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harass.html
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<!DOCTYPE html>
<html>
<head>
<title>Register</title>
<style>
legend{
text-align: center;
font-size: 50px;
}
li{
display:inline-block;
}
table{
font-size: 20px;
}
</style>
</head>
<body bgcolor=#ff6633>
<legend ><strong>Reporting harassement for sexual abuse</strong></legend>
<br>
<br>
<h2>Please send us details about the incident you would like to report. Our Complaint Center will analyze your complaint and take the appropriate measures.</h2>
<table>
<form action="regpost.php" method='POST'>
<table align="center">
<!--<tr>
<td>
Date of complaint
</td>
<td>
<input type="date" name="complaint">
</td>
</tr>-->
<tr>
<td>Name</td>
<td><input type="text" placeholder ="First" name="name1">
<input type="text" placeholder="Last" name="name2">
</td>
</tr>
<tr>
<td>Gender</td>
<td>
<!-- <input type="radio" name="Gender" value=male>Male -->
<input type="radio" name="Gender" value=Female>Female
<input type="radio" name="Gender" value=Other>Other
</td>
</tr>
<tr>
<td>
DOB
</td>
<td><input type="date" name="date"></td>
</tr>
<tr>
<td>
Upload Image(Optional)
</td>
<td><input type="file" size="25" accept="Image/*" name="Upload">
</tr>
<tr>
<td>
Email
</td>
<td>
<input type="Email" name="Email">
</td>
</tr>
<tr>
<td>
Date of reported incident
</td>
<td><input type="date" name="incident_date"></td>
</tr>
<tr>
<td>
Incident Location
</td>
<td>
<input type="text" placeholder="location" name="location">
</td>
</tr>
<tr>
<td>
Is person known ?
</td>
<td><input type="radio" name="yes" value="yes">yes
<input type="radio" name="no" value="no">no</td>
</tr>
<tr>
<td>
Complaint Details
</td>
<td>
<textarea name="complaint details" cols="40" rows="5"></textarea>
</td>
</tr>
<tr>
<td>
Injured or not?
<br> Please explain
</td>
<td>
<textarea name="desired outcome" cols="40" rows="5"></textarea>
</td>
</tr>
<!--<tr>
<td>
</td>
<td>Suggest the steps that should be taken to avoid a repeat of the problem
.
</td>
</tr>-->
<tr>
<td><br></td>
<td><br></td>
</tr>
<tr>
<td>  <input type="submit" name="submit" value="Submit"></td>
<td>  <input type="reset" name="reset"></td>
</tr>
</table>
</form>
</table>
</body>
</html>