{"id":10055,"date":"2022-03-25T11:34:32","date_gmt":"2022-03-25T15:34:32","guid":{"rendered":"https:\/\/www.bbbso.ca\/formulaire-de-candidature-pour-le-programme-de-mentorat-grandes-soeurs\/"},"modified":"2022-03-25T11:34:32","modified_gmt":"2022-03-25T15:34:32","slug":"formulaire-de-candidature-pour-le-programme-de-mentorat-grandes-soeurs","status":"publish","type":"page","link":"https:\/\/www.bbbso.ca\/fr\/formulaire-de-candidature-pour-le-programme-de-mentorat-grandes-soeurs\/","title":{"rendered":"Formulaire de candidature pour le programme de mentorat Grandes Soeurs"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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class='gf_progressbar_percentage percentbar_blues percentbar_10' style='width:10%;'><span>10%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_52_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_52' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_52_164\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_164'>Company<\/label><div class='ginput_container'><input name='input_164' id='input_52_164' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_52_164'>Ce champ n\u2019est utilis\u00e9 qu\u2019\u00e0 des fins de validation et devrait rester inchang\u00e9.<\/div><\/div><div id=\"field_52_149\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p><em>As of November 25 2021, \u00a0Big Brothers Big Sisters of Ottawa requires all volunteers to be fully vaccinated at the time of applying. Volunteers are required to provide proof of vaccination, and be required to disclose their vaccination status in order to make an informed decision about how their match will proceed.<\/em><\/p><\/div><fieldset id=\"field_52_150\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >At this time have you received two doses of a Health Canada approved COVID- 19 Vaccine?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_52_150'>\n\t\t\t<div class='gchoice gchoice_52_150_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_150' type='radio' value='Yes'  id='choice_52_150_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_52_150_0' id='label_52_150_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_52_150_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_150' type='radio' value='No'  id='choice_52_150_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_52_150_1' id='label_52_150_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_52_151\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><!-- wp:paragraph {\"fontSize\":\"medium\"} -->\n<p class=\"has-medium-font-size\">During this time Big Brothers Big Sisters of Ottawa requires all volunteers to be fully vaccinated in effort to minimize the risk, and spread of the COVID-19 virus.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"fontSize\":\"medium\"} -->\n<p class=\"has-medium-font-size\">For this reason we are unable to move forward with completing a volunteer application.<\/p>\n<!-- \/wp:paragraph --><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_52_152' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_52_2' class='gform_page' data-js='page-field-id-152' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_52_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_52_153\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Please select your mentoring location<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_52_153'>\n\t\t\t<div class='gchoice gchoice_52_153_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_153' type='radio' value='Ottawa'  id='choice_52_153_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_52_153_0' id='label_52_153_0' class='gform-field-label gform-field-label--type-inline'>Ottawa<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_52_153_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_153' type='radio' value='Renfrew County'  id='choice_52_153_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_52_153_1' id='label_52_153_1' class='gform-field-label gform-field-label--type-inline'>Renfrew County<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_52_157' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_52_157' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_52_3' class='gform_page' data-js='page-field-id-157' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_52_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_52_154\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><!-- wp:paragraph -->\n<p>Have you read the summary of our <a href=\"https:\/\/www.bbbso.ca\/get-involved\/apply-to-be-a-mentor\/\">Volunteer Programs<\/a> and reviewed the <a href=\"https:\/\/www.bbbso.ca\/frequently-asked-questions\/\">FAQ<\/a> page?<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>Have questions or need more info? Please contact Stephanie Chretien-Gaudreau at <a href=\"mailto:stephanie.chretien-gaudreau@bigbrothersbigsisters.ca\">stephanie.chretien-gaudreau@bigbrothersbigsisters.ca<\/a> or 613-247-4776, ext. 324 prior to beginning your application.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3><i class=\"fas fa-check-circle\"><\/i> STEP 1: COMPLETE APPLICATION FORM<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph {\"style\":{\"color\":{\"background\":\"#ffb81c\"}}} -->\n<p class=\"has-background\" style=\"background-color:#ffb81c\"><strong>Complete Application<\/strong> form by selecting START APPLICATION PROCESS NOW below. You must include reference contact information (email address, phone number, etc) to submit your application.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:spacer {\"height\":\"28px\"} -->\n<div style=\"height:28px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n<!-- \/wp:spacer -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3><i class=\"fas fa-check-circle\"><\/i> STEP 2: SCHEDULE IN-PERSON TRAINING AND INTERVIEW<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph {\"style\":{\"color\":{\"background\":\"#ffb81c\"}}} -->\n<p class=\"has-background\" style=\"background-color:#ffb81c\">Once we have <strong>received at least 2 of your references<\/strong> completed questionnaires - you will be contacted via email to book your interview. Please monitor your provided email inbox (including Spam\/Junk folders).<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:spacer {\"height\":\"28px\"} -->\n<div style=\"height:28px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n<!-- \/wp:spacer -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3><i class=\"fas fa-check-circle\"><\/i> STEP 3: COMPLETE ONLINE TRAINING<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph {\"style\":{\"color\":{\"background\":\"#ffb81c\"}}} -->\n<p class=\"has-background\" style=\"background-color:#ffb81c\">Once interview has been completed, you will be able to book your training to complete.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:spacer {\"height\":\"28px\"} -->\n<div style=\"height:28px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n<!-- \/wp:spacer -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3><i class=\"fas fa-check-circle\"><\/i> STEP 4: COMPLETE VULNERABLE SECTOR AND CRIMINAL RECORD CHECK<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph {\"style\":{\"color\":{\"background\":\"#ffb81c\"}}} -->\n<p class=\"has-background\" style=\"background-color:#ffb81c\">Obtain Vulnerable Sector Police records check\/return required form<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:spacer {\"height\":\"28px\"} -->\n<div style=\"height:28px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n<!-- \/wp:spacer -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3><i class=\"fas fa-check-circle\"><\/i> STEP 5: READY TO BE MATCHED!<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph {\"style\":{\"color\":{\"background\":\"#ffb81c\"}}} -->\n<p class=\"has-background\" style=\"background-color:#ffb81c\"><strong>As part of the application process, we require 3 to 4 adult references.&nbsp;<\/strong> We will also be asking you to provide basic personal, demographic and contact information.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:spacer {\"height\":\"28px\"} -->\n<div style=\"height:28px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n<!-- \/wp:spacer -->\n\n<!-- wp:paragraph -->\n<p>Prior to starting the application, please take a moment to gather email and phone contact information for your references.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p>If you encounter any issues with this form please contact Stephanie Chretien-Gaudreau at 613-247-4776, ext. 324.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph -->\n<p><strong>NOTE: It can take up to 8 weeks to go through our mentor application process and be matched with a youth\/child.<\/strong><\/p>\n<!-- \/wp:paragraph --><\/div><fieldset id=\"field_52_158\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_158.1' id='input_52_158_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_52_158_1' >I have read all of the above steps.