{"id":1492,"date":"2024-04-18T10:37:41","date_gmt":"2024-04-18T09:37:41","guid":{"rendered":"https:\/\/divessl.com\/ts-basic-medico\/"},"modified":"2024-04-19T12:09:45","modified_gmt":"2024-04-19T11:09:45","slug":"bateig-de-busseig","status":"publish","type":"page","link":"https:\/\/divessl.com\/ca\/inscripcio\/bateig-de-busseig\/","title":{"rendered":"Bateig de busseig"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row el_class=&#8221;box-formulario&#8221;][vc_column][vc_empty_space height=&#8221;64px&#8221;][vc_column_text css=&#8221;&#8221; el_class=&#8221;titulo-form-insc&#8221;]Formulari d&#8217;inscripci\u00f3[\/vc_column_text]<style id=\"wpforms-css-vars-1478\">\n\t\t\t\t#wpforms-1478 {\n\t\t\t\t\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full ts-basic wpforms-render-modern\" id=\"wpforms-1478\"><form id=\"wpforms-form-1478\" class=\"wpforms-validate wpforms-form\" data-formid=\"1478\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/ca\/wp-json\/wp\/v2\/pages\/1492\" data-token=\"351b687fe4dc8afc91615b44b353da6f\" data-token-time=\"1779327229\"><noscript class=\"wpforms-error-noscript\">Activeu el JavaScript al navegador per a poder completar el formulari.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Activeu el JavaScript al navegador per a poder completar el formulari.<\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-1478-field_242-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"242\"><\/div><div id=\"wpforms-1478-field_239-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"239\"><div id=\"wpforms-1478-field_239\" aria-errormessage=\"wpforms-1478-field_239-error\"><h2>Try Scuba - Basic Diver<\/h2><\/div><\/div><div id=\"wpforms-1478-field_49-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"49\"><div id=\"wpforms-1478-field_49\" aria-errormessage=\"wpforms-1478-field_49-error\"><h3>Dades personals<\/h3><\/div><\/div><div id=\"wpforms-1478-field_23-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"23\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_1-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_1\">Nom <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1478-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" aria-errormessage=\"wpforms-1478-field_1-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_2-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_2\">Cognoms <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1478-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" aria-errormessage=\"wpforms-1478-field_2-error\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_26-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"26\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-25-25\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_3-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_3\">N\u00famero de DNI o N\u00famero de Passaport <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1478-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" aria-errormessage=\"wpforms-1478-field_3-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_4-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_4\">Data de naixement <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1478-field_4\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][4][date]\" aria-errormessage=\"wpforms-1478-field_4-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_246-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"246\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_246\">G\u00e8nere <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-1478-field_246\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][246]\" required=\"required\"><option value=\"Home\"  class=\"choice-1 depth-1\"  >Home<\/option><option value=\"Dona\"  class=\"choice-2 depth-1\"  >Dona<\/option><option value=\"No vull dir-ho\"  class=\"choice-3 depth-1\"  >No vull dir-ho<\/option><\/select><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_27-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"27\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_31-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_31\">Pa\u00eds <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-1478-field_31\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][31]\" required=\"required\"><option value=\"Afganistan\"  class=\"choice-4 depth-1\"  >Afganistan<\/option><option value=\"Alb\u00e0nia\"  class=\"choice-5 depth-1\"  >Alb\u00e0nia<\/option><option value=\"Alemanya\"  class=\"choice-6 depth-1\"  >Alemanya<\/option><option value=\"Andorra\"  class=\"choice-7 depth-1\"  >Andorra<\/option><option value=\"Angola\"  class=\"choice-8 depth-1\"  >Angola<\/option><option value=\"Anguilla\"  class=\"choice-9 depth-1\"  >Anguilla<\/option><option value=\"Antigua i Barbuda\"  class=\"choice-10 depth-1\"  >Antigua i Barbuda<\/option><option value=\"Ant\u00e0rtida\"  class=\"choice-11 depth-1\"  >Ant\u00e0rtida<\/option><option value=\"Alg\u00e8ria\"  class=\"choice-12 depth-1\"  >Alg\u00e8ria<\/option><option value=\"Argentina\"  class=\"choice-13 depth-1\"  >Argentina<\/option><option value=\"Arm\u00e8nia\"  class=\"choice-14 depth-1\"  >Arm\u00e8nia<\/option><option value=\"Aruba\"  class=\"choice-15 depth-1\"  >Aruba<\/option><option value=\"Austr\u00e0lia\"  class=\"choice-16 depth-1\"  >Austr\u00e0lia<\/option><option value=\"\u00c0ustria\"  class=\"choice-17 depth-1\"  >\u00c0ustria<\/option><option value=\"Azerbaidjan\"  class=\"choice-18 depth-1\"  >Azerbaidjan<\/option><option value=\"Bahames\"  class=\"choice-19 depth-1\"  >Bahames<\/option><option value=\"Bangladesh\"  class=\"choice-20 depth-1\"  >Bangladesh<\/option><option value=\"Barbados\"  class=\"choice-21 depth-1\"  >Barbados<\/option><option value=\"Bahrain\"  class=\"choice-22 depth-1\"  >Bahrain<\/option><option value=\"Belize\"  class=\"choice-23 depth-1\"  >Belize<\/option><option value=\"Ben\u00edn\"  class=\"choice-24 depth-1\"  >Ben\u00edn<\/option><option value=\"Bermudes\"  class=\"choice-25 depth-1\"  >Bermudes<\/option><option value=\"Belar\u00fas\"  class=\"choice-26 depth-1\"  >Belar\u00fas<\/option><option value=\"Bol\u00edvia, Estat Plurinacional de\"  class=\"choice-27 depth-1\"  >Bol\u00edvia, Estat Plurinacional de<\/option><option value=\"Bonaire, Sint Eustatius i Saba\"  class=\"choice-28 depth-1\"  >Bonaire, Sint Eustatius i Saba<\/option><option value=\"B\u00f2snia i Hercegovina\"  class=\"choice-29 depth-1\"  >B\u00f2snia i Hercegovina<\/option><option value=\"Botswana\"  class=\"choice-30 depth-1\"  >Botswana<\/option><option value=\"Brasil\"  class=\"choice-31 depth-1\"  >Brasil<\/option><option value=\"Brunei\"  class=\"choice-32 depth-1\"  >Brunei<\/option><option value=\"Bulg\u00e0ria\"  class=\"choice-33 depth-1\"  >Bulg\u00e0ria<\/option><option value=\"Burkina Faso\"  class=\"choice-34 depth-1\"  >Burkina Faso<\/option><option value=\"Burundi\"  class=\"choice-35 depth-1\"  >Burundi<\/option><option value=\"Bhutan\"  class=\"choice-36 depth-1\"  >Bhutan<\/option><option value=\"B\u00e8lgica\"  class=\"choice-37 depth-1\"  >B\u00e8lgica<\/option><option value=\"Cap Verd\"  class=\"choice-38 depth-1\"  >Cap Verd<\/option><option value=\"Cambodja\"  class=\"choice-39 depth-1\"  >Cambodja<\/option><option value=\"Camerun\"  class=\"choice-40 depth-1\"  >Camerun<\/option><option value=\"Canad\u00e0\"  class=\"choice-41 depth-1\"  >Canad\u00e0<\/option><option value=\"Txad\"  class=\"choice-42 depth-1\"  >Txad<\/option><option value=\"Chile\"  class=\"choice-43 depth-1\"  >Chile<\/option><option value=\"Xina\"  class=\"choice-44 depth-1\"  >Xina<\/option><option value=\"Xipre\"  class=\"choice-45 depth-1\"  >Xipre<\/option><option value=\"Col\u00f2mbia\"  class=\"choice-46 depth-1\"  >Col\u00f2mbia<\/option><option value=\"Comores\"  class=\"choice-47 depth-1\"  >Comores<\/option><option value=\"Congo\"  class=\"choice-48 depth-1\"  >Congo<\/option><option value=\"Congo (Rep\u00fablica Democr\u00e0tica del)\"  class=\"choice-49 depth-1\"  >Congo (Rep\u00fablica Democr\u00e0tica del)<\/option><option value=\"Corea (Rep\u00fablica de)\"  class=\"choice-50 depth-1\"  >Corea (Rep\u00fablica de)<\/option><option value=\"Corea del Nord\"  class=\"choice-51 depth-1\"  >Corea del Nord<\/option><option value=\"Costa Rica\"  class=\"choice-52 depth-1\"  >Costa Rica<\/option><option value=\"Costa d&#039;Ivori\"  class=\"choice-53 depth-1\"  >Costa d'Ivori<\/option><option value=\"Cro\u00e0cia\"  class=\"choice-54 depth-1\"  >Cro\u00e0cia<\/option><option value=\"Cuba\"  class=\"choice-55 depth-1\"  >Cuba<\/option><option value=\"Cura\u00e7ao\"  class=\"choice-56 depth-1\"  >Cura\u00e7ao<\/option><option value=\"Dinamarca\"  class=\"choice-57 depth-1\"  >Dinamarca<\/option><option value=\"Dominica\"  class=\"choice-58 depth-1\"  >Dominica<\/option><option value=\"Equador\"  class=\"choice-59 depth-1\"  >Equador<\/option><option value=\"Egipte\"  class=\"choice-60 depth-1\"  >Egipte<\/option><option value=\"El Salvador\"  class=\"choice-61 depth-1\"  >El Salvador<\/option><option value=\"Emirats \u00c0rabs Units\"  class=\"choice-62 depth-1\"  >Emirats \u00c0rabs Units<\/option><option value=\"Eritrea\"  class=\"choice-63 depth-1\"  >Eritrea<\/option><option value=\"Eslov\u00e0quia\"  class=\"choice-64 depth-1\"  >Eslov\u00e0quia<\/option><option value=\"Eslov\u00e8nia\"  class=\"choice-65 depth-1\"  >Eslov\u00e8nia<\/option><option value=\"Espanya\"  selected='selected' class=\"choice-66 depth-1\"  >Espanya<\/option><option value=\"Santa Seu (Estat del Vatic\u00e0)\"  class=\"choice-67 depth-1\"  >Santa Seu (Estat del Vatic\u00e0)<\/option><option value=\"Estats Units d&#039;Am\u00e8rica\"  class=\"choice-68 depth-1\"  >Estats Units d'Am\u00e8rica<\/option><option value=\"Est\u00f2nia\"  class=\"choice-69 depth-1\"  >Est\u00f2nia<\/option><option value=\"Eti\u00f2pia\"  class=\"choice-70 depth-1\"  >Eti\u00f2pia<\/option><option value=\"Federaci\u00f3 Russa\"  class=\"choice-71 depth-1\"  >Federaci\u00f3 Russa<\/option><option value=\"Fiji\"  class=\"choice-72 depth-1\"  >Fiji<\/option><option value=\"Filipines\"  class=\"choice-73 depth-1\"  >Filipines<\/option><option value=\"Finl\u00e0ndia\"  class=\"choice-74 depth-1\"  >Finl\u00e0ndia<\/option><option value=\"Fran\u00e7a\"  class=\"choice-75 depth-1\"  >Fran\u00e7a<\/option><option value=\"Gabon\"  class=\"choice-76 depth-1\"  >Gabon<\/option><option value=\"G\u00e0mbia\"  class=\"choice-77 depth-1\"  >G\u00e0mbia<\/option><option value=\"Ge\u00f2rgia\"  class=\"choice-78 depth-1\"  >Ge\u00f2rgia<\/option><option value=\"Ghana\"  class=\"choice-79 depth-1\"  >Ghana<\/option><option value=\"Gibraltar\"  class=\"choice-80 depth-1\"  >Gibraltar<\/option><option value=\"Grenada\"  class=\"choice-81 depth-1\"  >Grenada<\/option><option value=\"Gr\u00e8cia\"  class=\"choice-82 depth-1\"  >Gr\u00e8cia<\/option><option value=\"Groenl\u00e0ndia\"  class=\"choice-83 depth-1\"  >Groenl\u00e0ndia<\/option><option value=\"Guadalupe\"  class=\"choice-84 depth-1\"  >Guadalupe<\/option><option value=\"Guam\"  class=\"choice-85 depth-1\"  >Guam<\/option><option value=\"Guatemala\"  class=\"choice-86 depth-1\"  >Guatemala<\/option><option value=\"Guaiana Francesa\"  class=\"choice-87 depth-1\"  >Guaiana Francesa<\/option><option value=\"Guernsey\"  class=\"choice-88 depth-1\"  >Guernsey<\/option><option value=\"Guinea\"  class=\"choice-89 depth-1\"  >Guinea<\/option><option value=\"Guinea Equatorial\"  class=\"choice-90 depth-1\"  >Guinea Equatorial<\/option><option value=\"Guinea Bissau\"  class=\"choice-91 depth-1\"  >Guinea Bissau<\/option><option value=\"Guyana\"  class=\"choice-92 depth-1\"  >Guyana<\/option><option value=\"Hait\u00ed\"  class=\"choice-93 depth-1\"  >Hait\u00ed<\/option><option value=\"Hondures\"  class=\"choice-94 depth-1\"  >Hondures<\/option><option value=\"Hong Kong\"  class=\"choice-95 depth-1\"  >Hong Kong<\/option><option value=\"Hongria\"  class=\"choice-96 depth-1\"  >Hongria<\/option><option value=\"\u00cdndia\"  class=\"choice-97 depth-1\"  >\u00cdndia<\/option><option value=\"Indon\u00e8sia\"  class=\"choice-98 depth-1\"  >Indon\u00e8sia<\/option><option value=\"Iraq\"  class=\"choice-99 depth-1\"  >Iraq<\/option><option value=\"Irlanda (Rep\u00fablica de)\"  class=\"choice-100 depth-1\"  >Irlanda (Rep\u00fablica de)<\/option><option value=\"Rep\u00fablica Isl\u00e0mica de l&#039;Iran\"  class=\"choice-101 depth-1\"  >Rep\u00fablica Isl\u00e0mica de l'Iran<\/option><option value=\"Illa Bouvet\"  class=\"choice-102 depth-1\"  >Illa Bouvet<\/option><option value=\"Illa Norfolk\"  class=\"choice-103 depth-1\"  >Illa