<link href="//maxcdn.bootstrapcdn.com/bootstrap/4.1.1/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//maxcdn.bootstrapcdn.com/bootstrap/4.1.1/js/bootstrap.min.js"></script> <script src="//cdnjs.cloudflare.com/ajax/libs/jquery/3.2.1/jquery.min.js"></script> <!------ Include the above in your HEAD tag ----------> <div class="container"> <div class="row"> <img src="http://ec2-34-217-80-204.us-west-2.compute.amazonaws.com:5010/images/ABTA.jpeg" alt="ABTA is the UK’s largest travel association, representing travel agents and tour operators" class="center" style="width:100px;height:100px" class="center"></row> <div class="row"> <h3>Checklist for Disabled and Less Mobile Passengers</h3><p> <h5> We want everyone to enjoy completely successful travel arrangements. We strongly recommend that this checklist be completed before making a booking if you have a disability or a medical condition requiring special travel, accommodation or dietary arrangements. The form should also be used to give information regarding specific needs for equipment and / or medication you may have. It can be completed by you or the travel agent. The questions are not meant to be intrusive - the information you provide will be treated confidentially and will be used only to check that the accommodation, transport and facilities in the destination are right for you. It all helps to ensure you receive a quality service tailored to your particular needs.</h5> <form class="form-horizontal"> <fieldset> <!-- Custom Tours --> <legend>Air Travel</legend><p> <h5> If you’re travelling by air you should provide information about your needs to the airline you will be using, at least 48 hours before you travel and preferably at time of booking, especially if you are planning on taking your own wheelchair or an assistance dog. Pre-notification is vital because without it you have no legal guarantee that you’ll get the assistance you need on your journey.</h5><p> <h5> You’ll see an arrow like this > in the checklist to highlight the pre-notification info that airports, airlines, ship operators and maritime ports need. Your travel agent or tour operator will send your information to the appropriate people.</h5><p> <font color="#183592"><h5> Please complete the details below, remember to tick the YES or NO options of the following pages where relevant.</h5><p> <h5> Remember to look for the arrows > for the information you should provide at least 48 hours in advance.</h5><p></font> <legend>A: YOUR TRAVEL DETAILS</legend> <!-- Text input--> <div class="form-group"> <label class="col-md-6 control-label" for="textinput">Lead Name</label> <div class="col-md-6"> <input id="textinput" name="textinput" placeholder="Name of the person making the booking" class="form-control input-md" required="" type="text"> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-6 control-label" for="textinput">Your Name</label> <div class="col-md-6"> <input id="textinput" name="textinput" placeholder="If different from the Name above" class="form-control input-md" required="" type="text"> </div> </div>