{"id":17752,"date":"2025-09-16T16:59:54","date_gmt":"2025-09-16T20:59:54","guid":{"rendered":"https:\/\/readtogrow.org\/enquete-prenatale-enquete-1-pre\/"},"modified":"2025-09-16T16:59:55","modified_gmt":"2025-09-16T20:59:55","slug":"enquete-prenatale-enquete-1-pre","status":"publish","type":"page","link":"https:\/\/readtogrownew.bulldogstudios.com\/fr\/enquete-prenatale-enquete-1-pre\/","title":{"rendered":"Enqu\u00eate pr\u00e9natale &#8211; enqu\u00eate 1 (pr\u00e9)"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"17752\" class=\"elementor elementor-17752 elementor-10750\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2fe4ce8f page-header e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no wpr-column-slider-no wpr-equal-height-no e-con e-parent\" data-id=\"2fe4ce8f\" data-element_type=\"container\" data-e-type=\"container\" id=\"page-header\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-154bee41 elementor-widget elementor-widget-text-editor\" data-id=\"154bee41\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h1>Enqu\u00eate pr\u00e9natale \u2013 enqu\u00eate 1 (pr\u00e9)<\/h1>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-1b55caf0 form e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no wpr-column-slider-no wpr-equal-height-no e-con e-parent\" data-id=\"1b55caf0\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-47d8f3d9 e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no wpr-column-slider-no wpr-equal-height-no e-con e-child\" data-id=\"47d8f3d9\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-18553a1f elementor-widget elementor-widget-text-editor\" data-id=\"18553a1f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Nous vous remercions d&rsquo;avoir particip\u00e9 \u00e0 notre enqu\u00eate.<\/p><p>Veuillez prendre quelques minutes pour r\u00e9pondre \u00e0 cette enqu\u00eate pr\u00e9natale afin que nous puissions vous fournir des livres et des informations sur l&rsquo;alphab\u00e9tisation pour vous et votre b\u00e9b\u00e9. Nous vous demandons de compl\u00e9ter vos informations personnelles, suivies de quelques questions vraies ou fausses. Veuillez r\u00e9pondre \u00e0 toutes les questions obligatoires (marqu\u00e9es d&rsquo;un ast\u00e9risque). Vos r\u00e9ponses resteront totalement confidentielles.   <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-500acb9 elementor-widget elementor-widget-shortcode\" data-id=\"500acb9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><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 InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_17' ><div id='gf_17' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Enqu\u00eate pr\u00e9natale 1 (pr\u00e9)<\/h2>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>\u00ab\u00a0<span class=\"gfield_required gfield_required_asterisk\">*<\/span>\u00a0\u00bb indique les champs n\u00e9cessaires<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_17' id='gform_17'  action='\/fr\/wp-json\/wp\/v2\/pages\/17752#gf_17' data-formid='17' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_17' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_17_41\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_17_40\" class=\"gfield gfield--type-html gfield--input-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\"  >(<span class=\"red\">*<\/span> indique les champs obligatoires)<\/div><div id=\"field_17_42\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full 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_17_42'>Date du jour&nbsp;:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_42' id='input_17_42' type='text' value='10\/19\/2026' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/jj\/aaaa' aria-describedby=\"input_17_42_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_17_42_date_format' class='screen-reader-text'>MM slash JJ slash AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_17_42' class='gform_hidden' value='https:\/\/readtogrownew.bulldogstudios.