Norfolk<\/option><option value=\"Illa de Man\"  class=\"choice-104 depth-1\"  >Illa de Man<\/option><option value=\"Illa Christmas\"  class=\"choice-105 depth-1\"  >Illa Christmas<\/option><option value=\"Isl\u00e0ndia\"  class=\"choice-106 depth-1\"  >Isl\u00e0ndia<\/option><option value=\"Illes Caiman\"  class=\"choice-107 depth-1\"  >Illes Caiman<\/option><option value=\"Illes Cocos\"  class=\"choice-108 depth-1\"  >Illes Cocos<\/option><option value=\"Illes Cook\"  class=\"choice-109 depth-1\"  >Illes Cook<\/option><option value=\"Illes F\u00e8roe\"  class=\"choice-110 depth-1\"  >Illes F\u00e8roe<\/option><option value=\"Illes Heard i McDonald\"  class=\"choice-111 depth-1\"  >Illes Heard i McDonald<\/option><option value=\"Illes Falkland (Malvines)\"  class=\"choice-112 depth-1\"  >Illes Falkland (Malvines)<\/option><option value=\"Illes Mariannes Septentrionals\"  class=\"choice-113 depth-1\"  >Illes Mariannes Septentrionals<\/option><option value=\"Illes Marshall\"  class=\"choice-114 depth-1\"  >Illes Marshall<\/option><option value=\"Illes Salom\u00f3\"  class=\"choice-115 depth-1\"  >Illes Salom\u00f3<\/option><option value=\"Illes Turks i Caicos\"  class=\"choice-116 depth-1\"  >Illes Turks i Caicos<\/option><option value=\"Illes Menors Allunyades dels Estats Units\"  class=\"choice-117 depth-1\"  >Illes Menors Allunyades dels Estats Units<\/option><option value=\"Illes Verges dels Estats Units\"  class=\"choice-118 depth-1\"  >Illes Verges dels Estats Units<\/option><option value=\"Illes Verges Brit\u00e0niques\"  class=\"choice-119 depth-1\"  >Illes Verges Brit\u00e0niques<\/option><option value=\"Illes Ge\u00f2rgia del Sud i Sandwich del Sud\"  class=\"choice-120 depth-1\"  >Illes Ge\u00f2rgia del Sud i Sandwich del Sud<\/option><option value=\"Illes \u00c5land\"  class=\"choice-121 depth-1\"  >Illes \u00c5land<\/option><option value=\"Israel\"  class=\"choice-122 depth-1\"  >Israel<\/option><option value=\"It\u00e0lia\"  class=\"choice-123 depth-1\"  >It\u00e0lia<\/option><option value=\"Jamaica\"  class=\"choice-124 depth-1\"  >Jamaica<\/option><option value=\"Jap\u00f3\"  class=\"choice-125 depth-1\"  >Jap\u00f3<\/option><option value=\"Jersey\"  class=\"choice-126 depth-1\"  >Jersey<\/option><option value=\"Jord\u00e0nia\"  class=\"choice-127 depth-1\"  >Jord\u00e0nia<\/option><option value=\"Qatar\"  class=\"choice-128 depth-1\"  >Qatar<\/option><option value=\"Kazajist\u00e1n\"  class=\"choice-129 depth-1\"  >Kazajist\u00e1n<\/option><option value=\"Kenya\"  class=\"choice-130 depth-1\"  >Kenya<\/option><option value=\"Kirguizstan\"  class=\"choice-131 depth-1\"  >Kirguizstan<\/option><option value=\"Kiribati\"  class=\"choice-132 depth-1\"  >Kiribati<\/option><option value=\"Kosovo\"  class=\"choice-133 depth-1\"  >Kosovo<\/option><option value=\"Kuwait\"  class=\"choice-134 depth-1\"  >Kuwait<\/option><option value=\"Lesotho\"  class=\"choice-135 depth-1\"  >Lesotho<\/option><option value=\"Let\u00f2nia\"  class=\"choice-136 depth-1\"  >Let\u00f2nia<\/option><option value=\"Lib\u00e8ria\"  class=\"choice-137 depth-1\"  >Lib\u00e8ria<\/option><option value=\"L\u00edbia\"  class=\"choice-138 depth-1\"  >L\u00edbia<\/option><option value=\"Liechtenstein\"  class=\"choice-139 depth-1\"  >Liechtenstein<\/option><option value=\"Litu\u00e0nia\"  class=\"choice-140 depth-1\"  >Litu\u00e0nia<\/option><option value=\"Luxemburg\"  class=\"choice-141 depth-1\"  >Luxemburg<\/option><option value=\"L\u00edban\"  class=\"choice-142 depth-1\"  >L\u00edban<\/option><option value=\"Macau\"  class=\"choice-143 depth-1\"  >Macau<\/option><option value=\"Maced\u00f2nia del Nord (Rep\u00fablica de)\"  class=\"choice-144 depth-1\"  >Maced\u00f2nia del Nord (Rep\u00fablica de)<\/option><option value=\" Madagascar\"  class=\"choice-145 depth-1\"  >Madagascar<\/option><option value=\"Mal\u00e0isia\"  class=\"choice-146 depth-1\"  >Mal\u00e0isia<\/option><option value=\"Malawi\"  class=\"choice-147 depth-1\"  >Malawi<\/option><option value=\"Maldives\"  class=\"choice-148 depth-1\"  >Maldives<\/option><option value=\"Mali\"  class=\"choice-149 depth-1\"  >Mali<\/option><option value=\"Malta\"  class=\"choice-150 depth-1\"  >Malta<\/option><option value=\"Marroc\"  class=\"choice-151 depth-1\"  >Marroc<\/option><option value=\"Martinica\"  class=\"choice-152 depth-1\"  >Martinica<\/option><option value=\"Maurici\"  class=\"choice-153 depth-1\"  >Maurici<\/option><option value=\"Maurit\u00e0nia\"  class=\"choice-154 depth-1\"  >Maurit\u00e0nia<\/option><option value=\"Mayotte\"  class=\"choice-155 depth-1\"  >Mayotte<\/option><option value=\"Micron\u00e8sia, Estats Federats de\"  class=\"choice-156 depth-1\"  >Micron\u00e8sia, Estats Federats de<\/option><option value=\"Mold\u00e0via, Rep\u00fablica de\"  class=\"choice-157 depth-1\"  >Mold\u00e0via, Rep\u00fablica de<\/option><option value=\"Mong\u00f2lia\"  class=\"choice-158 depth-1\"  >Mong\u00f2lia<\/option><option value=\"Montenegro\"  class=\"choice-159 depth-1\"  >Montenegro<\/option><option value=\"Montserrat\"  class=\"choice-160 depth-1\"  >Montserrat<\/option><option value=\"Mo\u00e7ambic\"  class=\"choice-161 depth-1\"  >Mo\u00e7ambic<\/option><option value=\"Myanmar\"  class=\"choice-162 depth-1\"  >Myanmar<\/option><option value=\"M\u00e8xic\"  class=\"choice-163 depth-1\"  >M\u00e8xic<\/option><option value=\"M\u00f2naco\"  class=\"choice-164 depth-1\"  >M\u00f2naco<\/option><option value=\"Nam\u00edbia\"  class=\"choice-165 depth-1\"  >Nam\u00edbia<\/option><option value=\"Nauru\"  class=\"choice-166 depth-1\"  >Nauru<\/option><option value=\"Nepal\"  class=\"choice-167 depth-1\"  >Nepal<\/option><option value=\"Nicaragua\"  class=\"choice-168 depth-1\"  >Nicaragua<\/option><option value=\"Nig\u00e8ria\"  class=\"choice-169 depth-1\"  >Nig\u00e8ria<\/option><option value=\"Niue\"  class=\"choice-170 depth-1\"  >Niue<\/option><option value=\"Noruega\"  class=\"choice-171 depth-1\"  >Noruega<\/option><option value=\"Nova Caled\u00f2nia\"  class=\"choice-172 depth-1\"  >Nova Caled\u00f2nia<\/option><option value=\"Nova Zelanda\"  class=\"choice-173 depth-1\"  >Nova Zelanda<\/option><option value=\"N\u00edger\"  class=\"choice-174 depth-1\"  >N\u00edger<\/option><option value=\"Oman\"  class=\"choice-175 depth-1\"  >Oman<\/option><option value=\"Pakistan\"  class=\"choice-176 depth-1\"  >Pakistan<\/option><option value=\"Palau\"  class=\"choice-177 depth-1\"  >Palau<\/option><option value=\"Palestina (Estat de)\"  class=\"choice-178 depth-1\"  >Palestina (Estat de)<\/option><option value=\"Panam\u00e0\"  class=\"choice-179 depth-1\"  >Panam\u00e0<\/option><option value=\"Papua Nova Guinea\"  class=\"choice-180 depth-1\"  >Papua Nova Guinea<\/option><option value=\"Paraguai\"  class=\"choice-181 depth-1\"  >Paraguai<\/option><option value=\"Pa\u00efsos Baixos\"  class=\"choice-182 depth-1\"  >Pa\u00efsos Baixos<\/option><option value=\"Per\u00fa\"  class=\"choice-183 depth-1\"  >Per\u00fa<\/option><option value=\"Pitcairn\"  class=\"choice-184 depth-1\"  >Pitcairn<\/option><option value=\"Polin\u00e8sia francesa\"  class=\"choice-185 depth-1\"  >Polin\u00e8sia francesa<\/option><option value=\"Pol\u00f2nia\"  class=\"choice-186 depth-1\"  >Pol\u00f2nia<\/option><option value=\"Portugal\"  class=\"choice-187 depth-1\"  >Portugal<\/option><option value=\"Puerto Rico\"  class=\"choice-188 depth-1\"  >Puerto Rico<\/option><option value=\"Regne Unit de la Gran Bretanya i Irlanda del Nord\"  class=\"choice-189 depth-1\"  >Regne Unit de la Gran Bretanya i Irlanda del Nord<\/option><option value=\"Rep\u00fablica Centreafricana\"  class=\"choice-190 depth-1\"  >Rep\u00fablica Centreafricana<\/option><option value=\"Rep\u00fablica Txeca\"  class=\"choice-191 depth-1\"  >Rep\u00fablica Txeca<\/option><option value=\"Rep\u00fablica Dominicana\"  class=\"choice-192 depth-1\"  >Rep\u00fablica Dominicana<\/option><option value=\"Rep\u00fablica Democr\u00e0tica Popular de Laos\"  class=\"choice-193 depth-1\"  >Rep\u00fablica Democr\u00e0tica Popular de Laos<\/option><option value=\"Rep\u00fablica \u00c0rab S\u00edria\"  class=\"choice-194 depth-1\"  >Rep\u00fablica \u00c0rab S\u00edria<\/option><option value=\"Reuni\u00f3\"  class=\"choice-195 depth-1\"  >Reuni\u00f3<\/option><option value=\"Rwanda\"  class=\"choice-196 depth-1\"  >Rwanda<\/option><option value=\"Romania\"  class=\"choice-197 depth-1\"  >Romania<\/option><option value=\"Saint Christopher i Nevis\"  class=\"choice-198 depth-1\"  >Saint Christopher i Nevis<\/option><option value=\"Samoa\"  class=\"choice-199 depth-1\"  >Samoa<\/option><option value=\"Samoa Americana\"  class=\"choice-200 depth-1\"  >Samoa Americana<\/option><option value=\"Saint Barth\u00e9lemy\"  class=\"choice-201 depth-1\"  >Saint Barth\u00e9lemy<\/option><option value=\"Sant Mar\u00ed\"  class=\"choice-202 depth-1\"  >Sant Mar\u00ed<\/option><option value=\"Saint Martin (part francesa)\"  class=\"choice-203 depth-1\"  >Saint Martin (part francesa)<\/option><option value=\"Sint Maarten (part neerlandesa)\"  class=\"choice-204 depth-1\"  >Sint Maarten (part neerlandesa)<\/option><option value=\"Sant Pere i Miquel\u00f3\"  class=\"choice-205 depth-1\"  >Sant Pere i Miquel\u00f3<\/option><option value=\"Sant Vicen\u00e7 i les Grenadines\"  class=\"choice-206 depth-1\"  >Sant Vicen\u00e7 i les Grenadines<\/option><option value=\"Saint Helena, Ascension i Tristan da Cunha\"  class=\"choice-207 depth-1\"  >Saint Helena, Ascension i Tristan da Cunha<\/option><option value=\"Saint Lucia\"  class=\"choice-208 depth-1\"  >Saint Lucia<\/option><option value=\"Sao Tom\u00e9 i Pr\u00edncep\"  class=\"choice-209 depth-1\"  >Sao Tom\u00e9 i Pr\u00edncep<\/option><option value=\"Saudita Ar\u00e0bia\"  class=\"choice-210 depth-1\"  >Saudita Ar\u00e0bia<\/option><option value=\"Senegal\"  class=\"choice-211 depth-1\"  >Senegal<\/option><option value=\"S\u00e8rbia\"  class=\"choice-212 depth-1\"  >S\u00e8rbia<\/option><option value=\"Seychelles\"  class=\"choice-213 depth-1\"  >Seychelles<\/option><option value=\"Serra Lleona\"  class=\"choice-214 depth-1\"  >Serra Lleona<\/option><option value=\"Singapur\"  class=\"choice-215 depth-1\"  >Singapur<\/option><option value=\"Som\u00e0lia\"  class=\"choice-216 depth-1\"  >Som\u00e0lia<\/option><option value=\"Sri Lanka\"  class=\"choice-217 depth-1\"  >Sri Lanka<\/option><option value=\"Suazil\u00e0ndia (Regne de)\"  class=\"choice-218 depth-1\"  >Suazil\u00e0ndia (Regne de)<\/option><option value=\"Sud-\u00e0frica\"  class=\"choice-219 depth-1\"  >Sud-\u00e0frica<\/option><option value=\"Sudan\"  class=\"choice-220 depth-1\"  >Sudan<\/option><option value=\"Sudan del sud\"  class=\"choice-221 depth-1\"  >Sudan del sud<\/option><option value=\"Su\u00e8cia\"  class=\"choice-222 depth-1\"  >Su\u00e8cia<\/option><option value=\"Su\u00efssa\"  class=\"choice-223 depth-1\"  >Su\u00efssa<\/option><option value=\"Surinam\"  class=\"choice-224 depth-1\"  >Surinam<\/option><option value=\"Svalbard i Jan Mayen\"  class=\"choice-225 depth-1\"  >Svalbard i Jan Mayen<\/option><option value=\"S\u00e0hara Occidental\"  class=\"choice-226 depth-1\"  >S\u00e0hara Occidental<\/option><option value=\"Tail\u00e0ndia\"  class=\"choice-227 depth-1\"  >Tail\u00e0ndia<\/option><option value=\"Taiwan, Rep\u00fablica de la Xina\"  class=\"choice-228 depth-1\"  >Taiwan, Rep\u00fablica de la Xina<\/option><option value=\"Tanz\u00e0nia (Rep\u00fablica Unida de)\"  class=\"choice-229 depth-1\"  >Tanz\u00e0nia (Rep\u00fablica Unida de)<\/option><option value=\"Tadjikistan\"  class=\"choice-230 depth-1\"  >Tadjikistan<\/option><option value=\"Territori Brit\u00e0nic de l&#039;Oce\u00e0 \u00cdndic\"  class=\"choice-231 depth-1\"  >Territori Brit\u00e0nic de l'Oce\u00e0 \u00cdndic<\/option><option value=\"Terres Australs i Ant\u00e0rtiques Franceses\"  class=\"choice-232 depth-1\"  >Terres Australs i Ant\u00e0rtiques Franceses<\/option><option value=\"Timor-Leste\"  class=\"choice-233 depth-1\"  >Timor-Leste<\/option><option value=\"Togo\"  class=\"choice-234 depth-1\"  >Togo<\/option><option value=\"Tokelau\"  class=\"choice-235 depth-1\"  >Tokelau<\/option><option value=\"Tonga\"  class=\"choice-236 depth-1\"  >Tonga<\/option><option value=\"Trinitat i Tobago\"  class=\"choice-237 depth-1\"  >Trinitat i Tobago<\/option><option value=\"Turkmenistan\"  class=\"choice-238 depth-1\"  >Turkmenistan<\/option><option value=\"Tuvalu\"  class=\"choice-239 depth-1\"  >Tuvalu<\/option><option value=\"Tun\u00edsia\"  class=\"choice-240 depth-1\"  >Tun\u00edsia<\/option><option value=\"Turquia\"  class=\"choice-241 depth-1\"  >Turquia<\/option><option