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My email send all the inflrmation only in text not html.

 

<?
session_start();

if (isset($_POST['SendOrder_y'])){

$CopyMe=$_POST['SendCopy'];

$to = "me@me.com"; 

$to1 = $CopyMe;

$subject = "Order Form";  

$headers = "From:".$_SESSION['email']."\r\n";  
$headers .= "MIME-Version: 1.0\r\n"  
  . "Content-Type: text/html; charset=\"iso-8859-1\"\r\n"  
  . "Content-Transfer-Encoding: 7bit\r\n";
  
  
ob_start(); // start buffer

include ("orderSendEmail.php");

$message = ob_get_contents(); // assign buffer contents to variable

ob_end_clean(); // end buffer and remove buffer contents

mail($to, $subject, $message, $headers);

echo"SENT";

} 
?>

 

 

I am not going to post the whole email but this should give you an Idea of my trouble today.  Below is what actually shows up in the email.

 

Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Nonspam: None


<html> <head> <meta http-equiv="Content-Type" content="text/html; charset=windows-1252"> <link href="email.css" rel="stylesheet" type="text/css" /> <title>FHS Appraiser Source</title> </head>  <body> <table border=0 width=100%><tr> 		<td><b><font face=verdana>APPRAISAL ORDER REQUEST FORM</font></b></td> 		<td  -------- AND SO ON...

 

Any help today?

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change

$headers .= "MIME-Version: 1.0\r\n"  
  . "Content-Type: text/html; charset=\"iso-8859-1\"\r\n"  
  . "Content-Transfer-Encoding: 7bit\r\n";

 

to

$headers =  "From:".$_SESSION['email']."\r\n";  
$headers .= "MIME-Version: 1.0\r\n";
$headers .= "Content-Type: text/html; charset=\"iso-8859-1\"\r\n";
$headers .= "Content-Transfer-Encoding: 7bit\r\n";

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I changed the headers and that didn't work????

 

This is the first line that shows in the email. >>> Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Nonspam: None

 

Then thier are several breaks and then the written html

 

Do you think that has something to with it?

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Message as requested.

 

<?
session_start();

echo"
<html>
<head>
<style>
#orderTitle{
font-weight:bold;
font-size:14px;
color:#006000;
border-bottom:#000080 solid 2px;
font-family:verdana;
}

#orderLable{
font-size:12px;
padding:3px;
font-family:verdana;
}
</style>
<head>
<body>
<table border=0 width=100%>
<form action='orderSubmitEmail.php' method=post>
<tr>
	<td><b><font face=verdana>APPRAISAL ORDER REQUEST FORM</font></b></td>
	<td id=orderLable align=right><input type=checkbox name='SendCopy' value='".$_SESSION['email']."'> Send Me A Copy</td>
</tr>
</table>
<div id=orderRequestForm style='width:678px; height:296px; overflow:auto; margin-bottom:10px;'>	
<table border=0 width=100%>	
<tr>
	<td colspan=2><div id=orderTitle>Company / Contact information</div></td>
</tr>
<tr>
	<td width=25%> </td>
	<td width=75%> </td>
</tr>
<tr>
	<td id='orderLable' width=25%>Business:</td>
	<td width=75% id='orderLable'>".$_SESSION['yourBusiness']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Company:</td>
	<td width=75% id='orderLable'>".$_SESSION['companyName']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Contact Person:</td>
	<td width=75% id='orderLable'>".$_SESSION['contactPersonFirst']." ".$_SESSION['contactPersonLast']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Phone:</td>
	<td width=75% id='orderLable'>(".$_SESSION['phone1'].") ".$_SESSION['phone2']."-".$_SESSION['phone3']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Alternate Phone:</td>
	<td width=75% id='orderLable'>(".$_SESSION['altphone1'].") ".$_SESSION['altphone2']."-".$_SESSION['altphone3']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Fax Number:</td>
	<td width=75% id='orderLable'>(".$_SESSION['fax1'].") ".$_SESSION['fax2']."-".$_SESSION['fax3']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Email:</td>
	<td width=75% id='orderLable'>".$_SESSION['email']."</td>
</tr>
<tr>
	<td id='orderLable' width=25% valign=top>Address:</td>
	<td width=75% id='orderLable'>".$_SESSION['contactaddress']."<br>".$_SESSION['contactcity'].", ".$_SESSION['contactstate']." ".$_SESSION['contactzip']."</td>
</tr>
<tr>
	<td width=25%> </td>
	<td width=75%> </td>
</tr>
<tr>
	<td width=25%> </td>
	<td width=75%> </td>
</tr>
<tr>
	<td colspan=2><div id=orderTitle>Inspection And Property Access Information</div></td>
</tr>
<tr>
	<td width=25%> </td>
	<td width=75%> </td>
</tr>
<tr>
	<td id='orderLable' width=25%>Property Type:</td>
	<td width=75% id='orderLable'>".$_SESSION['service']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Property Address:</td>
	<td width=75% id='orderLable'>".$_SESSION['prop_address']."<br>".$_SESSION['prop_city'].", ".$_SESSION['prop_state']." ".$_SESSION['prop_zip']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Contact:</td>
	<td width=75% id='orderLable'>".$_SESSION['contactForInspection']." </td>
</tr>
<tr>
	<td id='orderLable' width=25%>Contact Name:</td>
	<td width=75% id='orderLable'>".$_SESSION['inspContactPersonFirst']." ".$_SESSION['inspContactPersonLast']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Contact Phone Number:</td>
	<td width=75% id='orderLable'>(".$_SESSION['inspPhone1'].") ".$_SESSION['inspPhone2']."-".$_SESSION['inspPhone3']."</td>
</tr>
<tr>
	<td width=25%> </td>
	<td width=75%> </td>
</tr>
<tr>
	<td width=25%> </td>
	<td width=75%> </td>
</tr>
<tr>
	<td colspan=2><div id=orderTitle>Appraisal Detials</div></td>
</tr>
<tr>
	<td width=25%> </td>
	<td width=75%> </td>
</tr>
<tr>
	<td id='orderLable' width=25%>Purpose:</td>
	<td width=75% id='orderLable'>".$_SESSION['purpose']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Sale Price:</td>
	<td width=75% id='orderLable'>".$_SESSION['salePrice']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Report Type:</td>
	<td width=75% id='orderLable'>".$_SESSION['reportType']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>FHA:</td>
	<td width=75% id='orderLable'>".$_SESSION['fha']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Occupancy:</td>
	<td width=75% id='orderLable'>".$_SESSION['occupancy']."</td>
</tr>
<tr>
	<td id='orderLable' width=25% valign=top>Comments:</td>
	<td width=75% id='orderLable'>".$_SESSION['explainPurpose']."</td>
</tr>
<tr>
	<td width=25%> </td>
	<td width=75%> </td>
</tr>
<tr>
	<td width=25%> </td>
	<td width=75%> </td>
</tr>
<tr>
	<td id='orderLable' colspan=2 align=right>Brought to you by: <img border=0 src='logoSMALL.gif' border=0></td>
</tr>
</table>
</div>
<table border=0 width='100%'>
<tr>
	<td align=left><a href='contact.php'><img src='orderEdit.gif' border=0></a></td>
	<td align=right><input type=image name='SendOrder' src='orderSend.gif'></td>
</tr>
</form>
</table>
<body>
</html>
";

