abc1.html/letsgo.html at gh-pages · NaMiKA0305/abc1.html · GitHub

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<!DOCTYPE html><html>
    <head ><h1 style="text-align: center; font-family: cursive; ">Application for permission to date my Daughter</h1>
    </head>
    <syle>

    </syle>
<body>
   <b> Note:</b>Form is to be completed at least 20 days prior to date<br>
    <form action="_/action.php" >
        <fieldset>
            <legend><b>Personal Details:</b></legend>
            <label for="fname">First name:</label>
            <input type="text" id="fname" name="fname" placeholder="Enter Your Name"><br><br>
           <label for="fadd">Address:</label><input type="text" id="fadd" name="fadd" placeholder="Enter address here"><br><br>
           <label for="ph">Phone Number:</label><input type="number" id="ph" name="ph" placeholder="Enter 10 digit number"/><br>
           <br><label for="iq">IQ:</label><input type="text" id="iq" name="iq" placeholder="Enter IQ here"/><br><br>
           <label for="GENDER">GENDER:</label><br><input type="radio" id="GENDER" name="GENDER" value="male">Male<br>
           <input type="radio" id="GENDER" name="GENDER" value="Female">Female<br>
           <input type="radio" id="GENDER" name="GENDER" value="Other">Other<br><br>
           <label for="txt">Date of proposed outing:</label>
           <select>
               <option>select date</option>
               <option>1</option>
               <option>2</option>
               <option>3</option>
               <option>4</option>
               <option>5</option>
               <option>6</option>
               <option>7</option>
               <option>8</option>
               <option>9</option>
               <option>10</option>
               <option>11</option>
               <option>12</option>
               <option>13</option>
               <option>14</option>
               <option>15</option>
               <option>16</option>
               <option>17</option>
               <option>18</option>
         </select></fieldset><br>
         <fieldset>
         <lebel for="checkbox">Check All That Apply:</lebel><br><br>
         <input type="checkbox" id="form1" name="form1" value="option">
         <label for="form1">I have tattoos and/or piercings</label><br>
         <input type="checkbox" id="form2" name="form2" value="option">
         <label for="form2">I am more than 2 years old than my daughter</label><br>
         <input type="checkbox" id="form3" name="form3" value="option">
         <label for="form3">I own a panel van or U8 ute</label><br>
         <input type="checkbox" id="form4" name="form4" value="option">
         <label for="form4">I work Full-Time</label><br>
         <input type="checkbox" id="form5" name="form5" value="option">
         <label for="form5">My Parents are rich</label><br>
         </fieldset>
         <fieldset>
             <label>Polotical persuasion:</label>
             <select autofocus>
                 <option>Left wing</option>
                 <option>Right wing</option>
             </select>
             <label>Education Level Completed:</label>
             <select>
                 <option>University</option>
                 <option>College</option>
                 <option>School</option>
             </select>
      </fieldset>
      <fieldset>
          <legend ><b>Essay Section</b></legend>
          <label for="dicsription">In 50 words or more explain why you want to date my daughter</label><br><br>
          <textarea rows = "5" cols = "60" name = "description">Enter Text Here</textarea><br><br>
          <label for="dicsription">Please upload contact details for 2 references</label><br><br>
          <textarea rows = "5" cols = "60" name = "description">Enter Text Here</textarea><br><br>

          <label for="myfile">upload Police clearance certificate, Bank Statement and medical certificates here:</label>
          <input type="file" id="myfile" name="myfile" style="background-color: red; color:aliceblue;"><br><br>
      </fieldset>

      <input type="submit" value="send your application" style="color: white;  background-color: red;  text-decoration-color: aliceblue;">
    </form>
</body>
    </html>