value=\"Ucra\u00efna\"  class=\"choice-242 depth-1\"  >Ucra\u00efna<\/option><option value=\"Uganda\"  class=\"choice-243 depth-1\"  >Uganda<\/option><option value=\"Uruguai\"  class=\"choice-244 depth-1\"  >Uruguai<\/option><option value=\"Uzbekistan\"  class=\"choice-245 depth-1\"  >Uzbekistan<\/option><option value=\"Vanuatu\"  class=\"choice-246 depth-1\"  >Vanuatu<\/option><option value=\"Vene\u00e7uela (Rep\u00fablica Bolivariana de)\"  class=\"choice-247 depth-1\"  >Vene\u00e7uela (Rep\u00fablica Bolivariana de)<\/option><option value=\"Vietnam\"  class=\"choice-248 depth-1\"  >Vietnam<\/option><option value=\"Wallis i Futuna\"  class=\"choice-249 depth-1\"  >Wallis i Futuna<\/option><option value=\"Iemen\"  class=\"choice-250 depth-1\"  >Iemen<\/option><option value=\"Djibouti\"  class=\"choice-251 depth-1\"  >Djibouti<\/option><option value=\"Z\u00e0mbia\"  class=\"choice-252 depth-1\"  >Z\u00e0mbia<\/option><option value=\"Zimbabwe\"  class=\"choice-253 depth-1\"  >Zimbabwe<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_5\">Codi postal <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1478-field_5\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][5]\" aria-errormessage=\"wpforms-1478-field_5-error\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_28-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"28\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_33-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_33\">Tel\u00e8fon <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1478-field_33\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][33]\" aria-label=\"Tel\u00e8fon\" aria-errormessage=\"wpforms-1478-field_33-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_6-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_6\">Correu electr\u00f2nic <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1478-field_6\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][6]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1478-field_6-error\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_240-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"240\"><div id=\"wpforms-1478-field_240\" aria-errormessage=\"wpforms-1478-field_240-error\"><p><b>Vols que t'etiquetem a les teves fotos\/v\u00eddeos a les xarxes socials?<\/b><\/p><\/div><\/div><div id=\"wpforms-1478-field_29-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"29\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_8-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_8\">Instagram<\/label><input type=\"text\" id=\"wpforms-1478-field_8\" class=\"wpforms-field-medium\" name=\"wpforms[fields][8]\" placeholder=\"@\" aria-errormessage=\"wpforms-1478-field_8-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_9\">TikTok<\/label><input type=\"text\" id=\"wpforms-1478-field_9\" class=\"wpforms-field-medium\" name=\"wpforms[fields][9]\" placeholder=\"@\" aria-errormessage=\"wpforms-1478-field_9-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_50-container\" class=\"wpforms-field wpforms-field-html txt-red margin-top-bg\" data-field-id=\"50\"><div id=\"wpforms-1478-field_50\" aria-errormessage=\"wpforms-1478-field_50-error\"><h3>Si ets menor d'edat, dades a emplenar per pare\/mare\/tutor legal:<\/h3><\/div><\/div><div id=\"wpforms-1478-field_34-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"34\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_10-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-trigger\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_10\">Nom<\/label><input type=\"text\" id=\"wpforms-1478-field_10\" class=\"wpforms-field-medium\" name=\"wpforms[fields][10]\" aria-errormessage=\"wpforms-1478-field_10-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_11\">Cognoms<\/label><input type=\"text\" id=\"wpforms-1478-field_11\" class=\"wpforms-field-medium\" name=\"wpforms[fields][11]\" aria-errormessage=\"wpforms-1478-field_11-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_35-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"35\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_12\">N\u00famero de DNI o N\u00famero de Passaport<\/label><input type=\"text\" id=\"wpforms-1478-field_12\" class=\"wpforms-field-medium\" name=\"wpforms[fields][12]\" aria-errormessage=\"wpforms-1478-field_12-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_37-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"37\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_37\">Tel\u00e8fon<\/label><input type=\"tel\" id=\"wpforms-1478-field_37\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][37]\" aria-label=\"Tel\u00e8fon\" aria-errormessage=\"wpforms-1478-field_37-error\" ><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_51-container\" class=\"wpforms-field wpforms-field-html margin-top-bg\" data-field-id=\"51\"><div id=\"wpforms-1478-field_51\" aria-errormessage=\"wpforms-1478-field_51-error\"><h3>Dades per a l'activitat\n<\/h3><\/div><\/div><div id=\"wpforms-1478-field_36-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"36\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_13-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_13\">Data d&#039;entrada <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1478-field_13\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][13][date]\" aria-errormessage=\"wpforms-1478-field_13-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_14-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_14\">Data de sortida <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1478-field_14\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"1\" data-disable-todays-date=\"0\" data-input=\"true\" name=\"wpforms[fields][14][date]\" aria-errormessage=\"wpforms-1478-field_14-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_15-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_15\">Allotjament <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1478-field_15\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][15]\" aria-errormessage=\"wpforms-1478-field_15-error\" required><\/div><div id=\"wpforms-1478-field_52-container\" class=\"wpforms-field wpforms-field-html margin-top-bg\" data-field-id=\"52\"><div id=\"wpforms-1478-field_52\" aria-errormessage=\"wpforms-1478-field_52-error\"><p>En cas d'emerg\u00e8ncia avissar a<\/p><\/div><\/div><div id=\"wpforms-1478-field_38-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"38\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-33-33-33\"><div class=\"wpforms-layout-column wpforms-layout-column-33\" ><div id=\"wpforms-1478-field_16-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_16\">Nom <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1478-field_16\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][16]\" aria-errormessage=\"wpforms-1478-field_16-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\" ><div id=\"wpforms-1478-field_17-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_17\">Cognoms <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1478-field_17\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][17]\" aria-errormessage=\"wpforms-1478-field_17-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\" ><div id=\"wpforms-1478-field_40-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"40\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_40\">Tel\u00e8fon <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1478-field_40\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][40]\" aria-label=\"Tel\u00e8fon\" aria-errormessage=\"wpforms-1478-field_40-error\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_53-container\" class=\"wpforms-field wpforms-field-html margin-top-bg\" data-field-id=\"53\"><div id=\"wpforms-1478-field_53\" aria-errormessage=\"wpforms-1478-field_53-error\"><p>Informaci\u00f3 necess\u00e0ria per preparar el teu equip de busseig<\/p><\/div><\/div><div id=\"wpforms-1478-field_39-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"39\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-33-33-33\"><div class=\"wpforms-layout-column wpforms-layout-column-33\" ><div id=\"wpforms-1478-field_18-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_18\">Altura (cm) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-1478-field_18\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][18]\" step=\"any\" aria-errormessage=\"wpforms-1478-field_18-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\" ><div id=\"wpforms-1478-field_19-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_19\">Pes (kg) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-1478-field_19\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][19]\" step=\"any\" aria-errormessage=\"wpforms-1478-field_19-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\" ><div id=\"wpforms-1478-field_20-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_20\">Talla de cal\u00e7at (EU) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-1478-field_20\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][20]\" step=\"any\" aria-errormessage=\"wpforms-1478-field_20-error\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_57-container\" class=\"wpforms-field wpforms-field-html margin-top-bg\" data-field-id=\"57\"><div id=\"wpforms-1478-field_57\" aria-errormessage=\"wpforms-1478-field_57-error\"><h3>Declaro que:<\/h3>\n<ol>\n<li><p>Scuba School Lanzarote m'informa que, segons la llei espanyola, \u00e9s obligatori emplenar el q\u00fcestionari m\u00e8dic adjunt a aquest formulari i que tota la informaci\u00f3 que he proporcionat \u00e9s sincera, vera\u00e7 i que entenc que accepto la responsabilitat de qualsevol conseq\u00fc\u00e8ncia resultant per haver respost de manera inexacta o no haver revelat la informaci\u00f3 adequada.<\/p><\/li>\n<li><p>S\u00f3c plenament responsable de la cust\u00f2dia del material de lloguer propietat de l'escola, havent de restituir-lo en cas de p\u00e8rdua o sostracci\u00f3 del mateix durant la realitzaci\u00f3 de l'activitat contractada.<\/p><\/li>\n<li><p>Confirmo que se m'ha informat sobre els riscos inherents al busseig i que em comprometo a seguir les instruccions que em proporcioni l'instructor al briefing previ a la immersi\u00f3.<\/p><\/li>\n<li><p>Se m'informa que no es pot volar les 18 hores seg\u00fcents al final de la immersi\u00f3.<\/p>\n<p>A Scuba School Lanzarote, representada legalment per Luis Duque Garcia amb DNI 40.981.368Z, tractem la informaci\u00f3 que se'ns facilita per tal de prestar-li els serveis sol\u00b7licitats i realitzar-ne la facturaci\u00f3. Les dades proporcionades es conservaran mentre es mantingui la relaci\u00f3 comercial o durant els anys necessaris per complir les obligacions legals. Les dades no se cediran a tercers excepte en els casos en qu\u00e8 hi hagi una obligaci\u00f3 legal.<\/p>\n<p>Si signeu aquest document, s'autoritza Scuba School Lanzarote a utilitzar les vostres dades amb la finalitat d'oferir-vos nous serveis, promocions i comunicacions relacionades amb el busseig. Vost\u00e8 t\u00e9 dret a obtenir confirmaci\u00f3 sobre si a Scuba School Lanzarote estem tractant les seves dades personals de forma correcta, per tant, t\u00e9 dret a accedir a les seves dades personals, rectificar les dades inexactes o sol\u00b7licitar la seva supressi\u00f3 quan les dades ja no siguin necess\u00e0ries.< \/p>\n<\/p><p>Durant la realitzaci\u00f3 de les activitats es podran fer fotografies o enregistrament d'imatges, que seran utilitzades posteriorment per a activitats promocionals, divulgatives o educatives del submarinisme i de l'escola. Signant aquest document, consenteixo la realitzaci\u00f3 i tractament d'aquestes imatges.