{"id":502,"date":"2020-10-14T14:17:45","date_gmt":"2020-10-14T14:17:45","guid":{"rendered":"http:\/\/prefleuri.flywheelsites.com\/?page_id=502"},"modified":"2026-09-23T15:42:16","modified_gmt":"2026-09-23T15:42:16","slug":"online-application","status":"publish","type":"page","link":"https:\/\/prefleuri.ch\/fr\/admission\/online-application\/","title":{"rendered":"Inscription en ligne"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"502\" class=\"elementor elementor-502\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-db923be elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle\" data-id=\"db923be\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;jet_parallax_layout_list&quot;:[{&quot;_id&quot;:&quot;bb018b6&quot;,&quot;jet_parallax_layout_image&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_image_tablet&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_image_mobile&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_speed&quot;:{&quot;unit&quot;:&quot;%&quot;,&quot;size&quot;:50,&quot;sizes&quot;:[]},&quot;jet_parallax_layout_type&quot;:&quot;scroll&quot;,&quot;jet_parallax_layout_direction&quot;:&quot;1&quot;,&quot;jet_parallax_layout_fx_direction&quot;:null,&quot;jet_parallax_layout_z_index&quot;:0,&quot;jet_parallax_layout_bg_x&quot;:50,&quot;jet_parallax_layout_bg_x_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y&quot;:50,&quot;jet_parallax_layout_bg_y_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size&quot;:&quot;auto&quot;,&quot;jet_parallax_layout_bg_size_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_animation_prop&quot;:&quot;transform&quot;,&quot;jet_parallax_layout_on&quot;:[&quot;desktop&quot;,&quot;tablet&quot;]}],&quot;shape_divider_bottom&quot;:&quot;curve&quot;,&quot;shape_divider_bottom_negative&quot;:&quot;yes&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t<div class=\"elementor-shape elementor-shape-bottom\" aria-hidden=\"true\" data-negative=\"true\">\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 1000 100\" preserveAspectRatio=\"none\">\n\t<path class=\"elementor-shape-fill\" d=\"M500,97C126.7,96.3,0.8,19.8,0,0v100l1000,0V1C1000,19.4,873.3,97.8,500,97z\"\/>\n<\/svg>\t\t<\/div>\n\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6ab6006\" data-id=\"6ab6006\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-ad9907d elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"ad9907d\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[{&quot;jet_parallax_layout_image&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;_id&quot;:&quot;f173fde&quot;,&quot;jet_parallax_layout_image_tablet&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_image_mobile&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_speed&quot;:{&quot;unit&quot;:&quot;%&quot;,&quot;size&quot;:50,&quot;sizes&quot;:[]},&quot;jet_parallax_layout_type&quot;:&quot;scroll&quot;,&quot;jet_parallax_layout_direction&quot;:&quot;1&quot;,&quot;jet_parallax_layout_fx_direction&quot;:null,&quot;jet_parallax_layout_z_index&quot;:0,&quot;jet_parallax_layout_bg_x&quot;:50,&quot;jet_parallax_layout_bg_x_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y&quot;:50,&quot;jet_parallax_layout_bg_y_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size&quot;:&quot;auto&quot;,&quot;jet_parallax_layout_bg_size_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_animation_prop&quot;:&quot;transform&quot;,&quot;jet_parallax_layout_on&quot;:[&quot;desktop&quot;,&quot;tablet&quot;]}]}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-27120a2\" data-id=\"27120a2\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6d28a44 elementor-widget elementor-widget-heading\" data-id=\"6d28a44\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Start your Application<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0fa8718 elementor-widget elementor-widget-heading\" data-id=\"0fa8718\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Please Fill the Form<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6fe942f elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"6fe942f\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Online Application\" aria-label=\"Online Application\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"502\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"6fe942f\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Online Application \u2013 Prefleuri\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"502\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_cca7660 elementor-col-100\">\n\t\t\t\t\t<h3>Parents <\/h3>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-name elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMother Last Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Mother Last Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_7c7f8a3 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7c7f8a3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMother First Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_7c7f8a3]\" id=\"form-field-field_7c7f8a3\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Mother First Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMother's Email\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Mother&#039;s Email\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_b57ddfb elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b57ddfb\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMother's Telephone\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_b57ddfb]\" id=\"form-field-field_b57ddfb\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Mother&#039;s Telephone\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"T\u00e9l\u00e9phone de la m\u00e8re\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_51983c0 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_51983c0\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMother's Profession\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_51983c0]\" id=\"form-field-field_51983c0\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Mother&#039;s Profession\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_a9aa7a9 elementor-col-100\">\n\t\t\t\t\t<hr>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_da8dfb7 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_da8dfb7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFather Last Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_da8dfb7]\" id=\"form-field-field_da8dfb7\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Father Last Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_64868ef elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_64868ef\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFather First Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_64868ef]\" id=\"form-field-field_64868ef\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Father First Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_4509a67 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4509a67\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFather's Email\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[field_4509a67]\" id=\"form-field-field_4509a67\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Father&#039;s Email\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_a6aae82 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a6aae82\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFather's Telephone\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_a6aae82]\" id=\"form-field-field_a6aae82\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Father&#039;s Telephone\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"T\u00e9l\u00e9phone de la m\u00e8re\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_9e71259 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9e71259\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFather's Profession\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_9e71259]\" id=\"form-field-field_9e71259\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Father&#039;s Profession\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_841a35d elementor-col-100\">\n\t\t\t\t\t<\/br><h3>Contact<\/h3>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_0bad347 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0bad347\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAdress\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_0bad347]\" id=\"form-field-field_0bad347\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Street and Nr\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_654f3f1 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_654f3f1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPostcode\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_654f3f1]\" id=\"form-field-field_654f3f1\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Postcode\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_84997e1 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_84997e1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCity\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_84997e1]\" id=\"form-field-field_84997e1\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"City\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_a092341 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a092341\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCountry\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_a092341]\" id=\"form-field-field_a092341\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Country\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_1cff5b5 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1cff5b5\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEmail *\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[field_1cff5b5]\" id=\"form-field-field_1cff5b5\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Email *\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text\">\n\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_b497fa5]\" id=\"form-field-field_b497fa5\" class=\"elementor-field elementor-size-sm \" style=\"display:none !important;\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_d230207 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d230207\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tThe child lives with:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Parents\" id=\"form-field-field_d230207-0\" name=\"form_fields[field_d230207]\"> <label for=\"form-field-field_d230207-0\">Parents<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Mother\" id=\"form-field-field_d230207-1\" name=\"form_fields[field_d230207]\"> <label for=\"form-field-field_d230207-1\">Mother<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Father\" id=\"form-field-field_d230207-2\" name=\"form_fields[field_d230207]\"> <label for=\"form-field-field_d230207-2\">Father<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_636c4d6 elementor-col-100\">\n\t\t\t\t\t<hr>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_17562d0 elementor-col-100\">\n\t\t\t\t\t<\/br><h3>Child<\/h3>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_a6ffc7c elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a6ffc7c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tChild Last Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_a6ffc7c]\" id=\"form-field-field_a6ffc7c\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Child Last Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_778cf0b elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_778cf0b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tChild First Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_778cf0b]\" id=\"form-field-field_778cf0b\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Child First Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_5db932c elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5db932c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBirthday\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_5db932c]\" id=\"form-field-field_5db932c\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"dd\/mm\/yyy\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_0a822e4 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0a822e4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNationality\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_0a822e4]\" id=\"form-field-field_0a822e4\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Nationality\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_f5328cc elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f5328cc\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGender\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"M\" id=\"form-field-field_f5328cc-0\" name=\"form_fields[field_f5328cc]\"> <label for=\"form-field-field_f5328cc-0\">M<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"F\" id=\"form-field-field_f5328cc-1\" name=\"form_fields[field_f5328cc]\"> <label for=\"form-field-field_f5328cc-1\">F<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_7a0a8c8 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7a0a8c8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tArrival Date at Prefleuri\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_7a0a8c8]\" id=\"form-field-field_7a0a8c8\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"dd\/mm\/yyy\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_eb32648 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_eb32648\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tReligion\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_eb32648]\" id=\"form-field-field_eb32648\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Religion\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_76b5750 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_76b5750\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAllergies\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_76b5750]\" id=\"form-field-field_76b5750\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"If