld-wrp b1-fld-wrp bf-fld-wrp bf-field-wrapper \">\n    <\/div><\/div><div class=\"btcd-fld-itm b1-2 \"><div class=\"bf-text-field bI1 bN1 bO1  b1-2-fld-wrp b1-fld-wrp bf-fld-wrp bf-field-wrapper \">\n        <div class=\"bR1 bk1 bl1  b1-2-lbl-wrp b1-lbl-wrp bf-lbl-wrp bf-label-wrapper \"><label id=\"b1-2-1-lbl\" class=\"bA1 bD1 bR1 bV1 bW1 bg1 bh1 bi1 bAM1  b1-2-lbl b1-lbl bf-lbl bf-label \" for=\"b1-2-1\">\n          \n          \n          Ton nom\n          \n          <span class=\"bj1 bx1 by1 bBD1  b1-2-req-smbl b1-req-smbl bf-req-smbl bf-asterisk-symbol \" aria-hidden=\"true\">*<\/span>\n        <\/label><\/div>\n        <div class=\"b1-2-inp-wrp b1-inp-wrp bf-inp-wrp bf-input-wrapper \">\n          <div class=\"bO1 bAL1  b1-2-inp-fld-wrp b1-inp-fld-wrp bf-inp-fld-wrp bf-input-field-wrapper \">\n        <input id=\"b1-2-1\" class=\"bE1 bF1 bm1 bn1 bo1 bp1 bq1 br1 bs1 bt1 bu1 bz1 bAA1 bAB1 bAC1 bAD1 bAE1 bAF1 bAG1 bAH1 bAI1 bAJ1 bAK1 bAN1 bBB1 bBC1 bBX1 bBY1 bBZ1 bBa1  b1-2-fld b1-fld bf-fld bf-field \" type=\"text\" required aria-required=\"true\" aria-describedby=\"b1-2-err-txt\" placeholder=\"Ton nom ?\" name=\"text-1-2\" \/>\n        \n        \n      <\/div>\n      \n          \n          <div class=\"bJ1 bK1 bL1  b1-2-err-wrp b1-err-wrp bf-err-wrp bf-error-wrapper\" role=\"alert\" aria-live=\"assertive\" style=\"opacity: 0 !important;height: 0px !important\">\n        <div class=\"bH1  b1-2-err-inner b1-err-inner bf-err-inner bf-error-inner\">\n          \n          \n          <div id=\"b1-2-err-txt\" class=\"bA1 bD1 bQ1 bX1 bY1 bZ1 ba1 bb1 bc1 bd1 be1 bf1  b1-2-err-msg b1-err-msg bf-err-msg bf-error-messages-container  bI1  b1-2-err-txt b1-err-txt bf-err-txt bf-error-text  \" style=\"display: none !important\">\n            \n          <\/div>\n          \n          \n        <\/div>\n      <\/div>\n        <\/div>\n      <\/div><\/div><div class=\"btcd-fld-itm b1-4 \"><div class=\"bA1 bD1 bP1  b1-4-fld-wrp b1-fld-wrp bf-fld-wrp bf-field-wrapper \">\n    <\/div><\/div><div class=\"btcd-fld-itm b1-3 \"><div class=\"bf-email-field bI1 bM1 bN1 bO1  b1-3-fld-wrp b1-fld-wrp bf-fld-wrp bf-field-wrapper \">\n        <div class=\"bR1 bk1 bl1  b1-3-lbl-wrp b1-lbl-wrp bf-lbl-wrp bf-label-wrapper \"><label id=\"b1-3-1-lbl\" class=\"bA1 bD1 bR1 bV1 bW1 bg1 bh1 bi1 bBE1  b1-3-lbl b1-lbl bf-lbl bf-label \" for=\"b1-3-1\">\n          \n          \n          Ton email (promis, pas de spam)\n          \n          <span class=\"by1 bBF1  b1-3-req-smbl b1-req-smbl bf-req-smbl bf-asterisk-symbol \" aria-hidden=\"true\">*<\/span>\n        <\/label><\/div>\n        <div class=\"b1-3-inp-wrp b1-inp-wrp bf-inp-wrp bf-input-wrapper \">\n          <div class=\"bO1 bAL1  b1-3-inp-fld-wrp b1-inp-fld-wrp bf-inp-fld-wrp bf-input-field-wrapper \">\n        <input id=\"b1-3-1\" class=\"bE1 bF1 bm1 bn1 bo1 bp1 bq1 br1 bs1 bt1 bu1 bz1 bAA1 bAB1 bAC1 bAD1 bAE1 bAF1 bAG1 bAH1 bAI1 bAJ1 bAK1 bAN1 bBX1 bBY1 bBZ1 bBa1  b1-3-fld b1-fld bf-fld bf-field \" type=\"email\" required aria-required=\"true\" aria-describedby=\"b1-3-err-txt\" placeholder=\"Ton mail (promis, pas de spam)\" name=\"email-1-3\" \/>\n        \n        \n      <\/div>\n      \n          \n          <div class=\"bJ1 bK1 bL1  b1-3-err-wrp b1-err-wrp bf-err-wrp bf-error-wrapper\" role=\"alert\" aria-live=\"assertive\" style=\"opacity: 0 !important;height: 0px !important\">\n        <div class=\"bH1  b1-3-err-inner b1-err-inner bf-err-inner bf-error-inner\">\n          \n          \n          <div id=\"b1-3-err-txt\" class=\"bA1 bD1 bQ1 bX1 bY1 bZ1 ba1 bb1 bc1 bd1 be1 bf1  b1-3-err-msg b1-err-msg bf-err-msg bf-error-messages-container  bI1  b1-3-err-txt b1-err-txt bf-err-txt bf-error-text  \" style=\"display: none !important\">\n            \n          <\/div>\n          \n          \n        <\/div>\n      <\/div>\n        <\/div>\n      <\/div><\/div><div class=\"btcd-fld-itm b1-10 \"><div class=\"bA1 bD1 bP1  b1-10-fld-wrp b1-fld-wrp bf-fld-wrp bf-field-wrapper \">\n    <\/div><\/div><div class=\"btcd-fld-itm b1-12 \"><div class=\"bf-textarea-field bI1 bM1 bN1 bO1  b1-12-fld-wrp b1-fld-wrp bf-fld-wrp bf-field-wrapper \">\n        <div class=\"bR1 bk1 bl1  b1-12-lbl-wrp b1-lbl-wrp bf-lbl-wrp bf-label-wrapper \"><label id=\"b1-12-1-lbl\" class=\"bA1 bD1 bO1 bR1 bV1 bW1 bg1 bh1 bi1 bAM1  b1-12-lbl b1-lbl bf-lbl bf-label \" for=\"b1-12-1\">\n          \n          \n          Dis-nous ce qui t'am\u00e8ne ici...\n          \n          <span class=\"bx1 by1  b1-12-req-smbl b1-req-smbl bf-req-smbl bf-asterisk-symbol \" aria-hidden=\"true\">*<\/span>\n        <\/label><\/div>\n        <div class=\"b1-12-inp-wrp b1-inp-wrp bf-inp-wrp bf-input-wrapper \">\n          <div class=\"bO1 bAL1  b1-12-inp-fld-wrp b1-inp-fld-wrp bf-inp-fld-wrp bf-input-field-wrapper \">\n      <textarea id=\"b1-12-1\" class=\"bE1 bF1 bm1 bn1 bo1 bq1 br1 bt1 bu1 bv1 bw1 bz1 bAA1 bAB1 bAC1 bAD1 bAE1 bAF1 bAG1 bAH1 bAI1 bAJ1 bAK1 bAz1 bBV1 bBW1 bBX1 bBY1 bBZ1 bBa1  b1-12-fld b1-fld bf-fld bf-field \" required aria-required=\"true\" aria-describedby=\"b1-12-err-txt\" name=\"textarea-1-12\"><\/textarea>\n      \n      \n    <\/div>\n          \n          <div class=\"bJ1 bK1 bL1  b1-12-err-wrp b1-err-wrp bf-err-wrp bf-error-wrapper\" role=\"alert\" aria-live=\"assertive\" style=\"opacity: 0 !important;height: 0px !important\">\n        <div class=\"bH1  b1-12-err-inner b1-err-inner bf-err-inner bf-error-inner\">\n          \n          \n          <div id=\"b1-12-err-txt\" class=\"bA1 bD1 bQ1 bX1 bY1 bZ1 ba1 bb1 bc1 bd1 be1 bf1  b1-12-err-msg b1-err-msg bf-err-msg bf-error-messages-container  bI1  b1-12-err-txt b1-err-txt bf-err-txt bf-error-text  \" style=\"display: none !important\">\n            \n          <\/div>\n          \n          \n        <\/div>\n      <\/div>\n        <\/div>\n      <\/div><\/div><div class=\"btcd-fld-itm b1-14 \"><div class=\"bA1 bD1 bP1  b1-14-fld-wrp b1-fld-wrp bf-fld-wrp bf-field-wrapper \">\n    <\/div><\/div><div class=\"btcd-fld-itm b1-11 \"><div class=\"bf-check-field bI1 bM1 bN1 bO1  b1-11-fld-wrp b1-fld-wrp bf-fld-wrp bf-field-wrapper \">\n        <div class=\"bR1 bk1 bl1  b1-11-lbl-wrp b1-lbl-wrp bf-lbl-wrp bf-label-wrapper \"><label id=\"b1-11-1-lbl\" class=\"bA1 bD1 bR1 bV1 bW1 bg1 bh1 bi1 bj1 bAu1  b1-11-lbl b1-lbl bf-lbl bf-label \" for=\"b1-11-1\">\n          <span class=\"bx1 by1  b1-11-req-smbl b1-req-smbl bf-req-smbl bf-asterisk-symbol \" aria-hidden=\"true\">*<\/span>\n          \n          Cases \u00e0 cocher\n          \n          \n        <\/label><\/div>\n        <div class=\"b1-11-inp-wrp b1-inp-wrp bf-inp-wrp bf-input-wrapper \">\n          <div class=\"bJ1 bR1 bAe1  b1-11-cc b1-cc bf-cc bf-cc \" role=\"group\" aria-labelledby=\"b1-11-1-lbl\" aria-describedby=\"b1-11-err-txt\" aria-required=\"true\">\n        <svg class=\"bS1 bT1 bU1 bAr1  b1-11-cks b1-cks bf-cks bf-cks\" aria-hidden=\"true\">\n          <symbol id=\"b1-11-ck-svg\" viewbox=\"0 0 12 10\">\n            <polyline class=\"bAq1  b1-11-ck-svgline b1-ck-svgline bf-ck-svgline bf-ck-svgline\" points=\"1.5 6 4.5 9 10.5 1\"><\/polyline>\n          <\/symbol>\n        <\/svg>\n        \n        <div class=\"b1-11-cw b1-cw bf-cw bf-cw \">\n          <input id=\"b1-11-1-chk-0\" type=\"checkbox\" class=\"bS1 bAf1 bAg1 bAh1 bAi1 bAj1 bAk1 bAl1 bAm1 bAn1 bAo1 bBc1 bBd1 bBe1 bBf1  b1-11-ci b1-ci bf-ci bf-ci \" value=\"Formation\" name=\"check-1-11[]\" \/>\n          <label data-cl for=\"b1-11-1-chk-0\" class=\"bA1 bC1 bD1 bAs1  b1-11-cl b1-cl bf-cl bf-cl \">\n            <span data-bx class=\"bA1 bG1 bO1 bQ1 bAd1  b1-11-bx b1-bx bf-bx bf-box \">\n              <svg width=\"12\" height=\"10\" viewbox=\"0 0 12 10\" class=\"bAy1 bBi1  b1-11-svgwrp b1-svgwrp bf-svgwrp