{"id":8864,"date":"2020-06-23T23:40:52","date_gmt":"2020-06-23T21:40:52","guid":{"rendered":"https:\/\/www.accompagner.be\/vraag-voor-een-ambulante-begeleinding\/"},"modified":"2021-09-23T16:03:35","modified_gmt":"2021-09-23T14:03:35","slug":"aanvraag-om-een-begeleiding","status":"publish","type":"page","link":"https:\/\/bxl.accompagner.be\/nl\/aanvraag-om-een-begeleiding\/","title":{"rendered":"Aanvraag om een begeleiding"},"content":{"rendered":"\n<div>Vous pouvez <u>remplir<\/u> <u>ce formulaire en<\/u>\n<div class=\"wpml-ls-statics-footer wpml-ls wpml-ls-legacy-list-horizontal\">\n\t<ul><li class=\"wpml-ls-slot-footer wpml-ls-item wpml-ls-item-fr wpml-ls-first-item wpml-ls-item-legacy-list-horizontal\">\n\t\t\t\t<a href=\"https:\/\/bxl.accompagner.be\/fr\/\" class=\"wpml-ls-link\">\n                    <span class=\"wpml-ls-native\" lang=\"fr\">Fran\u00e7ais<\/span><\/a>\n\t\t\t<\/li><li class=\"wpml-ls-slot-footer wpml-ls-item wpml-ls-item-en wpml-ls-last-item wpml-ls-item-legacy-list-horizontal\">\n\t\t\t\t<a href=\"https:\/\/bxl.accompagner.be\/en\/\" class=\"wpml-ls-link\">\n                    <span class=\"wpml-ls-native\" lang=\"en\">English<\/span><\/a>\n\t\t\t<\/li><\/ul>\n<\/div>\n.<\/div>\n\n<p>De ruimtes van het formulier met een <span style=\"color:#cf2e2e\" class=\"tadv-color\">*<\/span> moeten ingevuld worden en mogen dus niet blanco gelaten worden. Het zijn essenti\u00eble gegevens voor het openen van een dossier en een goed verloop van een begeleiding. Onze Organisatie en onze vrijwilligers zijn gebonden aan het beroepsgeheim. Onze Organisatie en onze vrijwilligers zijn gebonden aan het beroepsgeheim. Gelieve rekening te houden dat onze vrijwilligers uw begunstigde niet op persoonlijk vlak kennen. SAls u tijd wilt besparen met uw volgende verzoeken, moet u de optie voor automatisch aanvullen in uw browser activeren (Google Chrome, Mozilla Forefox, Internet Explorer 7 en 8, Microsoft Edge). Om dat te doen opent u de <a aria-label=\"undefined (s&#x2019;ouvre dans un nouvel onglet)\" rel=\"noreferrer noopener\" href=\"http:\/\/www.accompagner.be\/wp-content\/uploads\/FORPARINT-Saisie-Automatique-Internet_NL.pdf\" target=\"_blank\">gids<\/a> en volgt u de procedure overeenkomstig de door u gebruikte browser. <b>Opgepast:<\/b> om te vermijden dat het bevestigingsformulier bij uw SPAM-berichten terechtkomt, doet u er goed aan om het mailadres <a href=\"mailto:info.saa@accompagner.be\">info.saa@accompager.be<\/a> in uw adresboek op te slagen. Neem contact met ons op voor meer informatie <strong>02\/580.20.33<\/strong> (9.00 tot 16.00 uur).<\/p>\n\n<div class=\"wp-block-columns has-pale-cyan-blue-background-color has-background\">\n<div class=\"wp-block-column\" style=\"flex-basis:100%\">\n<h4 class=\"has-text-align-center\"><a href=\"https:\/\/accompagner.be\/wp-content\/uploads\/Conditions-Generales-de-collaboration-SAA.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Voorwaarden voor samenwerking<\/strong><\/a><\/h4>\n\n\n\n<h4 class=\"has-text-align-center\"><a href=\"https:\/\/accompagner.be\/wp-content\/uploads\/Clauses-de-sous-traitance.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Clause de Sous-traitance<\/strong><\/a><\/h4>\n\n\n\n<h4 class=\"has-text-align-center\"><strong><a href=\"https:\/\/accompagner.be\/wp-content\/uploads\/Accord-de-partenariat-SAA.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Accord de Partenariat<\/a><\/strong><\/h4>\n<\/div>\n<\/div>\n\n<hr class=\"wp-block-separator\"\/>\n\n<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-6401\"><form id=\"wpforms-form-6401\" class=\"wpforms-validate wpforms-form\" data-formid=\"6401\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/nl\/wp-json\/wp\/v2\/pages\/8864\"><div class=\"wpforms-field-container\"><div id=\"wpforms-6401-field_26-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"26\"><h3 id=\"wpforms-6401-field_26\" name=\"wpforms[fields][26]\">Uw co\u00f6rdinaten [Institution demandant l&#039;accompagnement]<\/h3><\/div><div id=\"wpforms-6401-field_6-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_6\">Uw voornaam en naam <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-6401-field_6\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][6][first]\" required><label for=\"wpforms-6401-field_6\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-6401-field_6-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][6][last]\" required><label for=\"wpforms-6401-field_6-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-6401-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_11\">Naam van de Instelling waar u werkt <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" required><\/div><div id=\"wpforms-6401-field_13-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_13\">Naam van uw Dienst<\/label><input type=\"text\" id=\"wpforms-6401-field_13\" class=\"wpforms-field-medium\" name=\"wpforms[fields][13]\" ><\/div><div id=\"wpforms-6401-field_7-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_7\">Uw e-mail adres <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"email\" id=\"wpforms-6401-field_7\" class=\"wpforms-field-required wpforms-field-email-primary\" name=\"wpforms[fields][7][primary]\" required><label for=\"wpforms-6401-field_7\" class=\"wpforms-field-sublabel after \">Email<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"email\" id=\"wpforms-6401-field_7-secondary\" class=\"wpforms-field-email-secondary wpforms-field-required\" data-rule-confirm=\"#wpforms-6401-field_7\" name=\"wpforms[fields][7][secondary]\" required><label for=\"wpforms-6401-field_7-secondary\" class=\"wpforms-field-sublabel after \">Confirm Email<\/label><\/div><\/div><\/div><div id=\"wpforms-6401-field_78-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"78\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_78\">Telefoonnummer waar we u kunnen bereiken  <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_78\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][78]\" required><div class=\"wpforms-field-description\">Belgisch vaste of GSM telefoonnummer<\/div><\/div><div id=\"wpforms-6401-field_20-container\" class=\"wpforms-field wpforms-field-divider h5\" data-field-id=\"20\"><h3 id=\"wpforms-6401-field_20\" name=\"wpforms[fields][20]\">Co\u00f6rdinaten van de begunstigde voor een begeleiding<\/h3><\/div><div id=\"wpforms-6401-field_16-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_16\">Co\u00f6rdinaten van de begunstigde voor een begeleiding <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-6401-field_16\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][16][first]\" required><label for=\"wpforms-6401-field_16\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-6401-field_16-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][16][last]\" required><label for=\"wpforms-6401-field_16-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-6401-field_79-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"79\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_79\">Zijn gsm-nummer <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_79\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][79]\" required><div class=\"wpforms-field-description\">Belgisch vaste of GSM telefoonnummer<\/div><\/div><div id=\"wpforms-6401-field_19-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_19\">Is het de eerste keer dat u een begeleiding vraagt voor deze persoon?  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_19\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_19_1\" name=\"wpforms[fields][19]\" value=\"Ja\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_19_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_19_2\" name=\"wpforms[fields][19]\" value=\"Nee\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_19_2\">Nee<\/label><\/li><\/ul><\/div><div id=\"wpforms-6401-field_23-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"23\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_23\">De begunstigde weet waarom ondersteuning wordt aangeboden en hoe de informatiestroom tussen de verzoekende dienst en Les Amis d&#039;Accompagner verloopt. <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_23\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-6401-field_23_1\" name=\"wpforms[fields][23][]\" value=\"Ja\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_23_1\">Ja<\/label><\/li><\/ul><\/div><div id=\"wpforms-6401-field_24-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"24\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_24\">Geslacht <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_24\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_24_1\" name=\"wpforms[fields][24]\" value=\"M\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_24_1\">M<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_24_2\" name=\"wpforms[fields][24]\" value=\"V\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_24_2\">V<\/label><\/li><\/ul><\/div><div id=\"wpforms-6401-field_25-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"25\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_25\">Zijn datum van geboorte <span class=\"wpforms-required-label\">*<\/span><\/label><select name=\"wpforms[fields][25][date][d]\" id=\"wpforms-field_25-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][25][date][m]\" id=\"wpforms-field_25-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][25][date][y]\" id=\"wpforms-field_25-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><div id=\"wpforms-6401-field_28-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"28\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_28\">Zijn adres <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_28\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][28]\" placeholder=\"Geef indien mogelijk dit adres op: deurbel, nummer, verdiep etc.