{"id":21822,"date":"2022-10-24T12:01:06","date_gmt":"2022-10-24T16:01:06","guid":{"rendered":"https:\/\/srvcanadavrs.ca\/personal-release-consent-form\/"},"modified":"2023-05-19T15:25:35","modified_gmt":"2023-05-19T19:25:35","slug":"formulaire-de-decharge-de-responsibilite-personnelle","status":"publish","type":"page","link":"https:\/\/srvcanadavrs.ca\/fr\/formulaire-de-decharge-de-responsibilite-personnelle\/","title":{"rendered":"Formulaire de d\u00e9charge de responsibilit\u00e9 personnelle"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"21822\" class=\"elementor elementor-21822 elementor-21677\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-a5d50df elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"a5d50df\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[{&quot;jet_parallax_layout_image&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;_id&quot;:&quot;3b5fd69&quot;,&quot;jet_parallax_layout_image_tablet&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_image_mobile&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;jet_parallax_layout_speed&quot;:{&quot;unit&quot;:&quot;%&quot;,&quot;size&quot;:50,&quot;sizes&quot;:[]},&quot;jet_parallax_layout_type&quot;:&quot;scroll&quot;,&quot;jet_parallax_layout_direction&quot;:&quot;1&quot;,&quot;jet_parallax_layout_fx_direction&quot;:null,&quot;jet_parallax_layout_z_index&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x&quot;:50,&quot;jet_parallax_layout_bg_x_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_x_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y&quot;:50,&quot;jet_parallax_layout_bg_y_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_y_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size&quot;:&quot;auto&quot;,&quot;jet_parallax_layout_bg_size_tablet&quot;:&quot;&quot;,&quot;jet_parallax_layout_bg_size_mobile&quot;:&quot;&quot;,&quot;jet_parallax_layout_animation_prop&quot;:&quot;transform&quot;,&quot;jet_parallax_layout_on&quot;:[&quot;desktop&quot;,&quot;tablet&quot;]}]}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-9e02c42\" data-id=\"9e02c42\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5850ef9 uael-gf-check-yes uael-gf-ajax-yes uael-gf-style-box uael-gf-input-size-sm uael-gf-enable-classes-no uael-gf-button-left uael-gf-btn-size-sm elementor-widget elementor-widget-uael-gf-styler\" data-id=\"5850ef9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"uael-gf-styler.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"uael-gf-style uael-gf-check-style elementor-clickable\">\n\t\t<h3 class=\"uael-gf-form-title\">FORMULAIRE DE D\u00c9CHARGE DE RESPONSABILIT\u00c9 PERSONNELLE POUR PARA\u00ceTRE DANS UNE PHOTO, VID\u00c9O ET OU DANS UN FILM (\u00ab D\u00e9charge \u00bb)<\/h3>\n\t\t\t<p class=\"uael-gf-form-desc\"><p style=\"margin-top: 20px;text-align: center\">Lire le formulaire en LSQ : <a style=\"color: #5E1314\" href=\"https:\/\/www.youtube.com\/watch?v=ZSaNZZJoj2w\" target=\"_blank\" rel=\"noopener\"> <u>https:\/\/www.youtube.com\/watch?v=ZSaNZZJoj2w<\/u><\/a><\/p>\n<p style=\"margin-top: 20px\">MOYENNANT BONNE ET VALABLE CONTREPARTIE et le paiement ou la promesse de paiement \u00e0 mon nom le montant de UN dollar (1 $), je consens par les pr\u00e9sentes que mon nom, ma ressemblance, mon image, ma voix et toute autre similarit\u00e9 (commun\u00e9ment, ma \u00ab Ressemblance \u00bb) soit enregistr\u00e9e, photographi\u00e9e et film\u00e9e par l\u2019Administrateur canadien du SRV (\u00ab ACS \u00bb), inc., ainsi que tout renseignement, biographie, photographies ou mat\u00e9riel de toute nature fournis par moi (commun\u00e9ment, les \u00ab Contributions \u00bb) et que ma Ressemblance et mes Contributions soient comprises (en tout ou en partie, tel quel ou tel qu\u2019\u00e9dit\u00e9 \u00e0 l\u2019avenir) dans des vid\u00e9os (et tout autre mat\u00e9riel publicitaire ou promotionnel connexe) produits par l\u2019ACS (commun\u00e9ment, la \u00ab Production \u00bb). Sans limiter ce qui pr\u00e9c\u00e8de, j\u2019accorde \u00e0 l\u2019ACS par les pr\u00e9sentes les autres droits qui suivent :<br>\n<ul><li>J\u2019accorde \u00e0 l\u2019ACS les droits irr\u00e9vocables de licence et de sous-licence cessibles et pay\u00e9s en totalit\u00e9, sans droits d\u2019auteur mais sans obligation, de reproduire, publier, ex\u00e9cuter en public, exposer, synchroniser avec d\u2019autre contenu, exploiter, faire de la publicit\u00e9 et traduire la Production partout au monde et \u00e0 perp\u00e9tuit\u00e9, dans toutes les langues, en et par tout moyen m\u00e9diatique connus \u00e0 l\u2019heure actuelle ou d\u00e9couvert \u00e0 l\u2019avenir et pour quelque motif que ce soit.