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_17_43\" class=\"gfield gfield--type-text gfield--input-type-text 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_17_43'>Pr\u00e9nom&nbsp;:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_43' id='input_17_43' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_44\" class=\"gfield gfield--type-text gfield--input-type-text 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_17_44'>Nom&nbsp;:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_17_44' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_45\" class=\"gfield gfield--type-text gfield--input-type-text 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_17_45'>Adresse&nbsp;:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_17_45' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_46\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_46'>Adresse 2&nbsp;:<\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_17_46' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_47\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter 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_17_47'>Ville :<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_17_47' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_48\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-quarter html-label 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>\u00c9tat :<\/p>\n<p>CONNECTICUT<\/p><\/div><div id=\"field_17_49\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter 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_17_49'>Code postal :<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_49' id='input_17_49' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_50\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter 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_17_50'>Comt\u00e9 :<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_50' id='input_17_50' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choisir\u2026<\/option><option value='Fairfield' >Fairfield<\/option><option value='Hartford' >Hartford<\/option><option value='Litchfield' >Litchfield<\/option><option value='Middlesex' >Middlesex<\/option><option value='New Haven' >New Haven<\/option><option value='New London' >New London<\/option><option value='Tolland' >Tolland<\/option><option value='Windham' >Windham<\/option><\/select><\/div><\/div><div id=\"field_17_13\" class=\"gfield gfield--type-phone gfield--input-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_17_13'>T\u00e9l\u00e9phone fixe\/portable&nbsp;:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_13' id='input_17_13' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_14\" class=\"gfield gfield--type-email gfield--input-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_17_14'>Courriel&nbsp;:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_14' id='input_17_14' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_17_38\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_38'>Quelle est votre ann\u00e9e de naissance&nbsp;?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_38' id='input_17_38' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choisir...<\/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><\/select><\/div><\/div><div id=\"field_17_15\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_15'>Lieu des soins&nbsp;:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_15' id='input_17_15' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choisir\u2026<\/option><option value='Charter Oak Health Center' >Charter Oak Health Center<\/option><option value='Connecticut Childrens' >Connecticut Childrens<\/option><option value='Cornell Scott Hill Health Center' >Cornell Scott Hill Health Center<\/option><option value='Groupe m\u00e9dical Day Kimball OB\/GYN ou Centre de soins de sant\u00e9 Day Kimball' >Groupe m\u00e9dical Day Kimball OB\/GYN ou Centre de soins de sant\u00e9 Day Kimball<\/option><option value='Fair Haven Community Health' >Fair Haven Community Health<\/option><option value='Sage-femme' >Sage-femme<\/option><option value='Norwalk Community Health' >Norwalk Community Health<\/option><option value='Optimus Health Care' >Optimus Health Care<\/option><option value='Southwest' >Southwest<\/option><option value='Programme de soutien \u00e0 la parentalit\u00e9 UCONN Health' >Programme de soutien \u00e0 la parentalit\u00e9 UCONN Health<\/option><option value='Yale Maternal Fetal Medicine' >Yale Maternal Fetal Medicine<\/option><option value='Yale Center for Women\u2019s Health' >Yale Center for Women\u2019s Health<\/option><\/select><\/div><\/div><div id=\"field_17_19\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_19'>Est-ce la premi\u00e8re fois que vous recevez des informations de Read to Grow&nbsp;?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_19' id='input_17_19' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choisir\u2026<\/option><option value='Oui' >Oui<\/option><option value='Non' >Non<\/option><option value='Pas s\u00fbr(e)' >Pas s\u00fbr(e)<\/option><\/select><\/div><\/div><div id=\"field_17_20\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_20'>1. Un b\u00e9b\u00e9 est pr\u00eat \u00e0 apprendre d\u00e8s la naissance.