<\/p>\n<\/li>\n<\/ol><\/div><\/div><div id=\"wpforms-1478-field_41-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"41\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_45-container\" class=\"wpforms-field wpforms-field-signature margin-top-bg\" data-field-id=\"45\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_45\">Signatura <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1478-field_45\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][45]\" autocomplete=\"off\" inputmode=\"none\" aria-errormessage=\"wpforms-1478-field_45-error\" required><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-1478-field_45-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Clear Signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Clear Signature<\/div>\n\t\t\t<\/div><\/div><\/div><div id=\"wpforms-1478-field_21-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_21\">Data <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1478-field_21\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"1\" data-disable-todays-date=\"0\" data-input=\"true\" name=\"wpforms[fields][21][date]\" aria-errormessage=\"wpforms-1478-field_21-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_46-container\" class=\"wpforms-field wpforms-field-signature margin-top-bg wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"46\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_46\">Firma Tutor <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1478-field_46\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][46]\" autocomplete=\"off\" inputmode=\"none\" aria-errormessage=\"wpforms-1478-field_46-error\" required><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-1478-field_46-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Clear Signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Clear Signature<\/div>\n\t\t\t<\/div><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_241-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"241\"><div class=\"wpforms-clear wpforms-pagebreak-right\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"1\" data-formid=\"1478\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Seg\u00fcent<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2 last \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-1478-field_70-container\" class=\"wpforms-field wpforms-field-html margin-top-bg\" data-field-id=\"70\"><div id=\"wpforms-1478-field_70\" aria-errormessage=\"wpforms-1478-field_70-error\"><h1>Informe m\u00e8dic del bussejador<\/h1><h2>Q\u00fcestionari del participant<\/h2><\/div><\/div><div id=\"wpforms-1478-field_71-container\" class=\"wpforms-field wpforms-field-html margin-top-bg\" data-field-id=\"71\"><div id=\"wpforms-1478-field_71\" aria-errormessage=\"wpforms-1478-field_71-error\"><p>Les activitats de busseig recreatiu i apnea exigeixen que la persona que vol practicar-les gaudeixi de bona salut f\u00edsica i mental. Tot seguit, s'enumeren algunes de les malalties o problemes de salut que poden suposar un risc durant la pr\u00e0ctica del busseig. Els bussejadors que pateixen o s\u00f3n propensos a patir qualsevol d'aquestes afeccions s'han de sotmetre a un examen m\u00e8dic. Aquest q\u00fcestionari m\u00e8dic per a participants en programes de busseig et permet saber, com a refer\u00e8ncia, si et cal sotmetre't a aquest examen.<\/p>\n<p>Si tens algun dubte o consideres que els resultats del present formulari no es corresponen amb la teva condici\u00f3 f\u00edsica, consulta amb el teu metge abans de bussejar. Si et trobes malament, no busseges. Si creus que podries patir alguna malaltia contagiosa, protegeix-te i protegeix els altres: evita participar en activitats o sessions de formaci\u00f3 de busseig. En aquest formulari, el terme \u00abbusseig\u00bb fa refer\u00e8ncia tant al busseig recreatiu com a l'apnea. Aquest formulari est\u00e0 dissenyat per utilitzar-se fonamentalment com a avaluaci\u00f3 m\u00e8dica inicial als bussejadors que han comen\u00e7at recentment la pr\u00e0ctica d'aquesta activitat, per\u00f2 tamb\u00e9 \u00e9s adequat per a aquells que reben educaci\u00f3 cont\u00ednua. Per la teva seguretat i la dels bussejadors que t'acompanyen, respon totes les preguntes amb sinceritat.<\/p>\n<br \/><\/div><\/div><div id=\"wpforms-1478-field_115-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"115\"><div id=\"wpforms-1478-field_115\" aria-errormessage=\"wpforms-1478-field_115-error\"><h3>Instruccions<\/h3>\n<p>Completa aquest q\u00fcestionari com a requisit previ per rebre formaci\u00f3 relacionada amb l'apnea o el busseig amb equip aut\u00f2nom.<\/p>\n<p><b>Nota:<\/b> Si est\u00e0s embarassada o intentes quedar-te embarassada, no bussis.<\/p><\/div><\/div><div id=\"wpforms-1478-field_72-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"72\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_74-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"74\"><div id=\"wpforms-1478-field_74\" aria-errormessage=\"wpforms-1478-field_74-error\"><span class=\"numero-preg\">1<\/span><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_76-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"76\"><div id=\"wpforms-1478-field_76\" aria-errormessage=\"wpforms-1478-field_76-error\"><p>He tingut problemes als pulmons, amb la respiraci\u00f3, amb el cor o amb la sang que han afectat el meu rendiment f\u00edsic o mental normal.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_77-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-trigger\" data-field-id=\"77\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">He tingut problemes als pulmons, amb la respiraci\u00f3, amb el cor o amb la sang que han afectat el meu rendiment f\u00edsic o mental normal. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_77\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_77_1\" name=\"wpforms[fields][77]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-1478-field_77_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_77_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_77_2\" name=\"wpforms[fields][77]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_77_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_77_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_134-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"134\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_136-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"136\" style=\"display:none;\"><div id=\"wpforms-1478-field_136\" aria-errormessage=\"wpforms-1478-field_136-error\"><p>Una cirurgia tor\u00e0cica, una cirurgia card\u00edaca, una cirurgia de v\u00e0lvules card\u00edaques, un dispositiu m\u00e8dic implantable (per exemple, un stent, un marcapassos o un neuroestimulador), un pneumot\u00f2rax o una malaltia pulmonar cr\u00f2nica.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_137-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"137\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Una cirurgia tor\u00e0cica, una cirurgia card\u00edaca, una cirurgia de v\u00e0lvules card\u00edaques, un dispositiu m\u00e8dic implantable (per exemple, un stent, un marcapassos o un neuroestimulador), un pneumot\u00f2rax o una malaltia pulmonar cr\u00f2nica. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_137\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_137_1\" name=\"wpforms[fields][137]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_137_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_137_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_137_2\" name=\"wpforms[fields][137]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_137_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_137_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_138-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"138\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_139-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"139\" style=\"display:none;\"><div id=\"wpforms-1478-field_139\" aria-errormessage=\"wpforms-1478-field_139-error\"><p>Asma, sibil\u00e0ncies, al\u00b7l\u00e8rgies greus, al\u00b7l\u00e8rgia al pol\u00b7len o alguna obstrucci\u00f3 de les vies respirat\u00f2ries en els darrers 12 mesos, que limita la meva capacitat f\u00edsica o m'impedeix practicar exercici amb normalitat.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_140-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"140\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Asma, sibil\u00e0ncies, al\u00b7l\u00e8rgies greus, al\u00b7l\u00e8rgia al pol\u00b7len o alguna obstrucci\u00f3 de les vies respirat\u00f2ries en els darrers 12 mesos, que limita la meva capacitat f\u00edsica o m&#039;impedeix practicar exercici amb normalitat. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_140\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_140_1\" name=\"wpforms[fields][140]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_140_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_140_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_140_2\" name=\"wpforms[fields][140]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_140_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_140_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_141-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"141\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_142-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"142\" style=\"display:none;\"><div id=\"wpforms-1478-field_142\" aria-errormessage=\"wpforms-1478-field_142-error\"><p>Un problema o malaltia del cor, per exemple, angina de pit, dolor al pit en fer esfor\u00e7os, insufici\u00e8ncia card\u00edaca, edema pulmonar per immersi\u00f3 o infart agut de miocardi o accident cerebrovascular, o estic en tractament per alguna afecci\u00f3 card\u00edaca.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_143-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"143\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Un problema o malaltia del cor, per exemple, angina de pit, dolor al pit en fer esfor\u00e7os, insufici\u00e8ncia card\u00edaca, edema pulmonar per immersi\u00f3 o infart agut de miocardi o accident cerebrovascular, o estic en tractament per alguna afecci\u00f3 card\u00edaca. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_143\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_143_1\" name=\"wpforms[fields][143]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_143_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_143_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_143_2\" name=\"wpforms[fields][143]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_143_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_143_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_144-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"144\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_145-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"145\" style=\"display:none;\"><div id=\"wpforms-1478-field_145\" aria-errormessage=\"wpforms-1478-field_145-error\"><p>Bronquitis cr\u00f2nica i tos persistent en els darrers 12 mesos o m'han diagnosticat un emfisema pulmonar.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_146-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"146\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Bronquitis cr\u00f2nica i tos persistent en els darrers 12 mesos o m&#039;han diagnosticat un emfisema pulmonar. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_146\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_146_1\" name=\"wpforms[fields][146]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_146_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_146_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_146_2\" name=\"wpforms[fields][146]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_146_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_146_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_147-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"147\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_148-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"148\" style=\"display:none;\"><div id=\"wpforms-1478-field_148\" aria-errormessage=\"wpforms-1478-field_148-error\"><p>S\u00edmptomes que afecten els pulmons, la respiraci\u00f3, el cor o la sang en els \u00faltims 30 dies i que perjudiquen el meu rendiment f\u00edsic o mental.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_149-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"149\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">S\u00edmptomes que afecten els pulmons, la respiraci\u00f3, el cor o la sang en els \u00faltims 30 dies i que perjudiquen el meu rendiment f\u00edsic o mental. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_149\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_149_1\" name=\"wpforms[fields][149]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_149_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_149_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_149_2\" name=\"wpforms[fields][149]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_149_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_149_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_79-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"79\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_80-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"80\"><div id=\"wpforms-1478-field_80\" aria-errormessage=\"wpforms-1478-field_80-error\"><span class=\"numero-preg\">2<\/span><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_81-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"81\"><div id=\"wpforms-1478-field_81\" aria-errormessage=\"wpforms-1478-field_81-error\"><p>Tinc m\u00e9s de 45 anys.