{"id":912,"date":"2025-01-29T09:54:37","date_gmt":"2025-01-29T15:54:37","guid":{"rendered":"https:\/\/ircom.carmis.ai\/?page_id=912"},"modified":"2025-01-29T11:39:44","modified_gmt":"2025-01-29T17:39:44","slug":"asp-hey-registration-form","status":"publish","type":"page","link":"https:\/\/ircom.carmis.ai\/fr\/asp-hey-registration-form\/","title":{"rendered":"Formulaire d&#039;inscription ASP et HEY"},"content":{"rendered":"<div id=\"cs-content\" class=\"cs-content\"><div class=\"x-section e912-e1 mpc-0 formbg\"><div class=\"x-row x-container max width e912-e2 mpc-1 mpc-2 innerformbg\"><div class=\"x-row-inner\"><div class=\"x-col e912-e3 mpc-3 NsdSpacerSmallAll\"><script>\nvar 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    <h2 class=\"gform_title\">IRCOM - ASP & HEY Registration Form<\/h2>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_11' id='gform_11'  action='\/fr\/wp-json\/wp\/v2\/pages\/912#gf_11' data-formid='11' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_11' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_11_151\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_151'>X\/Twitter<\/label><div class='gfield_description' id='gfield_description_11_151'>Ce champ n\u2019est utilis\u00e9 qu\u2019\u00e0 des fins de validation et devrait rester inchang\u00e9.<\/div><div class='ginput_container'><input name='input_151' id='input_11_151' type='text' value='' autocomplete='new-password'\/><\/div><\/div><div id=\"field_11_37\" class=\"gfield gfield--type-text gfield--width-third FIRST_NAME gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_37'>Child First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_11_37' type='text' value='' class='large'   tabindex='1'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_38\" class=\"gfield gfield--type-text gfield--width-third LAST_NAME gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_38'>Child Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_11_38' type='text' value='' class='large'   tabindex='2'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_16\" class=\"gfield gfield--type-select gfield--width-quarter GENDER gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_16'>Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_16' id='input_11_16' class='medium gfield_select' tabindex='3'   aria-required=\"true\" aria-invalid=\"false\" ><option value='M' >Male<\/option><option value='F' >Female<\/option><option value='X' >Non-Binary<\/option><option value='U' >Unknown<\/option><\/select><\/div><\/div><div id=\"field_11_5\" class=\"gfield gfield--type-text gfield--width-two-thirds ADDRESS1 copy-5-to-144 gwcopy gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_5'>Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_11_5' type='text' value='' class='large'   tabindex='4'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_6\" class=\"gfield gfield--type-text gfield--width-quarter POSTALCODE copy-6-to-145 gwcopy gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_6'>Postal Code<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_11_6' type='text' value='' class='medium'   tabindex='5'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_66\" class=\"gfield gfield--type-text gfield--width-quarter TELE1 copy-66-to-146 gwcopy gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_66'>Phone (Cell)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_66' id='input_11_66' type='text' value='' class='large'   tabindex='6'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_67\" class=\"gfield gfield--type-text gfield--width-quarter TELE2 field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_67'>Phone (Home)<\/label><div class='ginput_container ginput_container_text'><input name='input_67' id='input_11_67' type='text' value='' class='large'   tabindex='7'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_68\" class=\"gfield gfield--type-text gfield--width-third PHONENUMBERS field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_68'>Phone (Other)<\/label><div class='ginput_container ginput_container_text'><input name='input_68' id='input_11_68' type='text' value='' class='large'   tabindex='8'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_84\" class=\"gfield gfield--type-select gfield--width-half CAN_STATUS gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_84'>Immigration Status<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_84' id='input_11_84' class='large gfield_select' tabindex='9'   aria-required=\"true\" aria-invalid=\"false\" ><option value='0001' >Canadian Citizen<\/option><option value='0002' >Government Assisted Refugees (GAR)<\/option><option value='0022' >Private Sponsored Refugees (PSR)<\/option><option value='0006' >Refugee Claimant (RC)<\/option><option value='0024' >Provincial Nominee<\/option><option value='0018' >Ukraine CUAET Permit<\/option><option value='0003' >Permanent Resident<\/option><option value='0025' >Protected Person<\/option><\/select><\/div><\/div><div id=\"field_11_85\" class=\"gfield gfield--type-select gfield--width-third CNT_CITIZENSHIP gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_85'>Country of Origin<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_85' id='input_11_85' class='large gfield_select' tabindex='10'   aria-required=\"true\" aria-invalid=\"false\" ><option value='001' >Abu Dhabi<\/option><option value='002' >Afghanistan<\/option><option value='003' >Albania<\/option><option value='004' >Alderney<\/option><option value='005' >Algeria<\/option><option value='006' >American Samoa<\/option><option value='007' >Andorra<\/option><option value='008' >Angola<\/option><option value='009' >Anguilla<\/option><option value='010' >Antigua \/ Barbuda<\/option><option value='011' >Argentina<\/option><option value='012' >Armenia<\/option><option value='013' >Aruba<\/option><option value='014' >Australia<\/option><option value='015' >Austria<\/option><option value='016' >Azerbaijan<\/option><option value='017' >Bahamas Is.