<\/li>\n<li>Je conviens que les d\u00e9cisions de l\u2019ACS d\u2019utiliser ou de ne pas utiliser la Production telle que pr\u00e9sent\u00e9e ici est \u00e0 sa seule et absolue discr\u00e9tion et que je n\u2019aurai aucun droit d\u2019approbation, aucun droit de r\u00e9clamation d\u2019une quelconque forme d\u2019indemnisation ni de prestations, ni tout avantage d\u00e9coulant de l\u2019utilisation ou de l\u2019exploitation de la Production.<\/li>\n<li>Je d\u00e9gage l\u2019ACS, ses officiers, directeurs, employ\u00e9s, repr\u00e9sentants, agents autoris\u00e9s, titulaires de permis et toute autre entit\u00e9 prenant part au d\u00e9veloppement, \u00e0 la production ou l\u2019exploitation de la Production (commun\u00e9ment, les \u00ab Productions des Parties \u00bb) de toute r\u00e9clamation d\u2019aucune sorte que je ou mes h\u00e9ritiers, ex\u00e9cuteurs, administrateurs, repr\u00e9sentants l\u00e9gaux, successeurs ou ayants droit ayons jamais eu, n\u2019avons actuellement ou n\u2019aurons jamais \u00e0 l\u2019avenir, d\u00e9rivant de, ou d'une autre mani\u00e8re reli\u00e9e, \u00e0 l\u2019utilisation de la Production, conform\u00e9ment aux modalit\u00e9s d\u00e9crites dans les pr\u00e9sentes.<\/li>\n<li>Je conviens que la Production sera la propri\u00e9t\u00e9 unique et exclusive de l\u2019ACS et je transf\u00e8re et c\u00e8de \u00e0 l\u2019ACS, \u00e0 perp\u00e9tuit\u00e9 et partout au monde tous les droits, titres et int\u00e9r\u00eats de toute sorte, qu\u2019ils soient connus actuellement ou \u00e0 l\u2019avenir (comprenant, mais sans s\u2019y limiter, les droits d\u2019auteur) dans, et \u00e0 la Production. De plus, je renonce aux droits moraux (et \u00e0 tous les droits de m\u00eame nature) dans, et \u00e0 la Production en faveur des Productions des Parties et, sans se limiter au pr\u00e9c\u00e9dent, je conviens que je n\u2019aurai pas le droit, pour quelque raison que ce soit, de m\u2019enjoindre, me restreindre ou interf\u00e9rer avec la distribution ou l\u2019exploitation de la Production.<\/li><\/ul>\nCette d\u00e9charge sera r\u00e9gie par les lois de l\u2019Ontario et les lois f\u00e9d\u00e9rales du Canada.<\/p>\n\t\t<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_39' style='display:none'><div id='gf_39' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>\u00ab\u00a0<span class=\"gfield_required gfield_required_custom\">(Requis)<\/span>\u00a0\u00bb indique les champs n\u00e9cessaires<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_39' id='gform_39'  action='\/fr\/wp-json\/wp\/v2\/pages\/21822#gf_39' data-formid='39' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_39' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_39_21\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_39_21'>Phone<\/label><div class='ginput_container'><input name='input_21' id='input_39_21' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_39_21'>Ce champ n\u2019est utilis\u00e9 qu\u2019\u00e0 des fins de validation et devrait rester inchang\u00e9.<\/div><\/div><fieldset id=\"field_39_4\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_custom\">(Requis)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_39_4'><div class='gchoice gchoice_39_4_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_4.1' type='checkbox'  value='J\u2019ai lu et je comprends cet \u00e9nonc\u00e9 de responsabilit\u00e9 avant de signer et je connais tr\u00e8s bien toutes les modalit\u00e9s pr\u00e9c\u00e9dentes. Je garantis et d\u00e9clare que j\u2019ai le plein droit, l\u2019autorit\u00e9 et la capacit\u00e9 de signer cette d\u00e9charge, que j\u2019accorde tous les droits conc\u00e9d\u00e9s par les pr\u00e9sentes et qu\u2019aucuns droits ni consentements suppl\u00e9mentaires ne sont n\u00e9cessaires pour l\u2019ex\u00e9cution enti\u00e8re des termes de la pr\u00e9sente d\u00e9charge.'  id='choice_39_4_1' tabindex='1'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_39_4_1' id='label_39_4_1' class='gform-field-label gform-field-label--type-inline'>J\u2019ai lu et je comprends cet \u00e9nonc\u00e9 de responsabilit\u00e9 avant de signer et je connais tr\u00e8s bien toutes les modalit\u00e9s pr\u00e9c\u00e9dentes. Je garantis et d\u00e9clare que j\u2019ai le plein droit, l\u2019autorit\u00e9 et la capacit\u00e9 de signer cette d\u00e9charge, que j\u2019accorde tous les droits conc\u00e9d\u00e9s par les pr\u00e9sentes et qu\u2019aucuns droits ni consentements suppl\u00e9mentaires ne sont n\u00e9cessaires pour l\u2019ex\u00e9cution enti\u00e8re des termes de la pr\u00e9sente d\u00e9charge.