?>

 

Thank you for your help in this.

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I have a message because this is what comes to my inbox once submitted:

 

 

 

Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: 7bit X-Nonspam: None


<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=windows-1252">
<style>
#orderTitle{
font-weight:bold;
font-size:14px;
color:#006000;
border-bottom:#000080 solid 2px;
font-family:verdana;
}

#orderLable{
font-size:12px;
padding:3px;
font-family:verdana;
}
</style>
<head>
<body>
<table border=0 width=100%>
<tr>
	<td><b><font face=verdana>APPRAISAL ORDER REQUEST FORM</font></b></td>
	<td id=orderLable align=right><input type=checkbox name='SendCopy' value='".$_SESSION['email']."'> Send Me A Copy</td>
</tr>
</table>
<div id=orderRequestForm style='width:678px; height:296px; overflow:auto; margin-bottom:10px;'>	
<table border=0 width=100%>	
<tr>
	<td colspan=2><div id=orderTitle>Company / Contact information</div></td>
</tr>
<tr>
	<td width=25%> </td>
	<td width=75%> </td>
</tr>
<tr>
	<td id='orderLable' width=25%>Business:</td>
	<td width=75% id='orderLable'>".$_SESSION['yourBusiness']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Company:</td>
	<td width=75% id='orderLable'>".$_SESSION['companyName']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Contact Person:</td>
	<td width=75% id='orderLable'>".$_SESSION['contactPersonFirst']." ".$_SESSION['contactPersonLast']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Phone:</td>
	<td width=75% id='orderLable'>(".$_SESSION['phone1'].") ".$_SESSION['phone2']."-".$_SESSION['phone3']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Alternate Phone:</td>
	<td width=75% id='orderLable'>(".$_SESSION['altphone1'].") ".$_SESSION['altphone2']."-".$_SESSION['altphone3']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Fax Number:</td>
	<td width=75% id='orderLable'>(".$_SESSION['fax1'].") ".$_SESSION['fax2']."-".$_SESSION['fax3']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Email:</td>
	<td width=75% id='orderLable'>".$_SESSION['email']."</td>
</tr>
<tr>
	<td id='orderLable' width=25% valign=top>Address:</td>
	<td width=75% id='orderLable'>".$_SESSION['contactaddress']."<br>".$_SESSION['contactcity'].", ".$_SESSION['contactstate']." ".$_SESSION['contactzip']."</td>
</tr>
<tr>
	<td width=25%> </td>
	<td width=75%> </td>
</tr>
<tr>
	<td width=25%> </td>
	<td width=75%> </td>
</tr>
<tr>
	<td colspan=2><div id=orderTitle>Inspection And Property Access Information</div></td>
</tr>
<tr>
	<td width=25%> </td>
	<td width=75%> </td>
</tr>
<tr>
	<td id='orderLable' width=25%>Property Type:</td>
	<td width=75% id='orderLable'>".$_SESSION['service']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Property Address:</td>
	<td width=75% id='orderLable'>".$_SESSION['prop_address']."<br>".$_SESSION['prop_city'].", ".$_SESSION['prop_state']." ".$_SESSION['prop_zip']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Contact:</td>
	<td width=75% id='orderLable'>".$_SESSION['contactForInspection']." </td>
</tr>
<tr>
	<td id='orderLable' width=25%>Contact Name:</td>
	<td width=75% id='orderLable'>".$_SESSION['inspContactPersonFirst']." ".$_SESSION['inspContactPersonLast']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Contact Phone Number:</td>
	<td width=75% id='orderLable'>(".$_SESSION['inspPhone1'].") ".$_SESSION['inspPhone2']."-".$_SESSION['inspPhone3']."</td>
</tr>
<tr>
	<td width=25%> </td>
	<td width=75%> </td>
</tr>
<tr>
	<td width=25%> </td>
	<td width=75%> </td>
</tr>
<tr>
	<td colspan=2><div id=orderTitle>Appraisal Detials</div></td>
</tr>
<tr>
	<td width=25%> </td>
	<td width=75%> </td>
</tr>
<tr>
	<td id='orderLable' width=25%>Purpose:</td>
	<td width=75% id='orderLable'>".$_SESSION['purpose']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Sale Price:</td>
	<td width=75% id='orderLable'>".$_SESSION['salePrice']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Report Type:</td>
	<td width=75% id='orderLable'>".$_SESSION['reportType']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>FHA:</td>
	<td width=75% id='orderLable'>".$_SESSION['fha']."</td>
</tr>
<tr>
	<td id='orderLable' width=25%>Occupancy:</td>
	<td width=75% id='orderLable'>".$_SESSION['occupancy']."</td>
</tr>
<tr>
	<td id='orderLable' width=25% valign=top>Comments:</td>
	<td width=75% id='orderLable'>".$_SESSION['explainPurpose']."</td>
</tr>
<tr>
	<td width=25%> </td>
	<td width=75%> </td>
</tr>
<tr>
	<td width=25%> </td>
	<td width=75%> </td>
</tr>
<tr>
	<td id='orderLable' colspan=2 align=right>Brought to you by: <img border=0 src='logoSMALL.gif' border=0></td>
</tr>
</table>
</div>
<table border=0 width='100%'>
<tr>
	<td align=left><a href='contact.php'><img src='orderEdit.gif' border=0></a></td>
	<td align=right><input type=image name='SendOrder' src='orderSend.gif'></td>
</tr>
</table>
<body>
</html>