<\/option><option value='018' >Bahrain<\/option><option value='019' >Bangladesh<\/option><option value='020' >Barbados<\/option><option value='021' >Belarus<\/option><option value='022' >Belgium<\/option><option value='023' >Belize<\/option><option value='024' >Benin Peoples Republic<\/option><option value='025' >Bermuda<\/option><option value='026' >Bhutan<\/option><option value='027' >Bolivia<\/option><option value='028' >Bophuthatswana<\/option><option value='029' >Bosnia and Herzegovina<\/option><option value='030' >Botswana Republic Of<\/option><option value='031' >Brazil<\/option><option value='032' >Brechou<\/option><option value='033' >Brit. Virgin Islands<\/option><option value='034' >Brunei<\/option><option value='035' >Bulgaria<\/option><option value='036' >Burkina Faso<\/option><option value='038' >Burundi<\/option><option value='245' >Cambodia<\/option><option value='039' >Cameroon<\/option><option value='040' >Canada<\/option><option value='041' >Canary Islands<\/option><option value='042' >Cape Verde<\/option><option value='043' >Cayman Islands<\/option><option value='044' >Cent. African Republic<\/option><option value='045' >Chad Republic Of<\/option><option value='047' >Chile<\/option><option value='048' >China (PRC)<\/option><option value='049' >Colombia<\/option><option value='050' >Comoros<\/option><option value='051' >Congo Democratic Republic of<\/option><option value='052' >Congo Republic Of<\/option><option value='053' >Cook Islands<\/option><option value='054' >Costa Rica<\/option><option value='055' >Croatia<\/option><option value='056' >Cuba<\/option><option value='057' >Cyprus<\/option><option value='058' >Czech Republic<\/option><option value='059' >Denmark<\/option><option value='060' >Djibouti<\/option><option value='061' >Dominican Republic<\/option><option value='062' >Ecuador<\/option><option value='063' >Egypt<\/option><option value='064' >El Salvador<\/option><option value='065' >England<\/option><option value='066' >Equatorial Guinea<\/option><option value='067' >Eritrea<\/option><option value='068' >Estonia<\/option><option value='069' >Ethiopia<\/option><option value='070' >Falkland Is.<\/option><option value='071' >Federal Rep. Of Germany<\/option><option value='072' >Fiji<\/option><option value='073' >Finland<\/option><option value='074' >Formosa<\/option><option value='075' >Fr. Polynesia<\/option><option value='076' >France<\/option><option value='077' >French Guiana<\/option><option value='078' >Gabon Republic<\/option><option value='079' >Gambia<\/option><option value='080' >Georgia<\/option><option value='081' >Ghana<\/option><option value='082' >Gibraltar<\/option><option value='083' >Greece<\/option><option value='084' >Greenland<\/option><option value='085' >Grenada<\/option><option value='086' >Guadaloupe<\/option><option value='087' >Guam<\/option><option value='088' >Guatemala<\/option><option value='089' >Guinea Republic<\/option><option value='090' >Guinea-bissau<\/option><option value='091' >Guyana<\/option><option value='092' >Haiti<\/option><option value='093' >Honduras<\/option><option value='094' >Hong Kong<\/option><option value='095' >Hungary<\/option><option value='096' >Iceland<\/option><option value='097' >India<\/option><option value='098' >Indonesia Republic Of<\/option><option value='099' >Iran<\/option><option value='100' >Iraq<\/option><option value='101' >Ireland, Republic of<\/option><option value='102' >Israel<\/option><option value='103' >Italy<\/option><option value='104' >Ivory Coast Republic<\/option><option value='105' >Jamaica<\/option><option value='106' >Japan<\/option><option value='107' >Jordan<\/option><option value='108' >Kampuchea Democratic<\/option><option value='109' >Kazakhstan<\/option><option value='110' >Kenya<\/option><option value='111' >Kerguelen Islands<\/option><option value='113' >Kiribati<\/option><option value='114' >Korea North<\/option><option value='115' >Korea South<\/option><option value='116' >Kosovo<\/option><option value='117' >Kuwait<\/option><option value='112' >Kyrgyzstan<\/option><option value='118' >Laos<\/option><option value='119' >Latvia<\/option><option value='120' >Lebanon<\/option><option value='121' >Lesotho<\/option><option value='122' >Liberia<\/option><option value='123' >Libya<\/option><option value='124' >Liechtenstein<\/option><option value='125' >Lithuania<\/option><option value='126' >Luxembourg<\/option><option value='127' >Macao<\/option><option value='128' >Macedonia<\/option><option value='129' >Madagascar<\/option><option value='130' >Malawi<\/option><option value='131' >Malaysia<\/option><option value='132' >Maldives, Republic Of<\/option><option value='133' >Mali, Republic Of<\/option><option value='134' >Malta<\/option><option value='135' >Marshall Is.