{embed="_embeds/_html-header"}

<body class="nav-hidden" id="" data-page="">

<header class="header no-hero">
	{embed="_embeds/_header"}
</header>

{exp:channel:entries channel="create_account" limit="1"}
<!-- Page Content -->
<div class="page-content">
	<div class="content-main">
		<section class="bottom-rule">
			<h1 class="page-title"><span>{title}</span></h1>
			{create_account_body}
		</section>

		<section class="bottom-rule">
			<h2 class="title-black-box">{create_account_form_title}</h2>
			{exp:freeform:form form:class="form-create" form_name="user_registration"}

					<fieldset>
						<label>{freeform:label:first_name}</label>
						<input type="text" name="first_name" placeholder="{freeform:label:first_name}">

						<label>{freeform:label:middle_initial}</label>
						<input type="text" name="middle_initial" placeholder="{freeform:label:middle_initial}">

						<label>{freeform:label:last_name}</label>
						<input type="text" name="last_name" placeholder="{freeform:label:last_name}">
					</fieldset>

					<fieldset>
						<label>{freeform:label:street}</label>
						<input type="text" name="street" placeholder="{freeform:label:street}">

						<label>{freeform:label:city}</label>
						<input type="text" name="city" placeholder="{freeform:label:city}">

						<label>{freeform:label:state}</label>
						<input type="text" name="state" placeholder="{freeform:label:state}">

						<label>{freeform:label:zip}</label>
						<input type="text" name="zip" placeholder="{freeform:label:zip}">
					</fieldset>

					<fieldset>
						<label>{freeform:label:phone_number}</label>
						<input type="text" name="phone_number" placeholder="{freeform:label:phone_number}">

						<label>{freeform:label:mobile_phone}</label>
						<input type="text" name="mobile_phone" placeholder="{freeform:label:mobile_phone}">

						<label>{freeform:label:work_phone}</label>
						<input type="text" name="work_phone" placeholder="{freeform:label:work_phone}">
					</fieldset>

					<fieldset>
						<label>{freeform:label:email}</label>
						<input type="text" name="email" placeholder="{freeform:label:email}">

						<label>{freeform:label:password}</label>
						<input type="text" name="password" placeholder="{freeform:label:password}">

						<label>{freeform:label:confirm_password}</label>
						<input type="text" name="confirm_password" placeholder="{freeform:label:confirm_password}">
					</fieldset>

					<!-- 

					<label class="block-label"><input type="checkbox" name="check-enable-master" id="check-enable-master" value=""><span>Check box if you want to add yourself as a driver. Otherwise, leave unchecked and add drivers later.</span></label>
					<fieldset id="enable-master" disabled>
						<div class="disabled-screen">
							<div class="birthday-wrap">
								<span class="fake-placeholder">Birthdate</span>
								<select class="birth-month">
									<option value="1">01 - January</option>
									<option value="2">02 - February</option>
									<option value="3">03 - March</option>
									<option value="4">04 - April</option>
									<option value="5">05 - May</option>
									<option value="6">06 - June</option>
									<option value="7">07 - July</option>
									<option value="8">08 - August</option>
									<option value="9">09 - September</option>
									<option value="10">10 - October</option>
									<option value="11">11 - November</option>
									<option value="12">12 - December</option>
								</select>
								<select class="birth-day">
									<option value="1">01</option>
									<option value="2">02</option>
									<option value="3">03</option>
									<option value="4">04</option>
									<option value="5">05</option>
									<option value="6">06</option>
									<option value="7">07</option>
									<option value="8">08</option>
									<option value="9">09</option>
									<option value="10">10</option>
									<option value="11">11</option>
									<option value="12">12</option>
									<option value="13">13</option>
									<option value="14">14</option>
									<option value="15">15</option>
									<option value="16">16</option>
									<option value="17">17</option>
									<option value="18">18</option>
									<option value="19">19</option>
									<option value="20">20</option>
									<option value="21">21</option>
									<option value="22">22</option>
									<option value="23">23</option>
									<option value="24">24</option>
									<option value="25">25</option>
									<option value="26">26</option>
									<option value="27">27</option>
									<option value="28">28</option>
									<option value="29">29</option>
									<option value="30">30</option>
									<option value="31">31</option>
								</select> 
								<select class="birth-year">