<\/label><input type='hidden' name='input_158.2' value='I have read all of the above steps.' class='gform_hidden' \/><input type='hidden' name='input_158.3' value='3' class='gform_hidden' \/><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_52_155' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_52_155' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_52_4' class='gform_page' data-js='page-field-id-155' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_52_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_52_2\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Personal Information<\/h3><div class='gsection_description' id='gfield_description_52_2'>* denotes that answers to these questions are mandatory<\/div><\/div><fieldset id=\"field_52_3\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Legal Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_52_3'>\n                            \n                            <span id='input_52_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.3' id='input_52_3_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_52_3_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_52_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.6' id='input_52_3_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_52_3_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                <\/span>\n                            \n                        <\/div><div class='gfield_description' id='gfield_description_52_3'>Please Note: Your Legal name is required on this application. Please ensure you fill out your application using the name on your Driver\u2019s License or Birth Certificate.<\/div><\/fieldset><fieldset id=\"field_52_143\" class=\"gfield gfield--type-name field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Preferred Named - If applicable<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_52_143'>\n                            \n                            <span id='input_52_143_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_143.3' id='input_52_143_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_52_143_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_52_143_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_143.6' id='input_52_143_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_52_143_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_52_6\" class=\"gfield gfield--type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_6'>Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_6' id='input_52_6' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Male' >Male<\/option><option value='Female' >Female<\/option><option value='Transgendered' >Transgendered<\/option><option value='Non-Binary' >Non-Binary<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_52_163\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_163'>Please specify.<\/label><div class='ginput_container ginput_container_text'><input name='input_163' id='input_52_163' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_52_148\" class=\"gfield gfield--type-html gfield--width-full warning gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  >We have reached our limit of female applicants, at this time. Please try again at a later date.<\/div><fieldset id=\"field_52_8\" class=\"gfield gfield--type-date gfield--input-type-datefield gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Date of Birth (mm\/dd\/yyyy)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div id='input_52_8' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_52_8_1_container'>\n                                            <input type='number' maxlength='2' name='input_8[]' id='input_52_8_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_52_8_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Mois<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_52_8_2_container'>\n                                            <input type='number' maxlength='2' name='input_8[]' id='input_52_8_2' value=''   aria-required='true'   placeholder='JJ' min='1' max='31' step='1'\/>\n                                            <label for='input_52_8_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Jour<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_52_8_3_container'>\n                                            <input type='number' maxlength='4' name='input_8[]' id='input_52_8_3' value=''   aria-required='true'   placeholder='AAAA' min='1920' max='2027' step='1'\/>\n                                            <label for='input_52_8_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Ann\u00e9e<\/label>\n                                       <\/div>\n                                   <\/div><\/fieldset><fieldset id=\"field_52_7\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_52_7' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_52_7_1_container' >\n                                        <input type='text' name='input_7.1' id='input_52_7_1' value=''   placeholder='Street Address' aria-required='true'    \/>\n                                        <label for='input_52_7_1' id='input_52_7_1_label' class='gform-field-label gform-field-label--type-sub '>Adresse postale<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_52_7_3_container' >\n                                    <input type='text' name='input_7.3' id='input_52_7_3' value=''   placeholder='City' aria-required='true'    \/>\n                                    <label for='input_52_7_3' id='input_52_7_3_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_52_7_4_container' >\n                                        <select name='input_7.4' id='input_52_7_4'     aria-required='true'    ><option value='' ><\/option><option value='Alberta' >Alberta<\/option><option value='Colombie-Britannique' >Colombie-Britannique<\/option><option value='Manitoba' >Manitoba<\/option><option value='Nouveau-Brunswick' >Nouveau-Brunswick<\/option><option value='Terre-Neuve-et-Labrador' >Terre-Neuve-et-Labrador<\/option><option value='Territoires du Nord-Ouest' >Territoires du Nord-Ouest<\/option><option value='Nouvelle-\u00c9cosse' >Nouvelle-\u00c9cosse<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' selected='selected'>Ontario<\/option><option value='\u00cele du Prince-\u00c9douard' >\u00cele du Prince-\u00c9douard<\/option><option value='Qu\u00e9bec' >Qu\u00e9bec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><\/select>\n                                        <label for='input_52_7_4' id='input_52_7_4_label' class='gform-field-label gform-field-label--type-sub '>Province<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_52_7_5_container' >\n                                    <input type='text' name='input_7.5' id='input_52_7_5' value=''   placeholder='Postal Code' aria-required='true'    \/>\n                                    <label for='input_52_7_5' id='input_52_7_5_label' class='gform-field-label gform-field-label--type-sub '>Code postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_7.6' id='input_52_7_6' value='Canada' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_52_18\" class=\"gfield gfield--type-list gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Telephone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Cell<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Home  (N\/A if none)<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Business (N\/A if none)<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_18_cell1 gform-grid-col' data-label='Cell'><input aria-invalid='false' aria-required=\"true\"  aria-label='Cell, Ligne 1' data-aria-label-template='Cell, Ligne {0}' type='text' name='input_18[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_18_cell2 gform-grid-col' data-label='Home  (N\/A if none)'><input aria-invalid='false' aria-required=\"true\"  aria-label='Home  (N\/A if none), Ligne 1' data-aria-label-template='Home  (N\/A if none), Ligne {0}' type='text' name='input_18[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_18_cell3 gform-grid-col' data-label='Business (N\/A if none)'><input aria-invalid='false' aria-required=\"true\"  aria-label='Business (N\/A if none), Ligne 1' data-aria-label-template='Business (N\/A if none), Ligne {0}' type='text' name='input_18[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Ajouter une autre ligne' onclick='gformAddListItem(this, 0)'>Ajouter<\/button>   <button type='button'  class='delete_list_item' aria-label='Supprimer la ligne 1' data-aria-label-template='Supprimer la ligne {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Retirer<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><fieldset id=\"field_52_13\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_52_13_container'>\n                                <span id='input_52_13_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_13' id='input_52_13' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_52_13' class='gform-field-label gform-field-label--type-sub '>Saisissez un e-mail<\/label>\n                                <\/span>\n                                <span id='input_52_13_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_13_2' id='input_52_13_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_52_13_2' class='gform-field-label gform-field-label--type-sub '>Confirmez l\u2019e-mail<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_52_131\" class=\"gfield gfield--type-email field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_131'>Alternate Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_131' id='input_52_131' type='email' value='' class='medium'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_52_11\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_11'>Language Preference<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_11' id='input_52_11' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='English' >English<\/option><option value='French' >French<\/option><\/select><\/div><\/div><div id=\"field_52_12\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_12'>Other languages spoken:<\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_52_12' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_52_130\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_130'>If bilingual, would you be comfortable mentoring in French?