<\/option><option value='136' >Martinique<\/option><option value='137' >Mauritania<\/option><option value='138' >Mauritius<\/option><option value='139' >Mayotte<\/option><option value='140' >Mexico<\/option><option value='141' >Moldova<\/option><option value='142' >Monaco<\/option><option value='143' >Mongolia People&#039;s Republic<\/option><option value='144' >Montserrat<\/option><option value='145' >Morocco<\/option><option value='146' >Mozambique<\/option><option value='037' >Myanmar<\/option><option value='147' >Namibia<\/option><option value='148' >Nauru<\/option><option value='149' >Nepal<\/option><option value='150' >Netherlands<\/option><option value='151' >Netherlands, Ant.<\/option><option value='152' >Nevis<\/option><option value='153' >New Caledonia<\/option><option value='154' >New Zealand<\/option><option value='155' >Nicaragua<\/option><option value='156' >Niger Republic<\/option><option value='157' >Nigeria<\/option><option value='158' >Northern Ireland<\/option><option value='159' >Norway<\/option><option value='239' >Oman<\/option><option value='160' >Pakistan<\/option><option value='161' >Palestine<\/option><option value='162' >Panama<\/option><option value='163' >Panama Canal Zone<\/option><option value='164' >Papua New Guinea<\/option><option value='165' >Paraguay<\/option><option value='166' >Peru<\/option><option value='167' >Philippines<\/option><option value='168' >Pitcairn Is.<\/option><option value='169' >Poland<\/option><option value='170' >Portugal<\/option><option value='171' >Puerto Rico<\/option><option value='172' >Qatar<\/option><option value='173' >Reunion<\/option><option value='174' >Romania<\/option><option value='175' >Russia<\/option><option value='176' >Rwanda<\/option><option value='177' >Samoa<\/option><option value='178' >San Marino<\/option><option value='179' >Sao Tome E Principe<\/option><option value='180' >Saudi Arabia<\/option><option value='181' >Scotland<\/option><option value='182' >Senegal<\/option><option value='183' >Serbia<\/option><option value='184' >Seychelles<\/option><option value='185' >Sierra Leone<\/option><option value='186' >Singapore<\/option><option value='243' >Slovakia (Slovak Republic)<\/option><option value='242' >Slovenia<\/option><option value='187' >Solomons, The<\/option><option value='188' >Somalia<\/option><option value='189' >South Africa, Republic Of<\/option><option value='240' >South Sudan<\/option><option value='190' >Spain<\/option><option value='191' >Sri Lanka<\/option><option value='192' >St.Helena<\/option><option value='193' >St.Kitts-nevis<\/option><option value='194' >St.Lucia<\/option><option value='195' >St.Pierre Et Miquelon<\/option><option value='196' >St.Vincent And The Grenadines<\/option><option value='197' >Stateless<\/option><option value='198' >Sudan Dem. Rep. Of<\/option><option value='199' >Suriname<\/option><option value='200' >Swaziland<\/option><option value='201' >Sweden<\/option><option value='202' >Switzerland<\/option><option value='203' >Syria<\/option><option value='244' >Taiwan (ROC)<\/option><option value='204' >Tajikistan<\/option><option value='205' >Tanzania, United Republic Of<\/option><option value='206' >Thailand<\/option><option value='207' >Tibet<\/option><option value='208' >Togo Republic Of<\/option><option value='209' >Tonga<\/option><option value='210' >Trinidad &amp; Tobago Dem. Rep. Of<\/option><option value='211' >Tunisia<\/option><option value='212' >Turkey<\/option><option value='213' >Turkmenistan<\/option><option value='214' >Turks &amp; Caicos<\/option><option value='215' >Tuvalu<\/option><option value='216' >U.S. Virgin Is.<\/option><option value='219' >Uganda<\/option><option value='220' >Ukraine<\/option><option value='221' >United Arab Emirates<\/option><option value='241' >United Kingdom<\/option><option value='217' >United States Of America<\/option><option value='223' >Uruguay<\/option><option value='224' >Uzbekistan<\/option><option value='225' >Vanuatu<\/option><option value='226' >Vatican City St.<\/option><option value='227' >Venezuela<\/option><option value='228' >Vietnam<\/option><option value='231' >Wales<\/option><option value='232' >Wallis And Futuna<\/option><option value='233' >Western Sahara<\/option><option value='234' >Yemen, Republic Of<\/option><option value='235' >Yugoslavia<\/option><option value='236' >Zaire, Republic Of<\/option><option value='237' >Zambia<\/option><option value='238' >Zimbabwe<\/option><\/select><\/div><\/div><div id=\"field_11_138\" class=\"gfield gfield--type-text gfield--width-half FOSSIDNO field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_138'>Permanent Resident Card# (8 or 10 digits)<\/label><div class='ginput_container ginput_container_text'><input name='input_138' id='input_11_138' type='text' value='' class='large'   tabindex='11'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_120\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-third DATE_BIRTH gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_120'>Date of Birth (As per PR