{"id":2976,"date":"2020-05-19T15:48:21","date_gmt":"2020-05-19T19:48:21","guid":{"rendered":"https:\/\/pmbiaquebec.ca\/formulaire-reconnaissance-acceptation-risques-copy\/"},"modified":"2023-03-19T18:00:43","modified_gmt":"2023-03-19T22:00:43","slug":"formulaire1","status":"publish","type":"page","link":"https:\/\/pmbiaquebec.ca\/fr\/formulaire1\/","title":{"rendered":"Formulaire reconnaissance et acceptation des risques"},"content":{"rendered":"<div class=\"wpcf7 no-js\" id=\"wpcf7-f7538-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/fr\/wp-json\/wp\/v2\/pages\/2976#wpcf7-f7538-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\" data-trp-original-action=\"\/fr\/wp-json\/wp\/v2\/pages\/2976#wpcf7-f7538-o1\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"7538\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.9.8\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f7538-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<input type=\"hidden\" name=\"_wpcf7dtx_version\" value=\"5.0.7\" \/>\n<\/div>\n<p class=\"text-center my-5\">Original document in French - English translated via DeepL.com\n<\/p>\n<h4 class=\"text-center my-5\">FORMULAIRE DE RECONNAISSANCE ET ACCEPTATION DES RISQUES\n<\/h4>\n<h4 class=\"text-center my-5\">A REMPLIR OBLIGATOIREMENT AVANT LE DEBUT DU COURS\n<\/h4>\n<div class=\"d-md-flex\">\n\t<div class=\"w-50 mr-2 mb-3\">\n\t\t<p><label> Cours \/ Clinique r\u00e9serv\u00e9e ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"courriel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"courriel\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"w-50 ml-2 mb-3\">\n\t<\/div>\n<\/div>\n<div class=\"d-md-flex\">\n\t<div class=\"w-50 mr-2 mb-3\">\n\t\t<p><label> Nom<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"last-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"last-name\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"w-50 ml-2 mb-3\">\n\t\t<p><label> Pr\u00e9nom<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"first-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"first-name\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"d-md-flex\">\n\t<div class=\"w-50 mr-2 mb-3\">\n\t\t<p><label> Courriel<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"courriel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"courriel\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"w-50 ml-2 mb-3\">\n\t\t<p><label> Cellulaire<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"phone\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"d-md-flex\">\n\t<div class=\"w-50 mr-2 mb-3\">\n\t\t<p><label> Nom \u00e0 contacter en cas d'urgence<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"nom-urgence\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nom-urgence\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"w-50 ml-2 mb-3\">\n\t\t<p><label> T\u00e9l\u00e9phone en cas d'urgence<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tel-urgence\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"tel-urgence\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"d-md-flex\">\n\t<div class=\"w-50 mr-2 mb-3\">\n\t\t<p><label> Nom du parent si mineur<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"nom-minuer\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nom-minuer\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"w-50 ml-2 mb-3\">\n\t\t<p><label> Pr\u00e9nom du parent si mineur<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"prenom-minuer\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"prenom-minuer\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"d-md-flex\">\n\t<div class=\"w-50 mr-2 mb-3\">\n\t\t<p><label> Qui vous \u00e0 r\u00e9f\u00e9r\u00e9 \u00e0 L'\u00c9cole de v\u00e9lo L'\u00c9cole de v\u00e9lo bikeskills?