{"id":8864,"date":"2020-06-23T23:40:52","date_gmt":"2020-06-23T21:40:52","guid":{"rendered":"https:\/\/www.accompagner.be\/vraag-voor-een-ambulante-begeleinding\/"},"modified":"2024-03-18T14:20:28","modified_gmt":"2024-03-18T13:20:28","slug":"aanvraag-om-een-begeleiding","status":"publish","type":"page","link":"https:\/\/accompagner.be\/nl\/aanvraag-om-een-begeleiding\/","title":{"rendered":"Aanvraag om een begeleiding"},"content":{"rendered":"\n<div>Vous pouvez <u>remplir<\/u> <u>ce formulaire en<\/u>\n<div class=\"wpml-ls-statics-footer wpml-ls wpml-ls-legacy-list-horizontal\">\n\t<ul><li class=\"wpml-ls-slot-footer wpml-ls-item wpml-ls-item-fr wpml-ls-first-item wpml-ls-item-legacy-list-horizontal\">\n\t\t\t\t<a href=\"https:\/\/accompagner.be\/fr\/\" class=\"wpml-ls-link\">\n                    <span class=\"wpml-ls-native\" lang=\"fr\">Fran\u00e7ais<\/span><\/a>\n\t\t\t<\/li><li class=\"wpml-ls-slot-footer wpml-ls-item wpml-ls-item-en wpml-ls-last-item wpml-ls-item-legacy-list-horizontal\">\n\t\t\t\t<a href=\"https:\/\/accompagner.be\/en\/\" class=\"wpml-ls-link\">\n                    <span class=\"wpml-ls-native\" lang=\"en\">English<\/span><\/a>\n\t\t\t<\/li><\/ul>\n<\/div>\n.<\/div>\n\n\n\n<p>De ruimtes van het formulier met een <span style=\"color:#cf2e2e\" class=\"tadv-color\">*<\/span> moeten ingevuld worden en mogen dus niet blanco gelaten worden. Het zijn essenti\u00eble gegevens voor het openen van een dossier en een goed verloop van een begeleiding. Onze Organisatie en onze vrijwilligers zijn gebonden aan het beroepsgeheim. Onze Organisatie en onze vrijwilligers zijn gebonden aan het beroepsgeheim. Gelieve rekening te houden dat onze vrijwilligers uw begunstigde niet op persoonlijk vlak kennen. SAls u tijd wilt besparen met uw volgende verzoeken, moet u de optie voor automatisch aanvullen in uw browser activeren (Google Chrome, Mozilla Forefox, Internet Explorer 7 en 8, Microsoft Edge). Om dat te doen opent u de <a aria-label=\"undefined (s\u2019ouvre dans un nouvel onglet)\" rel=\"noreferrer noopener\" href=\"http:\/\/www.accompagner.be\/wp-content\/uploads\/FORPARINT-Saisie-Automatique-Internet_NL.pdf\" target=\"_blank\">gids<\/a> en volgt u de procedure overeenkomstig de door u gebruikte browser. <b>Opgepast:<\/b> om te vermijden dat het bevestigingsformulier bij uw SPAM-berichten terechtkomt, doet u er goed aan om het mailadres <a href=\"mailto:info.saa@accompagner.be\">info.saa@accompager.be<\/a> in uw adresboek op te slagen. Neem contact met ons op voor meer informatie <strong>02\/580.20.33<\/strong> (9.00 tot 16.00 uur).<\/p>\n\n\n\n<div class=\"wp-block-columns has-pale-cyan-blue-background-color has-background\">\n<div class=\"wp-block-column\" style=\"flex-basis:100%\">\n<h4 class=\"has-text-align-center\"><a href=\"https:\/\/accompagner.be\/wp-content\/uploads\/FORPARCGC_Conditions_generales_collaboration_2023_NL.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Voorwaarden voor samenwerking<\/strong><\/a><\/h4>\n\n\n\n<h4 class=\"has-text-align-center\"><a href=\"https:\/\/accompagner.be\/wp-content\/uploads\/Clauses-de-sous-traitance.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Clause de Sous-traitance<\/strong><\/a><\/h4>\n<\/div>\n<\/div>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-6401\"><form id=\"wpforms-form-6401\" class=\"wpforms-validate wpforms-form\" data-formid=\"6401\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/nl\/wp-json\/wp\/v2\/pages\/8864\"><div class=\"wpforms-field-container\"><div id=\"wpforms-6401-field_26-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"26\"><h3 id=\"wpforms-6401-field_26\" name=\"wpforms[fields][26]\">Uw co\u00f6rdinaten [Institution demandant l&#039;accompagnement]<\/h3><\/div><div id=\"wpforms-6401-field_6-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_6\">Uw voornaam en naam <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-6401-field_6\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][6][first]\" placeholder=\"Pr\u00e9nom du travailleur\" required><label for=\"wpforms-6401-field_6\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-6401-field_6-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][6][last]\" placeholder=\"Nom du travailleur\" required><label for=\"wpforms-6401-field_6-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-6401-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_11\">Naam van de Instelling waar u werkt <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" required><\/div><div id=\"wpforms-6401-field_13-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_13\">Naam van