\" required><\/div><div id=\"wpforms-6401-field_29-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"29\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_29\">Zijn nationaliteit <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_29\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][29]\" required><\/div><div id=\"wpforms-6401-field_30-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"30\" style=\"display:none;\"><div id=\"wpforms-6401-field_30\"><div><hr style=\"border-top: 2px dashed red;\" ;=\"\"> --- Si votre b\u00e9n\u00e9ficiaire n'est pas belge ou naturalis\u00e9 belge ---<\/div><\/div><\/div><div id=\"wpforms-6401-field_31-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"31\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_31\">Datum van aankomst te Belgi\u00eb <span class=\"wpforms-required-label\">*<\/span><\/label><select name=\"wpforms[fields][31][date][d]\" id=\"wpforms-field_31-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][31][date][m]\" id=\"wpforms-field_31-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][31][date][y]\" id=\"wpforms-field_31-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><div id=\"wpforms-6401-field_32-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"32\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_32\">Verblijfsstatuut <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-6401-field_32\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][32]\" required=\"required\"><option value=\"-- kiezen --\" >-- kiezen --<\/option><option value=\"Verblijfsstatuut\" >Verblijfsstatuut<\/option><option value=\"Vluchtelingenkaart\" >Vluchtelingenkaart<\/option><option value=\"Aanvraag voor asiel\" >Aanvraag voor asiel<\/option><option value=\"Regularisatieaanvraag\" >Regularisatieaanvraag<\/option><option value=\"Inschrijving van vreemdelingen\" >Inschrijving van vreemdelingen<\/option><option value=\"Zonder statuut\" >Zonder statuut<\/option><\/select><\/div><div id=\"wpforms-6401-field_36-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"36\" style=\"display:none;\"><div id=\"wpforms-6401-field_36\"><hr style=\"border-top: 2px dashed red;\"><\/div><\/div><div id=\"wpforms-6401-field_34-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"34\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_34\">Herkomst van inkomen  <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-6401-field_34\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][34]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>-- Dit is de belangrijkste bron van uw begunstigde --<\/option><option value=\"Werknemer\" >Werknemer<\/option><option value=\"Werkloosheidsvergoeding\" >Werkloosheidsvergoeding<\/option><option value=\"Integratie-inkomsten (OCMW)\" >Integratie-inkomsten (OCMW)<\/option><option value=\"Pensionsuitkering\" >Pensionsuitkering<\/option><option value=\"Kinderbijslag\" >Kinderbijslag<\/option><option value=\"onderhoudsuitkering\" >onderhoudsuitkering<\/option><option value=\"Studiebeurs\" >Studiebeurs<\/option><option value=\"Zonder inkomen\" >Zonder inkomen<\/option><option value=\"Andere\" >Andere<\/option><\/select><\/div><div id=\"wpforms-6401-field_77-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"77\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_77\">Gelieve te specificeren <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_77\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][77]\" required><\/div><div id=\"wpforms-6401-field_35-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"35\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_35\">Zijn familiale situatie <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-6401-field_35\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][35]\" required=\"required\"><option value=\"-- kiezen --\" >-- kiezen --<\/option><option value=\"Alleenstaanden\" >Alleenstaanden<\/option><option value=\"Gezin zonder kinderen\" >Gezin zonder kinderen<\/option><option value=\"Gezin met kinderen\" >Gezin met kinderen<\/option><option value=\"Feitelijk samenwonende\" >Feitelijk samenwonende<\/option><option value=\"Eenoudergezin\" >Eenoudergezin<\/option><\/select><\/div><div id=\"wpforms-6401-field_63-container\" class=\"wpforms-field wpforms-field-number wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"63\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_63\">Aantal personen ten laste ( van de begunstigde) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" pattern=\"[0-9]*\" id=\"wpforms-6401-field_63\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][63]\" required><\/div><div id=\"wpforms-6401-field_37-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"37\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_37\">Zijn burgerlijke staat <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-6401-field_37\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][37]\" required=\"required\"><option value=\"-- kiezen --\" >-- kiezen --<\/option><option value=\"Ongehuwd\" >Ongehuwd<\/option><option value=\"Gehuwd\" >Gehuwd<\/option><option value=\"Feitekijk gescheiden\" >Feitekijk gescheiden<\/option><option value=\"Wettelijk gescheiden\" >Wettelijk gescheiden<\/option><option value=\"Weduwe weduwenaar\" >Weduwe weduwenaar<\/option><\/select><\/div><div