existing precise which allergies\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_3591607 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3591607\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSurgeries\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_3591607]\" id=\"form-field-field_3591607\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"If existing precise which surgeries\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_26dff7b elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_26dff7b\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFormer injuries\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_26dff7b]\" id=\"form-field-field_26dff7b\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"If existing precise which injuries\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_272532e elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_272532e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTreatment in progress\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_272532e]\" id=\"form-field-field_272532e\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"If existing precise which treatment\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_14d3eb6 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_14d3eb6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSpecial Diet\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_14d3eb6]\" id=\"form-field-field_14d3eb6\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"If required please the diet\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-field_a0f8b0f elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a0f8b0f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPicture of the child\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[field_a0f8b0f]\" id=\"form-field-field_a0f8b0f\" class=\"elementor-field elementor-size-sm  elementor-upload-field\" data-maxsize=\"5\" data-maxsize-message=\"This file exceeds the maximum allowed size.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_b3f0aef elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b3f0aef\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDo you authorize Pr\u00e9fleuri to publish  photos of the child on our website and brochures?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_b3f0aef-0\" name=\"form_fields[field_b3f0aef]\"> <label for=\"form-field-field_b3f0aef-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_b3f0aef-1\" name=\"form_fields[field_b3f0aef]\"> <label for=\"form-field-field_b3f0aef-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_f0da1c9 elementor-col-100\">\n\t\t\t\t\t<hr>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_229f211 elementor-col-100\">\n\t\t\t\t\t<\/br><h3>Previous School<\/h3>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_d6c27da elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d6c27da\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSchool Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_d6c27da]\" id=\"form-field-field_d6c27da\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"School Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_d150e5f elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d150e5f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLevel\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_d150e5f]\" id=\"form-field-field_d150e5f\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Level\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_77e0aa2 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_77e0aa2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tClass at Prefleuri\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_77e0aa2]\" id=\"form-field-field_77e0aa2\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Class at Prefleuri\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_a8068e4 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a8068e4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tRemarks\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_a8068e4]\" id=\"form-field-field_a8068e4\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Remarks\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_cb14322 elementor-col-100\">\n\t\t\t\t\t<hr>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_2ced4e6 elementor-col-100\">\n\t\t\t\t\t<\/br><h3>Enrollment<\/h3>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_936f269 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_936f269\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tResidential\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Day Student\" id=\"form-field-field_936f269-0\" name=\"form_fields[field_936f269]\"> <label for=\"form-field-field_936f269-0\">Day Student<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Full Boarding\" id=\"form-field-field_936f269-1\" name=\"form_fields[field_936f269]\"> <label for=\"form-field-field_936f269-1\">Full Boarding<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Flexi Boarding\" id=\"form-field-field_936f269-2\" name=\"form_fields[field_936f269]\"> <label for=\"form-field-field_936f269-2\">Flexi Boarding<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_491b74f elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_491b74f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCurriculum\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"British Curriculum\" id=\"form-field-field_491b74f-0\" name=\"form_fields[field_491b74f]\"> <label for=\"form-field-field_491b74f-0\">British Curriculum<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"French Curriculum\" id=\"form-field-field_491b74f-1\" name=\"form_fields[field_491b74f]\"> <label for=\"form-field-field_491b74f-1\">French Curriculum<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_4c2ed0a elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4c2ed0a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHow did you hear about Prefleuri?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-eicon-caret-down\" viewBox=\"0 0 571.4 571.4\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M571 393Q571 407 561 418L311 668Q300 679 286 679T261 668L11 418Q0 407 0 393T11 368 36 357H536Q550 357 561 368T571 393Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_4c2ed0a]\" id=\"form-field-field_4c2ed0a\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"Internet\">Internet<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Newspaper\">Newspaper<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Business Relation\">Business Relation<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Friend\">Friend<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_6edd830 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6edd830\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tReference\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_6edd830]\" id=\"form-field-field_6edd830\" class=\"elementor-field elementor-size-sm  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