uw Dienst<\/label><input type=\"text\" id=\"wpforms-6401-field_13\" class=\"wpforms-field-medium\" name=\"wpforms[fields][13]\" ><\/div><div id=\"wpforms-6401-field_7-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_7\">Uw e-mail adres <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"email\" id=\"wpforms-6401-field_7\" class=\"wpforms-field-required wpforms-field-email-primary\" name=\"wpforms[fields][7][primary]\" required><label for=\"wpforms-6401-field_7\" class=\"wpforms-field-sublabel after \">Email<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"email\" id=\"wpforms-6401-field_7-secondary\" class=\"wpforms-field-email-secondary wpforms-field-required\" data-rule-confirm=\"#wpforms-6401-field_7\" name=\"wpforms[fields][7][secondary]\" required><label for=\"wpforms-6401-field_7-secondary\" class=\"wpforms-field-sublabel after \">Confirm Email<\/label><\/div><\/div><\/div><div id=\"wpforms-6401-field_98-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"98\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_98\">Adresse mail d&#039;un.e coll\u00e8gue si je suis absent.e <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"email\" id=\"wpforms-6401-field_98\" class=\"wpforms-field-required wpforms-field-email-primary\" name=\"wpforms[fields][98][primary]\" required><label for=\"wpforms-6401-field_98\" class=\"wpforms-field-sublabel after \">Email<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"email\" id=\"wpforms-6401-field_98-secondary\" class=\"wpforms-field-email-secondary wpforms-field-required\" data-rule-confirm=\"#wpforms-6401-field_98\" name=\"wpforms[fields][98][secondary]\" required><label for=\"wpforms-6401-field_98-secondary\" class=\"wpforms-field-sublabel after \">Confirm Email<\/label><\/div><\/div><\/div><div id=\"wpforms-6401-field_78-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"78\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_78\">Telefoonnummer waar we u kunnen bereiken  <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_78\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][78]\" required><div class=\"wpforms-field-description\">Belgisch vaste of GSM telefoonnummer<\/div><\/div><div id=\"wpforms-6401-field_20-container\" class=\"wpforms-field wpforms-field-divider h5\" data-field-id=\"20\"><h3 id=\"wpforms-6401-field_20\" name=\"wpforms[fields][20]\">Co\u00f6rdinaten van de begunstigde voor een begeleiding<\/h3><\/div><div id=\"wpforms-6401-field_16-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_16\">Co\u00f6rdinaten van de begunstigde voor een begeleiding <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-6401-field_16\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][16][first]\" required><label for=\"wpforms-6401-field_16\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-6401-field_16-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][16][last]\" required><label for=\"wpforms-6401-field_16-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-6401-field_79-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"79\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_79\">Zijn gsm-nummer <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_79\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][79]\" required><div class=\"wpforms-field-description\">Belgisch vaste of GSM telefoonnummer<\/div><\/div><div id=\"wpforms-6401-field_19-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_19\">Is het de eerste keer dat u een begeleiding vraagt voor deze persoon?  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_19\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_19_1\" name=\"wpforms[fields][19]\" value=\"Ja\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_19_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_19_2\" name=\"wpforms[fields][19]\" value=\"Nee\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_19_2\">Nee<\/label><\/li><\/ul><\/div><div id=\"wpforms-6401-field_23-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"23\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_23\">De begunstigde weet waarom ondersteuning wordt aangeboden en hoe de informatiestroom tussen de verzoekende dienst en Les Amis d&#039;Accompagner verloopt. <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_23\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-6401-field_23_1\" name=\"wpforms[fields][23][]\" value=\"Ja\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_23_1\">Ja<\/label><\/li><\/ul><\/div><div id=\"wpforms-6401-field_24-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"24\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_24\">Geslacht <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_24\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_24_1\" name=\"wpforms[fields][24]\" value=\"M\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_24_1\">M<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_24_2\" name=\"wpforms[fields][24]\" value=\"V\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_24_2\">V<\/label><\/li><\/ul><\/div><div id=\"wpforms-6401-field_25-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"25\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_25\">Zijn datum van geboorte <span class=\"wpforms-required-label\">*<\/span><\/label><select name=\"wpforms[fields][25][date][d]\" id=\"wpforms-field_25-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][25][date][m]\" id=\"wpforms-field_25-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][25][date][y]\" id=\"wpforms-field_25-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><div id=\"wpforms-6401-field_28-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"28\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_28\">Zijn adres <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_28\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][28]\" placeholder=\"Geef indien mogelijk dit adres op: deurbel, nummer, verdiep etc.\" required><\/div><div id=\"wpforms-6401-field_29-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"29\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_29\">Zijn nationaliteit <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_29\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][29]\" required><\/div><div id=\"wpforms-6401-field_30-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"30\" style=\"display:none;\"><div id=\"wpforms-6401-field_30\"><div><hr style=\"border-top: 2px dashed red;\" ;=\"\"> --- Si votre b\u00e9n\u00e9ficiaire n'est pas belge ou naturalis\u00e9 belge ---<\/div><\/div><\/div><div id=\"wpforms-6401-field_31-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"31\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_31\">Datum van aankomst te Belgi\u00eb<\/label><select name=\"wpforms[fields][31][date][d]\" id=\"wpforms-field_31-day\" class=\"wpforms-field-date-time-date-day\" ><option class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][31][date][m]\" id=\"wpforms-field_31-month\" class=\"wpforms-field-date-time-date-month\" ><option class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][31][date][y]\" id=\"wpforms-field_31-year\" class=\"wpforms-field-date-time-date-year\" ><option class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><div id=\"wpforms-6401-field_32-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"32\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_32\">Verblijfsstatuut <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-6401-field_32\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][32]\" required=\"required\"><option value=\"-- kiezen --\" >-- kiezen --<\/option><option value=\"Verblijfsstatuut\" >Verblijfsstatuut<\/option><option value=\"Vluchtelingenkaart\" >Vluchtelingenkaart<\/option><option value=\"Aanvraag voor asiel\" >Aanvraag voor asiel<\/option><option value=\"Regularisatieaanvraag\" >Regularisatieaanvraag<\/option><option value=\"Inschrijving van vreemdelingen\" >Inschrijving van vreemdelingen<\/option><option value=\"Zonder statuut\" >Zonder statuut<\/option><\/select><\/div><div id=\"wpforms-6401-field_36-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"36\" style=\"display:none;\"><div id=\"wpforms-6401-field_36\"><hr style=\"border-top: 2px dashed red;\"><\/div><\/div><div id=\"wpforms-6401-field_34-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"34\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_34\">Herkomst van inkomen  <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-6401-field_34\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][34]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>-- Dit is de belangrijkste bron van uw begunstigde --<\/option><option value=\"Werknemer\" >Werknemer<\/option><option value=\"Werkloosheidsvergoeding\" >Werkloosheidsvergoeding<\/option><option value=\"Integratie-inkomsten (OCMW)\" >Integratie-inkomsten (OCMW)<\/option><option value=\"Pensionsuitkering\" >Pensionsuitkering<\/option><option value=\"Kinderbijslag\" >Kinderbijslag<\/option><option value=\"onderhoudsuitkering\" >onderhoudsuitkering<\/option><option value=\"Studiebeurs\" >Studiebeurs<\/option><option value=\"Zonder inkomen\" >Zonder inkomen<\/option><option