id=\"wpforms-6401-field_39-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"39\"><h3 id=\"wpforms-6401-field_39\" name=\"wpforms[fields][39]\">Uit te voeren Begeleiding<\/h3><\/div><div id=\"wpforms-6401-field_40-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"40\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_40\">Datum van Begeleiding <span class=\"wpforms-required-label\">*<\/span><\/label><select name=\"wpforms[fields][40][date][d]\" id=\"wpforms-field_40-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][40][date][m]\" id=\"wpforms-field_40-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][40][date][y]\" id=\"wpforms-field_40-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2026\" >2026<\/option><option value=\"2027\" >2027<\/option><\/select><\/div><div id=\"wpforms-6401-field_73-container\" class=\"wpforms-field wpforms-field-date-time wpf_6pct\" data-field-id=\"73\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_73\">Vertrekuur van de start van de begeleiding <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_73-time\" class=\"wpforms-field-date-time-time\" data-rule-time24h=\"true\" data-time-format=\"H:i\" data-step=\"30\" name=\"wpforms[fields][73][time]\" placeholder=\"HH:MM\" required><\/div><div id=\"wpforms-6401-field_46-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"46\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_46\">Plaats en adres van de start van de begeleiding <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_46\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][46]\" placeholder=\"Geef indien mogelijk dit adres op: deurbel, nummer, verdiep etc.\" required><\/div><div id=\"wpforms-6401-field_47-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"47\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_47\">Plaats waar zich te begeven <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_47\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][47]\" required><\/div><div id=\"wpforms-6401-field_66-container\" class=\"wpforms-field wpforms-field-text wpforms-two-fourths wpforms-first\" data-field-id=\"66\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_66\">Plaats waar men zich naartoe moet begeven <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_66\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][66]\" placeholder=\"-- Straat --\" required><\/div><div id=\"wpforms-6401-field_68-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fourth\" data-field-id=\"68\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_68\">Nummer <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_68\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][68]\" placeholder=\"Straat nummer\" required><\/div><div id=\"wpforms-6401-field_69-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fourth\" data-field-id=\"69\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_69\">Bus<\/label><input type=\"text\" id=\"wpforms-6401-field_69\" class=\"wpforms-field-medium\" name=\"wpforms[fields][69]\" ><\/div><div id=\"wpforms-6401-field_70-container\" class=\"wpforms-field wpforms-field-number wpforms-one-third wpforms-first\" data-field-id=\"70\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_70\">Postcode <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" pattern=\"[0-9]*\" id=\"wpforms-6401-field_70\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][70]\" required><\/div><div id=\"wpforms-6401-field_71-container\" class=\"wpforms-field wpforms-field-text wpforms-two-thirds\" data-field-id=\"71\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_71\">Plaats <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_71\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][71]\" required><\/div><div id=\"wpforms-6401-field_74-container\" class=\"wpforms-field wpforms-field-date-time wpf_6pct\" data-field-id=\"74\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_74\">Uur van afspraak of van permanentie waar men zich moet begeven) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_74-time\" class=\"wpforms-field-date-time-time\" data-rule-time24h=\"true\" data-time-format=\"H:i\" data-step=\"30\" name=\"wpforms[fields][74][time]\" placeholder=\"HH:MM\" required><\/div><div id=\"wpforms-6401-field_51-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"51\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_51\">Naam van de persoon die de begunstigde zal ontmoeten <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_51\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][51]\" required><\/div><div id=\"wpforms-6401-field_80-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"80\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_80\">Telefoon van de persoon die de begunstigde zal ontmoeten <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_80\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][80]\" required><div class=\"wpforms-field-description\">Belgisch vaste of GSM telefoonnummer<\/div><\/div><div id=\"wpforms-6401-field_53-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"53\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_53\">Reden waarom de begunstigde om een begeleiding vraagt <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-6401-field_53\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][53]\" placeholder=\"EX: vertaling, behoefte aan morele ondersteuning, behoefte aan hulp om te begrijpen, hulp nodig om de weg te vinden, behoefte aan fysieke ondersteuning ... - Wees voorzichtig, onze vrijwilligers mogen geen bagage dragen of een rolstoel duwen, noch met hun wagen begeleiden. - Let op, wij zijn geen gespecialiseerde vertaaldienst.