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_39_6\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Je d\u00e9clare avoir atteint l\u2019\u00e2ge de la majorit\u00e9 dans ma province ou territoire de r\u00e9sidence.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_custom\">(Requis)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_39_6'>\n\t\t\t<div class='gchoice gchoice_39_6_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Oui' checked='checked' id='choice_39_6_0' onchange='gformToggleRadioOther( this )'  tabindex='2'  \/>\n\t\t\t\t\t<label for='choice_39_6_0' id='label_39_6_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_39_6_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Non'  id='choice_39_6_1' onchange='gformToggleRadioOther( this )'  tabindex='3'  \/>\n\t\t\t\t\t<label for='choice_39_6_1' id='label_39_6_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_39_14\" class=\"gfield gfield--type-hidden gfield--width-full gform_hidden field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class='ginput_container ginput_container_text'><input name='input_14' id='input_39_14' type='hidden' class='gform_hidden'  aria-invalid=\"false\" value='30\/06\/2026' \/><\/div><\/div><fieldset id=\"field_39_7\" class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_custom\">(Requis)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_39_7'>\n                            \n                            <span id='input_39_7_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_7.3' id='input_39_7_3' value='' tabindex='5'  aria-required='true'   placeholder='Pr\u00e9nom'  \/>\n                                                    <label for='input_39_7_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_39_7_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_7.6' id='input_39_7_6' value='' tabindex='7'  aria-required='true'   placeholder='Nom'  \/>\n                                                    <label for='input_39_7_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Nom<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_39_8\" class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nom du t\u00e9moin<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_custom\">(Requis)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_39_8'>\n                            \n                            <span id='input_39_8_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_8.3' id='input_39_8_3' value='' tabindex='10'  aria-required='true'   placeholder='Pr\u00e9nom du t\u00e9moin'  \/>\n                                                    <label for='input_39_8_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_39_8_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_8.6' id='input_39_8_6' value='' tabindex='12'  aria-required='true'   placeholder='Nom du t\u00e9moin'  \/>\n                                                    <label for='input_39_8_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Nom<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_39_9\" class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Adresse<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_custom\">(Requis)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_39_9' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_39_9_1_container' >\n                                        <input type='text' name='input_9.1' id='input_39_9_1' value='' tabindex='14'  placeholder='Ligne d&#039;adresse' aria-required='true'    \/>\n                                        <label for='input_39_9_1' id='input_39_9_1_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Ligne d'adresse<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_39_9_2_container' >\n                                        <input type='text' name='input_9.2' id='input_39_9_2' value='' tabindex='15'  placeholder='Ligne d&#039;adresse 2'  aria-required='false'   \/>\n                                        <label for='input_39_9_2' id='input_39_9_2_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Ligne d'adresse 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_39_9_3_container' >\n                                    <input type='text' name='input_9.3' id='input_39_9_3' value='' tabindex='16'  placeholder='Municipalit\u00e9' aria-required='true'    \/>\n                                    <label