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HTML

              
                <form accept-charset="UTF-8" action="" class="form" id="pardot-form" method="post" name="pardot-form">
		<style type="text/css">
		form.form p label { color: #000000; float: none; text-align: left; line-height: 1em; width: auto; }
		form.form p.submit { margin-left: 5px; }
		form.form p.no-label { margin-left: 50px; }
		form.form span.value { margin-left: 0px; }
		form.form p span.description { margin-left: 0px; }
		form.form p.required label, form.form span.required label { background-position: top left; background: none; padding-left: 0px; }
		form.form .pd-radio:after { content: " "; display: table; clear: both; }
		form.form .pd-radio { *zoom: 1; }
		form.form .pd-radio .value span { float: left !important; }
		</style>
		<p class="form-field form-col-1 first_name pd-text required required-custom"><label class="field-label" for="93172_108787pi_93172_108787">First Name *</label> <input class="text" id="93172_108787pi_93172_108787" maxlength="40" name="93172_108787pi_93172_108787" onchange="" onfocus="" size="30" type="text" value=""></p>
		<div id="error_for_93172_108787pi_93172_108787" style="display:none"></div>
		<p class="form-field form-col-2 last_name pd-text required required-custom"><label class="field-label" for="93172_108789pi_93172_108789">Last Name *</label> <input class="text" id="93172_108789pi_93172_108789" maxlength="80" name="93172_108789pi_93172_108789" onchange="" onfocus="" size="30" type="text" value=""></p>
		<div id="error_for_93172_108789pi_93172_108789" style="display:none"></div>
		<p class="form-field form-col-2 email pd-text required required-custom"><label class="field-label" for="93172_108791pi_93172_108791">Email *</label> <input class="text" id="93172_108791pi_93172_108791" maxlength="255" name="93172_108791pi_93172_108791" onchange="piAjax.auditEmailField(this, 93172, 108791, 146929247);" onfocus="" size="30" type="text" value=""></p>
		<div id="error_for_93172_108791pi_93172_108791" style="display:none"></div>
		<p class="form-field Response_1 pd-checkbox"><label class="field-label" for="93172_108793pi_93172_108793">Im a checkbox with a label</label> <span class="value"><span><input id="93172_108793pi_93172_108793_1228947" name="93172_108793pi_93172_108793_1228947" onchange="" type="checkbox" value="1228947"><label class="inline" for="93172_108793pi_93172_108793_1228947"><img src="https://jennamolby.com/wp-content/uploads/2021/09/radio-1.png" width="70"> <span>Checkbox 1</span></label></span><span><input id="93172_108793pi_93172_108793_1228949" name="93172_108793pi_93172_108793_1228949" onchange="" type="checkbox" value="1228949"><label class="inline" for="93172_108793pi_93172_108793_1228949"><img src="https://jennamolby.com/wp-content/uploads/2021/09/radio-2.png" width="70"> <span>Checkbox 2</span></label></span><span><input id="93172_108793pi_93172_108793_1228951" name="93172_108793pi_93172_108793_1228951" onchange="" type="checkbox" value="1228951"><label class="inline" for="93172_108793pi_93172_108793_1228951"><img src="https://jennamolby.com/wp-content/uploads/2021/09/radio-3.png" width="70"> <span>Checkbox 3</span></label></span></span></p>
		<div id="error_for_93172_108793pi_93172_108793" style="display:none"></div>
		<p style="position:absolute; width:190px; left:-9999px; top: -9999px;visibility:hidden;"><label for="pi_extra_field">Comments</label> <input id="pi_extra_field" name="pi_extra_field" type="text"></p><!-- forces IE5-8 to correctly submit UTF8 content  -->
		<input name="_utf8" type="hidden" value="☃">
		<p class="submit"><input accesskey="s" type="submit" value="Submit"></p>
		<link href="https://code.jquery.com/ui/1.12.1/themes/base/jquery-ui.css" rel="stylesheet"><!-- Load jQuery -->
		<script src="https://code.jquery.com/jquery-1.12.4.js">
		</script><!-- Load the jQuery UI JS library -->
		<script src="https://code.jquery.com/ui/1.12.1/jquery-ui.js">
		</script>
		<script>
		$(function() {
		var myDate = new Date("January 1, 1903");
		  $( "p.Date_Field input" ).datepicker({
		      changeMonth: true,
		      changeYear: true,
		      dateFormat: 'yy-mm-dd',
		      maxDate: '0',
		      yearRange: '1903:2021',
		      defaultDate: myDate
		  });
		});
		</script> 
		<script type="text/javascript">
		//<![CDATA[

		  var anchors = document.getElementsByTagName("a");
		  for (var i=0; i<anchors.length; i++) {
		      var anchor = anchors[i];
		      if(anchor.getAttribute("href")&&!anchor.getAttribute("target")) {
		          anchor.target = "_top";
		      }
		  }
		      
