{"id":59,"date":"2019-01-23T20:32:47","date_gmt":"2019-01-23T19:32:47","guid":{"rendered":"https:\/\/demo.deblock-it.nl\/ehbo-ursem\/?page_id=59"},"modified":"2019-04-26T14:58:57","modified_gmt":"2019-04-26T13:58:57","slug":"aanvraag-hulpverlening","status":"publish","type":"page","link":"https:\/\/www.ehbo-ursem.nl\/?page_id=59","title":{"rendered":"Aanvraag hulpverlening"},"content":{"rendered":"<span itemprop=\"description\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f125-o1\" lang=\"nl-NL\" dir=\"ltr\" data-wpcf7-id=\"125\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F59#wpcf7-f125-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contactformulier\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"125\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"nl_NL\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f125-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<p>Vul onderstaand formulier zo volledig mogelijk in. Dan zullen wij zo spoedig mogelijk contact met u opnemen.\n<\/p>\n<p>De velden met een (*) zijn verplichte invulvelden.\n<\/p>\n<p><label> Naam aanvrager*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> Organisatie*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-organisation\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-organisation\" \/><\/span> <\/label>\n<\/p>\n<p><label> Adres*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-address\" \/><\/span> <\/label>\n<\/p>\n<p><label> Postcode*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-postalcode\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-postalcode\" \/><\/span> <\/label>\n<\/p>\n<p><label> Plaats*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-city\" \/><\/span> <\/label>\n<\/p>\n<p><label> Telefoon*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-phonenumber\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"your-phonenumber\" \/><\/span> <\/label>\n<\/p>\n<p><label> E-mailadres*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span> <\/label>\n<\/p>\n<p><label> Naam contactpersoon*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-contactperson\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-contactperson\" \/><\/span> <\/label>\n<\/p>\n<p><label> Commerci\u00eble organisatie*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-commercialorg\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"your-commercialorg\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"your-commercialorg\" value=\"Nee\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Nee<\/span><\/span><\/span><\/span>\n<\/p>\n<p><label> Soort evenement*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-eventtype\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-eventtype\" \/><\/span> <\/label>\n<\/p>\n<p><label> Datum evenement*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-eventdate\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"your-eventdate\" \/><\/span> <\/label>\n<\/p>\n<p><b>Locatie evenement<\/b>\n<\/p>\n<p><label> Adres*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-eventaddress\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-eventaddress\" \/><\/span> <\/label>\n<\/p>\n<p><label> Postcode*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-eventpostalcode\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-eventpostalcode\" \/><\/span> <\/label>\n<\/p>\n<p><label> Plaats*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-eventcity\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-eventcity\" \/><\/span> <\/label>\n<\/p>\n<p><label> Evenement aanvangstijd*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-eventstarttime\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-eventstarttime\" \/><\/span> <\/label>\n<\/p>\n<p><label> Evenement eindtijd*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-eventendtime\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-eventendtime\" \/><\/span> <\/label>\n<\/p>\n<p><label> Verwachte aantal deelnemers*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-eventparticipators\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-eventparticipators\" \/><\/span> <\/label>\n<\/p>\n<p><label> Evenement binnen of buiten*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-eventlocation\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"your-eventlocation[]\" value=\"Binnen\" \/><span class=\"wpcf7-list-item-label\">Binnen<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-eventlocation[]\" value=\"Buiten\" \/><span class=\"wpcf7-list-item-label\">Buiten<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"your-eventlocation[]\" value=\"Beide\" \/><span class=\"wpcf7-list-item-label\">Beide<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"your-eventlocation[]\" value=\"Meerdere locaties\" \/><span class=\"wpcf7-list-item-label\">Meerdere locaties<\/span><\/span><\/span><\/span>\n<\/p>\n<p><b>Overige gegevens locatie<\/b>\n<\/p>\n<p><label> EHBO ruimte aanwezig<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-ehboroom\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"your-ehboroom\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"your-ehboroom\" value=\"Nee\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Nee<\/span><\/span><\/span><\/span><br \/>\n<label> Afgeschermd \/ afgedekt<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-shielded\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"your-shielded\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"your-shielded\" value=\"Nee\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Nee<\/span><\/span><\/span><\/span><br \/>\n<label> AED apparaat aanwezig<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-aed\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"your-aed\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"your-aed\" value=\"Nee\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Nee<\/span><\/span><\/span><\/span><br \/>\n<label> Stromend water aanwezig<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-water\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"your-water\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"your-water\" value=\"Nee\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Nee<\/span><\/span><\/span><\/span><br \/>\n<label> Electriciteit aanwezig<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-electricity\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"your-electricity\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"your-electricity\" value=\"Nee\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Nee<\/span><\/span><\/span><\/span><br \/>\n<label> Communicatiemiddelen<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-communication\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"your-communication\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"your-communication\" value=\"Nee\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Nee<\/span><\/span><\/span><\/span>\n<\/p>\n<p><label> Aantal hulpposten nodig (hulpposten altijd per 2 personen per dagdeel)*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-amountaidposts\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-amountaidposts\" \/><\/span><br \/>\n<i>Catering is verplicht voor de aanwezige EHBO-ers<br \/>\nCatering verzorging: koffie\/thee\/fris\/maaltijd (indien van toepassing)<\/i>\n<\/p>\n<p><label> Bijzonderheden en opmerkingen<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-message\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"your-message\"><\/textarea><\/span> <\/label>\n<\/p>\n<p>Ondergetekende, aanvrager, verklaart kennis te hebben genomen van en akkoord te gaan met de voorwaarden en vergoeding hulpverlening.\n<\/p>\n<p><label> Plaats*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-signedcity\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-signedcity\" \/><\/span> <\/label>\n<\/p>\n<p><label> Datum*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-signeddate\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"your-signeddate\" \/><\/span> <\/label>\n<\/p>\n<p><label> Naam ondertekenaar*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-signeename\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-signeename\" \/><\/span> <\/label>\n<\/p>\n<div class=\"wpcf7-turnstile cf-turnstile\" data-sitekey=\"0x4AAAAAAByiR3FS6b9dUVKk\" data-response-field-name=\"_wpcf7_turnstile_response\"><\/div>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Verzenden\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n<span>","protected":false},"excerpt":{"rendered":"<p class=\"excerpt\"><span itemprop=\"description\"><\/span><\/p>\n<p class=\"more-link-p btn-align-right\"><a class=\"blue zoom-btn\" href=\"https:\/\/www.ehbo-ursem.nl\/?page_id=59\">Lees verder<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-59","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.ehbo-ursem.nl\/index.php?rest_route=\/wp\/v2\/pages\/59","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ehbo-ursem.nl\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.ehbo-ursem.nl\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.ehbo-ursem.nl\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ehbo-ursem.nl\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=59"}],"version-history":[{"count":2,"href":"https:\/\/www.ehbo-ursem.nl\/index.php?rest_route=\/wp\/v2\/pages\/59\/revisions"}],"predecessor-version":[{"id":127,"href":"https:\/\/www.ehbo-ursem.nl\/index.php?rest_route=\/wp\/v2\/pages\/59\/revisions\/127"}],"wp:attachment":[{"href":"https:\/\/www.ehbo-ursem.nl\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=59"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}