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_130' id='input_52_130' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/div><div id=\"field_52_132\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_132'>Marital Status<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_132' id='input_52_132' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Single' >Single<\/option><option value='Married' >Married<\/option><option value='Dating' >Dating<\/option><option value='Divorced' >Divorced<\/option><option value='Widowed' >Widowed<\/option><option value='Common Law' >Common Law<\/option><option value='Seperated' >Seperated<\/option><\/select><\/div><\/div><div id=\"field_52_133\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_133'>Partner\/Spouse Name (If applicable)<\/label><div class='ginput_container ginput_container_text'><input name='input_133' id='input_52_133' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_52_17\" class=\"gfield gfield--type-list gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Emergency Contact<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Relationship<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Telephone<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_17_cell1 gform-grid-col' data-label='Name'><input aria-invalid='false' aria-required=\"true\"  aria-label='Name, Ligne 1' data-aria-label-template='Name, Ligne {0}' type='text' name='input_17[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_17_cell2 gform-grid-col' data-label='Relationship'><input aria-invalid='false' aria-required=\"true\"  aria-label='Relationship, Ligne 1' data-aria-label-template='Relationship, Ligne {0}' type='text' name='input_17[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_17_cell3 gform-grid-col' data-label='Telephone'><input aria-invalid='false' aria-required=\"true\"  aria-label='Telephone, Ligne 1' data-aria-label-template='Telephone, Ligne {0}' type='text' name='input_17[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Ajouter une autre ligne' onclick='gformAddListItem(this, 0)'>Ajouter<\/button>   <button type='button'  class='delete_list_item' aria-label='Supprimer la ligne 1' data-aria-label-template='Supprimer la ligne {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Retirer<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_52_161\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><b style=\"color:red\"><i>Thank you for your interest in becoming a mentor. At this time, our pool of volunteers in your area may be currently full.<\/i><\/b><\/div><div id=\"field_52_162\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><b style=\"color:green\"><i>Thank you for your interest in becoming a mentor. Please continue filling out the volunteer application.<\/i><\/b><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_52_134' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_52_134' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_52_5' class='gform_page' data-js='page-field-id-134' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_52_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_52_20\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_20'>What is your country of origin?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_20' id='input_52_20' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Brazil' >Brazil<\/option><option value='Brunei' >Brunei<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Congo, Republic of the' >Congo, Republic of the<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czech Republic' >Czech Republic<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='East Timor' >East Timor<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kosovo' >Kosovo<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Laos' >Laos<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macedonia' >Macedonia<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='North Korea' >North Korea<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russia' >Russia<\/option><option value='Rwanda' >Rwanda<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Korea' >South Korea<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Sudan, South' >Sudan, South<\/option><option value='Suriname' >Suriname<\/option><option value='Swaziland' >Swaziland<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria' >Syria<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania' >Tanzania<\/option><option value='Thailand' >Thailand<\/option><option value='Togo' >Togo<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkey' >Turkey<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Vatican City' >Vatican City<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><\/select><\/div><\/div><div id=\"field_52_21\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_21'>Are you a visible minority?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_21' id='input_52_21' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/div><div id=\"field_52_22\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_22'>What is your immigration status:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_22' id='input_52_22' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='I am a Refugee' >I am a Refugee<\/option><option value='I am a Permanent Resident' >I am a Permanent Resident<\/option><option value='I am a Canadian Citizen' >I am a Canadian Citizen<\/option><\/select><\/div><\/div><div id=\"field_52_23\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_23'>How long have you been in Canada?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_23' id='input_52_23' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Less than 5 years' >Less than 5 years<\/option><option value='More than 5 years' >More than 5 years<\/option><\/select><\/div><\/div><fieldset id=\"field_52_25\" class=\"gfield gfield--type-date gfield--input-type-datefield field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Date of Arrival in Canada:<\/legend><div id='input_52_25' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_52_25_1_container'>\n                                            <input type='number' maxlength='2' name='input_25[]' id='input_52_25_1' value=''   aria-required='false'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_52_25_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Mois<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_52_25_2_container'>\n                                            <input type='number' maxlength='2' name='input_25[]' id='input_52_25_2' value=''   aria-required='false'   placeholder='JJ' min='1' max='31' step='1'\/>\n                                            <label for='input_52_25_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Jour<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_52_25_3_container'>\n                                            <input type='number' maxlength='4' name='input_25[]' id='input_52_25_3' value=''   aria-required='false'   placeholder='AAAA' min='1920' max='2027' step='1'\/>\n                                            <label for='input_52_25_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Ann\u00e9e<\/label>\n                                       <\/div>\n                                   <\/div><\/fieldset><div id=\"field_52_35\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_35'>Are you Indigenous?