<link href="//netdna.bootstrapcdn.com/bootstrap/3.1.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//netdna.bootstrapcdn.com/bootstrap/3.1.0/js/bootstrap.min.js"></script> <script src="//code.jquery.com/jquery-1.11.1.min.js"></script> <!------ Include the above in your HEAD tag ----------> <form class="form-horizontal"> <fieldset> <!-- Form Name --> <legend>EMERGENCY</legend> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="TYPE"></label> <div class="col-md-5"> <input id="TYPE" name="TYPE" type="text" placeholder="TYPE OF EMERGENCY" class="form-control input-md" required=""> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="NAME"></label> <div class="col-md-5"> <input id="NAME" name="NAME" type="text" placeholder="NAME" class="form-control input-md"> </div> </div> <!-- Prepended text--> <div class="form-group"> <label class="col-md-4 control-label" for="CONTACT"></label> <div class="col-md-5"> <div class="input-group"> <span class="input-group-addon">+91</span> <input id="CONTACT" name="CONTACT" class="form-control" placeholder=" " type="text" required=""> </div> </div> </div> <!-- Textarea --> <div class="form-group"> <label class="col-md-4 control-label" for="ADDRESS"></label> <div class="col-md-4"> <textarea class="form-control" id="ADDRESS" name="ADDRESS">ADDRESS</textarea> </div> </div> <!-- Search input--> <div class="form-group"> <label class="col-md-4 control-label" for="LANDMARK"></label> <div class="col-md-5"> <input id="LANDMARK" name="LANDMARK" type="search" placeholder="EX: LANDMARK" class="form-control input-md"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="PINCODE"></label> <div class="col-md-5"> <input id="PINCODE" name="PINCODE" type="text" placeholder="PINCODE" class="form-control input-md" required=""> </div> </div> <!-- Multiple Checkboxes --> <div class="form-group"> <label class="col-md-4 control-label" for="checkboxes">send alert to</label> <div class="col-md-4"> <div class="checkbox"> <label for="checkboxes-0"> <input type="checkbox" name="checkboxes" id="checkboxes-0" value="1"> AMBULANCE </label> </div> <div class="checkbox"> <label for="checkboxes-1"> <input type="checkbox" name="checkboxes" id="checkboxes-1" value="2"> FIRE </label> </div> <div class="checkbox"> <label for="checkboxes-2"> <input type="checkbox" name="checkboxes" id="checkboxes-2" value="3"> POLICE </label> </div> </div> </div> <!-- Button --> <div class="form-group"> <label class="col-md-4 control-label" for="singlebutton"></label> <div class="col-md-4"> <button id="singlebutton" name="singlebutton" class="btn btn-primary">START EMERGENCY</button> </div> </div> </fieldset> </form>