value=\"Andere\" >Andere<\/option><\/select><\/div><div id=\"wpforms-6401-field_77-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"77\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_77\">Gelieve te specificeren <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_77\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][77]\" required><\/div><div id=\"wpforms-6401-field_104-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"104\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_104\">Sa situation familiale <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-6401-field_104\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][104]\" required=\"required\"><option value=\"-- Choisir --\" >-- Choisir --<\/option><option value=\"Isol\u00e9(e)\" >Isol\u00e9(e)<\/option><option value=\"Couple sans enfant\" >Couple sans enfant<\/option><option value=\"Couple avec enfant(s)\" >Couple avec enfant(s)<\/option><option value=\"Cohabitant(e) de fait\" >Cohabitant(e) de fait<\/option><option value=\"Famille monoparentale\" >Famille monoparentale<\/option><\/select><\/div><div id=\"wpforms-6401-field_37-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"37\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_37\">Zijn burgerlijke staat <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-6401-field_37\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][37]\" required=\"required\"><option value=\"-- kiezen --\" >-- kiezen --<\/option><option value=\"Ongehuwd\" >Ongehuwd<\/option><option value=\"Gehuwd\" >Gehuwd<\/option><option value=\"Feitekijk gescheiden\" >Feitekijk gescheiden<\/option><option value=\"Wettelijk gescheiden\" >Wettelijk gescheiden<\/option><option value=\"Weduwe weduwenaar\" >Weduwe weduwenaar<\/option><\/select><\/div><div id=\"wpforms-6401-field_39-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"39\"><h3 id=\"wpforms-6401-field_39\" name=\"wpforms[fields][39]\">Uit te voeren Begeleiding<\/h3><\/div><div id=\"wpforms-6401-field_40-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"40\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_40\">Datum van Begeleiding <span class=\"wpforms-required-label\">*<\/span><\/label><select name=\"wpforms[fields][40][date][d]\" id=\"wpforms-field_40-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][40][date][m]\" id=\"wpforms-field_40-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][40][date][y]\" id=\"wpforms-field_40-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2026\" >2026<\/option><option value=\"2027\" >2027<\/option><\/select><\/div><div id=\"wpforms-6401-field_73-container\" class=\"wpforms-field wpforms-field-date-time wpf_6pct\" data-field-id=\"73\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_73\">Vertrekuur van de start van de begeleiding <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_73-time\" class=\"wpforms-field-date-time-time\" data-rule-time24h=\"true\" data-time-format=\"H:i\" data-step=\"30\" name=\"wpforms[fields][73][time]\" placeholder=\"HH:MM\" required><\/div><div id=\"wpforms-6401-field_112-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"112\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_112\">Lieu du rendez-vous b\u00e9n\u00e9ficiaire\/accompagnant <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_112\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][112]\" required><\/div><div id=\"wpforms-6401-field_46-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"46\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_46\">Plaats en adres van de start van de begeleiding <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_46\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][46]\" placeholder=\"Geef indien mogelijk dit adres op: deurbel, nummer, verdiep etc.\" required><\/div><div id=\"wpforms-6401-field_47-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"47\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_47\">Plaats waar zich te begeven <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_47\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][47]\" placeholder=\"L&#039;institution o\u00f9 votre usager a rendez-vous\" required><\/div><div id=\"wpforms-6401-field_66-container\" class=\"wpforms-field wpforms-field-text wpforms-two-fourths wpforms-first\" data-field-id=\"66\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_66\">Plaats waar men zich naartoe moet begeven <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_66\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][66]\" placeholder=\"-- Straat --\" required><\/div><div