Card)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_120' id='input_11_120' type='text' value='' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon' tabindex='12'  placeholder='dd\/mm\/yyyy' aria-describedby=\"input_11_120_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_11_120_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_11_120' class='gform_hidden' value='https:\/\/ircom.carmis.ai\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_11_22\" class=\"gfield gfield--type-text gfield--width-third EDU_SCHOOL copy-22-to-147 gwcopy field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_22'>Current School<\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_11_22' type='text' value='' class='large'   tabindex='13'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_23\" class=\"gfield gfield--type-select gfield--width-quarter EDU_GRADE copy-23-to-148 gwcopy field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_23'>Grade<\/label><div class='ginput_container ginput_container_select'><select name='input_23' id='input_11_23' class='large gfield_select' tabindex='14'    aria-invalid=\"false\" ><option value='Grade 1' >Grade 1<\/option><option value='Grade 2' >Grade 2<\/option><option value='Grade 3' >Grade 3<\/option><option value='Grade 4' >Grade 4<\/option><option value='Grade 5' >Grade 5<\/option><option value='Grade 6' >Grade 6<\/option><option value='Grade 7' >Grade 7<\/option><option value='Grade 8' >Grade 8<\/option><option value='Grade 9' >Grade 9<\/option><option value='Grade 10' >Grade 10<\/option><option value='Grade 11' >Grade 11<\/option><option value='Grade 12' >Grade 12<\/option><\/select><\/div><\/div><div id=\"field_11_25\" class=\"gfield gfield--type-text gfield--width-quarter EDU_STUDYFIELD copy-25-to-149 gwcopy field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_25'>Student Number<\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_11_25' type='text' value='' class='large'   tabindex='15'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_26\" class=\"gfield gfield--type-text gfield--width-half PHIN_NUMBER field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_26'>MHSC Health Insurance (P.H.I.N.)<\/label><div class='gfield_description' id='gfield_description_11_26'>9 digits<\/div><div class='ginput_container ginput_container_text'><input name='input_26' id='input_11_26' type='text' value='' class='large'  aria-describedby=\"gfield_description_11_26\" tabindex='16'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_28\" class=\"gfield gfield--type-text gfield--width-third MHS_NUMBER field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_28'>Registration number<\/label><div class='gfield_description' id='gfield_description_11_28'>6 digits\n<\/div><div class='ginput_container ginput_container_text'><input name='input_28' id='input_11_28' type='text' value='' class='large'  aria-describedby=\"gfield_description_11_28\" tabindex='17'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_86\" class=\"gfield gfield--type-text gfield--width-half EMER_NAME copy-86-to-143 gwcopy gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_86'>Parent\/Guardian - Full Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_86' id='input_11_86' type='text' value='' class='large'   tabindex='18'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_87\" class=\"gfield gfield--type-text gfield--width-third EMER_TELE1 gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_87'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_87' id='input_11_87' type='text' value='' class='large'   tabindex='19'  aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_88\" class=\"gfield gfield--type-text gfield--width-half EMER2_NAME field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_88'>Emergency Contact - Full Name<\/label><div class='ginput_container ginput_container_text'><input name='input_88' id='input_11_88' type='text' value='' class='large'   tabindex='20'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_89\" class=\"gfield gfield--type-text gfield--width-third EMER2_TELE field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_89'>Phone<\/label><div class='ginput_container ginput_container_text'><input name='input_89' id='input_11_89' type='text' value='' class='large'   tabindex='21'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_141\" class=\"gfield gfield--type-multiselect gfield--width-five-sixths Reason_Inquiry field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_141'>Select the Program(s) you want to be involved whith<\/label><div class='ginput_container ginput_container_multiselect'><select multiple='multiple'  size='7' name='input_141[]' id='input_11_141' class='large gfield_select' tabindex='22'  aria-invalid=\"false\"  ><option value='0011' >Children&#039;s Program (6-12 years)<\/option><option value='0012' >Homework Club (12-18 years)<\/option><option value='0013' >Youth Program (12-18 years)<\/option><\/select><\/div><\/div><div id=\"field_11_134\" class=\"gfield gfield--type-multiselect gfield--width-five-sixths HIGH_NEED_TYPE field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_134'>Health Information About the Child<\/label><div class='gfield_description' id='gfield_description_11_134'>Please fill out any of the following that apply. The more information that we have allows us