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	<h4>Your Full Name
	</h4>
</header>
<div class="editor-field-full">
	<p><span class="wpcf7-form-control-wrap" data-name="your-name"><input size="40" maxlength="400" class="wpcf7-form-control wpcf7-text wpcf7-validates-as-required" aria-required="true" aria-invalid="false" value="" type="text" name="your-name" /></span>
	</p>
</div>

<!-- Email -->
<header class="form">
	<h4>Your Email Address
	</h4>
</header>
<div class="editor-field-full">
	<p><span class="wpcf7-form-control-wrap" data-name="your-email"><input size="40" maxlength="400" class="wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email" aria-required="true" aria-invalid="false" value="" type="email" name="your-email" /></span>
	</p>
</div>
<header class="form">
	<h4>What age are your children?
	</h4>
</header>
<div class="editor-field-full">
	<p><span class="wpcf7-form-control-wrap" data-name="your-childage"><span class="wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required"><span class="wpcf7-list-item first"><input type="checkbox" name="your-childage[]" value="Pregnant" /><span class="wpcf7-list-item-label">Pregnant</span></span><span class="wpcf7-list-item"><input type="checkbox" name="your-childage[]" value="Newborn" /><span class="wpcf7-list-item-label">Newborn</span></span><span class="wpcf7-list-item"><input type="checkbox" name="your-childage[]" value="Toddler" /><span class="wpcf7-list-item-label">Toddler</span></span><span class="wpcf7-list-item last"><input type="checkbox" name="your-childage[]" value="Children over 5" /><span class="wpcf7-list-item-label">Children over 5</span></span></span></span>
	</p>
</div>
<header class="form">
	<h4>Would you like to receive updates from Lots for Tots?
	</h4>
</header>
<div class="editor-field-full">
	<p><span class="wpcf7-form-control-wrap" data-name="your-consent"><span class="wpcf7-form-control wpcf7-checkbox"><span class="wpcf7-list-item first last"><input type="checkbox" name="your-consent[]" value="Yes, please send me the latest information from Lots for Tots" /><span class="wpcf7-list-item-label">Yes, please send me the latest information from Lots for Tots</span></span></span></span>
	</p>
</div>
<div class="editor-label-buttons clear">
	<p><input class="wpcf7-form-control wpcf7-submit has-spinner" type="submit" value="Send" />
	</p>
</div><div class="wpcf7-response-output" aria-hidden="true"></div>
</form>
</div>
				
		</div>
	  </div>
	
	
	</div>
	
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