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_82-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-trigger\" data-field-id=\"82\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Tinc m\u00e9s de 45 anys. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_82\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_82_1\" name=\"wpforms[fields][82]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-1478-field_82_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_82_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_82_2\" name=\"wpforms[fields][82]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_82_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_82_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_150-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"150\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_151-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"151\" style=\"display:none;\"><div id=\"wpforms-1478-field_151\" aria-errormessage=\"wpforms-1478-field_151-error\"><p>Actualment fumo o inhalo nicotina en altres formats.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_152-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"152\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Actualment fumo o inhalo nicotina en altres formats. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_152\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_152_1\" name=\"wpforms[fields][152]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_152_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_152_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_152_2\" name=\"wpforms[fields][152]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_152_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_152_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_153-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"153\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_154-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"154\" style=\"display:none;\"><div id=\"wpforms-1478-field_154\" aria-errormessage=\"wpforms-1478-field_154-error\"><p>Tinc el colesterol alt.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_155-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"155\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Tinc el colesterol alt. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_155\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_155_1\" name=\"wpforms[fields][155]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_155_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_155_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_155_2\" name=\"wpforms[fields][155]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_155_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_155_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_156-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"156\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_157-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"157\" style=\"display:none;\"><div id=\"wpforms-1478-field_157\" aria-errormessage=\"wpforms-1478-field_157-error\"><p>Tinc hipertensi\u00f3 arterial.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_158-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"158\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Tinc hipertensi\u00f3 arterial. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_158\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_158_1\" name=\"wpforms[fields][158]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_158_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_158_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_158_2\" name=\"wpforms[fields][158]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_158_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_158_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_159-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"159\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_160-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"160\" style=\"display:none;\"><div id=\"wpforms-1478-field_160\" aria-errormessage=\"wpforms-1478-field_160-error\"><p><\/p><p>Tinc un familiar (de primer o de segon grau de consanguinitat) que ha mort de mort sobtada, malaltia card\u00edaca o accident cerebrovascular abans dels 50 anys o tinc antecedents familiars de malalties card\u00edaques diagnosticades abans dels 50 anys (incloses les alteracions del ritme card\u00edac, malaltia de les art\u00e8ries coron\u00e0ries o una cardiomiopatia).<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_161-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"161\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Tinc un familiar (de primer o de segon grau de consanguinitat) que ha mort de mort sobtada, malaltia card\u00edaca o accident cerebrovascular abans dels 50 anys o tinc antecedents familiars de malalties card\u00edaques diagnosticades abans dels 50 anys (incloses les alteracions del ritme card\u00edac, malaltia de les art\u00e8ries coron\u00e0ries o una cardiomiopatia). <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_161\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_161_1\" name=\"wpforms[fields][161]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_161_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_161_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_161_2\" name=\"wpforms[fields][161]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_161_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_161_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_83-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"83\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_84-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"84\"><div id=\"wpforms-1478-field_84\" aria-errormessage=\"wpforms-1478-field_84-error\"><span class=\"numero-preg\">3<\/span><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_85-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"85\"><div id=\"wpforms-1478-field_85\" aria-errormessage=\"wpforms-1478-field_85-error\"><p>Em costa fer exercici moderat (per exemple, caminar 1.6 quil\u00f2metres en 14 minuts o 200 metres sense descansar) o no he pogut fer activitat f\u00edsica normal per motius de salut o pel meu estat f\u00edsic en els \u00faltims 12 mesos.<\/p> p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_86-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns\" data-field-id=\"86\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Em costa fer exercici moderat (per exemple, caminar 1.6 quil\u00f2metres en 14 minuts o 200 metres sense descansar) o no he pogut fer activitat f\u00edsica normal per motius de salut o pel meu estat f\u00edsic en els \u00faltims 12 mesos. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_86\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_86_1\" name=\"wpforms[fields][86]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_86_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_86_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_86_2\" name=\"wpforms[fields][86]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_86_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_86_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_87-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"87\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_88-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"88\"><div id=\"wpforms-1478-field_88\" aria-errormessage=\"wpforms-1478-field_88-error\"><span class=\"numero-preg\">4<\/span><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_89-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"89\"><div id=\"wpforms-1478-field_89\" aria-errormessage=\"wpforms-1478-field_89-error\"><p>He tingut algun problema ocular, auditiu o relacionat amb les fosses nasals o els pits paranasals.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_90-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-trigger\" data-field-id=\"90\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">He tingut algun problema ocular, auditiu o relacionat amb les fosses nasals o els pits paranasals. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_90\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_90_1\" name=\"wpforms[fields][90]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-1478-field_90_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_90_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_90_2\" name=\"wpforms[fields][90]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_90_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_90_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_162-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"162\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_163-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"163\" style=\"display:none;\"><div id=\"wpforms-1478-field_163\" aria-errormessage=\"wpforms-1478-field_163-error\"><p>Una cirurgia sinusal en els darrers 6 mesos.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_164-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"164\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Una cirurgia sinusal en els darrers 6 mesos. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_164\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_164_1\" name=\"wpforms[fields][164]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_164_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_164_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_164_2\" name=\"wpforms[fields][164]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_164_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_164_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_165-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"165\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_166-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"166\" style=\"display:none;\"><div id=\"wpforms-1478-field_166\" aria-errormessage=\"wpforms-1478-field_166-error\"><p>Alguna malaltia auditiva o una cirurgia de l'o\u00efda, p\u00e8rdua d'audici\u00f3 o alteracions de l'equilibri.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_167-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"167\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Alguna malaltia auditiva o una cirurgia de l&#039;o\u00efda, p\u00e8rdua d&#039;audici\u00f3 o alteracions de l&#039;equilibri. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_167\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_167_1\" name=\"wpforms[fields][167]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_167_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_167_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_167_2\" name=\"wpforms[fields][167]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_167_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_167_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_168-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"168\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_169-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"169\" style=\"display:none;\"><div id=\"wpforms-1478-field_169\" aria-errormessage=\"wpforms-1478-field_169-error\"><p>Sinusitis cr\u00f2nica en els darrers 12 mesos.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_170-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"170\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Sinusitis cr\u00f2nica en els darrers 12 mesos. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_170\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_170_1\" name=\"wpforms[fields][170]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_170_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_170_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_170_2\" name=\"wpforms[fields][170]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_170_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_170_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_171-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"171\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_172-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"172\" style=\"display:none;\"><div id=\"wpforms-1478-field_172\" aria-errormessage=\"wpforms-1478-field_172-error\"><p>Una cirurgia ocular en els darrers 3 mesos.