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"refferal\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"refferal\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"w-50 ml-2 mb-3\">\n\t<\/div>\n<\/div>\n<p><label><\/label>\n<\/p>\n<h4 class> 1) \u00c9TAT DE SANT\u00c9<br \/>\n\t<div class=\"d-md-flex\">\n\t\t<div class=\"w-50 mr-2 mb-3\">\n\t\t\t<p><label> Age des participants<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Age\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Age\" \/><\/span> <\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"w-50 ml-2 mb-3\">\n\t\t\t<p><label> Genre <span class=\"wpcf7-form-control-wrap\" data-name=\"genre\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"genre\"><option value=\"Male\">Homme<\/option><option value=\"Female\">Femme<\/option><option value=\"Non binary\">Non-binaire<\/option><\/select><\/span> <\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div><br \/>\n\t<div class=\"d-md-flex\">\n\t\t<div class=\"w-50 mr-2 mb-3\">\n\t\t\t<p><label> Avez-vous des sympt\u00f4mes associ\u00e9s au Covid-19?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"covid\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"covid\"><option value=\"Yes\">Oui<\/option><option value=\"No\">Non<\/option><\/select><\/span> <\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"w-50 ml-2 mb-3\">\n\t\t\t<p><label> Avez-vous voyag\u00e9 au cours de 14 derniers jours?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"covid1\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"covid1\"><option value=\"No\">Non<\/option><option value=\"Yes\">Oui<\/option><\/select><\/span> <\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div><br \/>\n\t<div class=\"d-md-flex\">\n\t\t<div class=\"w-50 mr-2 mb-3\">\n\t\t\t<p><label> Avez-vous \u00e9t\u00e9 en contact avec quelqu'un qui a des sympt\u00f4mes de Covid-19?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"covid3\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"covid3\"><option value=\"No\">Non<\/option><option value=\"Yes\">Oui<\/option><\/select><\/span> <\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"w-50 ml-2 mb-3\">\n\t\t<\/div>\n\t<\/div><br \/>\n\t<div class=\"d-md-flex\">\n\t\t<div class=\"w-50 mr-2 mb-3\">\n\t\t\t<p><label> \u00cates vous enceinte?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"enceinte\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"enceinte\"><option value=\"Ne s&#039;applique pas\">Ne s&#039;applique pas<\/option><option value=\"No\">Non<\/option><option value=\"Yes\">Oui<\/option><\/select><\/span> <\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"w-50 ml-2 mb-3\">\n\t\t\t<p><label> Prenez-vous des m\u00e9dicaments?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"medicaments\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"medicaments\"><option value=\"Yes\">Oui<\/option><option value=\"No\">Non<\/option><\/select><\/span> <\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div><br \/>\n<label> Si vous prenez des m\u00e9dicaments, lesquelles?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"medicaments-lesquelles\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"medicaments-lesquelles\" \/><\/span> <\/label><br \/>\n<label>Avez-vous des probl\u00e8mes de sant\u00e9 physique, \u00e9motionnels ou comportementaux qui directement ou indirectement vous limiteraient dans la pratique de l\u2019activit\u00e9 \u00e0 laquelle vous allez participer ?<br \/>\nExemples: Probl\u00e8mes respiratoires, cardiaques, diab\u00e8te, de vision, de surdit\u00e9, vertige, peur des hauteurs \/ des chiens, limitation de vos mouvements, blessures ant\u00e9rieures?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"problemes\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"problemes\" \/><\/span> <\/label><br \/>\n<label>Avez-vous des allergies ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"allergies\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"allergies\" \/><\/span> <\/label><br \/>\n<label>Avez-vous des appr\u00e9hensions quant \u00e0 la pratique du v\u00e9lo de montagne ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"apprehensions\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"apprehensions\" \/><\/span> <\/label><br \/>\n\t<h4 class=\"text-center my-5\">Si vous avez r\u00e9pondu oui \u00e0 l\u2019un des items de la section 1, VOUS DEVEZ RENCONTRER L'ENTRA\u00ceNEUR ET LUI EN FAIRE PART.