57 lines
1.7 KiB
PHP
57 lines
1.7 KiB
PHP
|
<p>Welcome to Lockbox by Open Privacy! To get started, replace the contents of this form in <tt>php/form.inc.php</tt> with your own. If you know HTML you can write the form yourself. Otherwise you can use any form building tool that outputs to HTML.</p>
|
||
|
|
|
||
|
|
<form method="post">
|
||
|
|
|
||
|
|
<h2>Application Questions</h2>
|
||
|
|
|
||
|
|
<input type="text" name="email" style="display:none">
|
||
|
|
|
||
|
|
<p>1. What is your name (preferred or legal)?</p>
|
||
|
|
<input type="text" name="01_name">
|
||
|
|
|
||
|
|
<p>2. What city/neighbourhood do you live in?</p>
|
||
|
|
<input type="text" name="02_where">
|
||
|
|
|
||
|
|
<p>3. Is there anything else you'd like us to know?</p>
|
||
|
|
<textarea name="03_misc"></textarea>
|
||
|
|
|
||
|
|
<p>4. What is your favourite flavour?</p>
|
||
|
|
<select name="04_fav">
|
||
|
|
<option>Strawberry</option>
|
||
|
|
<option>Lettuce</option>
|
||
|
|
<option>Shoelace</option>
|
||
|
|
<option>Other</option>
|
||
|
|
</select>
|
||
|
|
|
||
|
|
<p>5. Pick one?</p>
|
||
|
|
<label><input type="radio" name="05_pick" value="10-12"> 10-12</label>
|
||
|
|
<label><input type="radio" name="05_pick" value="13+"> 13+</label>
|
||
|
|
<label><input type="radio" name="05_pick" value="25 and a pickle"> 25 and a pickle</label>
|
||
|
|
|
||
|
|
<p>Please remember to click the Submit button below once you are ready.</p>
|
||
|
|
|
||
|
|
<script type="text/javascript">
|
||
|
|
function h(cb) {
|
||
|
|
const btn = document.getElementById("btnsubmit");
|
||
|
|
if (cb.checked) {
|
||
|
|
btn.disabled = false;
|
||
|
|
btn.classList.remove('button-disabled');
|
||
|
|
btn.classList.add('button-primary');
|
||
|
|
} else {
|
||
|
|
btn.disabled = true;
|
||
|
|
btn.classList.remove('button-primary');
|
||
|
|
btn.classList.add('button-disabled');
|
||
|
|
}
|
||
|
|
}
|
||
|
|
</script>
|
||
|
|
<br>
|
||
|
|
<label>
|
||
|
|
<input type="checkbox" name="09_agree" onchange="h(this)">
|
||
|
|
I acknowledge that everything in this form is true to the best of my knowledge.
|
||
|
|
</label>
|
||
|
|
<br>
|
||
|
|
|
||
|
|
<input type="submit" class="button-disabled" id="btnsubmit" value="Submit" disabled>
|
||
|
|
|
||
|
|
</form>
|