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_20' id='input_17_20' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choisir\u2026<\/option><option value='Vrai' >Vrai<\/option><option value='Faux' >Faux<\/option><option value='Pas s\u00fbr(e)' >Pas s\u00fbr(e)<\/option><\/select><\/div><\/div><div id=\"field_17_21\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_21'>2. Les parents sont les premiers enseignants d\u2019un b\u00e9b\u00e9.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_21' id='input_17_21' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choisir\u2026<\/option><option value='Vrai' >Vrai<\/option><option value='Faux' >Faux<\/option><option value='Pas s\u00fbr(e)' >Pas s\u00fbr(e)<\/option><\/select><\/div><\/div><div id=\"field_17_22\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_22'>3. Le d\u00e9veloppement du cerveau est le plus important au cours des 3 premi\u00e8res ann\u00e9es de la vie d\u2019une personne.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_22' id='input_17_22' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choisir\u2026<\/option><option value='Vrai' >Vrai<\/option><option value='Faux' >Faux<\/option><option value='Pas s\u00fbr(e)' >Pas s\u00fbr(e)<\/option><\/select><\/div><\/div><div id=\"field_17_24\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_24'>4. Partager des livres et lire avec un b\u00e9b\u00e9 stimule le cerveau et les comp\u00e9tences linguistiques.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_24' id='input_17_24' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choisir\u2026<\/option><option value='Vrai' >Vrai<\/option><option value='Faux' >Faux<\/option><option value='Pas s\u00fbr(e)' >Pas s\u00fbr(e)<\/option><\/select><\/div><\/div><div id=\"field_17_23\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_23'>5. Parler et lire augmentent le vocabulaire d\u2019un enfant (mots que l\u2019enfant conna\u00eet).<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_23' id='input_17_23' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choisir\u2026<\/option><option value='Vrai' >Vrai<\/option><option value='Faux' >Faux<\/option><option value='Pas s\u00fbr(e)' >Pas s\u00fbr(e)<\/option><\/select><\/div><\/div><div id=\"field_17_25\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_25'>6. Le temps pass\u00e9 devant un \u00e9cran (t\u00e9l\u00e9viseurs, t\u00e9l\u00e9phones, tablettes ou ordinateurs) n\u2019est pas recommand\u00e9 pour les enfants de moins de 2&nbsp;ans.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_25' id='input_17_25' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choisir\u2026<\/option><option value='Vrai' >Vrai<\/option><option value='Faux' >Faux<\/option><option value='Pas s\u00fbr(e)' >Pas s\u00fbr(e)<\/option><\/select><\/div><\/div><div id=\"field_17_26\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_26'>7. Principale langue parl\u00e9e \u00e0 la maison&nbsp;:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_26' id='input_17_26' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choisir\u2026<\/option><option value='Anglais' >Anglais<\/option><option value='Espagnol' >Espagnol<\/option><option value='Autre' >Autre<\/option><\/select><\/div><\/div><div id=\"field_17_27\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_27'>8. Si autre langue, veuillez pr\u00e9ciser.<\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_17_27' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_17_37\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_37'>9. Combien d\u2019enfants avez-vous \u00e0 la maison&nbsp;?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_37' id='input_17_37' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choisir\u2026<\/option><option value='Aucun (je suis enceinte de mon premier enfant)' >Aucun (je suis enceinte de mon premier enfant)<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3 ou plus' >3 ou plus<\/option><\/select><\/div><\/div><div id=\"field_17_29\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_17_39\" class=\"gfield gfield--type-html gfield--input-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\"  ><h5>Si vous \u00eates enceinte de votre premier enfant, vous avez termin\u00e9 le sondage. Merci&nbsp;! Si vous avez des enfants, veuillez r\u00e9pondre \u00e0 la s\u00e9rie de questions suivante.<\/h5><\/div><div id=\"field_17_30\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_30'>10. Dans quel h\u00f4pital votre\/vos enfant(s) est\/sont-il(s) n\u00e9(s)&nbsp;?