\n\t<\/h4><br \/>\n<label><b>En transmettant ces informations \u00e0 L'\u00c9cole de v\u00e9lo Bikeskills, j\u2019accepte le risque additionnel qui pourrait entra\u00eener une possible aggravation de mon \u00e9tat de sant\u00e9<\/b><\/label><br \/>\n\t<div class=\"d-md-flex\">\n\t\t<div class=\"w-50 mr-2 mb-3\">\n\t\t\t<p><label><b> Choisir:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ACCEPT-risque\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"ACCEPT-risque\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"I ACCEPT \/ (this acts as a signature)\">J'ACCEPTE (Ceci fait office de signature)<\/option><option value=\"I do not accept (your participation will be compromised)\">Je n'accepte pas (votre participation est compromise)<\/option><\/select><\/span> <\/b><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"w-50 ml-2 mb-3\">\n\t\t<\/div>\n\t<\/div><br \/>\n<label>\n\t\t<h4 class> 2) RISQUES INH\u00c9RENTS \u00c0 L\u2019ACTIVIT\u00c9\n\t\t<\/h4><\/label><br \/>\n<label> Je reconnais avoir \u00e9t\u00e9 inform\u00e9 sur les risques inh\u00e9rents aux activit\u00e9s qui font partis du programme de L'\u00c9cole de v\u00e9lo pmbiaquebec.ca.<br \/>\nLes risques de l\u2019activit\u00e9 \u00ab cours technique en v\u00e9lo de montagne \u00bb \u00e0 laquelle je vais participer sont, de fa\u00e7on plus particuli\u00e8re, mais non-limitatives \u00e0 :<br \/>\n\u2022 Blessures dues \u00e0 des chutes \u00e0 v\u00e9lo<br \/>\n\u2022 Blessure dues \u00e0 un contact avec un objet (v\u00e9lo, arbre, branche, roche)<br \/>\n\u2022 Blessures dues \u00e0 un effort physique intense<br \/>\n\u2022 Blessures dues aux conditions climatiques changeantes (hypothermie, coup de chaleur)<br \/>\n\u2022 Blessures r\u00e9sultant de contact accidentel ou non entre les individus<br \/>\n\u2022 Allergie alimentaire (s\u2019il y a lieu)<br \/>\n<\/label><br \/>\n\t<div class=\"d-md-flex\">\n\t\t<div class=\"w-50 mr-2 mb-3\">\n\t\t\t<p><label><b> SVP Choisir :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ACCEPTATION-RISQUE1\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"ACCEPTATION-RISQUE1\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"I ACCEPT \/ (this acts as a signature)\">J'ACCEPTE (Ceci fait office de signature)<\/option><option value=\"I do not accept (your participation will be compromised)\">Je n'accepte pas (votre participation est compromise)<\/option><\/select><\/span><\/b><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"w-50 ml-2 mb-3\">\n\t\t<\/div>\n\t<\/div><br \/>\n<label>\n\t\t<h4 class> 3) CONFIRMATION DES RENSEIGNEMENTS ET ACCEPTATION DES RISQUES\n\t\t<\/h4><\/label><br \/>\n<label>I certify that the information on this form is accurate to the best of my knowledge. I certify that I have not deliberately omitted any information about my health status, whether relevant or not. I am aware that the information contained in this form is confidential and is intended to better plan and supervise the safety of the activities in which I will participate and that it will allow bikeskills to draw up a profile of its clientele. I am aware that the activities offered by bikeskills take place in semi-natural or natural environments that may be rugged and, consequently, are further away from medical services. This could result in long delays in the event of an emergency requiring evacuation, and consequently, a possible aggravation of my condition or injury. Having been made aware of these risks and having had the opportunity to discuss them with a person in charge of the activity, I acknowledge that I have been informed of the risks inherent to the activities and that I am able to undertake the activity in full knowledge of the facts and accepting the risks that this activity may entail. I also agree to play an active role in managing these risks by adopting a preventive attitude towards myself and others around me. The coach reserves the right to exclude any person he\/she deems to be a risk to him\/her or the rest of the group. I understand that I may leave this activity for any reason.