for='input_39_9_3' id='input_39_9_3_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Municipalit\u00e9<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_39_9_4_container' >\n                                        <input type='text' name='input_9.4' id='input_39_9_4' value='' tabindex='18'    placeholder='Province' aria-required='true'    \/>\n                                        <label for='input_39_9_4' id='input_39_9_4_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Province<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_39_9_5_container' >\n                                    <input type='text' name='input_9.5' id='input_39_9_5' value='' tabindex='19'  placeholder='Code postale' aria-required='true'    \/>\n                                    <label for='input_39_9_5' id='input_39_9_5_label' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Code postale<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_9.6' id='input_39_9_6' value='Canada' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_39_10\" class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_39_10'>T\u00e9l\u00e9phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_custom\">(Requis)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_10' id='input_39_10' type='tel' value='' class='large' tabindex='20' placeholder='T\u00e9l\u00e9phone' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_39_11\" class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_39_11'>Adresse courriel<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_custom\">(Requis)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_11' id='input_39_11' type='email' value='' class='large' tabindex='21'  placeholder='Adresse courriel' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_39_12\" class=\"gfield gfield--type-signature gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_39_12'>Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_custom\">(Requis)<\/span><\/span><\/label><input type='hidden' value='' name='input_12' id='input_39_12_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_39_12_Container' class='gfield_signature_container ginput_container' style='height:180px; width:500px; ' ><canvas id='input_39_12' width='500' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#fafafa; cursor: url(https:\/\/srvcanadavrs.ca\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_39_12_toolbar' style='margin:5px 0;position:relative;height:20px;width:500px;max-width:100%;'><img id = 'input_39_12_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_39_12_data' name='input_39_12_data' value=''><\/div><\/div><div id=\"field_39_13\" class=\"gfield gfield--type-signature gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_39_13'>Signature du t\u00e9moin<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_custom\">(Requis)<\/span><\/span><\/label><input type='hidden' value='' name='input_13' id='input_39_13_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_39_13_Container' class='gfield_signature_container ginput_container' style='height:180px; width:500px; ' ><canvas id='input_39_13' width='500' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#fafafa; cursor: url(https:\/\/srvcanadavrs.ca\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_39_13_toolbar' style='margin:5px 0;position:relative;height:20px;width:500px;max-width:100%;'><img id = 'input_39_13_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_39_13_data' name='input_39_13_data' value=''><\/div><\/div><div id=\"field_39_20\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p style=\"text-align: center;\"><u><b>*REMPLIR CETTE SECTION SI LA PERSONNE N\u2019A PAS L\u2019\u00c2GE DE LA MAJORIT\u00c9\nDANS SA PROVINCE OU TERRITOIRE DE R\u00c9SIDENCE<\/u><\/b><\/p><\/div><fieldset id=\"field_39_15\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent (Under Age of Majority)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_custom\">(Requis)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_39_15'><div class='gchoice gchoice_39_15_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.1' type='checkbox'  value='J\u2019ai lu, compris et accept\u00e9 la d\u00e9charge qui pr\u00e9c\u00e8de. Je d\u00e9clare et garantis \u00eatre le parent ou tuteur l\u00e9gal de la personne nomm\u00e9e dans la d\u00e9charge ci-dessus, que cette personne est mineure, que je suis autoris\u00e9(e) \u00e0 signer et que j\u2019accepte les modalit\u00e9s de cette d\u00e9charge en mon propre nom et au nom de la personne mineure. Je conviens d&#039;indemniser les parties de production contre toute perte ou