{"id":8130,"date":"2023-05-30T14:51:26","date_gmt":"2023-05-30T12:51:26","guid":{"rendered":"https:\/\/santepsy.ch\/formulaire-inscription-modification\/"},"modified":"2023-10-06T15:58:53","modified_gmt":"2023-10-06T13:58:53","slug":"formular-anmeldung-aenderung","status":"publish","type":"page","link":"https:\/\/santepsy.ch\/de\/formular-anmeldung-aenderung\/","title":{"rendered":"Formular Anmeldung\/\u00c4nderung"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_6' style='display:none'>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Anmeldung<\/h2>\n                            <p class='gform_description'><\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>\u201e<span class=\"gfield_required gfield_required_asterisk\">*<\/span>\u201c zeigt erforderliche Felder an<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_6'  action='\/de\/wp-json\/wp\/v2\/pages\/8130' data-formid='6' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_6' class='gform_fields top_label form_sublabel_above description_above validation_below'><fieldset id=\"field_6_65\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Sie m\u00f6chten &#8230;<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_6_65'>\n\t\t\t<div class='gchoice gchoice_6_65_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Vous inscrire'  id='choice_6_65_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_65_0' id='label_6_65_0' class='gform-field-label gform-field-label--type-inline'>Sich anmelden<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_65_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Modifier vos informations (Merci de remplir uniquement les champs que vous souhaitez modifier.)'  id='choice_6_65_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_65_1' id='label_6_65_1' class='gform-field-label gform-field-label--type-inline'>Ihre Informationen \u00e4ndern (Bitte f\u00fcllen Sie nur die Felder aus, die Sie \u00e4ndern m\u00f6chten).<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_6_9\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_9'>Name der Einrichtung<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_6_9' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_43\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_43'>Adresse<\/label><div class='ginput_container ginput_container_text'><input name='input_43' id='input_6_43' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_44\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_44'>Stadt<\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_6_44' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_46\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_46'>PLZ<\/label><div class='ginput_container ginput_container_number'><input name='input_46' id='input_6_46' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_6_13\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_13'> E-mail-Adresse<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_13' id='input_6_13' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_6_15\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_15'>Telefon<\/label><div class='ginput_container ginput_container_phone'><input name='input_15' id='input_6_15' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_16\" class=\"gfield gfield--type-website gfield--input-type-website gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_16'>Website<\/label><div class='ginput_container ginput_container_website'>\n                    <input name='input_16' id='input_6_16' type='url' value='' class='large'    placeholder='https:\/\/'  aria-invalid=\"false\" \/>\n                <\/div><\/div><div id=\"field_6_21\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_21'>\u00d6ffnungszeiten<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_21' id='input_6_21' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_6_63\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_63'>Gesprochene Sprache(n)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_63' id='input_6_63' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_23\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_23'>Beschreibung<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_23' id='input_6_23' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_6_55\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Zielgruppe(n)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_6_55'><div class='gchoice gchoice_6_55_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.1' type='checkbox'  value='Erwachsene (ohne Unterscheidung)'  id='choice_6_55_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_55_1' id='label_6_55_1' class='gform-field-label gform-field-label--type-inline'>Erwachsene (ohne Unterscheidung)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_55_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.2' type='checkbox'  value='Kinder'  id='choice_6_55_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_55_2' id='label_6_55_2' class='gform-field-label gform-field-label--type-inline'>Kinder<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_55_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.3' type='checkbox'  value='Familien'  id='choice_6_55_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_55_3' id='label_6_55_3' class='gform-field-label gform-field-label--type-inline'>Familien<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_55_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.4' type='checkbox'  value='Frauen (spezifisch)'  id='choice_6_55_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_55_4' id='label_6_55_4' class='gform-field-label gform-field-label--type-inline'>Frauen (spezifisch)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_55_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.5' type='checkbox'  value='M\u00e4nner (spezifisch)'  id='choice_6_55_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_55_5' id='label_6_55_5' class='gform-field-label gform-field-label--type-inline'>M\u00e4nner (spezifisch)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_55_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.6' type='checkbox'  value='Jugendliche'  id='choice_6_55_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_55_6' id='label_6_55_6' class='gform-field-label gform-field-label--type-inline'>Jugendliche<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_55_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.7' type='checkbox'  value='LGBT'  id='choice_6_55_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_55_7' id='label_6_55_7' class='gform-field-label gform-field-label--type-inline'>LGBT<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_55_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.8' type='checkbox'  value='Migranten'  id='choice_6_55_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_55_8' id='label_6_55_8' class='gform-field-label gform-field-label--type-inline'>Migranten<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_55_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.9' type='checkbox'  value='Senioren'  id='choice_6_55_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_55_9' id='label_6_55_9' class='gform-field-label gform-field-label--type-inline'>Senioren<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_55_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.11' type='checkbox'  value='Angeh\u00f6rige'  id='choice_6_55_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_55_11' id='label_6_55_11' class='gform-field-label gform-field-label--type-inline'>Angeh\u00f6rige<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_55_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.12' type='checkbox'  value='Fachleute (Vermittlung)'  id='choice_6_55_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_55_12' id='label_6_55_12' class='gform-field-label gform-field-label--type-inline'>Fachleute (Vermittlung)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_55_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.13' type='checkbox'  value='Andere Sprachen'  id='choice_6_55_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_55_13' id='label_6_55_13' class='gform-field-label gform-field-label--type-inline'>Andere Sprachen<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_6_56\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Leistung(en)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_6_56'><div class='gchoice gchoice_6_56_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.1' type='checkbox'  value='Massnahmen zur Pr\u00e4vention und Gesundheitsf\u00f6rderung'  id='choice_6_56_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_56_1' id='label_6_56_1' class='gform-field-label gform-field-label--type-inline'>Massnahmen zur Pr\u00e4vention und Gesundheitsf\u00f6rderung<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_56_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.2' type='checkbox'  value='Beratung - Orientierung - Unterst\u00fctzung'  id='choice_6_56_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_56_2' id='label_6_56_2' class='gform-field-label gform-field-label--type-inline'>Beratung &#8211; Orientierung &#8211; Unterst\u00fctzung<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_56_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.3' type='checkbox'  value='Ausbildung'  id='choice_6_56_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_56_3' id='label_6_56_3' class='gform-field-label gform-field-label--type-inline'>Ausbildung<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_56_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.4' type='checkbox'  value='Langfristiges Wohnheim - Gesch\u00fctzte Wohnungen - Tempor\u00e4res Wohnheim'  id='choice_6_56_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_56_4' id='label_6_56_4' class='gform-field-label gform-field-label--type-inline'>Langfristiges Wohnheim &#8211; Gesch\u00fctzte Wohnungen &#8211; Tempor\u00e4res Wohnheim<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_56_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.5' type='checkbox'  value='Information und soziale Betreuung'  id='choice_6_56_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_56_5' id='label_6_56_5' class='gform-field-label gform-field-label--type-inline'>Information und soziale Betreuung<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_56_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.6' type='checkbox'  value='Information und Sensibilisierung der \u00d6ffentlichkeit'  id='choice_6_56_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_56_6' id='label_6_56_6' class='gform-field-label gform-field-label--type-inline'>Information und Sensibilisierung der \u00d6ffentlichkeit<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_56_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.7' type='checkbox'  value='Rechtliche Informationen'  id='choice_6_56_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_56_7' id='label_6_56_7' class='gform-field-label gform-field-label--type-inline'>Rechtliche Informationen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_56_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.8' type='checkbox'  value='Empfangsdienst - Selbsthilfe - Gespr\u00e4chsgruppe'  id='choice_6_56_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_56_8' id='label_6_56_8' class='gform-field-label gform-field-label--type-inline'>Empfangsdienst &#8211; Selbsthilfe &#8211; Gespr\u00e4chsgruppe<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_56_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.9' type='checkbox'  value='Behandlung - Therapie'  id='choice_6_56_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_56_9' id='label_6_56_9' class='gform-field-label gform-field-label--type-inline'>Behandlung &#8211; Therapie<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_6_57\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Themenbereich(e)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_6_57'><div class='gchoice gchoice_6_57_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.1' type='checkbox'  value='Sucht, Abh\u00e4ngigkeit'  id='choice_6_57_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_57_1' id='label_6_57_1' class='gform-field-label gform-field-label--type-inline'>Sucht, Abh\u00e4ngigkeit<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_57_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.2' type='checkbox'  value='Behinderung, Invalidit\u00e4t'  id='choice_6_57_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_57_2' id='label_6_57_2' class='gform-field-label gform-field-label--type-inline'>Behinderung, Invalidit\u00e4t<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_57_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.3' type='checkbox'  value='Elternschaft, Familienleben und Kinder'  id='choice_6_57_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_57_3' id='label_6_57_3' class='gform-field-label gform-field-label--type-inline'>Elternschaft, Familienleben und Kinder<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_57_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.4' type='checkbox'  value='Sant\u00e9 mentale'  id='choice_6_57_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_57_4' id='label_6_57_4' class='gform-field-label gform-field-label--type-inline'>Sant\u00e9 mentale<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_57_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.5' type='checkbox'  value='S\u00e9paration, divorce, deuil'  id='choice_6_57_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_57_5' id='label_6_57_5' class='gform-field-label gform-field-label--type-inline'>S\u00e9paration, divorce, deuil<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_57_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.6' type='checkbox'  value='Sexualit\u00e9'  id='choice_6_57_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_57_6' id='label_6_57_6' class='gform-field-label gform-field-label--type-inline'>Sexualit\u00e9<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_57_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.7' type='checkbox'  value='Troubles psychiques'  id='choice_6_57_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_57_7' id='label_6_57_7' class='gform-field-label gform-field-label--type-inline'>Troubles psychiques<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_57_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.8' type='checkbox'  value='Travail, ch\u00f4mage, int\u00e9gration sociale'  id='choice_6_57_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_57_8' id='label_6_57_8' class='gform-field-label gform-field-label--type-inline'>Travail, ch\u00f4mage, int\u00e9gration sociale<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_57_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.9' type='checkbox'  value='Violences, maltraitances, abus'  id='choice_6_57_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_57_9' id='label_6_57_9' class='gform-field-label gform-field-label--type-inline'>Violences, maltraitances, abus<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_57_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.11' type='checkbox'  value='Autres'  id='choice_6_57_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_57_11' id='label_6_57_11' class='gform-field-label gform-field-label--type-inline'>Autres<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_6_58\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Kanton(e)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_6_58'><div class='gchoice gchoice_6_58_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.1' type='checkbox'  value='Freiburg'  id='choice_6_58_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_58_1' id='label_6_58_1' class='gform-field-label gform-field-label--type-inline'>Freiburg<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_58_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.2' type='checkbox'  value='Genf'  id='choice_6_58_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_58_2' id='label_6_58_2' class='gform-field-label gform-field-label--type-inline'>Genf<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_58_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.3' type='checkbox'  value='Jura'  id='choice_6_58_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_58_3' id='label_6_58_3' class='gform-field-label gform-field-label--type-inline'>Jura<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_58_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.4' type='checkbox'  value='Neuenburg'  id='choice_6_58_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_58_4' id='label_6_58_4' class='gform-field-label gform-field-label--type-inline'>Neuenburg<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_58_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.5' type='checkbox'  value='Wallis'  id='choice_6_58_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_58_5' id='label_6_58_5' class='gform-field-label gform-field-label--type-inline'>Wallis<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_58_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.6' type='checkbox'  