<br \/>\n<\/label><br \/>\n\t<div class=\"d-md-flex\">\n\t\t<div class=\"w-50 mr-2 mb-3\">\n\t\t\t<p><label><b> Choisir:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ACCEPTATION-renseignement\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"ACCEPTATION-renseignement\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"I ACCEPT \/ (this acts as a signature)\">J'ACCEPTE (Ceci fait office de signature)<\/option><option value=\"I do not accept (your participation will be compromised)\">Je n'accepte pas (votre participation est compromise)<\/option><\/select><\/span> <\/b><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"w-50 ml-2 mb-3\">\n\t\t<\/div>\n\t<\/div><br \/>\n<label>\n\t\t<h4 class> 4) DROGUES ET ALCOOL\n\t\t<\/h4><\/label><br \/>\n<label>je m'engage \u00e0 ne pas utiliser, poss\u00e9der ou \u00eatre sous l'influence d'une drogue, d'une substance ill\u00e9gale ou d'un m\u00e9dicament (sur ordonnance ou non) qui n'est pas mentionn\u00e9 dans la section 1 du pr\u00e9sent formulaire. Je confirme \u00e9galement que je ne suis pas sous l'influence de l'alcool ou de drogues r\u00e9cr\u00e9atives et que je le resterai pendant toute la dur\u00e9e de l'activit\u00e9. Je suis conscient(e) que tout manquement \u00e0 ces r\u00e8gles de ma part peut entra\u00eener mon expulsion sans pr\u00e9avis et sans possibilit\u00e9 de remboursement.<br \/>\n<\/label><br \/>\n\t<div class=\"d-md-flex\">\n\t\t<div class=\"w-50 mr-2 mb-3\">\n\t\t\t<p><label><b> Choisir:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ACCEPTATION-ALCOOL\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"ACCEPTATION-ALCOOL\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"I ACCEPT \/ (this acts as a signature)\">J'ACCEPTE (Ceci fait office de signature)<\/option><option value=\"I do not accept (your participation will be compromised)\">Je n'accepte pas (votre participation est compromise)<\/option><\/select><\/span> <\/b><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"w-50 ml-2 mb-3\">\n\t\t<\/div>\n\t<\/div><br \/>\n<label>\n\t\t<h4 class> 5) D\u00c9CHARGE DE RESPONSABILIT\u00c9 MAT\u00c9RIELLE\n\t\t<\/h4><\/label><br \/>\n<label>Je soussign\u00e9, renonce par la pr\u00e9sente \u00e0 toute r\u00e9clamation, ainsi qu\u2019\u00e0 toute poursuite en dommage et int\u00e9r\u00eats pour tous dommages aux biens et mat\u00e9riel m\u2019appartenant. (usure normale, perte, bris, vol, vandalisme.)<\/label><br \/>\n\t<div class=\"d-md-flex\">\n\t\t<div class=\"w-50 mr-2 mb-3\">\n\t\t\t<p><label><b> Choisir:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ACCEPTATION-DECHARGE\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"ACCEPTATION-DECHARGE\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"I ACCEPT \/ (this acts as a signature)\">J'ACCEPTE (Ceci fait office de signature)<\/option><option value=\"I do not accept (your participation will be compromised)\">Je n'accepte pas (votre participation est compromise)<\/option><\/select><\/span> <\/b><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"w-50 ml-2 mb-3\">\n\t\t<\/div>\n\t<\/div><br \/>\n<label>\n\t\t<h4 class> 6) AUTORISATION \u00c0 INTERVENIR EN CAS D\u2019URGENCE\n\t\t<\/h4><\/label><br \/>\n<label>Je, soussign\u00e9, autorise l'entra\u00eeneur responsable de L'\u00c9cole de v\u00e9lo Bikeskills \u00e0 prodiguer tous les premiers soins n\u00e9cessaires. J\u2019autorise \u00e9galement l'entra\u00eeneur responsable de L'\u00c9cole de v\u00e9lo bikeskills \u00e0 prendre la d\u00e9cision dans le cas d\u2019un accident \u00e0 me transporter (par ambulance, h\u00e9licopt\u00e8re, garde c\u00f4ti\u00e8re ou autrement) dans un \u00e9tablissement hospitalier ou de sant\u00e9 communautaire, le tout, s\u2019il y a lieu, \u00e0 mes propres frais.