r\u00e9clamation si la personne mineure renie la d\u00e9charge parce qu&#039;elle \u00e9tait mineure, ou pour toute autre raison, quelle qu&#039;elle soit.'  id='choice_39_15_1' tabindex='22'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_39_15_1' id='label_39_15_1' class='gform-field-label gform-field-label--type-inline'>J\u2019ai lu, compris et accept\u00e9 la d\u00e9charge qui pr\u00e9c\u00e8de. Je d\u00e9clare et garantis \u00eatre le parent ou tuteur l\u00e9gal de la personne nomm\u00e9e dans la d\u00e9charge ci-dessus, que cette personne est mineure, que je suis autoris\u00e9(e) \u00e0 signer et que j\u2019accepte les modalit\u00e9s de cette d\u00e9charge en mon propre nom et au nom de la personne mineure. Je conviens d'indemniser les parties de production contre toute perte ou r\u00e9clamation si la personne mineure renie la d\u00e9charge parce qu'elle \u00e9tait mineure, ou pour toute autre raison, quelle qu'elle soit.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_39_16\" class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nom<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_custom\">(Requis)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_39_16'>\n                            \n                            <span id='input_39_16_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_16.3' id='input_39_16_3' value='' tabindex='24'  aria-required='true'   placeholder='Pr\u00e9nom'  \/>\n                                                    <label for='input_39_16_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_39_16_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_16.6' id='input_39_16_6' value='' tabindex='26'  aria-required='true'   placeholder='Nom'  \/>\n                                                    <label for='input_39_16_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Nom<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_39_17\" class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nom du t\u00e9moin<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_custom\">(Requis)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_39_17'>\n                            \n                            <span id='input_39_17_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_17.3' id='input_39_17_3' value='' tabindex='29'  aria-required='true'   placeholder='Pr\u00e9nom du t\u00e9moin'  \/>\n                                                    <label for='input_39_17_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_39_17_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_17.6' id='input_39_17_6' value='' tabindex='31'  aria-required='true'   placeholder='Nom du t\u00e9moin'  \/>\n                                                    <label for='input_39_17_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Nom<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_39_18\" class=\"gfield gfield--type-signature gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_39_18'>Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_custom\">(Requis)<\/span><\/span><\/label><input type='hidden' value='' name='input_18' id='input_39_18_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_39_18_Container' class='gfield_signature_container ginput_container' style='height:180px; width:500px; ' ><canvas id='input_39_18' width='500' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#fafafa; cursor: url(https:\/\/srvcanadavrs.ca\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_39_18_toolbar' style='margin:5px 0;position:relative;height:20px;width:500px;max-width:100%;'><img id = 'input_39_18_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_39_18_data' name='input_39_18_data' value=''><\/div><\/div><div id=\"field_39_19\" class=\"gfield gfield--type-signature gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_39_19'>Signature du t\u00e9moin<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_custom\">(Requis)<\/span><\/span><\/label><input type='hidden' value='' name='input_19' id='input_39_19_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_39_19_Container' class='gfield_signature_container ginput_container' style='height:180px; width:500px; ' ><canvas id='input_39_19' width='500' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#fafafa; cursor: url(https:\/\/srvcanadavrs.ca\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_39_19_toolbar' style='margin:5px 0;position:relative;height:20px;width:500px;max-width:100%;'><img id = 'input_39_19_resetbutton' 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