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_35' id='input_52_35' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/div><fieldset id=\"field_52_33\" class=\"gfield gfield--type-list field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Region\/Community:<\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">First Nations:<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">M\u00e9tis:<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Inuit:<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Other (please specify):<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_33_cell1 gform-grid-col' data-label='First Nations:'><input aria-invalid='false'   aria-label='First Nations:, Ligne 1' data-aria-label-template='First Nations:, Ligne {0}' type='text' name='input_33[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_33_cell2 gform-grid-col' data-label='M\u00e9tis:'><input aria-invalid='false'   aria-label='M\u00e9tis:, Ligne 1' data-aria-label-template='M\u00e9tis:, Ligne {0}' type='text' name='input_33[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_33_cell3 gform-grid-col' data-label='Inuit:'><input aria-invalid='false'   aria-label='Inuit:, Ligne 1' data-aria-label-template='Inuit:, Ligne {0}' type='text' name='input_33[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_33_cell4 gform-grid-col' data-label='Other (please specify):'><input aria-invalid='false'   aria-label='Other (please specify):, Ligne 1' data-aria-label-template='Other (please specify):, Ligne {0}' type='text' name='input_33[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Ajouter une autre ligne' onclick='gformAddListItem(this, 0)'>Ajouter<\/button>   <button type='button'  class='delete_list_item' aria-label='Supprimer la ligne 1' data-aria-label-template='Supprimer la ligne {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Retirer<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><fieldset id=\"field_52_27\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >First Nations (please select all that apply):<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_52_27'><div class='gchoice gchoice_52_27_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.1' type='checkbox'  value='Cree'  id='choice_52_27_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_52_27_1' id='label_52_27_1' class='gform-field-label gform-field-label--type-inline'>Cree<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_52_27_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.2' type='checkbox'  value='Algonquin'  id='choice_52_27_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_52_27_2' id='label_52_27_2' class='gform-field-label gform-field-label--type-inline'>Algonquin<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_52_27_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.3' type='checkbox'  value='Mi&#039;kmaq'  id='choice_52_27_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_52_27_3' id='label_52_27_3' class='gform-field-label gform-field-label--type-inline'>Mi'kmaq<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_52_27_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.4' type='checkbox'  value='Ojibway'  id='choice_52_27_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_52_27_4' id='label_52_27_4' class='gform-field-label gform-field-label--type-inline'>Ojibway<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_52_27_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_27.5' type='checkbox'  value='Other (please specify):'  id='choice_52_27_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_52_27_5' id='label_52_27_5' class='gform-field-label gform-field-label--type-inline'>Other (please specify):<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_52_135\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_52_38\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_38'>What prompted you to apply?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_38' id='input_52_38' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Always Known' >Always Known<\/option><option value='Brochure' >Brochure<\/option><option value='Business\/Corporate' >Business\/Corporate<\/option><option value='Television' >Television<\/option><option value='Formerly a Little' >Formerly a Little<\/option><option value='Info Booth' >Info Booth<\/option><option value='Newspaper' >Newspaper<\/option><option value='Presentation' >Presentation<\/option><option value='Radio' >Radio<\/option><option value='Social Media' >Social Media<\/option><option value='Special Events' >Special Events<\/option><option value='Website' >Website<\/option><option value='Word of Mouth' >Word of Mouth<\/option><option value='Campus Recruitment' >Campus Recruitment<\/option><option value='Other:' >Other:<\/option><\/select><\/div><\/div><div id=\"field_52_39\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_39'>If other, please specify:<\/label><div class='ginput_container ginput_container_text'><input name='input_39' id='input_52_39' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_52_42\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_42'>Would you be interested in helping with Fundraising events?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_42' id='input_52_42' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/div><div id=\"field_52_43\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_43'>I would like to sign up for BBBSO\u2019s Blog:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_43' id='input_52_43' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/div><div id=\"field_52_44\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_44'>I would like to sign up for BBBSO\u2019s Monthly Newsletter:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_44' id='input_52_44' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_52_50' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_52_50' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_52_6' class='gform_page' data-js='page-field-id-50' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_52_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_52_45\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Vulnerable Sector Reference and Experience<\/h3><div class='gsection_description' id='gfield_description_52_45'>NOTE: A vulnerable sector check is an enhanced criminal record for individuals who have volunteered with children or vulnerable persons.<\/div><\/div><div id=\"field_52_46\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_46'>Have you ever been, or applied to be, a volunteer with a Big Brother Big Sister agency in the past?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_46' id='input_52_46' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/div><div id=\"field_52_47\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_47'>If yes, with which agency(ies) were you involved?<\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_52_47' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_52_127\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_127'>Please list any Bigs, Littles or Parents of Littles (or other volunteers or clients associated with BBBSO) whom you know.<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_127' id='input_52_127' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_52_53\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><div class='gsection_description' id='gfield_description_52_53'>We will contact all vulnerable sector agencies \u2013 please provide the following information:<\/div><\/div><div id=\"field_52_51\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_51'>Agency\/Organization<\/label><div class='ginput_container ginput_container_text'><input name='input_51' id='input_52_51' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_52_54\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_54'>When did you volunteer\/work with this agency\/organization?<\/label><div class='ginput_container ginput_container_text'><input name='input_54' id='input_52_54' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_52_56\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_56'>For how long did you volunteer\/work?<\/label><div class='ginput_container ginput_container_text'><input name='input_56' id='input_52_56' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_52_60\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_60'>Contact Person:<\/label><div class='ginput_container ginput_container_text'><input name='input_60' id='input_52_60' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_52_73\" class=\"gfield gfield--type-email field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_73'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_73' id='input_52_73' type='email' value='' class='medium'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_52_72\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_72'>Telephone<\/label><div class='ginput_container ginput_container_phone'><input name='input_72' id='input_52_72' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_52_55\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_55'>Agency\/Organization<\/label><div class='ginput_container ginput_container_text'><input name='input_55' id='input_52_55' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_52_57\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_57'>When did you volunteer\/work with this agency\/organization?<\/label><div class='ginput_container ginput_container_text'><input name='input_57' id='input_52_57' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_52_58\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_58'>For how long did you volunteer\/work?