\" required><\/textarea><\/div><div id=\"wpforms-6401-field_54-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_54\">Vertaling nodig <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_54\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_54_1\" name=\"wpforms[fields][54]\" value=\"ja\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_54_1\">ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_54_2\" name=\"wpforms[fields][54]\" value=\"nee\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_54_2\">nee<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_54_3\" name=\"wpforms[fields][54]\" value=\"ja maar niet onontbeerlijk. De begunstigde beheers de taal een beetje\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_54_3\">ja maar niet onontbeerlijk. De begunstigde beheers de taal een beetje<\/label><\/li><\/ul><\/div><div id=\"wpforms-6401-field_55-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"55\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_55\">Taal gesproken door de begunstigde<\/label><input type=\"text\" id=\"wpforms-6401-field_55\" class=\"wpforms-field-small\" name=\"wpforms[fields][55]\" placeholder=\"In te vullen indien vertaling nodig is\" ><\/div><div id=\"wpforms-6401-field_57-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"57\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_57\">Aanpak te realiseren <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-6401-field_57\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][57]\" placeholder=\"Beschrijf het proces dat de begunstigde met behulp van de vrijwilliger zou willen doen. Bijv. .: uw arts ontmoeten, dit of dat document verkrijgen, de route naar uw nieuw dagcentrum leren... **** A traduire *** Description de la situation, du but \u00e0 atteindre, des documents \u00e0 obtenir,...\" required><\/textarea><\/div><div id=\"wpforms-6401-field_58-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"58\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_58\">Aanvullende informatie<\/label><textarea id=\"wpforms-6401-field_58\" class=\"wpforms-field-medium\" name=\"wpforms[fields][58]\" placeholder=\"Geef, indien van toepassing, de specifieke kenmerken van de begunstigde aan, als deze de afwikkeling van de begeleiding kunnen be\u00efnvloeden. Bijvoorbeeld: rolstoel, kinderwagen, moeilijk lopen, verslaving, epilepsie, fobie(angsttoestand?) ...\" ><\/textarea><\/div><div id=\"wpforms-6401-field_61-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"61\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_61\">Dient de begeleider terug te keren naar de plaats waar de begeleiding is gestart? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_61\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_61_1\" name=\"wpforms[fields][61]\" value=\"ja\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_61_1\">ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_61_2\" name=\"wpforms[fields][61]\" value=\"nee\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_61_2\">nee<\/label><\/li><\/ul><\/div><div id=\"wpforms-6401-field_91-container\" class=\"wpforms-field wpforms-field-gdpr-checkbox\" data-field-id=\"91\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_91\">Akkoord RGPD <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_91\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"checkbox\" id=\"wpforms-6401-field_91_1\" name=\"wpforms[fields][91][]\" value=\"Ik ga ermee akkoord dat Les Amis d&#039;Accompagnement mijn verzonden informatie opslaat, zodat deze op mijn verzoek kan reageren.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_91_1\">Ik ga ermee akkoord dat Les Amis d'Accompagnement mijn verzonden informatie opslaat, zodat deze op mijn verzoek kan reageren.<\/label><\/li><\/ul><\/div><div id=\"wpforms-6401-field_90-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"90\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_90\">Door dit formulier in te dienen, aanvaard ik dat de vzw Les Amis d&#039;Accompagnement<\/label><ul id=\"wpforms-6401-field_90\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-6401-field_90_1\" name=\"wpforms[fields][90][]\" value=\"neemt contact met me op om me informatie over haar te sturen\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_90_1\">neemt contact met me op om me informatie over haar te sturen<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-6401-field_90_2\" name=\"wpforms[fields][90][]\" value=\"stuurt mij de nieuwsbrief\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_90_2\">stuurt mij de nieuwsbrief<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms-6401-field-hp\" class=\"wpforms-field-label\">Phone<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms-6401-field-hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"6401\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"8\"><button type=\"submit\" name=\"wpforms[submit]\" class=\"wpforms-submit \" id=\"wpforms-submit-6401\" value=\"wpforms-submit\" aria-live=\"assertive\" data-alt-text=\"*** \u00e0 tradure *** Envoi en cours...