 

Except where you see ".$_SESSION['whatever']." the actual value is there.

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Okay let's try and solve your problem....

 

Firstly make sure you have the following class files in the root directory of your webpage directory:

1.class.phpmailer.php

2.class.pop3.php

3.class.smtp.php

 

then the following code is an example of a form that when submitted will forward to the second page which will send the email and then forward it to another third page which only displays a message saying the message was sent succesfully or a fourth saying that the message sending has failed.

 

Form: au pair.html

<html>
<head>
<title></title>

<script language="JavaScript" type="text/JavaScript">
<!--//hide script
function checkme() {
missinginfo = "";
if (!document.form.agree.checked) {
missinginfo += "Please be sure to certify that all provided information is accurate and correct.";
} 
if (missinginfo != "") {
"";
alert(missinginfo);
return false;
}
else { 
return true;
}
}

// --->
</script>

<style>
td{font-family:"arial";
font-size:"10pt";
color:"#DE9221";
}
</style>
</head>
<body topmargin="0" bottommargin="0" leftmargin="0" rightmargin="0" background="body-back.jpg">
<center>
<table cellpadding="0" cellspacing="0" border="0" height="100%">
<tr>
<td colspan="2" background="top2.jpg" width="807" height="156"> </td>
</tr>
<tr>
<td background="main2.jpg" width="807" valign="top">
<center><table width="780"><tr><td><br><h4>Au Pair Application Form</h4></center>
<form name="form" method="post" action="au pair.php" onSubmit="return checkme();">
<b><u>General Information</u></b>
<table>
<tr>
	<td>First name:</td>
	<td> </td>
	<td colspan="4"><input type="text" name="first_name" size="35"></td>
</tr>
<tr>
	<td>Last name:</td>
	<td> </td>
	<td colspan="4"><input type="text" name="last_name" size="35"></td>
</tr>
<tr>
	<td valign="top">Address:</td>
	<td> </td>
	<td colspan="4"><textarea cols="20" rows="3" name="addresss"></textarea></td>
</tr>
<tr>
	<td>Phone number:</td>
	<td> </td>
	<td colspan="4"><input type="text" name="phone_number" size="10"></td>
</tr>
<tr>
	<td>Cell phone number:</td>
	<td> </td>
	<td colspan="4"><input type="text" name="cell_number" size="10"></td>
</tr>
<tr>
	<td>Fax number:</td>
	<td> </td>
	<td><input type="text" name="fax" size="10"></td>
</tr>
<tr>
	<td>Email address:</td>
	<td> </td>
	<td colspan="4"><input type="text" name="email" size="35"></td>
</tr>
<tr>
	<td>Sex:</td>
	<td> </td>
	<td colspan="4"><input type='radio' name='sex' id='sex' value="Male">Male   <input type='radio' name='sex' id='sex' value="Female">Female</td>
</tr>
<tr>
	<td>Age:</td>
	<td> </td>
	<td><input type="text" name="age" size="5"></td>
	<td>Birthday:</td>
	<td> </td>
	<td><input type="text" name="birthday" size="10"></td>
</tr>
<tr>
	<td>City of birth:</td>
	<td> </td>
	<td><input type="text" name="birth_city" size="35"></td>
	<td>Country of birth:</td>
	<td> </td>
	<td><input type="text" name="birth_country" size="35"></td>
</tr>
<tr>
	<td>Height:</td>
	<td> </td>
	<td><input type="text" name="height" size="10"></td>
	<td>Weight:</td>
	<td> </td>
	<td><input type="text" name="weight" size="10"></td>
</tr>
<tr>
	<td>Eye colour:</td>
	<td> </td>
	<td><input type="text" name="eye_colour" size="10"></td>
	<td>Hair colour:</td>
	<td> </td>
	<td><input type="text" name="hair_colour" size="10"></td>
</tr>
<tr>
	<td>Passport number:</td>
	<td> </td>
	<td><input type="text" name="passport_number" size="20"></td>
	<td>Passport expiration date:</td>
	<td> </td>
	<td><input type="text" name="passport_date" size="20"></td>
</tr>
<tr>
	<td>First available departure date:</td>
	<td> </td>
	<td><input type="text" name="departure_date" size="10"></td>
	<td>Departure Airport:</td>
	<td> </td>
	<td><input type="text" name="departure_airport" size="20"></td>
</tr>
</table><br>
<b><u>Education</u></b>
<table>
<tr>
	<td>Highest level of education reached:</td>
	<td> </td>
	<td colspan="4"><input type="text" name="highest_education" size="35"></td>
</tr>
<tr>
	<td>Educational and professional training:</td>
	<td> </td>
	<td colspan="4"><input type="text" name="educational_training" size="35"></td>
</tr>
<tr>
	<td>Languages spoken:</td>
	<td> </td>
	<td colspan="4"><input type="text" name="languages_spoken" size="35"></td>
</tr>
</table><br>
<b><u>Experience in childcare</u></b>
<table>
<tr>
	<td align="center">Type of childcare<br>(baby-sitting, au pair, nanny, youth, etc.)</td>
	<td> </td>
	<td align="center">Dates<br>From and to</td>
	<td> </td>
	<td align="center">Ages of children<br>when started</td>
	<td> </td>
	<td align="center">Responsibilities</td>
	<td> </td>
	<td align="center">How often<br>(daily, weekly, monthly)</td>
	<td> </td>
	<td align="center">Name of<br>reference</td>
	<td> </td>
	<td align="center">Phone number<br>of reference</td>
</tr>
<tr>
	<td align="center"><input type="text" name="childcare_type" size="20"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_dates" size="10"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_ages" size="5"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_responsibilities" size="10"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_how_often" size="10"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_reference_name" size="10"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_reference_number" size="10"></td>
</tr>
<tr>
	<td align="center"><input type="text" name="childcare_type1" size="20"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_dates1" size="10"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_ages1" size="5"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_responsibilities1" size="10"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_how_often1" size="10"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_reference_name1" size="10"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_reference_number1" size="10"></td>
</tr>
<tr>
	<td align="center"><input type="text" name="childcare_type2" size="20"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_dates2" size="10"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_ages2" size="5"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_responsibilities2" size="10"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_how_often2" size="10"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_reference_name2" size="10"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_reference_number2" size="10"></td>
</tr>
<tr>
	<td align="center"><input type="text" name="childcare_type3" size="20"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_dates3" size="10"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_ages3" size="5"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_responsibilities3" size="10"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_how_often3" size="10"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_reference_name3" size="10"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_reference_number3" size="10"></td>
</tr>
<tr>
	<td align="center"><input type="text" name="childcare_type4" size="20"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_dates4" size="10"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_ages4" size="5"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_responsibilities4" size="10"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_how_often4" size="10"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_reference_name4" size="10"></td>
	<td> </td>
	<td align="center"><input type="text" name="childcare_reference_number4" size="10"></td>
</tr>
</table><br>
<table width="780">
<tr>
	<td>Age group preference:</td>
	<td> </td>
	<td><input type="text" name="age_preference" size="5"></td>
</tr>
<tr>
	<td valign="top">Reason:</td>
	<td> </td>
	<td><textarea cols="35" rows="3" name="reasons"></textarea></td>
</tr>
<tr>
	<td valign="top">List achievements, talents, and hobbies:</td>
	<td> </td>
	<td><textarea cols="50" rows="10" name="achievements"></textarea></td>
</tr>
</table><br>
<table width="780">
<tr>
	<td>Can you cook?</td>