to better meet the needs of your child. <\/div><div class='ginput_container ginput_container_multiselect'><select multiple='multiple'  size='7' name='input_134[]' id='input_11_134' class='large gfield_select' tabindex='23'  aria-invalid=\"false\"  aria-describedby=\"gfield_description_11_134\"><option value='0415' >Child has Allergies<\/option><option value='0418' >Carries an Epipen<\/option><option value='0420' >Child Has Asthma<\/option><option value='0421' >Carries an Inhaler<\/option><option value='0419' >Child wears a medic-alert bracelet<\/option><\/select><\/div><\/div><div id=\"field_11_103\" class=\"gfield gfield--type-textarea gfield--width-five-sixths GENREMARKS field_sublabel_above gfield--has-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_103'>More details<\/label><div class='gfield_description' id='gfield_description_11_103'>Please provide the name, details, symptoms and triggers of the condition\/allergy. Please also include a management plan and dosage requirements if medication is required.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_103' id='input_11_103' class='textarea large' tabindex='24' aria-describedby=\"gfield_description_11_103\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_11_111\" class=\"gfield gfield--type-html gfield--width-five-sixths gfield_html gfield_html_formatted field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><br \/><b>Emergency Care and Transportation Permission<\/b><\/div><div id=\"field_11_109\" class=\"gfield gfield--type-html gfield--width-half gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >I recognize that participation in IRCOM activities may expose my child to risk of injury. I agree not to hold IRCOM Inc. liable to any claims that may occur during any activity at IRCOM, or in its programs. I hereby grant IRCOM\u2019s director and\/or staff permission to secure proper medical treatment and transportation for my child to an appropriate facility for treatment, in case of emergency, and\/or when I am unable to be contacted.<\/div><div id=\"field_11_110\" class=\"gfield gfield--type-select gfield--width-quarter copy-110-to-135 gwcopy gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_11_110'><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_110' id='input_11_110' class='large gfield_select' tabindex='25'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='0417' >Yes<\/option><option value='0424' >No<\/option><\/select><\/div><\/div><div id=\"field_11_113\" class=\"gfield gfield--type-html gfield--width-five-sixths gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><br \/><b>General Permission<\/b><\/div><div id=\"field_11_114\" class=\"gfield gfield--type-html gfield--width-half gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >I hereby give permission for my child to participate in IRCOM\u2019s After-School programs, including sports and recreation, homework, peer support and health workshops. I understand that my child may be suspended or expelled from this Program for fighting, or other disciplining reasons determined by program staff and\/or director. I understand that IRCOM Inc. does not provide daycare services, and children are free to come and go as they please. I understand that should my child leave while attending the program, she\/he is no longer in care of the program staff.<\/div><div id=\"field_11_115\" class=\"gfield gfield--type-select gfield--width-quarter copy-115-to-136 gwcopy gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_11_115'><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_115' id='input_11_115' class='large gfield_select' tabindex='26'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='0422' >Yes<\/option><option value='0425' >No<\/option><\/select><\/div><\/div><div id=\"field_11_116\" class=\"gfield gfield--type-html gfield--width-five-sixths gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><br \/><b>Photograph Approval<\/b><\/div><div id=\"field_11_117\" class=\"gfield gfield--type-html gfield--width-half gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >I hereby authorize the IRCOM staff to take photographs of my child named in this application during program activities, and to display and otherwise use these photographs without charge, and solely for the purpose of promoting and reporting on programs at IRCOM.\n<\/div><div id=\"field_11_118\" class=\"gfield gfield--type-select gfield--width-quarter copy-118-to-137 gwcopy gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_11_118'><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_118' id='input_11_118' class='large gfield_select' tabindex='27'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='0423' >Yes<\/option><option value='0426' >No<\/option><\/select><\/div><\/div><div id=\"field_11_53\" class=\"gfield gfield--type-signature gfield--width-half SIGN1_PATH field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_53'>Parent\/Guardian&#039;s Signature<\/label><input type='hidden' value='' name='input_53' id='input_11_53_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_11_53_Container' class='gfield_signature_container ginput_container' style='height:180px; width:600px; ' ><canvas