<div class="container">
<form action="">
<div class="form-group">
<input type="text" class="form-control" required>
</div>
<div class="form-group">
<div class="form-check form-check-inline">
<input class="form-check-input" type="checkbox" id="" name="checkbox" value="option1">
<label class="form-check-label" for="">1</label>
</div>
<div class="form-check form-check-inline">
<input class="form-check-input" type="checkbox" id="" name="checkbox" value="option2">
<label class="form-check-label" for="">2</label>
</div>
<div class="form-check form-check-inline">
<input class="form-check-input" type="checkbox" id="" name="checkbox" value="option3">
<label class="form-check-label" for="">3</label>
</div>
</div>
<button type="submit" class="btn btn-info">送出</button>
</form>
</div>