		//]]>
		</script> <input id="hiddenDependentFields" name="hiddenDependentFields" type="hidden" value="">
	</form>
              
            
!

CSS

              
                
/* --- customize the checkboxes --- */
/* Put the checkbox text on one line */
#pardot-form .pd-checkbox label span  {
    display:block;
    float:none;
    padding-top:10px;
}
/* align the new checkboxes */
#pardot-form .pd-checkbox span.value {
  display:flex;
  width:100%;
  gap: 10px;
}
#pardot-form .pd-checkbox span.value span {
  flex-grow: 1;
  flex-basis: 0;
}
/* style the new checkboxes */
#pardot-form .pd-checkbox label.inline  {
    margin-top:5px;
    background-color:#FFF;
    display:flex;
    flex-direction:column;
    border:solid 1px #e8e8e8;
    padding:20px;
    text-align:center;
    -moz-border-radius:10px;
    -webkit-border-radius:10px;
    border-radius:10px;
    align-items:center;
    cursor:pointer;
}
/* hide the default checkbox */
#pardot-form .pd-checkbox input {
    display:none;
}
/* style the checkboxes when selected */
#pardot-form .pd-checkbox input:checked+label {
	background-color:#e8e8e8;
	border:solid 1px #539c18;
}

/* Other form CSS generated by https://jennamolby.com/pardot-form-style-generator/ */
/* Load the custom font */ 
@import url('https://fonts.googleapis.com/css2?family=Roboto&display=swap');
#pardot-form {
	font-family:'Roboto', sans-serif;
  width:100%;
  max-width:425px;
  margin:0 auto;
  background-color:#f4f4f4;
  padding:20px;
}
#pardot-form .form-field {
 	margin:0;
 	padding:5px 0 0 0;
} 
 /* The input fields */ 
 #pardot-form input.text,
 #pardot-form textarea.standard,
 #pardot-form select,
 #pardot-form input.date { 
	background-color:#FFFFFF;
	border:solid 1px #E0E0E0;
	font-size:15px;
	color:#757575;
	-moz-border-radius:0px;
	-webkit-border-radius:0px;
	border-radius:0px;
	padding-top:5px;
	padding-bottom:5px;
	padding-left:10px;
	padding-right:10px;
	width:100%;
	font-family:'Roboto', sans-serif;
	box-sizing:border-box;
}
/* the input fields on focus */ 
 #pardot-form input.text:focus,
 #pardot-form textarea.standard:focus,
 #pardot-form select:focus,
 #pardot-form input.date:focus { 
	border-color:#cccccc;
	outline: none;
}
#pardot-form span.value { 
	margin-left: 0;
}
/* the field labels */ 
 #pardot-form label {
	font-size:15px;
	color:#757575;
	font-weight:normal;
	padding-top:5px;
	padding-bottom:5px;
	float:none;
	text-align:left;
	width:auto;
	display:block;
}
/* the submit button */ 
 #pardot-form .submit input {
	margin:0;
  font-family:'Roboto', sans-serif;
	background-color:#2CA4BF;
	border:solid 1px #2CA4BF;
	font-size:16px;
  width:100%;
	color:#FFFFFF;
	font-weight:normal;
	padding-top:10px;
	padding-bottom:10px;
	padding-right:30px;
	padding-left:30px;
	-moz-border-radius:0px;
	-webkit-border-radius:0px;
	border-radius:0px;
}
/* the submit button hover */ 
 #pardot-form .submit input:hover {
	background-color:#1988a1;
	border-color:#1988a1;
	color:#FFFFFF;
}
/* the spacing around the submit button */ 
 #pardot-form .submit {
	margin:0;
	padding-top:10px;
	padding-bottom:0px;
	text-align:center;
}
              
            
!

JS

              
                
              
            
!
999px

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