value='Waadt'  id='choice_6_58_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_58_6' id='label_6_58_6' class='gform-field-label gform-field-label--type-inline'>Waadt<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_58_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.7' type='checkbox'  value='Tessin'  id='choice_6_58_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_58_7' id='label_6_58_7' class='gform-field-label gform-field-label--type-inline'>Tessin<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_6_40\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_40'>Name der Einrichtung<\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_6_40' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_47\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_47'>Adresse<\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_6_47' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_48\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_48'>Stadt<\/label><div class='ginput_container ginput_container_text'><input name='input_48' id='input_6_48' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_49\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_49'>PLZ<\/label><div class='ginput_container ginput_container_number'><input name='input_49' id='input_6_49' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_6_30\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_30'> E-mail-Adresse<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_30' id='input_6_30' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_6_31\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_31'>Telefon<\/label><div class='ginput_container ginput_container_phone'><input name='input_31' id='input_6_31' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_32\" class=\"gfield gfield--type-website gfield--input-type-website gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_32'>Website<\/label><div class='ginput_container ginput_container_website'>\n                    <input name='input_32' id='input_6_32' type='url' value='' class='large'    placeholder='https:\/\/'  aria-invalid=\"false\" \/>\n                <\/div><\/div><div id=\"field_6_33\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_33'>\u00d6ffnungszeiten<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_33' id='input_6_33' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_6_64\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_64'>Gesprochene Sprache(n)<\/label><div class='ginput_container ginput_container_text'><input name='input_64' id='input_6_64' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_35\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_35'>Beschreibung<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_35' id='input_6_35' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_6_59\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Zielgruppe(n)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_6_59'><div class='gchoice gchoice_6_59_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.1' type='checkbox'  value='Erwachsene (ohne Unterscheidung)'  id='choice_6_59_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_59_1' id='label_6_59_1' class='gform-field-label gform-field-label--type-inline'>Erwachsene (ohne Unterscheidung)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_59_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.2' type='checkbox'  value='Kinder'  id='choice_6_59_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_59_2' id='label_6_59_2' class='gform-field-label gform-field-label--type-inline'>Kinder<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_59_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.3' type='checkbox'  value='Familien'  id='choice_6_59_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_59_3' id='label_6_59_3' class='gform-field-label gform-field-label--type-inline'>Familien<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_59_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.4' type='checkbox'  value='Frauen (spezifisch)'  id='choice_6_59_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_59_4' id='label_6_59_4' class='gform-field-label gform-field-label--type-inline'>Frauen (spezifisch)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_59_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.5' type='checkbox'  value='M\u00e4nner (spezifisch)'  id='choice_6_59_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_59_5' id='label_6_59_5' class='gform-field-label gform-field-label--type-inline'>M\u00e4nner (spezifisch)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_59_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.6' type='checkbox'  value='Jugendliche'  id='choice_6_59_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_59_6' id='label_6_59_6' class='gform-field-label gform-field-label--type-inline'>Jugendliche<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_59_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.7' type='checkbox'  value='LGBT'  id='choice_6_59_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_59_7' id='label_6_59_7' class='gform-field-label gform-field-label--type-inline'>LGBT<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_59_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.8' type='checkbox'  value='Migranten'  id='choice_6_59_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_59_8' id='label_6_59_8' class='gform-field-label gform-field-label--type-inline'>Migranten<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_59_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.9' type='checkbox'  value='Senioren'  