id='input_11_53' width='600' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/ircom.carmis.ai\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_11_53_toolbar' style='margin:5px 0;position:relative;height:20px;width:600px;max-width:100%;'><img id = 'input_11_53_resetbutton' src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_11_53_data' name='input_11_53_data' value=''><\/div><\/div><div id=\"field_11_121\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-third SIGN1_DATE field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_121'>Sign Date<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_121' id='input_11_121' type='text' value='' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon' tabindex='28'  placeholder='dd\/mm\/yyyy' aria-describedby=\"input_11_121_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_11_121_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_11_121' class='gform_hidden' value='https:\/\/ircom.carmis.ai\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_11_57\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_11_63\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h4 style=\"text-align:center\">Off-Site Programs and activities Permission<\/h4>\n\n<p>This is to certify that I allow my child to attend off-site activities through the Immigrant and Refugee Community Organization of Manitoba (IRCOM) Inc. These activities may include, but are not limited to homework, sports games and practices, gym, community events, swimming, bowling, movies etc.<\/p>\n\n<p>&nbsp;<\/p>\n\n<p>I am aware that all youth participating in these programs will be supervised at all times by staff members and volunteers of IRCOM Inc. I agree that IRCOM Inc.is not responsible for any loss or damage to personal property or bodily injury suffered by the youth before during or after the activity.<\/p><\/div><div id=\"field_11_64\" class=\"gfield gfield--type-signature gfield--width-half SIGN2_PATH field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_64'>Parent\/Guardian&#039;s Signature<\/label><input type='hidden' value='' name='input_64' id='input_11_64_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_11_64_Container' class='gfield_signature_container ginput_container' style='height:180px; width:600px; ' ><canvas id='input_11_64' width='600' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/ircom.carmis.ai\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_11_64_toolbar' style='margin:5px 0;position:relative;height:20px;width:600px;max-width:100%;'><img id = 'input_11_64_resetbutton' src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_11_64_data' name='input_11_64_data' value=''><\/div><\/div><div id=\"field_11_122\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-half SIGN2_DATE field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_122'>Sign Date<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_122' id='input_11_122' type='text' value='' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon' tabindex='29'  placeholder='dd\/mm\/yyyy' aria-describedby=\"input_11_122_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_11_122_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_11_122' class='gform_hidden' value='https:\/\/ircom.carmis.ai\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_11_58\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h4 style=\"text-align:center\">Homework, Education and Youth Consent to Share Information<\/h4>\n\n<p style=\"text-align:justify\"><strong>The Homework, Education and Youth<\/strong> (HEY) Program is part of the after school programs of the Immigrant and Refugee Community Organization of Manitoba (IRCOM) Inc. and works in partnership with Winnipeg schools. HEY program staff may speak with staff of the participant&rsquo;s school (e.g. teachers, guidance, administrators) when appropriate to support the youth and his\/her family to achieve academic and social goals.<\/p>\n\n<p style=\"text-align:justify\">I give permission to the Homework, Education and Youth Program to share information with staff of my child&rsquo;s school or other programs of IRCOM as necessary to ensure that my child receives appropriate education and social support, programming and is able to successfully participate in and benefit from the HEY Program.<\/p>\n\n<p style=\"text-align:justify\">I understand that information regarding my child&rsquo;s school attendance and academic progress including course grades, as well as participation in HEY tutoring, literacy, leadership mentoring and enrichment may be shared with IRCOM staff and mentors when necessary, to support participation and success in the HEY Program.<\/p>\n\n<p style=\"text-align:justify\">I understand that the HEY Program will not release information to any other person or agency without my consent, except when required by law.