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index.html
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index.html
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<!--Karen Miguel
ITMD 361
Production Problem Three
February 22, 2017-->
<!DOCTYPE html>
<html lang = "en">
<head>
<meta charset = "UTF-8">
<title> Form </title>
</head>
<body>
<section id = "form_area">
<h1> Volunteer Form</h1>
<form method ="POST" action = "http://bloomingdale.sat.iit.edu/kriedan/lab3formscript.php" enctype = "multipart/form-data">
<fieldset id = "myinfo">
<legend> My Info </legend>
<p>
<label>First Name: <input type="text" name="first_name_field"></label>
</p>
<p>
<label>Last Name: <input type="text" name="last_name_field"></label>
</p>
<p>
<label>Phone Number: <input type="text" name="phone_field"></label>
</p>
<p>
<label>E-Mail: <input type="text" name="email_field"></label>
</p>
<p id = "Gender">
<label>Gender: </label>
<label>Female <input type="radio" name="gender_field" value="Female"></label>
<br>
<label>Male <input type ="radio" name="gender_field" value="Male"></label>
</p>
<p id = "Age">
<label>Age: </label>
<select name = "age_field">
<option value = "Under 18">Under 18</option>
<option value = "18 to 24">18-24</option>
<option value = "25 to 34">25-34</option>
<option value = "35 to 44">35-44</option>
<option value = "45 to 54">45-54</option>
<option value = "65 and Over">65+</option>
</select>
</p>
</fieldset>
<fieldset id = "Available">
<legend>My Availability</legend>
<label>Days Available: </label>
<p>
<label>Monday <input type="checkbox" name="available_field[]" value="Monday"></label>
</p>
<p>
<label>Tuesday <input type="checkbox" name="available_field[]" value="Tuesday"></label>
</p>
<p>
<label>Wednesday <input type="checkbox" name="available_field[]" value="Wednesday"></label>
</p>
<p>
<label>Thursday <input type="checkbox" name="available_field[]" value="Thursday"></label>
</p>
<p>
<label>Friday <input type="checkbox" name="available_field[]" value="Friday"></label>
</p>
<p>
<label>Saturday <input type="checkbox" name="available_field[]" value="Saturday"></label>
</p>
<p>
<label>Sunday <input type="checkbox" name="available_field[]" value="Sunday"></label>
</p>
<label>Any Comments?: </label>
<p>
<label for="commentbox"> </label>
<textarea cols="45" rows="5" name="comments_field" id="commentbox"></textarea>
</p>
<p>
<input type="hidden" name="hidden_field" value="Karen Miguel">
</p>
</fieldset>
<input type="Submit" value="Submit">
</form>
</section>
</body>
</html>