bf-svgwrp \" aria-hidden=\"true\">\n                <use data-ck-icn href=\"#b1-11-ck-svg\" class=\"bAp1  b1-11-ck-icn b1-ck-icn bf-ck-icn bf-ck-icon \" \/>\n              <\/svg>\n            <\/span>\n            <span class=\"bV1 bW1 bAt1  b1-11-ct b1-ct bf-ct bf-ct \">\n              Formation\n            <\/span>\n          <\/label>\n        <\/div>\n        <div class=\"b1-11-cw b1-cw bf-cw bf-cw \">\n          <input id=\"b1-11-1-chk-1\" type=\"checkbox\" class=\"bS1 bAf1 bAg1 bAh1 bAi1 bAj1 bAk1 bAl1 bAm1 bAn1 bAo1 bBc1 bBd1 bBe1 bBf1  b1-11-ci b1-ci bf-ci bf-ci \" value=\"Partenaire\" name=\"check-1-11[]\" \/>\n          <label data-cl for=\"b1-11-1-chk-1\" class=\"bA1 bC1 bD1 bAs1  b1-11-cl b1-cl bf-cl bf-cl \">\n            <span data-bx class=\"bA1 bG1 bO1 bQ1 bAd1  b1-11-bx b1-bx bf-bx bf-box \">\n              <svg width=\"12\" height=\"10\" viewbox=\"0 0 12 10\" class=\"bAy1 bBi1  b1-11-svgwrp b1-svgwrp bf-svgwrp bf-svgwrp \" aria-hidden=\"true\">\n                <use data-ck-icn href=\"#b1-11-ck-svg\" class=\"bAp1  b1-11-ck-icn b1-ck-icn bf-ck-icn bf-ck-icon \" \/>\n              <\/svg>\n            <\/span>\n            <span class=\"bV1 bW1 bAt1  b1-11-ct b1-ct bf-ct bf-ct \">\n              Partenaire\n            <\/span>\n          <\/label>\n        <\/div>\n        <div class=\"b1-11-cw b1-cw bf-cw bf-cw \">\n          <input id=\"b1-11-1-chk-2\" type=\"checkbox\" class=\"bS1 bAf1 bAg1 bAh1 bAi1 bAj1 bAk1 bAl1 bAm1 bAn1 bAo1 bBc1 bBd1 bBe1 bBf1  b1-11-ci b1-ci bf-ci bf-ci \" value=\"B\u00e9n\u00e9vole\" name=\"check-1-11[]\" \/>\n          <label data-cl for=\"b1-11-1-chk-2\" class=\"bA1 bC1 bD1 bAs1  b1-11-cl b1-cl bf-cl bf-cl \">\n            <span data-bx class=\"bA1 bG1 bO1 bQ1 bAd1  b1-11-bx b1-bx bf-bx bf-box \">\n              <svg width=\"12\" height=\"10\" viewbox=\"0 0 12 10\" class=\"bAy1 bBi1  b1-11-svgwrp b1-svgwrp bf-svgwrp bf-svgwrp \" aria-hidden=\"true\">\n                <use data-ck-icn href=\"#b1-11-ck-svg\" class=\"bAp1  b1-11-ck-icn b1-ck-icn bf-ck-icn bf-ck-icon \" \/>\n              <\/svg>\n            <\/span>\n            <span class=\"bV1 bW1 bAt1  b1-11-ct b1-ct bf-ct bf-ct \">\n              B\u00e9n\u00e9vole\n            <\/span>\n          <\/label>\n        <\/div>\n        <div class=\"b1-11-cw b1-cw bf-cw bf-cw \">\n          <input id=\"b1-11-1-chk-3\" type=\"checkbox\" class=\"bS1 bAf1 bAg1 bAh1 bAi1 bAj1 bAk1 bAl1 bAm1 bAn1 bAo1 bBc1 bBd1 bBe1 bBf1  b1-11-ci b1-ci bf-ci bf-ci \" value=\"Poste de Secours\" name=\"check-1-11[]\" \/>\n          <label data-cl