<html> <body> <form-template> <fields> <field type="header" subtype="h1" label="Client Information"/> <field type="header" subtype="h2" label="Full name"/> <field type="text" label="Prefix" name="prefix" subtype="text" className="form-control"/> <field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/> <field type="text" label="Middle name" name="middle-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/> <field type="text" label="Suffix" name="suffix" subtype="text" className="form-control"/> <field type="text" label="Preferred name" name="preferred-name" subtype="text" className="form-control"/> <field type="date" label="Date of Birth" name="date-of-birth" className="form-control"/> <field required="true" type="text" label="Email" name="email" subtype="text" className="form-control"/> <field type="text" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="text" label="State of Residency" name="state-of-residency" subtype="text" className="form-control"/> <field type="text" label="Availability Date Range (Earliest start date- latest end date)" name="availability-date-range-earliest-start-date-latest-end-date" subtype="text" className="form-control"/> <field type="checkbox-group" label="Walt Disney World&nbsp; &nbsp;Deluxe&nbsp; Resorts&nbsp;&nbsp;" name="walt-disney-world-deluxe-resorts-"> <option label="Disney Animal Kingdom Lodge" value="disney-animal-kingdom-lodge">Disney Animal Kingdom Lodge</option> <option label="Disney Beach Club Resort" value="disney-beach-club-resort">Disney Beach Club Resort</option> <option label="Disney Boardwalk Inn" value="disney-boardwalk-inn">Disney Boardwalk Inn</option> <option label="Disney Contemporary Resort" value="disney-contemporary-resort">Disney Contemporary Resort</option> <option label="Disney Grand Floridian Resort" value="disney-grand-floridian-resort">Disney Grand Floridian Resort</option> <option label="Disney Polynesian Village Resort" value="disney-polynesian-village-resort">Disney Polynesian Village Resort</option> <option label="Disney Wilderness Lodge" value="disney-wilderness-lodge">Disney Wilderness Lodge</option> <option label="Disney Yacht Club Resort" value="disney-yacht-club-resort">Disney Yacht Club Resort</option> </field> <field type="checkbox-group" label="Walt Disney World Resort Deluxe Villa Resorts" name="walt-disney-world-resort-deluxe-villa-resorts"> <option label="Bay Lake Tower at Disney's Contemporary Resort" value="bay-lake-tower-at-disneys-contemporary-resort">Bay Lake Tower at Disney's Contemporary Resort</option> <option label="Boulder Ridge Villas at Disney's Wilderness Lodge" value="boulder-ridge-villas-at-disneys-wilderness-lodge">Boulder Ridge Villas at Disney's Wilderness Lodge</option> <option label="Copper Creek Villas & Cabins at Disney's Wilderness Lodge" value="copper-creek-villas-cabins-at-disneys-wilderness-lodge">Copper Creek Villas & Cabins at Disney's Wilderness Lodge</option> <option label="Disney Animal Kingdom Villas- Jambo House" value="disney-animal-kingdom-villas-jambo-house">Disney Animal Kingdom Villas- Jambo House</option> <option label="Disney's Animal Kingdom Villas- Kidani Village" value="disneys-animal-kingdom-villas-kidani-village">Disney's Animal Kingdom Villas- Kidani Village</option> <option label="Disney's Beach Club Villas" value="disneys-beach-club-villas">Disney's Beach Club Villas</option> <option label="Disney's BoardWalk Villas" value="disneys-boardwalk-villas">Disney's BoardWalk Villas</option> <option label="Disney's Old Key West Resort" value="disneys-old-key-west-resort">Disney's Old Key West Resort</option> <option label="Disney's Polynesian Villas & Bungalows" value="disneys-polynesian-villas-bungalows">Disney's Polynesian Villas & Bungalows</option> <option label="Disney's Rivera Resort" value="disneys-rivera-resort">Disney's Rivera Resort</option> <option label="Disney's Saratoga Springs Resort & Spa" value="disneys-saratoga-springs-resort-spa">Disney's Saratoga Springs Resort & Spa</option> <option label="The Villas at Disney's Grand Floridian Redort & Spa" value="the-villas-at-disneys-grand-floridian-redort-spa">The Villas at Disney's Grand Floridian Redort & Spa</option> </field> <field type="checkbox-group" label="Walt Disney World Moderate Resorts" name="walt-disney-world-moderate-resorts"> <option label="Disney's Caribbean Beach Resort" value="disneys-caribbean-beach-resort">Disney's Caribbean Beach Resort</option> <option label="Disney's Coronado Springs Resort" value="disneys-coronado-springs-resort">Disney's