<\/p>\n\n<p style=\"text-align:justify\">I have read and agreed to the above terms:<\/p><\/div><div id=\"field_11_142\" class=\"gfield gfield--type-text gfield--input-type-adminonly_hidden gfield--width-five-sixths field_admin_only field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_administrative\"  ><input name='input_142' id='input_11_142' class='gform_hidden' type='hidden' data-gppa-live-merge-tag-value=\"@{:37:fallback[-]} @{:38:fallback[-]}\" value='- -'\/><\/div><div id=\"field_11_143\" class=\"gfield gfield--type-text gfield--input-type-adminonly_hidden gfield--width-half field_admin_only field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_administrative\"  ><input name='input_143' id='input_11_143' class='gform_hidden' type='hidden' data-gppa-live-merge-tag-value=\"@{:86:fallback[-]}\" value='-'\/><\/div><div id=\"field_11_146\" class=\"gfield gfield--type-text gfield--input-type-adminonly_hidden gfield--width-quarter field_admin_only field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_administrative\"  ><input name='input_146' id='input_11_146' class='gform_hidden' type='hidden' data-gppa-live-merge-tag-value=\"@{:66:fallback[-]}\" value='-'\/><\/div><div id=\"field_11_144\" class=\"gfield gfield--type-text gfield--input-type-adminonly_hidden gfield--width-half field_admin_only field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_administrative\"  ><input name='input_144' id='input_11_144' class='gform_hidden' type='hidden' data-gppa-live-merge-tag-value=\"@{:5:fallback[-]}\" value='-'\/><\/div><div id=\"field_11_145\" class=\"gfield gfield--type-text gfield--input-type-adminonly_hidden gfield--width-third field_admin_only field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_administrative\"  ><input name='input_145' id='input_11_145' class='gform_hidden' type='hidden' data-gppa-live-merge-tag-value=\"@{:6:fallback[-]}\" value='-'\/><\/div><div id=\"field_11_147\" class=\"gfield gfield--type-text gfield--input-type-adminonly_hidden gfield--width-third field_admin_only field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_administrative\"  ><input name='input_147' id='input_11_147' class='gform_hidden' type='hidden' data-gppa-live-merge-tag-value=\"@{:22:fallback[-]}\" value='-'\/><\/div><div id=\"field_11_148\" class=\"gfield gfield--type-text gfield--input-type-adminonly_hidden gfield--width-quarter field_admin_only field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_administrative\"  ><input name='input_148' id='input_11_148' class='gform_hidden' type='hidden' data-gppa-live-merge-tag-value=\"@{:23:fallback[-]}\" value='Grade 1'\/><\/div><div id=\"field_11_149\" class=\"gfield gfield--type-text gfield--input-type-adminonly_hidden gfield--width-quarter field_admin_only field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_administrative\"  ><input name='input_149' id='input_11_149' class='gform_hidden' type='hidden' data-gppa-live-merge-tag-value=\"@{:25:fallback[-]}\" value='-'\/><\/div><div id=\"field_11_59\" class=\"gfield gfield--type-signature gfield--width-half SIGN3_PATH field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_59'>Signature of Guardian<\/label><input type='hidden' value='' name='input_59' id='input_11_59_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_11_59_Container' class='gfield_signature_container ginput_container' style='height:180px; width:600px; ' ><canvas id='input_11_59' width='600' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/ircom.carmis.ai\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_11_59_toolbar' style='margin:5px 0;position:relative;height:20px;width:600px;max-width:100%;'><img id = 'input_11_59_resetbutton' src='data:image\/png;base64,iVBORw0KGgoAAAANSUhEUgAAABgAAAAYCAYAAADgdz34AAAAGXRFWHRTb2Z0d2FyZQBBZG9iZSBJbWFnZVJlYWR5ccllPAAAAtRJREFUeNrsld9rklEYx32nc7i2GulGtZg6XJbJyBeJzbGZJJVuAyFD7D8QumiG7nLXQuw6dtHN7oYwFtIgDG+2CGQtGf1grBpWIkPHaDpJZvZ95F2cqfPHRTfRgY\/H85znfb7nPc85z8sVi0XR32zcf4GmBTiOk8GWY8YSdEpwHpwG7eAA\/ABJsA3\/w5MEJOUGi8VyCUFFeCiGvlcsFvOFQqGtzK1d4Bzmr8DvDfy\/NyTgcDj6I5GIGA91YdiN4CW7RqNp83g8fZ2dna17e3v5ubm5r1tbWz8F8WH4v4PIh7oCTOumH4VCIQkGg6axsTElgkRhyoJTXq\/33srKStzpdL5KpVK0RVcxvw+Rb40KlNr09LTSbDZH8HcJ\/DqyY2sksE9Go1GHVqsN5fP5Yk9Pz3WIJNmctNQT8Pl8n\/DQZza40CjIokqlerywsMCTYWdnpwVjTb0kF1dXVy2sLR6Pn4HIJnu6mLZht9s3KUeUE7VarYPt459ZOqZlKMFEFRRVfI+QzMzMeBHOOTAw4GbnKt4AK6Vte0\/nHA6pBu\/T4ejoqAgnS4dTlT82U74aJOourYTn+ds1VlyNm+AReMjaK5LsdrvpxoqSyWSX8DbVSwDHtYJ+hi9gETxl\/SoCWK1WGfWJRKLQ0dGhO0kAq5MGAoFB\/OVZXC6XtqYAzvamwWCgMiDK5XKXsSL5CRpZv98vnp+fH2SNJpPpYk0BlIIXSJaB\/lOZkEqlNyCi4ahAHd8iajGUj41a2a+2xzmj0fgsFAoN0QA3lAJfAxMISDeVpx7jSbJnMplSOZ6amuptVIBaZHx8\/G0sFruj1+tlgo2KWh\/oF3opGWl+bW3t1uzsrHJ5eXm42Q+OGW\/wADc7gYe3w+Fwen19\/YByhMMgt9lsqpGRkQvYxifwfQnup9PprFwuX2rmi0ZvYAdDwurPgl1A9ek1eE7byqYR7P873+TfAgwATQiKdubVli0AAAAASUVORK5CYII=' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_11_59_data' name='input_11_59_data' value=''><\/div><\/div><div id=\"field_11_123\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-half SIGN3_DATE field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_123'>Sign Date<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_123' id='input_11_123' type='text' value='' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon' tabindex='30'  placeholder='dd\/mm\/yyyy' aria-describedby=\"input_11_123_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_11_123_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_11_123' class='gform_hidden' value='https:\/\/ircom.carmis.ai\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_11_61\" class=\"gfield gfield--type-signature gfield--width-half SIGN4_PATH field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_61'>Witness (IRCOM staff)<\/label><input