								-->
									<!-- This year minus however many years the youngest driver can be...14? -->
									<!--

									<option value="2000">2000</option> <option value="1999">1999</option> <option value="1998">1998</option> <option value="1997">1997</option> <option value="1996">1996</option> <option value="1995">1995</option> <option value="1994">1994</option> <option value="1993">1993</option> <option value="1992">1992</option> <option value="1991">1991</option> <option value="1990">1990</option> <option value="1989">1989</option> <option value="1988">1988</option> <option value="1987">1987</option> <option value="1986">1986</option> <option value="1985">1985</option> <option value="1984">1984</option> <option value="1983">1983</option> <option value="1982">1982</option> <option value="1981">1981</option> <option value="1980">1980</option> <option value="1979">1979</option> <option value="1978">1978</option> <option value="1977">1977</option> <option value="1976">1976</option> <option value="1975">1975</option> <option value="1974">1974</option> <option value="1973">1973</option> <option value="1972">1972</option> <option value="1971">1971</option> <option value="1970">1970</option> <option value="1969">1969</option> <option value="1968">1968</option> <option value="1967">1967</option> <option value="1966">1966</option> <option value="1965">1965</option> <option value="1964">1964</option> <option value="1963">1963</option> <option value="1962">1962</option> <option value="1961">1961</option> <option value="1960">1960</option> <option value="1959">1959</option> <option value="1958">1958</option> <option value="1957">1957</option> <option value="1956">1956</option> <option value="1955">1955</option> <option value="1954">1954</option> <option value="1953">1953</option> <option value="1952">1952</option> <option value="1951">1951</option> <option value="1950">1950</option> <option value="1949">1949</option> <option value="1948">1948</option> <option value="1947">1947</option> <option value="1946">1946</option> <option value="1945">1945</option> <option value="1944">1944</option> <option value="1943">1943</option> <option value="1942">1942</option> <option value="1941">1941</option> <option value="1940">1940</option> <option value="1939">1939</option> <option value="1938">1938</option> <option value="1937">1937</option> <option value="1936">1936</option> <option value="1935">1935</option> <option value="1934">1934</option> <option value="1933">1933</option> <option value="1932">1932</option> <option value="1931">1931</option> <option value="1930">1930</option> <option value="1929">1929</option> <option value="1928">1928</option> <option value="1927">1927</option> <option value="1926">1926</option> <option value="1925">1925</option> <option value="1924">1924</option> <option value="1923">1923</option> <option value="1922">1922</option> <option value="1921">1921</option> <option value="1920">1920</option> <option value="1919">1919</option> <option value="1918">1918</option> <option value="1917">1917</option> <option value="1916">1916</option> <option value="1915">1915</option> <option value="1914">1914</option> <option value="1913">1913</option> <option value="1912">1912</option> <option value="1911">1911</option> <option value="1910">1910</option> <option value="1909">1909</option> <option value="1908">1908</option> <option value="1907">1907</option> <option value="1906">1906</option> <option value="1905">1905</option> <option value="1904">1904</option> <option value="1903">1903</option> <option value="1902">1902</option> <option value="1901">1901</option> <option value="1900">1900</option> 
								</select>
							</div>
							<input type="text" placeholder="High School">
						</div>
					</fieldset> -->

					<fieldset>
						<label class="block-label"><input type="checkbox" name="" value=""><span>Recieve Century Driving School Emails</span></label>
					</fieldset>

					<input class="submit" type="submit" value="Create Account">
				</form>
			{/exp:freeform:form}
		</section>

	</div> <!-- /content-main -->
	{embed="_embeds/_sidebar"}

</div> <!-- /Page Content -->
{/exp:channel:entries}

<footer class="footer">
	{embed="_embeds/_footer"}
</footer>

{embed="_embeds/_footer_scripts"}
</body>
</html>