	<td><input type="radio" id="cook" name="cook" value="Yes">Yes   <input type="radio" id="cook" name="cook" value="No">No</td>
	<td>Can you swim?</td>
	<td><input type="radio" id="swim" name="swim" value="Yes">Yes   <input type="radio" id="swim" name="swim" value="No">No</td>
</tr>
<tr>
	<td valign="top" colspan="2">Are there any pets that you do not<br>want to be placed with?</td>
	<td> </td>
	<td colspan="4" valign="top"><input type="text" name="pets" size="35"></td>
</tr>
<tr>
	<td valign="top">Reason:</td>
	<td> </td>
	<td colspan="4"><textarea cols="35" rows="3" name="pets_reason"></textarea></td>
</tr>
</table></center><br>
<b><u>Driving information</u></b>
<table>
<tr>
	<td>Do you have a drivers license?</td>
	<td> </td>
	<td><input type="radio" id="drivers_license" name="drivers_license" value="Yes">Yes   <input type="radio" id="drivers_license" name="drivers_license" value="No">No</td>
</tr>
<tr>
	<td valign="top">When did you receive your drivers license?</td>
	<td> </td>
	<td><input type="text" name="drivers_when" size="20"></td>
</tr>
<tr>
	<td valign="top">How often do you drive?</td>
	<td> </td>
	<td><input type="text" name="drivers_how_often" size="20"></td>
</tr>
<tr>
	<td>Do you have your own car?</td>
	<td> </td>
	<td><input type="radio" id="drivers_car" name="drivers_car" value="Yes">Yes   <input type="radio" id="drivers_car" name="drivers_car" value="No">No</td>
</tr>
<tr>
	<td valign="top">How often do you have access to a car?</td>
	<td> </td>
	<td><input type="text" name="drivers_access" size="20"></td>
</tr>
<tr>
	<td valign="top">How heavy is the traffic that you typically drive in?</td>
	<td> </td>
	<td><input type="text" name="drivers_traffic" size="20"></td>
</tr>
<tr>
	<td valign="top">What car do you usually drive?</td>
	<td> </td>
	<td><input type="text" name="drivers_usual_car" size="20"></td>
</tr>
<tr>
	<td valign="top">Do you have any concerns with driving?</td>
	<td> </td>
	<td><input type="text" name="drivers_concerns" size="20"></td>
</tr>
</table><br>
<b><u>Family background</u></b>
<table>
<tr>
	<td>Fathers name:</td>
	<td> </td>
	<td><input type="text" name="fathers_name" size="20"></td>
	<td>Occupation:</td>
	<td> </td>
	<td><input type="text" name="fathers_occupation" size="20"></td>
</tr>
<tr>
	<td>Mothers name:</td>
	<td> </td>
	<td><input type="text" name="mothers_name" size="20"></td>
	<td>Occupation:</td>
	<td> </td>
	<td><input type="text" name="mothers_occupation" size="20"></td>
</tr>
<tr>
	<td valign="top">Address:</td>
	<td> </td>
	<td colspan="4"><textarea cols="20" rows="3" name="family_address"></textarea></td>
</tr>
<tr>
	<td>Telephone number:</td>
	<td> </td>
	<td><input type="text" name="fphone_number" size="20"></td>
	<td>Cell number:</td>
	<td> </td>
	<td><input type="text" name="fcell" size="20"></td>
</tr>
<tr>
	<td>Number of children:</td>
	<td> </td>
	<td><input type="text" name="no_children" size="5"></td>
</tr>
<tr>
	<td>Are they supportive of you<br>becoming an au pair abroad?</td>
	<td> </td>
	<td valign="top"><input type="radio" id="supportive" name="supportive" value="Yes">Yes   <input type="radio" id="supportive" name="supportive" value="No">No</td>
</tr>
<tr>
	<td>Do you have younger siblings?</td>
	<td> </td>
	<td><input type="radio" id="siblings" name="siblings" value="Yes">Yes   <input type="radio" id="siblings" name="siblings" value="No">No</td>
	<td>Age:</td>
	<td> </td>
	<td><input type="text" name="fage" size="10"></td>
</tr>
</table><br>
<b><u>About you</u></b>
<table>
<tr>
	<td>Have you lived away fom home?</td>
	<td> </td>
	<td><input type="radio" name="q1" id="q1" value="Yes">Yes   <input type="radio" name="q1" id="q1" value="No">No</td>
</tr>
<tr>
	<td>Have you lived abroad?</td>
	<td> </td>
	<td><input type="radio" name="q2" id="q2" value="Yes">Yes   <input type="radio" name="q2" id="q2" value="No">No</td>
</tr>
<tr>
	<td>Have you ever travelled out of the country?</td>
	<td> </td>
	<td><input type="radio" name="q3" id="q3" value="Yes">Yes   <input type="radio" name="q3" id="q3" value="No">No</td>
</tr>
<tr>
	<td>Do you have friends and family in South Africa?</td>
	<td> </td>
	<td><input type="radio" name="q4" id="q4" value="Yes">Yes   <input type="radio" name="q4" id="q4" value="No">No</td>
</tr>
<tr>
	<td>Do you drink alcoholic beverages?</td>
	<td> </td>
	<td><input type="radio" name="q5" id="q5" value="Yes">Yes   <input type="radio" name="q5" id="q5" value="No">No</td>
</tr>
<tr>
	<td>Do you smoke?</td>
	<td> </td>
	<td><input type="radio" name="q6" id="q6" value="Yes">Yes   <input type="radio" name="q6" id="q6" value="No">No</td>
</tr>
<tr>
	<td>Do you use illegal drugs?</td>
	<td> </td>
	<td><input type="radio" name="q7" id="q7" value="Yes">Yes   <input type="radio" name="q7" id="q7" value="No">No</td>
</tr>
<tr>