id=\"wpforms-6401-field_70-container\" class=\"wpforms-field wpforms-field-number wpforms-one-third wpforms-first\" data-field-id=\"70\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_70\">Postcode <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" pattern=\"[0-9]*\" id=\"wpforms-6401-field_70\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][70]\" required><\/div><div id=\"wpforms-6401-field_74-container\" class=\"wpforms-field wpforms-field-date-time wpf_6pct\" data-field-id=\"74\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_74\">Uur van afspraak of van permanentie waar men zich moet begeven) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_74-time\" class=\"wpforms-field-date-time-time\" data-rule-time24h=\"true\" data-time-format=\"H:i\" data-step=\"30\" name=\"wpforms[fields][74][time]\" placeholder=\"HH:MM\" required><\/div><div id=\"wpforms-6401-field_51-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"51\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_51\">Naam van de persoon die de begunstigde zal ontmoeten <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_51\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][51]\" placeholder=\"L&#039;interlocuteur de l&#039;usager lors de son rendez-vous\" required><div class=\"wpforms-field-description\">Sinon marquez : Inconnu<\/div><\/div><div id=\"wpforms-6401-field_80-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"80\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_80\">Telefoon van de persoon die de begunstigde zal ontmoeten <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_80\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][80]\" required><div class=\"wpforms-field-description\">Belgisch vaste of GSM telefoonnummer<\/div><\/div><div id=\"wpforms-6401-field_108-container\" class=\"wpforms-field wpforms-field-select\" data-field-id=\"108\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_108\">Raison n\u00e9cessistant l&#039;accompagnement <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-6401-field_108\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][108]\" required=\"required\"><option value=\"Veuillez choisir ce qui correspond\" >Veuillez choisir ce qui correspond<\/option><option value=\"Soutien moral\" >Soutien moral<\/option><option value=\"Soutien linguistique\" >Soutien linguistique<\/option><option value=\"Aide \u00e0 la compr\u00e9hension\" >Aide \u00e0 la compr\u00e9hension<\/option><option value=\"Orientation dans l&#039;espace\" >Orientation dans l&#039;espace<\/option><option value=\"Soutien physique durant le d\u00e9placement\" >Soutien physique durant le d\u00e9placement<\/option><option value=\"Aide \u00e0 la prise de notes\" >Aide \u00e0 la prise de notes<\/option><option value=\"Classement\/organisation\" >Classement\/organisation<\/option><option value=\"Autre\" >Autre<\/option><\/select><div class=\"wpforms-field-description\">=>Attention, nous ne sommes pas un service sp\u00e9cialis\u00e9 dans la traduction. =>Attention, nos volontaires ne sont pas habilit\u00e9s \u00e0 transporter des bagages, ni \u00e0 pousser une chaise roulante, ni \u00e0 faire des accompagnements avec leur v\u00e9hicule.<\/div><\/div><div id=\"wpforms-6401-field_110-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"110\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_110\">Veuillez expliciter votre choix<\/label><input type=\"text\" id=\"wpforms-6401-field_110\" class=\"wpforms-field-medium\" name=\"wpforms[fields][110]\" placeholder=\"Explicitez votre choix\" ><\/div><div id=\"wpforms-6401-field_54-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_54\">Vertaling nodig <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_54\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_54_1\" name=\"wpforms[fields][54]\" value=\"ja\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_54_1\">ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_54_2\" name=\"wpforms[fields][54]\" value=\"nee\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_54_2\">nee<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_54_3\" name=\"wpforms[fields][54]\" value=\"ja maar niet onontbeerlijk. De begunstigde beheers de taal een beetje\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_54_3\">ja maar niet onontbeerlijk. De begunstigde beheers de taal een beetje<\/label><\/li><\/ul><\/div><div id=\"wpforms-6401-field_55-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"55\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_55\">Taal gesproken door de begunstigde<\/label><input