\" data-submit-text=\"Verzenden\">Verzenden<\/button><\/div><\/form><\/div>  <!-- .wpforms-container -->\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Vous pouvez remplir ce formulaire en. De ruimtes van het formulier met een * moeten ingevuld worden en mogen dus niet blanco gelaten worden. Het zijn essenti\u00eble gegevens voor het openen van een dossier en een goed verloop van een begeleiding. Onze Organisatie en onze vrijwilligers zijn gebonden aan het beroepsgeheim. Onze Organisatie en onze [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"advgb_blocks_editor_width":"","advgb_blocks_columns_visual_guide":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v16.3 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Aanvraag om een begeleiding - Les Amis d\u2019Accompagner<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/bxl.accompagner.be\/nl\/aanvraag-om-een-begeleiding\/\" \/>\n<meta property=\"og:locale\" content=\"nl_NL\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Aanvraag om een begeleiding - Les Amis d\u2019Accompagner\" \/>\n<meta property=\"og:description\" content=\"Vous pouvez remplir ce formulaire en. De ruimtes van het formulier met een * moeten ingevuld worden en mogen dus niet blanco gelaten worden. Het zijn essenti\u00eble gegevens voor het openen van een dossier en een goed verloop van een begeleiding. Onze Organisatie en onze vrijwilligers zijn gebonden aan het beroepsgeheim. Onze Organisatie en onze [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/bxl.accompagner.be\/nl\/aanvraag-om-een-begeleiding\/\" \/>\n<meta property=\"og:site_name\" content=\"Les Amis d\u2019Accompagner\" \/>\n<meta property=\"article:modified_time\" content=\"2021-09-23T14:03:35+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\">\n\t<meta name=\"twitter:data1\" content=\"1 minute\">\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebSite\",\"@id\":\"https:\/\/bxl.accompagner.be\/fr\/#website\",\"url\":\"https:\/\/bxl.accompagner.be\/fr\/\",\"name\":\"Les Amis d\\u2019Accompagner\",\"description\":\"Samen stap voor stap\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":\"https:\/\/bxl.accompagner.be\/fr\/?s={search_term_string}\",\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"nl-NL\"},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/bxl.accompagner.be\/nl\/aanvraag-om-een-begeleiding\/#webpage\",\"url\":\"https:\/\/bxl.accompagner.be\/nl\/aanvraag-om-een-begeleiding\/\",\"name\":\"Aanvraag om een begeleiding - Les Amis d\\u2019Accompagner\",\"isPartOf\":{\"@id\":\"https:\/\/bxl.accompagner.be\/fr\/#website\"},\"datePublished\":\"2020-06-23T21:40:52+00:00\",\"dateModified\":\"2021-09-23T14:03:35+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/bxl.accompagner.be\/nl\/aanvraag-om-een-begeleiding\/#breadcrumb\"},\"inLanguage\":\"nl-NL\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/bxl.accompagner.be\/nl\/aanvraag-om-een-begeleiding\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/bxl.accompagner.be\/nl\/aanvraag-om-een-begeleiding\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"item\":{\"@type\":\"WebPage\",\"@id\":\"https:\/\/bxl.accompagner.be\/nl\/\",\"url\":\"https:\/\/bxl.accompagner.be\/nl\/\",\"name\":\"Accueil\"}},{\"@type\":\"ListItem\",\"position\":2,\"item\":{\"@id\":\"https:\/\/bxl.accompagner.be\/nl\/aanvraag-om-een-begeleiding\/#webpage\"}}]}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","coauthors":[],"author_meta":{"author_link":"https:\/\/bxl.accompagner.be\/nl\/author\/phd2019\/","display_name":"PhD2019"},"relative_dates":{"created":"Posted 6 years ago","modified":"Updated 5 years ago"},"featured_img_caption":"","_links":{"self":[{"href":"https:\/\/bxl.accompagner.be\/nl\/wp-json\/wp\/v2\/pages\/8864"}],"collection":[{"href":"https:\/\/bxl.accompagner.be\/nl\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/bxl.accompagner.be\/nl\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/bxl.accompagner.be\/nl\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/bxl.accompagner.be\/nl\/wp-json\/wp\/v2\/comments?post=8864"}],"version-history":[{"count":7,"href":"https:\/\/bxl.accompagner.be\/nl\/wp-json\/wp\/v2\/pages\/8864\/revisions"}],"predecessor-version":[{"id":10539,"href":"https:\/\/bxl.accompagner.be\/nl\/wp-json\/wp\/v2\/pages\/8864\/revisions\/10539"}],"wp:attachment":[{"href":"https:\/\/bxl.accompagner.be\/nl\/wp-json\/wp\/v2\/media?parent=8864"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}