	<td>Have you ever taken illegal drugs?</td>
	<td> </td>
	<td><input type="radio" name="q8" id="q8" value="Yes">Yes   <input type="radio" name="q8" id="q8" value="No">No</td>
</tr>
<tr>
	<td>Do you have any tattoos or piercings?</td>
	<td> </td>
	<td><input type="radio" name="q9" id="q9" value="Yes">Yes   <input type="radio" name="q9" id="q9" value="No">No</td>
</tr>
<tr>
	<td>Do you have any traffic tickets?</td>
	<td> </td>
<td><input type="radio" name="q10" id="q10" value="Yes">Yes   <input type="radio" name="q10" id="q10" value="No">No</td>	</tr>
<tr>
	<td>Have you ever been in a car accident?</td>
	<td> </td>
	<td><input type="radio" name="q11" id="q11" value="Yes">Yes   <input type="radio" name="q11" id="q11" value="No">No</td>
</tr>
<tr>
	<td>Do you have a criminal record?</td>
	<td> </td>
	<td><input type="radio" name="q12" id="q12" value="Yes">Yes   <input type="radio" name="q12" id="q12" value="No">No</td>
</tr>
<tr>
	<td>Do you have any racial prejudices?</td>
	<td> </td>
	<td><input type="radio" name="q13" id="q13" value="Yes">Yes   <input type="radio" name="q13" id="q13" value="No">No</td>
</tr>
<tr>
	<td>Are you currently in a romantic relationship?</td>
	<td> </td>
	<td><input type="radio" name="q14" id="q14" value="Yes">Yes   <input type="radio" name="q14" id="q14" value="No">No</td>
</tr>
<tr>
	<td>Have you ever been married?</td>
	<td> </td>
	<td><input type="radio" name="q15" id="q15" value="Yes">Yes   <input type="radio" name="q15" id="q15" value="No">No</td>
</tr>
<tr>
	<td>Do you have any financial commitments?</td>
	<td> </td>
	<td><input type="radio" name="q16" id="q16" value="Yes">Yes   <input type="radio" name="q16" id="q16" value="No">No</td>
</tr>
<tr>
	<td>Do you have any physical or mental limitations?</td>
	<td> </td>
	<td><input type="radio" name="q17" id="q17" value="Yes">Yes   <input type="radio" name="q17" id="q17" value="No">No</td>
</tr>
<tr>
	<td>Are you currently taking any medication?</td>
	<td> </td>
	<td><input type="radio" name="q18" id="q18" value="Yes">Yes   <input type="radio" name="q18" id="q18" value="No">No</td>
</tr>
<tr>
	<td>Do you have any medical conditions requiring treatment?</td>
	<td> </td>
	<td><input type="radio" name="q19" id="q19" value="Yes">Yes   <input type="radio" name="q19" id="q19" value="No">No</td>
</tr>
<tr>
	<td>Do you have any allergies?</td>
	<td> </td>
	<td><input type="radio" name="q20" id="q20" value="Yes">Yes   <input type="radio" name="q20" id="q20" value="No">No</td>
</tr>
<tr>
	<td>Do you have any dietary requirements?</td>
	<td> </td>
	<td><input type="radio" name="q21" id="q21" value="Yes">Yes   <input type="radio" name="q21" id="q21" value="No">No</td>
</tr>
<tr>
	<td>Are you a vegitarian?</td>
	<td> </td>
	<td><input type="radio" name="q22" id="q22" value="Yes">Yes   <input type="radio" name="q22" id="q22" value="No">No</td>
</tr>
<tr>
	<td>If yes, can you cook or be placed with a family who eats meat?</td>
	<td> </td>
	<td><input type="radio" name="q23" id="q23" value="Yes">Yes   <input type="radio" name="q23" id="q23" value="No">No</td>
</tr>
<tr>
	<td>Are you willing to work with a single father?</td>
	<td> </td>
	<td><input type="radio" name="q24" id="q24" value="Yes">Yes   <input type="radio" name="q24" id="q24" value="No">No</td>
</tr>
<tr>
	<td>Are you willing to work with a single mother?</td>
	<td> </td>
	<td><input type="radio" name="q25" id="q25" value="Yes">Yes   <input type="radio" name="q25" id="q25" value="No">No</td>
</tr>
<tr>
	<td>Do you know how to change a diaper?</td>
	<td> </td>
	<td><input type="radio" name="q26" id="q26" value="Yes">Yes   <input type="radio" name="q26" id="q26" value="No">No</td>
</tr>
</table><br>
Please explain the details for all the items to which you answered 'Yes'
<table>
<tr>
	<td><textarea cols="70" rows="10" name="yes"></textarea></td>
</tr>
</table><br>
<b><u>Emergency information</u></b>
<table>
<tr>
	<td>Name:</td>
	<td> </td>
	<td colspan="4"><input type="text" name="name" size="20"></td>
</tr>
<tr>
	<td valign="top">Address:</td>
	<td> </td>
	<td colspan="4"><textarea cols="20" rows="3" name="eaddress"></textarea></td>
</tr>
<tr>
	<td>City, State / Country:</td>
	<td> </td>
	<td><input type="text" name="csc" size="20"></td>
	<td>Postal code:</td>
	<td> </td>
	<td><input type="text" name="postal_code" size="5"></td>
</tr>
<tr>
	<td>Telephone number:</td>
	<td> </td>
	<td colspan="4"><input type="text" name="ephone" size="20"></td>
</tr>
</table><br><center><input type="checkbox" name="agree" value="agree_terms">I certify that the information provided in this form is complete and accurate. I agree to abide<br>
by all African Samaritan program requirements and the department of Home Affairs Regulations.<br><br><input type="submit" value="Submit"></td></tr></table>