type=\"text\" id=\"wpforms-6401-field_55\" class=\"wpforms-field-small\" name=\"wpforms[fields][55]\" placeholder=\"In te vullen indien vertaling nodig is\" ><\/div><div id=\"wpforms-6401-field_57-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"57\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_57\">Aanpak te realiseren <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-6401-field_57\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][57]\" placeholder=\"Beschrijf het proces dat de begunstigde met behulp van de vrijwilliger zou willen doen. Bijv. .: uw arts ontmoeten, dit of dat document verkrijgen, de route naar uw nieuw dagcentrum leren... **** A traduire *** Description de la situation, du but \u00e0 atteindre, des documents \u00e0 obtenir,...\" required><\/textarea><\/div><div id=\"wpforms-6401-field_58-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"58\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_58\">Aanvullende informatie<\/label><textarea id=\"wpforms-6401-field_58\" class=\"wpforms-field-medium\" name=\"wpforms[fields][58]\" placeholder=\"Geef, indien van toepassing, de specifieke kenmerken van de begunstigde aan, als deze de afwikkeling van de begeleiding kunnen be\u00efnvloeden. Bijvoorbeeld: rolstoel, kinderwagen, moeilijk lopen, verslaving, epilepsie, fobie(angsttoestand?) ...\" ><\/textarea><\/div><div id=\"wpforms-6401-field_61-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"61\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_61\">Dient de begeleider terug te keren naar de plaats waar de begeleiding is gestart? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_61\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_61_1\" name=\"wpforms[fields][61]\" value=\"ja\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_61_1\">ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_61_2\" name=\"wpforms[fields][61]\" value=\"nee\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_61_2\">nee<\/label><\/li><\/ul><\/div><div id=\"wpforms-6401-field_96-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"96\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_96\">Retour n\u00e9cessaire avec l&#039;accompagnateur vers le lieu de d\u00e9part de l&#039;accompagnement <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_96\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_96_1\" name=\"wpforms[fields][96]\" value=\"oui\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_96_1\">oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_96_2\" name=\"wpforms[fields][96]\" value=\"non\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_96_2\">non<\/label><\/li><\/ul><\/div><div id=\"wpforms-6401-field_103-container\" class=\"wpforms-field wpforms-field-gdpr-checkbox\" data-field-id=\"103\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_103\">Accord RGPD et Conditions g\u00e9n\u00e9rales de collaboration <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_103\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"checkbox\" id=\"wpforms-6401-field_103_1\" name=\"wpforms[fields][103][]\" value=\"J&#039;ai lu et j&#039;accepte les conditions g\u00e9n\u00e9rales de collaboration. Je consens \u00e0 ce que Les Amis d&#039;Accompagner stocke mes informations afin de r\u00e9pondre \u00e0 ma requ\u00eate.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_103_1\">J'ai lu et j'accepte les conditions g\u00e9n\u00e9rales de collaboration. Je consens \u00e0 ce que Les Amis d'Accompagner stocke mes informations afin de r\u00e9pondre \u00e0 ma requ\u00eate.<\/label><\/li><\/ul><\/div><div id=\"wpforms-6401-field_90-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"90\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_90\">Door dit formulier in te dienen, aanvaard ik dat de vzw Les Amis d&#039;Accompagnement<\/label><ul id=\"wpforms-6401-field_90\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-6401-field_90_1\" name=\"wpforms[fields][90][]\" value=\"neemt contact met me op om me informatie over haar te sturen\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_90_1\">neemt contact met me op om me informatie over haar te sturen<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-6401-field_90_2\" name=\"wpforms[fields][90][]\" value=\"stuurt mij de nieuwsbrief\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_90_2\">stuurt mij de nieuwsbrief<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms-6401-field-hp\" class=\"wpforms-field-label\">Name<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms-6401-field-hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"6401\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"8\"><button type=\"submit\" name=\"wpforms[submit]\" class=\"wpforms-submit \" id=\"wpforms-submit-6401\" value=\"wpforms-submit\" aria-live=\"assertive\" data-alt-text=\"*** \u00e0 tradure *** Envoi en cours...