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application_form.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8" />
<meta http-equiv="X-UA-Compatible" content="IE=edge" />
<meta name="viewport" content="width=device-width, initial-scale=1.0" />
<title>Student Application Form</title>
<link rel="stylesheet" href="app_form.css" />
</head>
<body>
<form action="/java/rest/api" method="GET">
<h2>Application For Permission To Date My Daughter</h2>
<p>
<strong>Note:</strong> Form is to be completed at least 21 days prior to
date
</p>
<h3>Personal Details</h3>
<label for="name">Name:</label>
<input
type="text"
name="name"
id="name"
placeholder="Enter name here"
/><br /><br />
<label for="address">Address:</label>
<input
type="text"
name="address"
id="address"
placeholder="Enter address here"
/><br /><br />
<label for="email">Email:</label>
<input
type="email"
name="email"
id="email"
placeholder="Enter email here"
/><br /><br />
<label for="phone">Phone Number:</label>
<input
type="tel"
name="phone"
id="phone"
placeholder="Enter 10 digit number"
/><br /><br />
<label for="iq">IQ:</label>
<input type="text" name="iq" id="iq" placeholder="Enter IQ here" />
<div>
<p>Gender</p>
<input type="radio" name="male" id="male" value="Male" />
<label for="male">Male</label><br />
<input type="radio" name="female" id="female" value="Female" />
<label for="female">Female</label><br />
<input type="radio" name="other" id="other" value="Other" />
<label for="other">Other</label>
</div>
<br />
<label for="passout">Date of Proposed Outing:</label>
<input type="date" name="passout" id="passout" />
<div>
<p>Check All That Apply</p>
<input
type="checkbox"
name="tatto"
id="tatto"
value="I have tattoos and/or piercings"
/>
<label for="tatto">I have tattoos and/or piercings</label><br />
<input
type="checkbox"
name="daughter"
id="daughter"
value="I am more than 2 years older than my daughter"
/>
<label for="daughter"
>I am more than 2 years older than my daughter</label
><br />
<input
type="checkbox"
name="V8"
id="V8"
value="I own a panel van or V8 ute"
/>
<label for="V8">I own a panel van or V8 ute</label><br />
<input
type="checkbox"
name="full-time"
id="full-time"
value="I work full-time"
checked
/>
<label for="full-time">I work full-time</label><br />
<input
type="checkbox"
name="rich"
id="rich"
value="My parents are rich"
checked
/>
<label for="rich">My parents are rich</label><br />
<input
type="checkbox"
name="location"
id="location"
value="Is the date at a well lit public location"
checked
/>
<label for="location">Is the date at a well lit public location</label>
</div>
<br />
<div>
Political Persuasion:
<select name="political" id="political">
<option value="Left Wing">Left Wing</option>
<option value="Right Wing">Right Wing</option>
<option value="Conservative">Conservative</option>
<option value="Nazi">Nazi</option>
<option value="None" selected>None</option>
</select>
Education Level Completed:
<select name="education" id="education">
<option value="University">University</option>
<option value="College">College</option>
<option value="High scholl">High scholl</option>
<option value="None" selected>None</option>
</select>
</div>
<h3>Essay Section</h3>
<label for="date_reason"
>In 50 words or more explain why you want to date my daughter</label
><br /><br />
<textarea
name="date_reason"
id="date_reason"
cols="40"
rows="8"
placeholder="Enter Text Here"
></textarea
><br /><br />
<div>
<label for="contact_details"
>Please upload contact details for 2 references</label
><br /><br />
<textarea
name="contact_details"
id="contact_details"
cols="40"
rows="8"
placeholder="Enter Text Here"
></textarea>
</div>
<br />
<label for="file_attach"
>Upload Police Clearance Certificate, Bank Statement and Medical
Certifiates here:
</label>
<input type="file" name="file_attach" id="file_attach" /><br /><br />
<button type="submit" id="submit_button">Send Your Application</button>
<button type="reset" id="reset_button">Reset</button>
</form>
</body>
</html>