<br><br><br></td>
</tr>
<tr>
<td valign="bottom" background="main2.jpg"><center><u><a href="http://www.mygeek.co.za"><b><font size="1"><font color="#FF6600">Designed and Empowered by <font color="#3C00FF">Geek Force</font><br>
Copyright © 2008</font></font></b></a></u></center><br></td>
</tr>
</table>
</center>
</body>
</html>

 

Mailer: au pair.php

 

<?php

require("class.phpmailer.php");

//the email address you want to send to
$arremails='info@aupair.com';

$mail = new PHPMailer();

$mail->IsSMTP(); // telling the class to use SMTP
$mail->Host = "smtp.aupai.com"; // SMTP server

//email address used by the form to send the email
$mail->From = "web@aupair.com";
$mail->AddAddress($arremails); 

$mail->Subject = "Au Pair Application Form";
$mail->IsHTML(true);
$mail->Body = "<table width='100%' height='100%'><tr><td bgcolor='#FFE4A3'>
<center><table><tr><td><br><h4>Au Pair Application Form</h4></center>
<b><u>General Information</u></b>
<table>
<tr>
	<td>First name:</td>
	<td> </td>
	<td colspan='4'>$_POST[first_name]</td>
</tr>
<tr>
	<td>Last name:</td>
	<td> </td>
	<td colspan='4'>$_POST[last_name]</td>
</tr>
<tr>
	<td valign='top'>Address:</td>
	<td> </td>
	<td colspan='4'>$_POST[addresss]</td>
</tr>
<tr>
	<td>Phone number:</td>
	<td> </td>
	<td colspan='4'>$_POST[phone_number]</td>
</tr>
<tr>
	<td>Cell phone number:</td>
	<td> </td>
	<td colspan='4'>$_POST[cell_number]</td>
</tr>
<tr>
	<td>Fax number:</td>
	<td> </td>
	<td>$_POST[fax]</td>
</tr>
<tr>
	<td>Email address:</td>
	<td> </td>
	<td colspan='4'>$_POST[email]</td>
</tr>
<tr>
	<td>Sex:</td>
	<td> </td>
	<td colspan='4'>$_POST[sex]</td>
</tr>
<tr>
	<td>Age:</td>
	<td> </td>
	<td>$_POST[age]</td>
	<td>Birthday:</td>
	<td> </td>
	<td>$_POST[birthday]</td>
</tr>
<tr>
	<td>City of birth:</td>
	<td> </td>
	<td>$_POST[birth_city]</td>
	<td>Country of birth:</td>
	<td> </td>
	<td>$_POST[birth_country]</td>
</tr>
<tr>
	<td>Height:</td>
	<td> </td>
	<td>$_POST[height]</td>
	<td>Weight:</td>
	<td> </td>
	<td>$_POST[weight]</td>
</tr>
<tr>
	<td>Eye colour:</td>
	<td> </td>
	<td>$_POST[eye_colour]</td>
	<td>Hair colour:</td>
	<td> </td>
	<td>$_POST[hair_colour]</td>
</tr>
<tr>
	<td>Passport number:</td>
	<td> </td>
	<td>$_POST[passport_number]</td>
	<td>Passport expiration date:</td>
	<td> </td>
	<td>$_POST[passport_date]</td>
</tr>
<tr>
	<td>First available departure date:</td>
	<td> </td>
	<td>$_POST[departure_date]</td>
	<td>Departure Airport:</td>
	<td> </td>
	<td>$_POST[departure_airport]</td>
</tr>
</table><br>
<b><u>Education</u></b>
<table>
<tr>
	<td>Highest level of education reached:</td>
	<td> </td>
	<td colspan='4'>$_POST[highest_education]</td>
</tr>
<tr>
	<td>Educational and professional training:</td>
	<td> </td>
	<td colspan='4'>$_POST[educational_training]</td>
</tr>
<tr>
	<td>Languages spoken:</td>
	<td> </td>
	<td colspan='4'>$_POST[languages_spoken]</td>
</tr>
</table></center><br>
<b><u>Experience in childcare</u></b>
<table cellspacing='0' cellpadding='0' border='0'>
<tr>
	<td bgcolor='#DE9221' align='center'>Type of childcare<br>(baby-sitting, au pair, nanny, youth, etc.)</td>
	<td bgcolor='#DE9221'> </td>
	<td bgcolor='#DE9221' align='center'>Dates<br>From and to</td>
	<td bgcolor='#DE9221'> </td>
	<td bgcolor='#DE9221' align='center'>Ages of children<br>when started</td>
	<td bgcolor='#DE9221'> </td>
	<td bgcolor='#DE9221' align='center'>Responsibilities</td>
	<td bgcolor='#DE9221'> </td>
	<td bgcolor='#DE9221' align='center'>How often<br>(daily, weekly, monthly)</td>
	<td bgcolor='#DE9221'> </td>
	<td bgcolor='#DE9221' align='center'>Name of<br>reference</td>
	<td bgcolor='#DE9221'> </td>
	<td bgcolor='#DE9221' align='center'>Phone number<br>of reference</td>
</tr>
<tr>
	<td align='center'>$_POST[childcare_type]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_dates]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_ages]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_responsibilities]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_how_often]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_reference_name]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_reference_number]</td>
</tr>
<tr>
	<td align='center'>$_POST[childcare_type1]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_dates1]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_ages1]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_responsibilities1]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_how_often1]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_reference_name1]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_reference_number1]</td>
</tr>
<tr>
	<td align='center'>$_POST[childcare_type2]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_dates2]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_ages2]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_responsibilities2]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_how_often2]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_reference_name2]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_reference_number2]</td>
</tr>
<tr>
	<td align='center'>$_POST[childcare_type3]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_dates3]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_ages3]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_responsibilities3]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_how_often3]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_reference_name3]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_reference_number3]</td>
</tr>
<tr>
	<td align='center'>$_POST[childcare_type4]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_dates4]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_ages4]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_responsibilities4]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_how_often4]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_reference_name4]</td>
	<td> </td>
	<td align='center'>$_POST[childcare_reference_number4]</td>
</tr>
</table><br>
<table>
<tr>
	<td width='200'>Age group preference:</td>
	<td> </td>
	<td>$_POST[age_preference]</td>
</tr>
<tr>
	<td valign='top'>Reason:</td>
	<td> </td>
	<td>$_POST[reasons]</td>
</tr>
<tr>
	<td valign='top'>List achievements, talents, and hobbies:</td>
	<td> </td>
	<td>$_POST[achievements]</td>
</tr>
</table><br>
<table>
<tr>
	<td>Can you cook?</td>
	<td>$_POST[cook]</td>
	<td>Can you swim?</td>
	<td>$_POST[swim]</td>
</tr>
<tr>
	<td valign='top' colspan='2'>Are there any pets that you do not<br>want to be placed with?</td>