\" data-submit-text=\"Verzenden\">Verzenden<\/button><\/div><\/form><\/div>  <!-- .wpforms-container -->\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Vous pouvez remplir ce formulaire en. De ruimtes van het formulier met een * moeten ingevuld worden en mogen dus niet blanco gelaten worden. Het zijn essenti\u00eble gegevens voor het openen van een dossier en een goed verloop van een begeleiding. Onze Organisatie en onze vrijwilligers zijn gebonden aan het beroepsgeheim. Onze Organisatie en onze [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"advgb_blocks_editor_width":"","advgb_blocks_columns_visual_guide":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v16.3 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Aanvraag om een begeleiding - Les Amis d\u2019Accompagner<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/accompagner.be\/nl\/aanvraag-om-een-begeleiding\/\" \/>\n<meta property=\"og:locale\" content=\"nl_NL\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Aanvraag om een begeleiding - Les Amis d\u2019Accompagner\" \/>\n<meta property=\"og:description\" content=\"Vous pouvez remplir ce formulaire en. De ruimtes van het formulier met een * moeten ingevuld worden en mogen dus niet blanco gelaten worden. Het zijn essenti\u00eble gegevens voor het openen van een dossier en een goed verloop van een begeleiding. Onze Organisatie en onze vrijwilligers zijn gebonden aan het beroepsgeheim. Onze Organisatie en onze [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/accompagner.be\/nl\/aanvraag-om-een-begeleiding\/\" \/>\n<meta property=\"og:site_name\" content=\"Les Amis d\u2019Accompagner\" \/>\n<meta property=\"article:modified_time\" content=\"2024-03-18T13:20:28+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\">\n\t<meta name=\"twitter:data1\" content=\"1 minute\">\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebSite\",\"@id\":\"https:\/\/accompagner.be\/fr\/#website\",\"url\":\"https:\/\/accompagner.be\/fr\/\",\"name\":\"Les Amis d\\u2019Accompagner\",\"description\":\"Samen stap voor stap\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":\"https:\/\/accompagner.be\/fr\/?s={search_term_string}\",\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"nl-NL\"},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/accompagner.be\/nl\/aanvraag-om-een-begeleiding\/#webpage\",\"url\":\"https:\/\/accompagner.be\/nl\/aanvraag-om-een-begeleiding\/\",\"name\":\"Aanvraag om een begeleiding - Les Amis d\\u2019Accompagner\",\"isPartOf\":{\"@id\":\"https:\/\/accompagner.be\/fr\/#website\"},\"datePublished\":\"2020-06-23T21:40:52+00:00\",\"dateModified\":\"2024-03-18T13:20:28+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/accompagner.be\/nl\/aanvraag-om-een-begeleiding\/#breadcrumb\"},\"inLanguage\":\"nl-NL\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/accompagner.be\/nl\/aanvraag-om-een-begeleiding\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/accompagner.be\/nl\/aanvraag-om-een-begeleiding\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"item\":{\"@type\":\"WebPage\",\"@id\":\"https:\/\/accompagner.be\/nl\/\",\"url\":\"https:\/\/accompagner.be\/nl\/\",\"name\":\"Accueil\"}},{\"@type\":\"ListItem\",\"position\":2,\"item\":{\"@id\":\"https:\/\/accompagner.be\/nl\/aanvraag-om-een-begeleiding\/#webpage\"}}]}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","coauthors":[],"author_meta":{"author_link":"https:\/\/accompagner.be\/nl\/author\/phd2019\/","display_name":"PhD2019"},"relative_dates":{"created":"Posted 6 years ago","modified":"Updated 2 years ago"},"featured_img_caption":"","_links":{"self":[{"href":"https:\/\/accompagner.be\/nl\/wp-json\/wp\/v2\/pages\/8864"}],"collection":[{"href":"https:\/\/accompagner.be\/nl\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/accompagner.be\/nl\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/accompagner.be\/nl\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/accompagner.be\/nl\/wp-json\/wp\/v2\/comments?post=8864"}],"version-history":[{"count":1,"href":"https:\/\/accompagner.be\/nl\/wp-json\/wp\/v2\/pages\/8864\/revisions"}],"predecessor-version":[{"id":11948,"href":"https:\/\/accompagner.be\/nl\/wp-json\/wp\/v2\/pages\/8864\/revisions\/11948"}],"wp:attachment":[{"href":"https:\/\/accompagner.be\/nl\/wp-json\/wp\/v2\/media?parent=8864"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}