<\/label><div class='ginput_container ginput_container_select'><select name='input_30' id='input_17_30' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choisir\u2026<\/option><option value='Backus' >Backus<\/option><option value='Bridgeport' >Bridgeport<\/option><option value='H\u00f4pital Bristol' >H\u00f4pital Bristol<\/option><option value='Charlotte Hungerford' >Charlotte Hungerford<\/option><option value='H\u00f4pital Danbury' >H\u00f4pital Danbury<\/option><option value='Day Kimball' >Day Kimball<\/option><option value='H\u00f4pital Greenwich' >H\u00f4pital Greenwich<\/option><option value='Griffin' >Griffin<\/option><option value='H\u00f4pital Hartford' >H\u00f4pital Hartford<\/option><option value='H\u00f4pital de Central CT' >H\u00f4pital de Central CT<\/option><option value='Lawrence + Memorial' >Lawrence + Memorial<\/option><option value='Manchester Memorial' >Manchester Memorial<\/option><option value='H\u00f4pital Middlesex' >H\u00f4pital Middlesex<\/option><option value='Centre m\u00e9dical Midstate' >Centre m\u00e9dical Midstate<\/option><option value='Norwalk' >Norwalk<\/option><option value='H\u00f4pital Sharon' >H\u00f4pital Sharon<\/option><option value='St. Francis' >St. Francis<\/option><option value='H\u00f4pital St. Mary\u2019s' >H\u00f4pital St. Mary\u2019s<\/option><option value='St. Vincent&#039;s' >St. Vincent&#039;s<\/option><option value='H\u00f4pital Stamford' >H\u00f4pital Stamford<\/option><option value='UCONN John Dempsey' >UCONN John Dempsey<\/option><option value='Waterbury' >Waterbury<\/option><option value='Yale \u2013 New Haven' >Yale \u2013 New Haven<\/option><option value='Autre' >Autre<\/option><\/select><\/div><\/div><div id=\"field_17_31\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_31'>11. Avez-vous re\u00e7u \u00e0 l\u2019h\u00f4pital une trousse gratuite contenant un livre pour b\u00e9b\u00e9 et un guide pour les parents de Read to Grow&nbsp;?<\/label><div class='ginput_container ginput_container_select'><select name='input_31' id='input_17_31' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choisir\u2026<\/option><option value='Oui' >Oui<\/option><option value='Non' >Non<\/option><option value='Je ne me souviens pas' >Je ne me souviens pas<\/option><\/select><\/div><\/div><div id=\"field_17_32\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_32'>12. Des livres pour enfants sont partag\u00e9s ou lus \u00e0 la maison avec mon\/mes enfant(s)&nbsp;:<\/label><div class='ginput_container ginput_container_select'><select name='input_32' id='input_17_32' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choisir\u2026<\/option><option value='Tous les jours' >Tous les jours<\/option><option value='4 \u00e0 6 fois par semaine' >4 \u00e0 6 fois par semaine<\/option><option value='1 \u00e0 3 fois par semaine' >1 \u00e0 3 fois par semaine<\/option><option value='Au moins 1 fois par semaine' >Au moins 1 fois par semaine<\/option><option value='Jamais' >Jamais<\/option><\/select><\/div><\/div><div id=\"field_17_33\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_17_33'>13. Chez moi, nous avons ce nombre de livres pour enfants&nbsp;:<\/label><div class='ginput_container ginput_container_select'><select name='input_33' id='input_17_33' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Choisir\u2026<\/option><option value='20 ou plus' >20 ou plus<\/option><option value='10 \u00e0 19' >10 \u00e0 19<\/option><option value='1 \u00e0 9' >1 \u00e0 9<\/option><option value='Aucun' >Aucun<\/option><\/select><\/div><\/div><div id=\"field_17_51\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_17_52\" class=\"gfield gfield--type-html gfield--input-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>Avant de soumettre votre formulaire, veuillez vous assurer que tous les champs obligatoires sont remplis.<\/p>\n\n<p>Une fois que vous aurez cliqu\u00e9 sur \u00ab&nbsp;Soumettre&nbsp;\u00bb, vous devriez voir un message indiquant \u00ab&nbsp;Merci d\u2019avoir rempli notre sondage&nbsp;! \u00bb Cela confirme que votre demande a bien \u00e9t\u00e9 transmise. <\/p>\n\n<p>Si vous ne voyez pas le message de remerciement, votre demande n\u2019a pas \u00e9t\u00e9 soumise avec succ\u00e8s. Veuillez v\u00e9rifier le formulaire et r\u00e9essayer. <\/p>\n\n<p>Merci pour votre temps et votre attention \u00e0 remplir notre sondage.