	<td colspan='4'>$_POST[pets]</td>
</tr>
<tr>
	<td valign='top'>Reason:</td>
	<td> </td>
	<td colspan='4'>$_POST[pets_reason]</td>
</tr>
</table></center><br>
<b><u>Driving information</u></b>
<center><table>
<tr>
	<td>Do you have a drivers license?</td>
	<td> </td>
	<td>$_POST[drivers_license]</td>
</tr>
<tr>
	<td valign='top'>When did you receive your drivers license?</td>
	<td> </td>
	<td>$_POST[drivers_when]</td>
</tr>
<tr>
	<td valign='top'>How often do you drive?</td>
	<td> </td>
	<td>$_POST[drivers_how_often]</td>
</tr>
<tr>
	<td>Do you have your own car?</td>
	<td> </td>
	<td>$_POST[drivers_car]</td>
</tr>
<tr>
	<td valign='top'>How often do you have access to a car?</td>
	<td> </td>
	<td>$_POST[drivers_access]</td>
</tr>
<tr>
	<td valign='top'>How heavy is the traffic that you typically drive in?</td>
	<td> </td>
	<td>$_POST[drivers_traffic]</td>
</tr>
<tr>
	<td valign='top'>What car do you usually drive?</td>
	<td> </td>
	<td>$_POST[drivers_usual_car]</td>
</tr>
<tr>
	<td valign='top'>Do you have any concerns with driving?</td>
	<td> </td>
	<td>$_POST[drivers_concerns]</td>
</tr>
</table><br>
<b><u>Family background</u></b>
<table>
<tr>
	<td>Fathers name:</td>
	<td> </td>
	<td>$_POST[fathers_name]</td>
	<td>Occupation:</td>
	<td> </td>
	<td>$_POST[fathers_occupation]</td>
</tr>
<tr>
	<td>Mothers name:</td>
	<td> </td>
	<td>$_POST[mothers_name]</td>
	<td>Occupation:</td>
	<td> </td>
	<td>$_POST[mothers_occupation]</td>
</tr>
<tr>
	<td valign='top'>Address:</td>
	<td> </td>
	<td colspan='4'>$_POST[family_address]</td>
</tr>
<tr>
	<td>Telephone number:</td>
	<td> </td>
	<td>$_POST[fphone_number]</td>
	<td>Cell number:</td>
	<td> </td>
	<td>$_POST[fcell]</td>
</tr>
<tr>
	<td>Number of children:</td>
	<td> </td>
	<td>$_POST[no_children]</td>
</tr>
<tr>
	<td>Are they supportive of you becoming an au pair abroad?</td>
	<td> </td>
	<td>$_POST[supportive]</td>
</tr>
<tr>
	<td>Do you have younger siblings?</td>
	<td> </td>
	<td>$_POST[siblings]</td>
	<td>Age:</td>
	<td> </td>
	<td>$_POST[fage]</td>
</tr>
</table><br>
<b><u>About you</u></b>
<table>
<tr>
	<td>Have you lived away fom home?</td>
	<td> </td>
	<td>$_POST[q1]</td>
</tr>
<tr>
	<td>Have you lived abroad?</td>
	<td> </td>
	<td>$_POST[q2]</td>
</tr>
<tr>
	<td>Have you ever travelled out of the country?</td>
	<td> </td>
	<td>$_POST[q3]</td>
</tr>
<tr>
	<td>Do you have friends and family in South Africa?</td>
	<td> </td>
	<td>$_POST[q4]</td>
</tr>
<tr>
	<td>Do you drink alcoholic beverages?</td>
	<td> </td>
	<td>$_POST[q5]</td>
</tr>
<tr>
	<td>Do you smoke?</td>
	<td> </td>
	<td>$_POST[q6]</td>
</tr>
<tr>
	<td>Do you use illegal drugs?</td>
	<td> </td>
	<td>$_POST[q7]</td>
</tr>
<tr>