<label><br \/>\n\t\t\t<div class=\"d-md-flex\">\n\t\t\t\t<div class=\"w-50 mr-2 mb-3\">\n<label><b> Choisir:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ACCEPTATION-AUTORISATION\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"ACCEPTATION-AUTORISATION\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"I ACCEPT \/ (this acts as a signature)\">J'ACCEPTE (Ceci fait office de signature)<\/option><option value=\"I do not accept (your participation will be compromised)\">Je n'accepte pas (votre participation est compromise)<\/option><\/select><\/span> <\/b><\/label>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"w-50 ml-2 mb-3\">\n\t\t\t\t<\/div>\n\t\t\t<\/div><br \/>\n<label>\n\t\t\t\t<h4 class> 7) COVID-19 et maladie de Lyme\n\t\t\t\t<\/h4><\/label><br \/>\n<label>Je comprend les risques associ\u00e9s au coronavirus Covid-19 et \u00e0 la maladie de Lyme, et je renonce \u00e0 toute r\u00e9clamation ainsi qu\u2019\u00e0 toute poursuite en dommage et int\u00e9r\u00eats r\u00e9sultant d'une transmission involontaire.<label><br \/>\n\t\t\t\t\t<div class=\"d-md-flex\">\n\t\t\t\t\t\t<div class=\"w-50 mr-2 mb-3\">\n<label><b> Choisir:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ACCEPTATION-COVID\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"ACCEPTATION-COVID\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"I ACCEPT \/ (this acts as a signature)\">J'ACCEPTE (Ceci fait office de signature)<\/option><option value=\"I do not accept (your participation will be compromised)\">Je n'accepte pas (votre participation est compromise)<\/option><\/select><\/span> <\/b><\/label>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"w-50 ml-2 mb-3\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div><br \/>\n<label>\n\t\t\t\t\t\t<h4 class> 8) Acceptation de risques et d\u00e9charge d'acceptation au site de pratique ou municipalit\u00e9 partenaire de L'\u00c9cole de v\u00e9lo Bikeskills\n\t\t\t\t\t\t<\/h4><\/label><br \/>\n<label>Je renonce \u00e0 toute r\u00e9clamation ainsi qu\u2019\u00e0 toute poursuite en dommage et int\u00e9r\u00eats envers les partenaires de L'\u00c9cole de v\u00e9lo bikeskills pour les activit\u00e9s d'encadrement.<label><br \/>\n\t\t\t\t\t\t\t<div class=\"d-md-flex\">\n\t\t\t\t\t\t\t\t<div class=\"w-50 mr-2 mb-3\">\n<label><b> Choisir:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ACCEPTATION-CNCB\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"ACCEPTATION-CNCB\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"I ACCEPT \/ (this acts as a signature)\">J'ACCEPTE (Ceci fait office de signature)<\/option><option value=\"I do not accept (your participation will be compromised)\">Je n'accepte pas (votre participation est compromise)<\/option><\/select><\/span> <\/b><\/label>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"w-50 ml-2 mb-3\">\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div><br \/>\n<label>J\u2019ai lu, je comprends et j\u2019accepte les termes et conditions pr\u00e9vus au pr\u00e9sent formulaire d'acceptation des risques et je m\u2019engage \u00e0 m\u2019y conformer. J\u2019atteste \u00e9galement la v\u00e9racit\u00e9 des renseignements transmis \u00e0 L'\u00c9cole de v\u00e9lo bikeskills. En foi de quoi, je transmets mon consentement en date d\u2019aujourd\u2019hui en s\u00e9lectionnant la case \u00ab J\u2019accepte \u00bb.<\/label><br \/>\n\t\t\t\t\t\t\t<div class=\"d-md-flex\">\n\t\t\t\t\t\t\t\t<div class=\"w-50 mr-2 mb-3\">\n<label><b> Choisir:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ACCEPTATION-formulaire\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"ACCEPTATION-formulaire\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"I ACCEPT \/ (this acts as a signature)\">J'ACCEPTE (Ceci fait office de signature)<\/option><option value=\"I do not accept (your participation will be compromised)\">Je n'accepte pas (votre participation est compromise)<\/option><\/select><\/span> <\/b><\/label>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"w-50 ml-2 mb-3\">\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div><br \/>\n<input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Envoyer\" \/><\/label><\/label><\/label><\/label><\/label><\/label>\n<\/h4><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<input type=\"hidden\" name=\"trp-form-language\" value=\"fr\"\/><\/form>\n<\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.2 - 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