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_173-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"173\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Una cirurgia ocular en els darrers 3 mesos. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_173\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_173_1\" name=\"wpforms[fields][173]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_173_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_173_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_173_2\" name=\"wpforms[fields][173]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_173_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_173_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_91-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"91\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_92-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"92\"><div id=\"wpforms-1478-field_92\" aria-errormessage=\"wpforms-1478-field_92-error\"><span class=\"numero-preg\">5<\/span><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_93-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"93\"><div id=\"wpforms-1478-field_93\" aria-errormessage=\"wpforms-1478-field_93-error\"><p>M'he operat en els darrers 12 mesos o actualment pateixo algun tipus d'afecci\u00f3 derivada d'una intervenci\u00f3 quir\u00fargica anterior.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_94-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns\" data-field-id=\"94\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">M&#039;he operat en els darrers 12 mesos o actualment pateixo algun tipus d&#039;afecci\u00f3 derivada d&#039;una intervenci\u00f3 quir\u00fargica anterior. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_94\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_94_1\" name=\"wpforms[fields][94]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_94_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_94_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_94_2\" name=\"wpforms[fields][94]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_94_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_94_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_95-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"95\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_96-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"96\"><div id=\"wpforms-1478-field_96\" aria-errormessage=\"wpforms-1478-field_96-error\"><span class=\"numero-preg\">6<\/span><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_97-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"97\"><div id=\"wpforms-1478-field_97\" aria-errormessage=\"wpforms-1478-field_97-error\"><p>He perdut el coneixement, he patit mals de cap per migranya, convulsions, un accident cerebrovascular o un traumatisme cranial greu o pateixo una malaltia o lesi\u00f3 neurol\u00f2gica permanent.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_98-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-trigger\" data-field-id=\"98\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">He perdut el coneixement, he patit mals de cap per migranya, convulsions, un accident cerebrovascular o un traumatisme cranial greu o pateixo una malaltia o lesi\u00f3 neurol\u00f2gica permanent. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_98\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_98_1\" name=\"wpforms[fields][98]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-1478-field_98_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_98_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_98_2\" name=\"wpforms[fields][98]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_98_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_98_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_174-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"174\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_175-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"175\" style=\"display:none;\"><div id=\"wpforms-1478-field_175\" aria-errormessage=\"wpforms-1478-field_175-error\"><p>Un traumatisme cranial amb p\u00e8rdua del coneixement en els darrers 5 anys.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_176-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"176\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Un traumatisme cranial amb p\u00e8rdua del coneixement en els darrers 5 anys. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_176\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_176_1\" name=\"wpforms[fields][176]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_176_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_176_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_176_2\" name=\"wpforms[fields][176]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_176_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_176_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_177-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"177\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_178-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"178\" style=\"display:none;\"><div id=\"wpforms-1478-field_178\" aria-errormessage=\"wpforms-1478-field_178-error\"><p>Lesions o malalties neurol\u00f2giques cr\u00f2niques.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_179-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"179\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Lesions o malalties neurol\u00f2giques cr\u00f2niques. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_179\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_179_1\" name=\"wpforms[fields][179]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_179_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_179_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_179_2\" name=\"wpforms[fields][179]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_179_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_179_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_180-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"180\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_181-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"181\" style=\"display:none;\"><div id=\"wpforms-1478-field_181\" aria-errormessage=\"wpforms-1478-field_181-error\"><p>Dolors de cap cr\u00f2nics per migranya en els \u00faltims 12 mesos o prenc medicaci\u00f3 per prevenir-los.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_182-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"182\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Dolors de cap cr\u00f2nics per migranya en els \u00faltims 12 mesos o prenc medicaci\u00f3 per prevenir-los. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_182\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_182_1\" name=\"wpforms[fields][182]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_182_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_182_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_182_2\" name=\"wpforms[fields][182]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_182_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_182_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_183-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"183\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_184-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"184\" style=\"display:none;\"><div id=\"wpforms-1478-field_184\" aria-errormessage=\"wpforms-1478-field_184-error\"><p>Desvaniments o desmais (p\u00e8rdua total\/parcial del coneixement) en els darrers 5 anys.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_185-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"185\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Desvaniments o desmais (p\u00e8rdua total\/parcial del coneixement) en els darrers 5 anys. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_185\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_185_1\" name=\"wpforms[fields][185]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_185_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_185_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_185_2\" name=\"wpforms[fields][185]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_185_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_185_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_186-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"186\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_187-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"187\" style=\"display:none;\"><div id=\"wpforms-1478-field_187\" aria-errormessage=\"wpforms-1478-field_187-error\"><p>Epil\u00e8psia o convulsions, o prenc medicaci\u00f3 per prevenir-los.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_188-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"188\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Epil\u00e8psia o convulsions, o prenc medicaci\u00f3 per prevenir-los. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_188\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_188_1\" name=\"wpforms[fields][188]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_188_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_188_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_188_2\" name=\"wpforms[fields][188]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_188_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_188_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_99-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"99\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_100-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"100\"><div id=\"wpforms-1478-field_100\" aria-errormessage=\"wpforms-1478-field_100-error\"><span class=\"numero-preg\">7<\/span><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_101-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"101\"><div id=\"wpforms-1478-field_101\" aria-errormessage=\"wpforms-1478-field_101-error\"><p>Estic seguint un tractament (o he seguit un tractament en els darrers cinc anys) per tractar problemes psicol\u00f2gics, trastorns de la personalitat, atacs de p\u00e0nic, una addicci\u00f3 a les drogues oa l'alcohol o m'han diagnosticat una dificultat d'aprenentatge o de comportament.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_102-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-trigger\" data-field-id=\"102\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Estic seguint un tractament (o he seguit un tractament en els darrers cinc anys) per tractar problemes psicol\u00f2gics, trastorns de la personalitat, atacs de p\u00e0nic, una addicci\u00f3 a les drogues oa l&#039;alcohol o m&#039;han diagnosticat una dificultat d&#039;aprenentatge o de comportament. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_102\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_102_1\" name=\"wpforms[fields][102]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-1478-field_102_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_102_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_102_2\" name=\"wpforms[fields][102]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_102_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_102_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_189-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"189\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_190-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"190\" style=\"display:none;\"><div id=\"wpforms-1478-field_190\" aria-errormessage=\"wpforms-1478-field_190-error\"><p>Problemes de salut conductual, mentals o psicol\u00f2gics que requereixen tractament m\u00e8dic o psiqui\u00e0tric.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_191-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"191\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Problemes de salut conductual, mentals o psicol\u00f2gics que requereixen tractament m\u00e8dic o psiqui\u00e0tric. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_191\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_191_1\" name=\"wpforms[fields][191]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_191_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_191_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_191_2\" name=\"wpforms[fields][191]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_191_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_191_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_192-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"192\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_193-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"193\" style=\"display:none;\"><div id=\"wpforms-1478-field_193\" aria-errormessage=\"wpforms-1478-field_193-error\"><p>Un trastorn depressiu greu, pensaments su\u00efcides, atacs de p\u00e0nic o un trastorn bipolar descontrolat que requereix medicaci\u00f3\/tractament psiqui\u00e0tric.