id='choice_6_59_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_59_9' id='label_6_59_9' class='gform-field-label gform-field-label--type-inline'>Senioren<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_59_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.11' type='checkbox'  value='Angeh\u00f6rige'  id='choice_6_59_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_59_11' id='label_6_59_11' class='gform-field-label gform-field-label--type-inline'>Angeh\u00f6rige<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_59_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.12' type='checkbox'  value='Fachleute (Vermittlung)'  id='choice_6_59_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_59_12' id='label_6_59_12' class='gform-field-label gform-field-label--type-inline'>Fachleute (Vermittlung)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_59_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_59.13' type='checkbox'  value='Andere Sprachen'  id='choice_6_59_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_59_13' id='label_6_59_13' class='gform-field-label gform-field-label--type-inline'>Andere Sprachen<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_6_60\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Leistung(en)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_6_60'><div class='gchoice gchoice_6_60_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.1' type='checkbox'  value='Massnahmen zur Pr\u00e4vention und Gesundheitsf\u00f6rderung'  id='choice_6_60_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_60_1' id='label_6_60_1' class='gform-field-label gform-field-label--type-inline'>Massnahmen zur Pr\u00e4vention und Gesundheitsf\u00f6rderung<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_60_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.2' type='checkbox'  value='Beratung - Orientierung - Unterst\u00fctzung'  id='choice_6_60_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_60_2' id='label_6_60_2' class='gform-field-label gform-field-label--type-inline'>Beratung &#8211; Orientierung &#8211; Unterst\u00fctzung<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_60_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.3' type='checkbox'  value='Ausbildung'  id='choice_6_60_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_60_3' id='label_6_60_3' class='gform-field-label gform-field-label--type-inline'>Ausbildung<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_60_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.4' type='checkbox'  value='Langfristiges Wohnheim - Gesch\u00fctzte Wohnungen - Tempor\u00e4res Wohnheim'  id='choice_6_60_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_60_4' id='label_6_60_4' class='gform-field-label gform-field-label--type-inline'>Langfristiges Wohnheim &#8211; Gesch\u00fctzte Wohnungen &#8211; Tempor\u00e4res Wohnheim<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_60_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.5' type='checkbox'  value='Information und soziale Betreuung'  id='choice_6_60_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_60_5' id='label_6_60_5' class='gform-field-label gform-field-label--type-inline'>Information und soziale Betreuung<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_60_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.6' type='checkbox'  value='Information und Sensibilisierung der \u00d6ffentlichkeit'  id='choice_6_60_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_60_6' id='label_6_60_6' class='gform-field-label gform-field-label--type-inline'>Information und Sensibilisierung der \u00d6ffentlichkeit<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_60_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.7' type='checkbox'  value='Rechtliche Informationen'  id='choice_6_60_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_60_7' id='label_6_60_7' class='gform-field-label gform-field-label--type-inline'>Rechtliche Informationen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_60_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.8' type='checkbox'  value='Empfangsdienst - Selbsthilfe - Gespr\u00e4chsgruppe'  id='choice_6_60_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_60_8' id='label_6_60_8' class='gform-field-label gform-field-label--type-inline'>Empfangsdienst &#8211; Selbsthilfe &#8211; Gespr\u00e4chsgruppe<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_60_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_60.9' type='checkbox'  value='Behandlung - Therapie'  id='choice_6_60_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_60_9' id='label_6_60_9' class='gform-field-label gform-field-label--type-inline'>Behandlung &#8211; Therapie<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_6_61\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Themenbereich(e)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_6_61'><div class='gchoice gchoice_6_61_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.1' type='checkbox'  value='Sucht, Abh\u00e4ngigkeit'  id='choice_6_61_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_61_1' id='label_6_61_1' class='gform-field-label gform-field-label--type-inline'>Sucht, Abh\u00e4ngigkeit<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_61_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.2' type='checkbox'  value='Behinderung, Invalidit\u00e4t'  id='choice_6_61_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_61_2' id='label_6_61_2' class='gform-field-label gform-field-label--type-inline'>Behinderung, Invalidit\u00e4t<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_61_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.3' type='checkbox'  