Lab4/index.html at master · lbenjamin17/Lab4 · GitHub

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<!DOCTYPE html>
<html lang="en">
  <head>
    <meta charset="UTF-8">
    <title>Lestisha Benjamin: Lab4</title>

  </head>
  <body>
    <header>
      <h1>Volunteer Form</h1>
	</header>
    <form action="http://bloomingdale.sat.iit.edu/kriedan/lab3formscript.php" method="POST">
	  <fieldset>
	    <legend><strong>My Info</strong></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>Email Address:<input type="text" name="email_field"></label></p>
		<p><label>Gender:</label>
		<input type="radio" name="gender_field" value="Male">Male
		<input type="radio" name="gender_field" value="Female">Female
		</p>
		<p><label>Age:</label>
		<select name="age_field">
		  <option value="under_18">under 18</option>
          <option value="18-24">18 - 24</option>
          <option value="25-34">25 - 34</option>
          <option value="35-44">35 - 44</option>
		  <option value="45-54">45 - 54</option>
          <option value="55-64">55 - 64</option>
          <option value="65_and_over">65 and over</option>
        </select></p>
	  </fieldset>
	  &nbsp;
	  <fieldset>
	    <legend><strong>My Availability</strong></legend>
		<p><label>Days Available:</label></p>
		<p><input type="checkbox" name="available_field[]" value="sunday"> Sunday</p>
		<p><input type="checkbox" name="available_field[]" value="monday"> Monday</p>
		<p><input type="checkbox" name="available_field[]" value="tuesday"> Tuesday</p>
		<p><input type="checkbox" name="available_field[]" value="wednesday"> Wednesday</p>
		<p><input type="checkbox" name="available_field[]" value="thursday"> Thursday</p>
		<p><input type="checkbox" name="available_field[]" value="friday"> Friday</p>
		<p><input type="checkbox" name="available_field[]" value="saturday"> Saturday</p>
		<p><label>Any Comments?:</label></p>
		<textarea rows="6" cols="60" name="comments_field">
		</textarea>
	  </fieldset>
        <p><input type="hidden" name="hidden_field" value="lbenjamin"></p>
		<input type="Submit" name="Submit" value="Submit">
	</form>

    <footer>
     &copy; Copyrighted. All Rights Reserved. Done By: Lestisha Benjamin. 2017
    </footer>
  </body>
</html>