<\/label><div class='ginput_container ginput_container_text'><input name='input_58' id='input_52_58' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_52_59\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_59'>Contact Person:<\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_52_59' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_52_70\" class=\"gfield gfield--type-email field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_70'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_70' id='input_52_70' type='email' value='' class='medium'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_52_71\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_71'>Telephone<\/label><div class='ginput_container ginput_container_phone'><input name='input_71' id='input_52_71' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_52_66' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_52_66' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_52_7' class='gform_page' data-js='page-field-id-66' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_52_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_52_67\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Employment &amp; Education<\/h3><\/div><div id=\"field_52_68\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_68'>Employer<\/label><div class='ginput_container ginput_container_text'><input name='input_68' id='input_52_68' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_52_69\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_69'>Occupation<\/label><div class='ginput_container ginput_container_text'><input name='input_69' id='input_52_69' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_52_75\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_75'>Length of time in this position<\/label><div class='ginput_container ginput_container_text'><input name='input_75' id='input_52_75' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_52_76\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_76'>If less than 5 years, your previous place of employment<\/label><div class='ginput_container ginput_container_text'><input name='input_76' id='input_52_76' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_52_77\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Please indicate the highest level of education that you have completed:<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_52_77'><div class='gchoice gchoice_52_77_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.1' type='checkbox'  value='Elementary School'  id='choice_52_77_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_52_77_1' id='label_52_77_1' class='gform-field-label gform-field-label--type-inline'>Elementary School<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_52_77_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.2' type='checkbox'  value='Secondary School'  id='choice_52_77_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_52_77_2' id='label_52_77_2' class='gform-field-label gform-field-label--type-inline'>Secondary School<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_52_77_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.3' type='checkbox'  value='Some College'  id='choice_52_77_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_52_77_3' id='label_52_77_3' class='gform-field-label gform-field-label--type-inline'>Some College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_52_77_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.4' type='checkbox'  value='College'  id='choice_52_77_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_52_77_4' id='label_52_77_4' class='gform-field-label gform-field-label--type-inline'>College<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_52_77_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.5' type='checkbox'  value='Some University'  id='choice_52_77_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_52_77_5' id='label_52_77_5' class='gform-field-label gform-field-label--type-inline'>Some University<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_52_77_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.6' type='checkbox'  value='University'  id='choice_52_77_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_52_77_6' id='label_52_77_6' class='gform-field-label gform-field-label--type-inline'>University<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_52_77_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.7' type='checkbox'  value='Post-Graduate Certificate'  id='choice_52_77_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_52_77_7' id='label_52_77_7' class='gform-field-label gform-field-label--type-inline'>Post-Graduate Certificate<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_52_77_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.8' type='checkbox'  value='Master&#039;s'  id='choice_52_77_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_52_77_8' id='label_52_77_8' class='gform-field-label gform-field-label--type-inline'>Master's<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_52_77_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.9' type='checkbox'  value='Ph.D'  id='choice_52_77_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_52_77_9' id='label_52_77_9' class='gform-field-label gform-field-label--type-inline'>Ph.D<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_52_77_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.11' type='checkbox'  value='Other'  id='choice_52_77_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_52_77_11' id='label_52_77_11' class='gform-field-label gform-field-label--type-inline'>Other<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_52_81\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_81'>If you are presently a student, where?<\/label><div class='ginput_container ginput_container_text'><input name='input_81' id='input_52_81' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_52_82\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_82'>Grade\/Level<\/label><div class='ginput_container ginput_container_text'><input name='input_82' id='input_52_82' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_52_78' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_52_78' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_52_8' class='gform_page' data-js='page-field-id-78' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_52_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_52_79\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Vehicle<\/h3><\/div><div id=\"field_52_83\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_83'>Do you own or have access to a vehicle?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_83' id='input_52_83' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/div><div id=\"field_52_84\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_84'>Do you have at least $1 million auto insurance coverage?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_84' id='input_52_84' class='medium gfield_select'  aria-describedby=\"gfield_description_52_84\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_52_84'><b>IF MARKED YES YOU WILL BE REQUIRED TO SUBMIT YOUR INSURANCE DOCUMENT AS STATING THIS COVERAGE AS PER REQUIREMENTS. ONE OF OUR STAFF WILL REQUEST THIS WHEN NEEDED. <\/b> Please note this is not your pink slips- but your insurance package. We will need only the page that proves this coverage.<\/div><\/div><div id=\"field_52_85\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_85'>Driver\u2019s Licence Number:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_85' id='input_52_85' type='text' value='' class='medium'  aria-describedby=\"gfield_description_52_85\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_52_85'>Please input n\/a if not applicable.<\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_52_86' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_52_86' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_52_9' class='gform_page' data-js='page-field-id-86' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_52_9' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_52_87\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">References<\/h3><div class='gsection_description' id='gfield_description_52_87'>Please complete all sections fully. Incomplete reference information may cause delays in processing your application.\n\n--Note: If you are involved in a relationship of significance (married, common-law, long-term partner\/ boyfriend\/ girlfriend) you must use this person as a reference.\n\n* denotes that answers to these questions are mandatory (if using that specific reference).\n\nPLEASE BE SURE TO INPUT A VALID EMAIL ADDRESS FOR EACH REFERENCE.  We will only contact the necessary references, therefore not all references will be contacted.   <\/div><\/div><fieldset id=\"field_52_88\" class=\"gfield gfield--type-list gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Significant Other\/Partner<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Relationship with you<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Years Known<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_88_cell1 gform-grid-col' data-label='Name'><input aria-invalid='false' aria-required=\"true\"  aria-label='Name, Ligne 1' data-aria-label-template='Name, Ligne {0}' type='text' name='input_88[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_88_cell2 gform-grid-col' data-label='Relationship with you'><input aria-invalid='false' aria-required=\"true\"  aria-label='Relationship with you, Ligne 1' data-aria-label-template='Relationship with you, Ligne {0}' type='text' name='input_88[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_88_cell3 gform-grid-col' data-label='Years Known'><input aria-invalid='false' aria-required=\"true\"  aria-label='Years Known, Ligne 1' data-aria-label-template='Years Known, Ligne {0}' type='text' name='input_88[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Ajouter une autre ligne' onclick='gformAddListItem(this, 0)'>Ajouter<\/button>   <button type='button'  class='delete_list_item' aria-label='Supprimer la ligne 1' data-aria-label-template='Supprimer la ligne {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Retirer<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_52_92\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_92'>Language Preference<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_92' id='input_52_92' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='English' >English<\/option><option value='French' >French<\/option><\/select><\/div><\/div><div id=\"field_52_90\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_90'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_90' id='input_52_90' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_52_96\" class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_96'>Telephone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_96' id='input_52_96' type='tel' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_52_137\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_52_137'><div class='gchoice gchoice_52_137_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_137.1' type='checkbox'  value='I confirm that if I have a significant other at present time, I&#039;ve provided them as the reference.'  id='choice_52_137_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_52_137_1' id='label_52_137_1' class='gform-field-label gform-field-label--type-inline'>I confirm that if I have a significant other at present time, I've provided them as the reference.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_52_93\" class=\"gfield gfield--type-list field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Volunteer Reference (or Employment Reference if no volunteer experience within the last 5 years)<\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Relationship with you<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Years Known (min 6 mths for Volunteer or min 1 year for Employment):<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_93_cell1 gform-grid-col' data-label='Name'><input aria-invalid='false'   aria-label='Name, Ligne 1' data-aria-label-template='Name, Ligne {0}' type='text' name='input_93[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_93_cell2 gform-grid-col' data-label='Relationship with you'><input aria-invalid='false'   aria-label='Relationship with you, Ligne 1' data-aria-label-template='Relationship with you, Ligne {0}' type='text' name='input_93[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_93_cell3 gform-grid-col' data-label='Years Known (min 6 mths for Volunteer or min 1 year for Employment):'><input aria-invalid='false'   aria-label='Years Known (min 6 mths for Volunteer or min 1 year for Employment):, Ligne 1' data-aria-label-template='Years Known (min 6 mths for Volunteer or min 1 year for Employment):, Ligne {0}' type='text' name='input_93[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Ajouter une autre ligne' onclick='gformAddListItem(this, 0)'>Ajouter<\/button>   <button type='button'  class='delete_list_item' aria-label='Supprimer la ligne 1' data-aria-label-template='Supprimer la ligne {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Retirer<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_52_94\" class=\"gfield gfield--type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_94'>This is a:<\/label><div class='ginput_container ginput_container_select'><select name='input_94' id='input_52_94' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Volunteer Reference' >Volunteer Reference<\/option><option value='Employment Reference' >Employment Reference<\/option><\/select><\/div><\/div><div id=\"field_52_98\" class=\"gfield gfield--type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_98'>Language Preference<\/label><div class='ginput_container ginput_container_select'><select name='input_98' id='input_52_98' class='medium gfield_select'     aria-invalid=\"false\" ><option value='English' >English<\/option><option value='French' >French<\/option><\/select><\/div><\/div><div id=\"field_52_95\" class=\"gfield gfield--type-email field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_95'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_95' id='input_52_95' type='email' value='' class='medium'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_52_101\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_101'>Telephone<\/label><div class='ginput_container ginput_container_phone'><input name='input_101' id='input_52_101' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_52_138\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_52_138'><div class='gchoice gchoice_52_138_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_138.1' type='checkbox'  value='I confirm that I&#039;ve provided a Volunteer Reference or Employer Reference'  id='choice_52_138_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_52_138_1' id='label_52_138_1' class='gform-field-label gform-field-label--type-inline'>I confirm that I've provided a Volunteer Reference or Employer Reference<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_52_97\" class=\"gfield gfield--type-list field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Vulnerable Sector Reference<\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Relationship with you<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Years Known<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_97_cell1 gform-grid-col' data-label='Name'><input aria-invalid='false'   aria-label='Name, Ligne 1' data-aria-label-template='Name, Ligne {0}' type='text' name='input_97[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_97_cell2 gform-grid-col' data-label='Relationship with you'><input aria-invalid='false'   aria-label='Relationship with you, Ligne 1' data-aria-label-template='Relationship with you, Ligne {0}' type='text' name='input_97[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_97_cell3 gform-grid-col' data-label='Years Known'><input aria-invalid='false'   aria-label='Years Known, Ligne 1' data-aria-label-template='Years Known, Ligne {0}' type='text' name='input_97[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Ajouter une autre ligne' onclick='gformAddListItem(this, 0)'>Ajouter<\/button>   <button type='button'  class='delete_list_item' aria-label='Supprimer la ligne 1' data-aria-label-template='Supprimer la ligne {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Retirer<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_52_99\" class=\"gfield gfield--type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_99'>Language Preference<\/label><div class='ginput_container ginput_container_select'><select name='input_99' id='input_52_99' class='medium gfield_select'     aria-invalid=\"false\" ><option value='English' >English<\/option><option value='French' >French<\/option><\/select><\/div><\/div><div id=\"field_52_104\" class=\"gfield gfield--type-email field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_104'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_104' id='input_52_104' type='email' value='' class='medium'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_52_105\" class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_105'>Telephone<\/label><div class='ginput_container ginput_container_phone'><input name='input_105' id='input_52_105' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_52_102\" class=\"gfield gfield--type-list gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Personal Reference<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Relationship with you<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Years Known (min 2 yrs):<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_102_cell1 gform-grid-col' data-label='Name'><input aria-invalid='false' aria-required=\"true\"  aria-label='Name, Ligne 1' data-aria-label-template='Name, Ligne {0}' type='text' name='input_102[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_102_cell2 gform-grid-col' data-label='Relationship with you'><input aria-invalid='false' aria-required=\"true\"  aria-label='Relationship with you, Ligne 1' data-aria-label-template='Relationship with you, Ligne {0}' type='text' name='input_102[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_102_cell3 gform-grid-col' data-label='Years Known (min 2 yrs):'><input aria-invalid='false' aria-required=\"true\"  aria-label='Years Known (min 2 yrs):, Ligne 1' data-aria-label-template='Years Known (min 2 yrs):, Ligne {0}' type='text' name='input_102[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Ajouter une autre ligne' onclick='gformAddListItem(this, 0)'>Ajouter<\/button>   <button type='button'  class='delete_list_item' aria-label='Supprimer la ligne 1' data-aria-label-template='Supprimer la ligne {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Retirer<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_52_107\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_107'>Language Preference<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_107' id='input_52_107' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='English' >English<\/option><option value='French' >French<\/option><\/select><\/div><\/div><div id=\"field_52_139\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_139'>Email (N\/A if none)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_139' id='input_52_139' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_52_140\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_140'>Telephone (N\/A if none)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_140' id='input_52_140' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_52_106\" class=\"gfield gfield--type-list gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Family Reference<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">Name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Relationship with you<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Years Known (min 2 yrs):<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_106_cell1 gform-grid-col' data-label='Name'><input aria-invalid='false' aria-required=\"true\"  aria-label='Name, Ligne 1' data-aria-label-template='Name, Ligne {0}' type='text' name='input_106[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_106_cell2 gform-grid-col' data-label='Relationship with you'><input aria-invalid='false' aria-required=\"true\"  aria-label='Relationship with you, Ligne 1' data-aria-label-template='Relationship with you, Ligne {0}' type='text' name='input_106[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_106_cell3 gform-grid-col' data-label='Years Known (min 2 yrs):'><input aria-invalid='false' aria-required=\"true\"  aria-label='Years Known (min 2 yrs):, Ligne 1' data-aria-label-template='Years Known (min 2 yrs):, Ligne {0}' type='text' name='input_106[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Ajouter une autre ligne' onclick='gformAddListItem(this, 0)'>Ajouter<\/button>   <button type='button'  class='delete_list_item' aria-label='Supprimer la ligne 1' data-aria-label-template='Supprimer la ligne {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Retirer<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_52_103\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_103'>Language Preference<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_103' id='input_52_103' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='English' >English<\/option><option value='French' >French<\/option><\/select><\/div><\/div><div id=\"field_52_141\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_141'>Email (N\/A if none)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_141' id='input_52_141' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_52_142\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_142'>Telephone (N\/A if none)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_142' id='input_52_142' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_52_111\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >By entering my full name and clicking Next:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_52_111'><div class='gchoice gchoice_52_111_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_111.1' type='checkbox'  value='I hereby attest that the information in this application is accurate to the best of my knowledge'  id='choice_52_111_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_52_111_1' id='label_52_111_1' class='gform-field-label gform-field-label--type-inline'>I hereby attest that the information in this application is accurate to the best of my knowledge<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_52_115\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_52_115'>\n                            \n                            <span id='input_52_115_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_115.3' id='input_52_115_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_52_115_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_52_115_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_115.6' id='input_52_115_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_52_115_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_52_125\" class=\"gfield gfield--type-date gfield--input-type-datefield field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Date<\/legend><div id='input_52_125' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_52_125_1_container'>\n                                            <input type='number' maxlength='2' name='input_125[]' id='input_52_125_1' value=''   aria-required='false'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_52_125_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Mois<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_52_125_2_container'>\n                                            <input type='number' maxlength='2' name='input_125[]' id='input_52_125_2' value=''   aria-required='false'   placeholder='JJ' min='1' max='31' step='1'\/>\n                                            <label for='input_52_125_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Jour<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_52_125_3_container'>\n                                            <input type='number' maxlength='4' name='input_125[]' id='input_52_125_3' value=''   aria-required='false'   placeholder='AAAA' min='1920' max='2027' step='1'\/>\n                                            <label for='input_52_125_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Ann\u00e9e<\/label>\n                                       <\/div>\n                                   <\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_52_112' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_52_112' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_52_10' class='gform_page' data-js='page-field-id-112' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_52_10' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_52_122\" class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_52_122'>VOLUNTEER PERMISSION AND RELEASE AGREEMENT<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><div id=\"wp-input_52_122-wrap\" class=\"wp-core-ui wp-editor-wrap tmce-active\"><link rel='stylesheet' id='dashicons-css' href='https:\/\/www.bbbso.ca\/wp-includes\/css\/dashicons.min.css?ver=7.0.4' media='all' \/>\n<link rel='stylesheet' id='editor-buttons-css' href='https:\/\/www.bbbso.ca\/wp-includes\/css\/editor.min.css?ver=7.0.4' media='all' \/>\n<div id=\"wp-input_52_122-editor-container\" class=\"wp-editor-container\"><textarea class=\"large wp-editor-area\" style=\"height: 280px\" autocomplete=\"off\" cols=\"40\" name=\"input_122\" id=\"input_52_122\">&lt;strong&gt;TO: Big Brothers Big Sisters of Ottawa (THE \u201cAGENCY\u201d) &lt;\/strong&gt;\n&lt;br&gt;\nThe Agency and Big Brothers Big Sisters Canada (\u201c&lt;strong&gt;BBBSC&lt;\/strong&gt;\u201d) are separate entities and this Agreement is between me and the Agency.\n&lt;ol&gt;\n \t&lt;li&gt;By applying to volunteer with the Agency (\u201cVolunteer Application\u201d) and signing this Agreement, I acknowledge, understand and accept that:&lt;\/li&gt;\n&lt;\/ol&gt;\n(a) \u00a0I am a legal resident of Canada and have reached the age of majority in the province or territory \u2028in which I reside. I acknowledge and agree that if I have not reached the age of majority of the province or territory in which I reside, my parent or legal guardian will also need to sign this Agreement in order for my Volunteer Application to be considered;\n(b) \u00a0There is no obligation on the Agency to accept my Volunteer Application or assign me as a volunteer into a mentoring program (a \u201c&lt;strong&gt;Mentoring Program&lt;\/strong&gt;\u201d) and the Agency may terminate my involvement in a Mentoring Program in its sole discretion and without reason;\n(c) \u00a0If I am accepted as a volunteer, my involvement in a Mentoring Program is not intended to create and shall not be construed as creating either an employee\u2013employer relationship or a contract for services that would allow me to receive a salary, compensation, payment or any benefits, monetary or otherwise; and\n(d) \u00a0If I am accepted into a Mentoring Program, I understand that I will be required to enter into a confidentiality agreement with the Agency, and I agree to abide by the volunteer position description(s) and code(s) of conduct established by the Agency, including any applicable guidelines, Standards and policies.