value='Elternschaft, Familienleben und Kinder'  id='choice_6_61_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_61_3' id='label_6_61_3' class='gform-field-label gform-field-label--type-inline'>Elternschaft, Familienleben und Kinder<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_61_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.4' type='checkbox'  value='Trennung, Scheidung, Trauer'  id='choice_6_61_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_61_4' id='label_6_61_4' class='gform-field-label gform-field-label--type-inline'>Trennung, Scheidung, Trauer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_61_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.5' type='checkbox'  value='Sexualit\u00e4t'  id='choice_6_61_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_61_5' id='label_6_61_5' class='gform-field-label gform-field-label--type-inline'>Sexualit\u00e4t<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_61_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.6' type='checkbox'  value='Psychische Erkrankungen'  id='choice_6_61_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_61_6' id='label_6_61_6' class='gform-field-label gform-field-label--type-inline'>Psychische Erkrankungen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_61_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.7' type='checkbox'  value='Arbeit - Besch\u00e4ftigung - Freizeit'  id='choice_6_61_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_61_7' id='label_6_61_7' class='gform-field-label gform-field-label--type-inline'>Arbeit &#8211; Besch\u00e4ftigung &#8211; Freizeit<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_61_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.8' type='checkbox'  value='Gewalt, Misshandlung, Missbrauch'  id='choice_6_61_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_61_8' id='label_6_61_8' class='gform-field-label gform-field-label--type-inline'>Gewalt, Misshandlung, Missbrauch<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_61_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.9' type='checkbox'  value='Andere'  id='choice_6_61_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_61_9' id='label_6_61_9' class='gform-field-label gform-field-label--type-inline'>Andere<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_6_62\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Kanton(e)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_6_62'><div class='gchoice gchoice_6_62_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.1' type='checkbox'  value='Freiburg'  id='choice_6_62_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_62_1' id='label_6_62_1' class='gform-field-label gform-field-label--type-inline'>Freiburg<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_62_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.2' type='checkbox'  value='Genf'  id='choice_6_62_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_62_2' id='label_6_62_2' class='gform-field-label gform-field-label--type-inline'>Genf<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_62_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.3' type='checkbox'  value='Jura'  id='choice_6_62_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_62_3' id='label_6_62_3' class='gform-field-label gform-field-label--type-inline'>Jura<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_62_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.4' type='checkbox'  value='Neuenburg'  id='choice_6_62_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_62_4' id='label_6_62_4' class='gform-field-label gform-field-label--type-inline'>Neuenburg<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_62_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.5' type='checkbox'  value='Wallis'  id='choice_6_62_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_62_5' id='label_6_62_5' class='gform-field-label gform-field-label--type-inline'>Wallis<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_62_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.6' type='checkbox'  value='Waadt'  id='choice_6_62_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_62_6' id='label_6_62_6' class='gform-field-label gform-field-label--type-inline'>Waadt<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_62_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.7' type='checkbox'  value='Tessin'  id='choice_6_62_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_62_7' id='label_6_62_7' class='gform-field-label gform-field-label--type-inline'>Tessin<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_6_66\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Datenschutzrichtlinie<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_6_66'><div class='gchoice gchoice_6_66_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_66.1' type='checkbox'  value='Indem Sie dieses K\u00e4stchen ankreuzen, best\u00e4tigen Sie, dass Sie unsere &lt;a href=&quot;\/de\/datenschutzrichtlinie-2\/&quot; title=&quot;Datenschutzrichtlinie lesen&quot; target=&quot;_blank&quot;&gt;Datenschutzrichtlinien&lt;\/a&gt; gelesen haben und ihnen zustimmen.'  id='choice_6_66_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_66_1' id='label_6_66_1' class='gform-field-label gform-field-label--type-inline'>Indem Sie dieses K\u00e4stchen ankreuzen, best\u00e4tigen Sie, dass Sie unsere <a href=\"\/de\/datenschutzrichtlinie-2\/\" title=\"Datenschutzrichtlinie lesen\" target=\"_blank\">Datenschutzrichtlinien<\/a> gelesen haben und ihnen zustimmen.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_6_67\" class=\"gfield gfield--type-captcha 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