for=\"b1-11-1-chk-3\" class=\"bA1 bC1 bD1 bAs1  b1-11-cl b1-cl bf-cl bf-cl \">\n            <span data-bx class=\"bA1 bG1 bO1 bQ1 bAd1  b1-11-bx b1-bx bf-bx bf-box \">\n              <svg width=\"12\" height=\"10\" viewbox=\"0 0 12 10\" class=\"bAy1 bBi1  b1-11-svgwrp b1-svgwrp bf-svgwrp bf-svgwrp \" aria-hidden=\"true\">\n                <use data-ck-icn href=\"#b1-11-ck-svg\" class=\"bAp1  b1-11-ck-icn b1-ck-icn bf-ck-icn bf-ck-icon \" \/>\n              <\/svg>\n            <\/span>\n            <span class=\"bV1 bW1 bAt1  b1-11-ct b1-ct bf-ct bf-ct \">\n              Poste de Secours\n            <\/span>\n          <\/label>\n        <\/div><div class=\"b1-11-cw b1-cw bf-cw bf-cw \">\n          <input id=\"b1-11-1-chk-4\" data-oopt=\"b1-11\" type=\"checkbox\" class=\"bS1 bAf1 bAg1 bAh1 bAi1 bAj1 bAk1 bAl1 bAm1 bAn1 bAo1 bBc1 bBd1 bBe1 bBf1  b1-11-ci b1-ci bf-ci bf-ci \" value=\"\" name=\"check-1-11[]\" \/>\n          <label data-cl for=\"b1-11-1-chk-4\" class=\"bA1 bC1 bD1 bAs1  b1-11-cl b1-cl bf-cl bf-cl \">\n            <span data-bx class=\"bA1 bG1 bO1 bQ1 bAd1  b1-11-bx b1-bx bf-bx bf-box b1-11-ck b1-ck bf-ck bf-ck \">\n              <svg width=\"12\" height=\"10\" viewbox=\"0 0 12 10\" class=\"bAy1 bBi1  b1-11-svgwrp b1-svgwrp bf-svgwrp bf-svgwrp \" aria-hidden=\"true\">\n                <use data-ck-icn href=\"#b1-11-ck-svg\" class=\"bAp1  b1-11-ck-icn b1-ck-icn bf-ck-icn bf-ck-icon \" \/>\n              <\/svg>\n            <\/span>\n            <span class=\"bV1 bW1 bAt1  b1-11-ct b1-ct bf-ct bf-ct \">\n              Autres\n            <\/span>\n          <\/label>\n          <div data-oinp-wrp class=\"bAw1  b1-11-other-inp-wrp b1-other-inp-wrp bf-other-inp-wrp bf-other-input-wrapper\">\n            <input data-bf-other-inp=\"b1-11-chk-4\" type=\"text\" class=\"bB1 bF1 bm1 bn1 bo1 bp1 bq1 br1 bs1 bt1 bu1 bv1 bw1 bAv1 bAx1 bBV1 bBW1 bBg1 bBh1  b1-11-other-inp b1-other-inp bf-other-inp bf-other-option-input \" placeholder=\"Autres\" \/>\n          <\/div>\n        <\/div>\n      <\/div>\n          \n          <div class=\"bJ1 bK1 bL1  b1-11-err-wrp b1-err-wrp bf-err-wrp bf-error-wrapper\" role=\"alert\" aria-live=\"assertive\" style=\"opacity: 0 !important;height: 0px !important\">\n        <div class=\"bH1  b1-11-err-inner b1-err-inner bf-err-inner bf-error-inner\">\n          \n          \n          <div id=\"b1-11-err-txt\" class=\"bA1 bD1 bQ1 bX1 bY1 bZ1 ba1 bb1 bc1 bd1 be1 bf1  b1-11-err-msg b1-err-msg bf-err-msg bf-error-messages-container  bI1  b1-11-err-txt b1-err-txt 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