Coronado Springs Resort</option> <option label="Disney's Port Orleans Resort- French Quarter" value="disneys-port-orleans-resort-french-quarter">Disney's Port Orleans Resort- French Quarter</option> <option label="Disney's Port Orleans Resort- Riverside" value="disneys-port-orleans-resort-riverside">Disney's Port Orleans Resort- Riverside</option> <option label="The Cabins at Disney's Fort Wilderness Resort" value="the-cabins-at-disneys-fort-wilderness-resort">The Cabins at Disney's Fort Wilderness Resort</option> </field> <field type="checkbox-group" label="Walt Disney World Value Resorts" name="walt-disney-world-value-resorts"> <option label="Disney's All Star Movies Resort" value="disneys-all-star-movies-resort">Disney's All Star Movies Resort</option> <option label="Disney's All Star Music Resort" value="disneys-all-star-music-resort">Disney's All Star Music Resort</option> <option label="Disney's All Star Sports Resort" value="disneys-all-star-sports-resort">Disney's All Star Sports Resort</option> <option label="Disney's Art of Animation Resort" value="disneys-art-of-animation-resort">Disney's Art of Animation Resort</option> <option label="Disney's Pop Century Resort" value="disneys-pop-century-resort">Disney's Pop Century Resort</option> </field> <field type="checkbox-group" label="Walt Disney World Fort Wilderness Resort &amp; Campground" name="walt-disney-world-fort-wilderness-resort-campground"> <option label="The Campsites at Disney's Fort Wilderness Resort" value="the-campsites-at-disneys-fort-wilderness-resort">The Campsites at Disney's Fort Wilderness Resort</option> </field> <field type="checkbox-group" label="Walt Disney World Other Deluxe Resorts" name="walt-disney-world-other-deluxe-resorts"> <option label="Wal Disney World Dolphin Hotel" value="wal-disney-world-dolphin-hotel">Wal Disney World Dolphin Hotel</option> <option label="Wal Disney World Swan Hotel" value="wal-disney-world-swan-hotel">Wal Disney World Swan Hotel</option> <option label="Walt Disney World Swan Reserve" value="walt-disney-world-swan-reserve">Walt Disney World Swan Reserve</option> </field> <field type="text" label="# of Rooms" name="-of-rooms" subtype="text" className="form-control"/> <field type="text" label="# of Adults/Children per Room" name="-of-adultschildren-per-room" subtype="text" className="form-control"/> <field type="text" label="Disney Trip Budget" name="disney-trip-budget" subtype="text" className="form-control"/> <field type="checkbox-group" label="Payment Options" name="payment-options"> <option label="Pay in Full" value="pay-in-full">Pay in Full</option> <option label="Deposit Now, Final Payments by Due Date" value="deposit-now-final-payments-by-due-date">Deposit Now, Final Payments by Due Date</option> </field> <field type="checkbox-group" label="Walt Disney World Dining Plan" name="walt-disney-world-dining-plan"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> </field> <field type="checkbox-group" label="Do any of the following apply to your or your passengers?" name="do-any-of-the-following-apply-to-your-or-your-passengers"> <option label="Military" value="military">Military</option> <option label="Police & EMT" value="police-emt">Police & EMT</option> <option label="Senior (55+)" value="senior-55">Senior (55+)</option> <option label="Accessible Room Required" value="accessible-room-required">Accessible Room Required</option> </field> <field type="checkbox-group" label="Other Disney Destinations" name="other-disney-destinations"> <option label="DisneyLand Resort" value="disneyland-resort">DisneyLand Resort</option> <option label="Adventure by Disney" value="adventure-by-disney">Adventure by Disney</option> <option label="Disney Cruise Line" value="disney-cruise-line">Disney Cruise Line</option> <option label="Aulani Resort. Hawaii" value="aulani-resort-hawaii">Aulani Resort. Hawaii</option> <option label="Other Disney Vacations" value="other-disney-vacations">Other Disney Vacations</option> </field> <field type="checkbox-group" label="When will you be ready to put a deposit down?" name="when-will-you-be-ready-to-put-a-deposit-down"> <option label="24 Hours" value="24-hours">24 Hours</option> <option label="2-3 days" value="23-days">2-3 days</option> <option label="1 Week max" value="1-week-max">1 Week max</option> <option label="Not in a rush" value="not-in-a-rush">Not in a rush</option> </field> </fields> </form-template> </body> </html>
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