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_194-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"194\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Un trastorn depressiu greu, pensaments su\u00efcides, atacs de p\u00e0nic o un trastorn bipolar descontrolat que requereix medicaci\u00f3\/tractament psiqui\u00e0tric. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_194\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_194_1\" name=\"wpforms[fields][194]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_194_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_194_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_194_2\" name=\"wpforms[fields][194]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_194_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_194_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_195-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"195\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_196-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"196\" style=\"display:none;\"><div id=\"wpforms-1478-field_196\" aria-errormessage=\"wpforms-1478-field_196-error\"><p>Una malaltia de salut mental o un trastorn d'aprenentatge o de desenvolupament que requereix atenci\u00f3 cont\u00ednua o una adaptaci\u00f3 especial.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_197-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"197\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Una malaltia de salut mental o un trastorn d&#039;aprenentatge o de desenvolupament que requereix atenci\u00f3 cont\u00ednua o una adaptaci\u00f3 especial. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_197\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_197_1\" name=\"wpforms[fields][197]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_197_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_197_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_197_2\" name=\"wpforms[fields][197]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_197_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_197_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_198-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"198\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_199-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"199\" style=\"display:none;\"><div id=\"wpforms-1478-field_199\" aria-errormessage=\"wpforms-1478-field_199-error\"><p>Addicci\u00f3 a les drogues oa l'alcohol en els darrers 5 anys per a la qual he requerit tractament.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_200-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"200\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Addicci\u00f3 a les drogues oa l&#039;alcohol en els darrers 5 anys per a la qual he requerit tractament. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_200\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_200_1\" name=\"wpforms[fields][200]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_200_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_200_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_200_2\" name=\"wpforms[fields][200]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_200_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_200_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_103-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"103\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_104-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"104\"><div id=\"wpforms-1478-field_104\" aria-errormessage=\"wpforms-1478-field_104-error\"><span class=\"numero-preg\">8<\/span><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_105-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"105\"><div id=\"wpforms-1478-field_105\" aria-errormessage=\"wpforms-1478-field_105-error\"><p>He tingut problemes d'esquena, h\u00e8rnia, \u00falceres o diabetis.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_106-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-trigger\" data-field-id=\"106\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">He tingut problemes d&#039;esquena, h\u00e8rnia, \u00falceres o diabetis. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_106\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_106_1\" name=\"wpforms[fields][106]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-1478-field_106_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_106_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_106_2\" name=\"wpforms[fields][106]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_106_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_106_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_201-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"201\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_202-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"202\" style=\"display:none;\"><div id=\"wpforms-1478-field_202\" aria-errormessage=\"wpforms-1478-field_202-error\"><p>Problemes d'esquena recurrents durant els darrers 6 mesos que limiten la meva activitat di\u00e0ria.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_203-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"203\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Problemes d&#039;esquena recurrents durant els darrers 6 mesos que limiten la meva activitat di\u00e0ria. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_203\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_203_1\" name=\"wpforms[fields][203]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_203_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_203_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_203_2\" name=\"wpforms[fields][203]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_203_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_203_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_205-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"205\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_206-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"206\" style=\"display:none;\"><div id=\"wpforms-1478-field_206\" aria-errormessage=\"wpforms-1478-field_206-error\"><p>Una cirurgia d'esquena o de columna vertebral en els darrers 12 mesos.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_207-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"207\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Una cirurgia d&#039;esquena o de columna vertebral en els darrers 12 mesos. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_207\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_207_1\" name=\"wpforms[fields][207]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_207_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_207_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_207_2\" name=\"wpforms[fields][207]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_207_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_207_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_208-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"208\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_209-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"209\" style=\"display:none;\"><div id=\"wpforms-1478-field_209\" aria-errormessage=\"wpforms-1478-field_209-error\"><p>Diabetis, ja sigui tractada mitjan\u00e7ant insulina o dieta, o diabetis gestacional, en els darrers 12 mesos.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_210-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"210\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Diabetis, ja sigui tractada mitjan\u00e7ant insulina o dieta, o diabetis gestacional, en els darrers 12 mesos. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_210\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_210_1\" name=\"wpforms[fields][210]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_210_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_210_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_210_2\" name=\"wpforms[fields][210]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_210_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_210_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_211-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"211\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_212-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"212\" style=\"display:none;\"><div id=\"wpforms-1478-field_212\" aria-errormessage=\"wpforms-1478-field_212-error\"><p>Una h\u00e8rnia sense corregir que limita les meves habilitats f\u00edsiques.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_213-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"213\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Una h\u00e8rnia sense corregir que limita les meves habilitats f\u00edsiques. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_213\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_213_1\" name=\"wpforms[fields][213]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_213_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_213_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_213_2\" name=\"wpforms[fields][213]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_213_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_213_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_214-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"214\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_215-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"215\" style=\"display:none;\"><div id=\"wpforms-1478-field_215\" aria-errormessage=\"wpforms-1478-field_215-error\"><p>\u00dalceres actives o no tractades, ferides problem\u00e0tiques o un tractament quir\u00fargic per a una \u00falcera en els darrers 6 mesos.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_216-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"216\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">\u00dalceres actives o no tractades, ferides problem\u00e0tiques o un tractament quir\u00fargic per a una \u00falcera en els darrers 6 mesos. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_216\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_216_1\" name=\"wpforms[fields][216]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-1478-field_216_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_216_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_216_2\" name=\"wpforms[fields][216]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_216_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_216_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_107-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"107\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_108-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"108\"><div id=\"wpforms-1478-field_108\" aria-errormessage=\"wpforms-1478-field_108-error\"><span class=\"numero-preg\">9<\/span><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_109-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"109\"><div id=\"wpforms-1478-field_109\" aria-errormessage=\"wpforms-1478-field_109-error\"><p>He patit recentment problemes estomacals o intestinals (per exemple, diarrea).<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_110-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-trigger\" data-field-id=\"110\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">He patit recentment problemes estomacals o intestinals (per exemple, diarrea). <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_110\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_110_1\" name=\"wpforms[fields][110]\" value=\"S\u00ed\" aria-errormessage=\"wpforms-1478-field_110_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_110_1\">S\u00ed<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_110_2\" name=\"wpforms[fields][110]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_110_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_110_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_217-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"217\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_218-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"218\" style=\"display:none;\"><div id=\"wpforms-1478-field_218\" aria-errormessage=\"wpforms-1478-field_218-error\"><p>Una cirurgia d'ostomia i no tinc autoritzaci\u00f3 m\u00e8dica per nedar o fer activitat f\u00edsica.