<div class="row">
  <div class="col-sm-6">
    <label>First name*</label>[text* firstname placeholder "ชื่อคุณลูก"]
  </div>
  <div class="col-sm-6">
    <label>Last name*</label>[text* lastname placeholder "นามสกุลคุณลูก"]
  </div>
</div>

<div class="row">
  <div class="col-sm-6">
    <label>First name* (mother)</label>[text* firstnamemom placeholder "ชื่อคุณแม่"]
  </div>
  <div class="col-sm-6">
    <label>Last name* (mother)</label>[text* lastnamemom placeholder "นามสกุลคุณแม่"]
  </div>
</div>

<div class="row">

  <div class="col-sm-4">
    <label>Age*</label>[tel* tel-age minlength:2 maxlength:2 placeholder "อายุคุณแม่ (ปี)"] 
  </div>

  <div class="col-sm-4">
    <label>Weight* (kg)</label>[text* weight maxlength:3 placeholder "น้ำหนักคุณแม่ (กก.)"]
  </div>

  <div class="col-sm-4">
    <label>Height* (cm)</label>[text* height maxlength:3  placeholder "ส่วนสูงคุณแม่ (ซม.)"]
  </div>
</div>


<div class="row">
  <div class="col-sm-12">
    <label>Mobile phone*</label>[tel* tel-985 minlength:10 maxlength:15 placeholder "เบอร์ติดต่อ"]
  </div>
</div>

<div class="row">
  <div class="col-sm-6">
    <label>E-Mail*</label>[email* email placeholder "อีเมล"]
  </div>
  <div class="col-sm-6">
    <label>Confirm E-Mail*</label>[email* email-confirm placeholder "อีเมล"] 
  </div>
</div>


<div class="row">
  <div class="col-sm-12">
     <label><br></label>
  </div>
</div>

<div class="row">
  <div class="col-sm-12">
    <label>Please select your available day* (วันที่คุณแม่สะดวกสำหรับออกกำลังกาย) </label> [checkbox* checkbox-day814 use_label_element "Mon&nbsp;&nbsp;" "Tue&nbsp;&nbsp;" "Wed&nbsp;&nbsp;" "Thu&nbsp;&nbsp;" "Fri&nbsp;&nbsp;" "Sat&nbsp;&nbsp;" "Sun&nbsp;&nbsp;"]
  </div>  
</div>

<div class="row">
  <div class="col-sm-12">
     <label><br></label>
  </div>
</div>

<div class="row">
  <div class="col-sm-12">
    <label>Please select your available time* (เวลาที่คุณแม่สะดวกสำหรับออกกำลังกาย)</label> [checkbox* checkbox-time812 use_label_element "Early morning (07:00-10:00)" "Morning (10:00-12:00)" "Noon (12:00-14:00)" "Afternoon (14:00-17:00)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;" "Evening (17:00-20:00)&nbsp;" "Late evening (20:00-22:00)"]
  </div>  
</div>

<div class="row">
  <div class="col-sm-12">
     <label><br></label>
  </div>
</div>



<div class="row">
  <div class="col-sm-6">
    [submit "Submit"]
  </div>
</div>