\n&lt;ol start=\"2\"&gt;\n \t&lt;li&gt;&lt;strong&gt;&lt;u&gt;Assumption of Risk, Release and Reimbursement&lt;\/u&gt;&lt;\/strong&gt;&lt;strong&gt;:&lt;\/strong&gt;&lt;\/li&gt;\n&lt;\/ol&gt;\nI acknowledge, understand and accept that:\n(a) \u00a0I am responsible for all risks associated with my involvement in a Mentoring Program including, without limitation, the risk of bodily or psychological harm or injury.\n(b) \u00a0Subject to local laws, I agree not to sue the Agency, BBBSC and\/or any of their member agencies in respect of any such injury or claim resulting from my participation in a Mentoring Program, my Volunteer Application, the acceptance or denial of my Volunteer Application, the Alumni Program and\/or my association with the Agency or BBBSC.\n(c) \u00a0I understand that I am fully responsible for any damage to my personal vehicle and\/or property during my volunteer involvement in a Mentoring Program and that neither BBBSC nor the Agency insures personal vehicles or property belonging to its volunteers;\n(d) \u00a0I agree to reimburse the Agency and\/or BBBSC and\/or any of their member agencies for any damages or losses of any kind (including but not limited to the injury of any other person and\/or damage to or loss of property) that may arise in connection with my gross negligence, wilful misconduct, or failure to act in accordance with published BBSC policies and guidelines and relating to or arising in connection with my participation in a Mentoring Program or my association with the Agency or BBBSC, including payment of any and all legal expenses of the Agency, BBBSC and\/or any of their member agencies.\n&lt;ol start=\"3\"&gt;\n \t&lt;li&gt;&lt;strong&gt;&lt;u&gt;Background Check&lt;\/u&gt;&lt;\/strong&gt;. I understand that my acceptance into the Mentoring Program will be conditional on my successful completion of a background check, which may include contacting the references included in my Volunteer Application and\/or a criminal record check, for the purposes of confirming my suitability for the Mentoring Program. I agree to provide all necessary consents for such background checks.&lt;\/li&gt;\n&lt;\/ol&gt;\n&lt;ol start=\"4\"&gt;\n \t&lt;li&gt;&lt;strong&gt;&lt;u&gt;Privacy Notice.&lt;\/u&gt;&lt;\/strong&gt; The personal information provided by me or otherwise collected by the Agency in connection with my application will be used by the Agency for the purpose of evaluating and considering my Volunteer Application and, if accepted into a Mentoring Program, for the purpose of administering the Mentoring Program. This information may include my name, phone number, mailing address, date of birth, results of background check, and driver\u2019s license and auto insurance information. My personal information will be maintained by the Agency on a confidential basis and will only be disclosed to the parent(s) and\/or guardian(s) of a child with whom the Agency may consider \u201cmatching\u201d me in a Mentoring Program, to representatives of a school or institution in connection with my participation in a site-based Mentoring Program, to the BBBSC as required for the purposes of accreditation reviews or legal proceedings and as otherwise required or permitted by law. In the event the Agency ceases operations, any and all information about me held by the Agency will be provided to BBBSC, another BBBSC agency selected by BBBSC, or both and will be used for the purposes set out above.&lt;\/li&gt;\n&lt;\/ol&gt;\n&lt;ol start=\"5\"&gt;\n \t&lt;li&gt;&lt;strong&gt;&lt;u&gt;Other Terms of this Agreement. &lt;\/u&gt;&lt;\/strong&gt;&lt;\/li&gt;\n&lt;\/ol&gt;\n(a) \u00a0In entering into this Agreement, I am not relying on any oral or written representations other \u2028than as set forth in this Agreement.\n(b) \u00a0This Agreement shall be governed by and construed pursuant to the laws of the Province or \u2028Territory in which the Agency is located.\n&lt;br&gt;\n(c) \u00a0In the event that any provision or term of this Agreement is held to be invalid, illegal or \u2028unenforceable, the remaining provisions of this Agreement shall remain in full force and effect.\n&lt;ol start=\"6\"&gt;\n \t&lt;li&gt;&lt;strong&gt;&lt;u&gt;Media Consent.&lt;\/u&gt;&lt;\/strong&gt; Any photographs or video productions taken of volunteers by agency staff at recreational events or match outings, or otherwise authorized by the Executive Director or Board of Directors, may be used by the agency for purposes of promotional material including brochures posters, newsletters, media information, advertisements, audio-visual productions and web pages, such as the Agency website and social media. Photographs or video productions may also be shared with community and school partners and Big Brothers Big Sisters of Canada for program promotion.&lt;\/li&gt;\n&lt;\/ol&gt;\n&lt;div class=\"page\" title=\"Page 7\"&gt;\n&lt;div class=\"layoutArea\"&gt;\n&lt;div class=\"column\"&gt;\n\n&lt;strong&gt;IMPORTANT:&lt;\/strong&gt; I acknowledge that I have read the terms of this Agreement, have been given an opportunity to obtain independent legal advice, and understand that it represents a waiver of certain of my legal rights, including my right to sue (subject to local laws). I further agree that such limits are reasonable and sign this Agreement freely, voluntarily and without duress.\n\n&lt;\/div&gt;\n&lt;\/div&gt;\n&lt;\/div&gt;<\/textarea><\/div>\n<\/div>\n\n<\/div><\/div><fieldset id=\"field_52_114\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >By ticking this check box:<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_52_114'><div class='gchoice gchoice_52_114_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.1' type='checkbox'  value='I confirm that I agree with item #6\u00a0of Media Consent.'  id='choice_52_114_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_52_114_1' id='label_52_114_1' class='gform-field-label gform-field-label--type-inline'>I confirm that I agree with item #6\u00a0of Media Consent.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_52_128\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >By entering my full name and clicking Submit:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_52_128'><div class='gchoice gchoice_52_128_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_128.1' type='checkbox'  value='I hereby confirm that I have completely read, fully understand  and agree with the statements outlined in the Volunteer Permission and Release Agreement.'  id='choice_52_128_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_52_128_1' id='label_52_128_1' class='gform-field-label gform-field-label--type-inline'>I hereby confirm that I have completely read, fully understand  and agree with the statements outlined in the Volunteer Permission and Release Agreement.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_52_124\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_52_124'>\n                            \n                            <span id='input_52_124_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_124.3' id='input_52_124_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_52_124_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_52_124_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_124.6' id='input_52_124_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_52_124_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_52_116\" class=\"gfield gfield--type-date gfield--input-type-datefield field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Date<\/legend><div id='input_52_116' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_52_116_1_container'>\n                                            <input type='number' maxlength='2' name='input_116[]' id='input_52_116_1' value=''   aria-required='false'   placeholder='MM' min='1' max='12' step='1'\/>\n                                            <label for='input_52_116_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Mois<\/label>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_52_116_2_container'>\n                                            <input type='number' maxlength='2' name='input_116[]' id='input_52_116_2' value=''   aria-required='false'   placeholder='JJ' min='1' max='31' step='1'\/>\n                                            <label for='input_52_116_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Jour<\/label>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_52_116_3_container'>\n                                            <input type='number' maxlength='4' name='input_116[]' id='input_52_116_3' value=''   aria-required='false'   placeholder='AAAA' min='1920' max='2027' step='1'\/>\n                                            <label for='input_52_116_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Ann\u00e9e<\/label>\n                  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