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_219-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"219\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Una cirurgia d&#039;ostomia i no tinc autoritzaci\u00f3 m\u00e8dica per nedar o fer activitat f\u00edsica. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_219\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_219_1\" name=\"wpforms[fields][219]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_219_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_219_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_219_2\" name=\"wpforms[fields][219]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_219_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_219_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_220-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"220\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_221-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"221\" style=\"display:none;\"><div id=\"wpforms-1478-field_221\" aria-errormessage=\"wpforms-1478-field_221-error\"><p>Quadres de deshidrataci\u00f3 en els darrers 7 dies que han requerit intervenci\u00f3 m\u00e8dica.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_222-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"222\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Quadres de deshidrataci\u00f3 en els darrers 7 dies que han requerit intervenci\u00f3 m\u00e8dica. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_222\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_222_1\" name=\"wpforms[fields][222]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_222_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_222_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_222_2\" name=\"wpforms[fields][222]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_222_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_222_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_223-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"223\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_224-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"224\" style=\"display:none;\"><div id=\"wpforms-1478-field_224\" aria-errormessage=\"wpforms-1478-field_224-error\"><p>\u00dalceres estomacals o intestinals actives o no tractades o un tractament quir\u00fargic per a una \u00falcera en els darrers 6 mesos.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_225-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"225\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">\u00dalceres estomacals o intestinals actives o no tractades o un tractament quir\u00fargic per a una \u00falcera en els darrers 6 mesos. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_225\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_225_1\" name=\"wpforms[fields][225]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_225_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_225_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_225_2\" name=\"wpforms[fields][225]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_225_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_225_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_226-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"226\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_227-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"227\" style=\"display:none;\"><div id=\"wpforms-1478-field_227\" aria-errormessage=\"wpforms-1478-field_227-error\"><p>Ardor d'est\u00f3mac freq\u00fcent, regurgitacions o malaltia per reflux gastroesof\u00e0gic (ERGE).<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_228-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"228\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Ardor d&#039;est\u00f3mac freq\u00fcent, regurgitacions o malaltia per reflux gastroesof\u00e0gic (ERGE). <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_228\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_228_1\" name=\"wpforms[fields][228]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_228_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_228_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_228_2\" name=\"wpforms[fields][228]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_228_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_228_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_229-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"229\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_230-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"230\" style=\"display:none;\"><div id=\"wpforms-1478-field_230\" aria-errormessage=\"wpforms-1478-field_230-error\"><p>Colitis ulcerosa activa o no controlada o malaltia de Crohn.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_231-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"231\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Colitis ulcerosa activa o no controlada o malaltia de Crohn. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_231\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_231_1\" name=\"wpforms[fields][231]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_231_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_231_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_231_2\" name=\"wpforms[fields][231]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_231_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_231_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_232-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"232\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_233-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"233\" style=\"display:none;\"><div id=\"wpforms-1478-field_233\" aria-errormessage=\"wpforms-1478-field_233-error\"><p>Una cirurgia bari\u00e0trica en els darrers 12 mesos.<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_234-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"234\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Una cirurgia bari\u00e0trica en els darrers 12 mesos. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_234\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_234_1\" name=\"wpforms[fields][234]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_234_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_234_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_234_2\" name=\"wpforms[fields][234]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_234_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_234_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_111-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"111\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_112-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"112\"><div id=\"wpforms-1478-field_112\" aria-errormessage=\"wpforms-1478-field_112-error\"><span class=\"numero-preg\">10<\/span><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1478-field_113-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"113\"><div id=\"wpforms-1478-field_113\" aria-errormessage=\"wpforms-1478-field_113-error\"><p>Estic prenent medicaments sota prescripci\u00f3 m\u00e8dica (excepte si es tracta d'anticonceptius o medicaments antipal\u00fadics que no siguin mefloquina com Lariam).<\/p><\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_114-container\" class=\"wpforms-field wpforms-field-radio si-no wpforms-list-2-columns\" data-field-id=\"114\"><fieldset><legend class=\"wpforms-field-label wpforms-label-hide\" aria-hidden=\"false\">Estic prenent medicaments sota prescripci\u00f3 m\u00e8dica (excepte si es tracta d&#039;anticonceptius o medicaments antipal\u00fadics que no siguin mefloquina com Lariam). <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1478-field_114\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_114_1\" name=\"wpforms[fields][114]\" value=\"S\u00ed *\" aria-errormessage=\"wpforms-1478-field_114_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_114_1\">S\u00ed *<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1478-field_114_2\" name=\"wpforms[fields][114]\" value=\"No\" aria-errormessage=\"wpforms-1478-field_114_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1478-field_114_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_116-container\" class=\"wpforms-field wpforms-field-html margin-top-bg\" data-field-id=\"116\"><div id=\"wpforms-1478-field_116\" aria-errormessage=\"wpforms-1478-field_116-error\"><h3>Signatura del participant<\/h3> <p><b>Si has respost \u00abNo\u00bb a les 10 preguntes anteriors, no cal una avaluaci\u00f3 m\u00e8dica. Afegeix a continuaci\u00f3 la data i la teva signatura per acceptar la declaraci\u00f3 del participant.<\/b><\/p> <p><b>Si has respost \u00abS\u00ed\u00bb en alguna casella assenyalada amb '*' ser\u00e0 revisat pel personal del Centre de Busseig i en cas que necessitem informaci\u00f3 addicional ens posarem en contacte amb tu.<\/b><\/p> <p><b>Declaraci\u00f3 del Participant: <\/b>He respost totes les preguntes honestament i entenc que accepto la responsabilitat per qualsevol conseq\u00fc\u00e8ncia resultant de qualsevol pregunta que pugui haver respost falsament o per no haver informat de qualsevol problema de salut existent o anterior.<\/p><\/div><\/div><div id=\"wpforms-1478-field_117-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"117\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_118-container\" class=\"wpforms-field wpforms-field-signature\" data-field-id=\"118\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_118\">Signatura del participant <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1478-field_118\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][118]\" autocomplete=\"off\" inputmode=\"none\" aria-errormessage=\"wpforms-1478-field_118-error\" aria-describedby=\"wpforms-1478-field_118-description\" required><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-1478-field_118-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Clear Signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Clear Signature<\/div>\n\t\t\t<\/div><\/div><div id=\"wpforms-1478-field_118-description\" class=\"wpforms-field-description\">(Si \u00e9s menor d'edat, cal la signatura del pare\/mare\/tutor del participant)<\/div><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><\/div><\/div><\/div><div id=\"wpforms-1478-field_133-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"133\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_122-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"122\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_122\">Nom del participant<\/label><input type=\"text\" id=\"wpforms-1478-field_122\" class=\"wpforms-field-medium\" name=\"wpforms[fields][122]\" aria-errormessage=\"wpforms-1478-field_122-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-1478-field_119-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"119\"><label class=\"wpforms-field-label\" for=\"wpforms-1478-field_119\">Data <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1478-field_119\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][119][date]\" aria-errormessage=\"wpforms-1478-field_119-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><\/div><div id=\"wpforms-1478-field_243-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"243\"><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" style=\"display:none;\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"1478\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/divessl.com\/ca\/wp-json\/wp\/v2\/pages\/1492\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1478\" class=\"wpforms-submit margin-top-bg\" data-alt-text=\"Enviant\" data-submit-text=\"Enviar\" aria-live=\"assertive\" value=\"wpforms-submit\">Enviar<\/button><\/div><\/form><\/div>  <!-- .wpforms-container -->[\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row el_class=&#8221;box-formulario&#8221;][vc_column][vc_empty_space height=&#8221;64px&#8221;][vc_column_text css=&#8221;&#8221; el_class=&#8221;titulo-form-insc&#8221;]Formulari d&#8217;inscripci\u00f3[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","protected":false},"author":7,"featured_media":0,"parent":1539,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-1492","page","type-page","status-publish"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ 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