	<td>Have you ever taken illegal drugs?</td>
	<td> </td>
	<td>$_POST[q8]</td>
</tr>
<tr>
	<td>Do you have any tattoos or piercings?</td>
	<td> </td>
	<td>$_POST[q9]</td>
</tr>
<tr>
	<td>Do you have any traffic tickets?</td>
	<td> </td>
	<td>$_POST[q10]</td>
</tr>
<tr>
	<td>Have you ever been in a car accident?</td>
	<td> </td>
	<td>$_POST[q11]</td>
</tr>
<tr>
	<td>Do you have a criminal record?</td>
	<td> </td>
	<td>$_POST[q12]</td>
</tr>
<tr>
	<td>Do you have any racial prejudices?</td>
	<td> </td>
	<td>$_POST[q13]</td>
</tr>
<tr>
	<td>Are you currently in a romantic relationship?</td>
	<td> </td>
	<td>$_POST[q14]</td>
</tr>
<tr>
	<td>Have you ever been married?</td>
	<td> </td>
	<td>$_POST[q15]</td>
</tr>
<tr>
	<td>Do you have any financial commitments?</td>
	<td> </td>
	<td>$_POST[q16]</td>
</tr>
<tr>
	<td>Do you have any physical or mental limitations?</td>
	<td> </td>
	<td>$_POST[q17]</td>
</tr>
<tr>
	<td>Are you currently taking any medication?</td>
	<td> </td>
	<td>$_POST[q18]</td>
</tr>
<tr>
	<td>Do you have any medical conditions requiring treatment?</td>
	<td> </td>
	<td>$_POST[q19]</td>
</tr>
<tr>
	<td>Do you have any allergies?</td>
	<td> </td>
	<td>$_POST[q20]</td>
</tr>
<tr>
	<td>Do you have any dietary requirements?</td>
	<td> </td>
	<td>$_POST[q21]</td>
</tr>
<tr>
	<td>Are you a vegitarian?</td>
	<td> </td>
	<td>$_POST[q22]</td>
</tr>
<tr>
	<td>If yes, can you cook or be placed with a family who eats meat?</td>
	<td> </td>
	<td>$_POST[q23]</td>
</tr>
<tr>
	<td>Are you willing to work with a single father?</td>
	<td> </td>
	<td>$_POST[q24]</td>
</tr>
<tr>
	<td>Are you willing to work with a single mother?</td>
	<td> </td>
	<td>$_POST[q25]</td>
</tr>
<tr>
	<td>Do you know how to change a diaper?</td>
	<td> </td>
	<td>$_POST[q26]</td>
</tr>
</table><br>
Please explain the details for all the items to which you answered 'Yes'
<table>
<tr>
	<td>$_POST[yes]</td>
</tr>
</table><br>
<b><u>Emergency information</u></b>
<table>
<tr>
	<td>Name:</td>
	<td> </td>
	<td colspan='4'>$_POST[name]</td>
</tr>
<tr>
	<td valign='top'>Address:</td>
	<td> </td>
	<td colspan='4'>$_POST[eaddress]</td>
</tr>
<tr>
	<td>City, State / Country:</td>
	<td> </td>
	<td>$_POST[csc]</td>
	<td>Postal code:</td>
	<td> </td>
	<td>$_POST[postal_code]</td>
</tr>
<tr>
	<td>Telephone number:</td>
	<td> </td>
	<td colspan='4'>$_POST[ephone]</td>
</tr>
</table></td></tr></table>
</td>
</tr>	
</table></center></td>
</tr>	
</table>";

if(!$mail->Send()) {
  echo "<script language=JavaScript>window.location='amailfail.html'</script><br>";
} else {
  echo "<script language=JavaScript>window.location='athankyou.html'</script><br>";
};
?>
</html>

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