type='hidden' value='' name='input_61' id='input_11_61_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_11_61_Container' class='gfield_signature_container ginput_container' style='height:180px; width:600px; ' ><canvas id='input_11_61' width='600' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/ircom.carmis.ai\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_11_61_toolbar' style='margin:5px 0;position:relative;height:20px;width:600px;max-width:100%;'><img id = 'input_11_61_resetbutton' src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_11_61_data' name='input_11_61_data' value=''><\/div><\/div><div id=\"field_11_124\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-half SIGN4_DATE field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_124'>Sign Date<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_124' id='input_11_124' type='text' value='' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon' tabindex='31'  placeholder='dd\/mm\/yyyy' aria-describedby=\"input_11_124_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_11_124_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_11_124' class='gform_hidden' value='https:\/\/ircom.carmis.ai\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_11_150\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><h3 class=\"gsection_title\">For IRCOM Administrative Use Only<\/h3><\/div><div id=\"field_11_119\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half DATE_VISITED field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_11_119'>Today&#039;s Date<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_119' id='input_11_119' type='text' value='06\/06\/2026' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon' tabindex='32'  placeholder='mm\/dd\/yyyy' aria-describedby=\"input_11_119_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_11_119_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_11_119' class='gform_hidden' value='https:\/\/ircom.carmis.ai\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_11_132\" class=\"gfield gfield--type-text gfield--width-half Reason field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_11_132'>Program<\/label><div class='ginput_container ginput_container_text'><input name='input_132' id='input_11_132' type='text' value='0002' class='small'   tabindex='33'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_135\" class=\"gfield gfield--type-text gfield--width-quarter field_sublabel_above gfield--no-description field_description_above field_validation_below 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inchang\u00e9.Child First Name(N\u00e9cessaire)Child Last Name(N\u00e9cessaire)Gender(N\u00e9cessaire)MaleFemaleNon-BinaryUnknownAddress(N\u00e9cessaire)Postal Code(N\u00e9cessaire)Phone (Cell)(N\u00e9cessaire)Phone (Home)Phone (Other)Immigration Status(N\u00e9cessaire)Canadian CitizenGovernment Assisted Refugees (GAR)Private Sponsored Refugees (PSR)Refugee Claimant (RC)Provincial NomineeUkraine CUAET PermitPermanent ResidentProtected PersonCountry of Origin(N\u00e9cessaire)Abu DhabiAfghanistanAlbaniaAlderneyAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua \/ BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamas Is.BahrainBangladeshBarbadosBelarusBelgiumBelizeBenin Peoples RepublicBermudaBhutanBoliviaBophuthatswanaBosnia and HerzegovinaBotswana Republic OfBrazilBrechouBrit. Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCanary IslandsCape &#8230; <\/p>\n<div><a href=\"https:\/\/ircom.carmis.ai\/fr\/asp-hey-registration-form\/\" class=\"more-link\">En savoir plus<\/a><\/div>","protected":false},"author":5,"featured_media":911,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"template-blank-4.php","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-912","page","type-page","status-publish","has-post-thumbnail","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ASP &amp; HEY Registration Form - CARMIS Smart Forms - IRCOM<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/ircom.carmis.ai\/fr\/asp-hey-registration-form\/\" \/>\n<meta property=\"og:locale\" content=\"fr_CA\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ASP &amp; HEY Registration Form - CARMIS Smart Forms - IRCOM\" \/>\n<meta property=\"og:description\" content=\"IRCOM - ASP &amp; HEY Registration Form X\/TwitterCe champ n\u2019est utilis\u00e9 qu\u2019\u00e0 des fins de validation et devrait rester inchang\u00e9.Child First Name(N\u00e9cessaire)Child Last Name(N\u00e9cessaire)Gender(N\u00e9cessaire)MaleFemaleNon-BinaryUnknownAddress(N\u00e9cessaire)Postal Code(N\u00e9cessaire)Phone (Cell)(N\u00e9cessaire)Phone (Home)Phone (Other)Immigration Status(N\u00e9cessaire)Canadian CitizenGovernment Assisted Refugees (GAR)Private Sponsored Refugees (PSR)Refugee Claimant (RC)Provincial NomineeUkraine CUAET PermitPermanent ResidentProtected PersonCountry of Origin(N\u00e9cessaire)Abu DhabiAfghanistanAlbaniaAlderneyAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua \/ BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamas Is.BahrainBangladeshBarbadosBelarusBelgiumBelizeBenin Peoples RepublicBermudaBhutanBoliviaBophuthatswanaBosnia and HerzegovinaBotswana Republic OfBrazilBrechouBrit. Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCanary IslandsCape ... 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