<\/p><\/div><fieldset id=\"field_17_11\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nom&nbsp;:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_17_11'>\n                            \n                            <span id='input_17_11_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_11.3' id='input_17_11_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_17_11_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_17_11_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_11.6' id='input_17_11_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_17_11_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_17_10\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' >Adresse postale&nbsp;:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_17_10' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_17_10_1_container' >\n                                        <input type='text' name='input_10.1' id='input_17_10_1' value=''    aria-required='true'    \/>\n                                        <label for='input_17_10_1' id='input_17_10_1_label' class='gform-field-label gform-field-label--type-sub '>Adresse postale<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_17_10_3_container' >\n                                    <input type='text' name='input_10.3' id='input_17_10_3' value=''    aria-required='true'    \/>\n                                    <label for='input_17_10_3' id='input_17_10_3_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_17_10_4_container' >\n                                        <select name='input_10.4' id='input_17_10_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='Samoa am\u00e9ricaines' >Samoa am\u00e9ricaines<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='Californie' >Californie<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' selected='selected'>Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District de Columbia' >District de Columbia<\/option><option value='Floride' >Floride<\/option><option value='G\u00e9orgie' >G\u00e9orgie<\/option><option value='Guam' >Guam<\/option><option value='Hawa\u00ef' >Hawa\u00ef<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiane' >Louisiane<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='Nouveau-Mexique' >Nouveau-Mexique<\/option><option value='New York' >New York<\/option><option value='Caroline du Nord' >Caroline du Nord<\/option><option value='Dakota du Nord' >Dakota du Nord<\/option><option value='\u00celes Mariannes du Nord' >\u00celes Mariannes du Nord<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvanie' >Pennsylvanie<\/option><option value='Porto Rico' >Porto Rico<\/option><option value='\u00cele de Rhode' >\u00cele de Rhode<\/option><option value='Caroline du Sud' >Caroline du Sud<\/option><option value='Dakota du Sud' >Dakota du Sud<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='\u00celes Vierges am\u00e9ricaines' >\u00celes Vierges am\u00e9ricaines<\/option><option value='Vermont' >Vermont<\/option><option value='Virginie' >Virginie<\/option><option value='Washington' >Washington<\/option><option value='Virginie-Occidentale' >Virginie-Occidentale<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Forces arm\u00e9es Am\u00e9riques' >Forces arm\u00e9es Am\u00e9riques<\/option><option value='Forces arm\u00e9es Europe' >Forces arm\u00e9es Europe<\/option><option value='Forces arm\u00e9es Pacifique' >Forces arm\u00e9es Pacifique<\/option><\/select>\n                                        <label for='input_17_10_4' id='input_17_10_4_label' class='gform-field-label gform-field-label--type-sub '>D\u00e9partement<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_17_10_5_container' >\n                                    <input type='text' name='input_10.5' id='input_17_10_5' value=''    aria-required='true'    \/>\n                                    <label for='input_17_10_5' id='input_17_10_5_label' class='gform-field-label gform-field-label--type-sub '>Code postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_10.6' id='input_17_10_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_17_35\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><label class='gfield_label gform-field-label' for='input_17_35'>Num\u00e9ro de t\u00e9l\u00e9phone fixe&nbsp;:<\/label><div class='ginput_container ginput_container_phone'><input name='input_35' id='input_17_35' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_17' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Soumettre'  \/> <input type='hidden' name='gform_ajax' value='form_id=17&amp;title=1&amp;description=&amp;tabindex=0&amp;theme=gravity-theme&amp;styles=[]&amp;hash=d15aea4f2ece2140877bd984313c2187' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_17' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_17' id='gform_theme_17' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_17' id='gform_style_settings_17' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_17' value='1' \/>\n            <input type='hidden' class='gform_hidden' 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