mirror of
https://github.com/skoobasteeve/rayandgwen-wedding.git
synced 2026-03-20 06:58:56 +00:00
36 lines
1001 B
Markdown
36 lines
1001 B
Markdown
---
|
|
title: "Gwen & Ray are getting married!"
|
|
layout: splash
|
|
permalink: /covid/
|
|
author_profile: false
|
|
masthead: false
|
|
header:
|
|
overlay_color: "#000"
|
|
overlay_filter: "0.4"
|
|
overlay_image: /assets/images/banner-sketch.jpg
|
|
excerpt: "November 13th 2021 <br> Brooklyn, NY"
|
|
---
|
|
|
|
[<- Home](../index.html)
|
|
{: .text-left}
|
|
|
|
# Submit your COVID-19 Vaccine Card
|
|
|
|
<form name="vaccine-submission" netlify-honeypot="bot-field" method="POST" data-netlify="true" action="/covid-success/" netlify>
|
|
<p class="hidden">
|
|
<label>Fill this out!: <input name="bot-field" /></label>
|
|
</p>
|
|
<p>
|
|
<label>Full Name <input type="text" name="name" required/></label>
|
|
</p>
|
|
<p>
|
|
<label>Vaccine Card <input type="file" name="vaccine_card" accept="image/png, image/jpeg, image/tiff, application/pdf, .heif" required/></label>
|
|
</p>
|
|
<p>
|
|
<label>Questions / Comments <input type="text" name="comments" /></label>
|
|
</p>
|
|
<p>
|
|
<button type="submit" class="btn btn--primary">Submit</button>
|
|
</p>
|
|
</form>
|