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testform2

<form id="form-app">
<fieldset class="row">

<!-- Heading -->
<div class="col-xs-12">
    <h3 class="legend">REGISTRO DE ESPECIES CAPTURADAS         </h3>
</div>

<!-- Paragraph Text -->
<div class="col-xs-12">
    <p>This is my form. Please fill it out. Thanks!</p>
</div>

<!-- Heading -->
<div class="col-xs-12">
    <h4 class="legend">PESCA NO COMERCIAL</h4>
</div>

<!-- Text -->
<div class="col-xs-12">
    <div class="form-group required-control">
        <label  class="control-label" for="text_1">Armador:</label>
        <input type="text" id="text_1" name="text_1" value="" data-alias="" class="form-control" required>
    </div>
</div>

<!-- Text -->
<div class="col-xs-12">
    <div class="form-group required-control">
        <label  class="control-label" for="text_2">Embarcación:</label>
        <input type="text" id="text_2" name="text_2" value="" data-alias="" class="form-control" required>
    </div>
</div>

<!-- Date -->
<div class="col-xs-12">
    <div class="form-group">
        <label  class="control-label" for="date_1">Fecha:</label>
        <input type="date" id="date_1" name="date_1" value="" data-alias="" class="form-control">
    </div>
</div>

<!-- Text -->
<div class="col-xs-12">
    <div class="form-group">
        <label  class="control-label" for="text_3">Isla/Sitio:</label>
        <input type="text" id="text_3" name="text_3" value="" data-alias="" class="form-control">
    </div>
</div>

<!-- Text -->
<div class="col-xs-12">
    <div class="form-group">
        <label  class="control-label" for="text_4">Posición de pesca GPS:</label>
        <input type="text" id="text_4" name="text_4" value="" data-alias="" class="form-control">
    </div>
</div>

<!-- Heading -->
<div class="col-xs-12">
    <h5 class="legend">USUARIOS ACTIVOS</h5>
</div>

<!-- Text -->
<div class="col-xs-12">
    <div class="form-group">
        <label  class="control-label" for="text_5">Usuario 1:</label>
        <input type="text" id="text_5" name="text_5" value="" data-alias="" class="form-control">
    </div>
</div>

<!-- Text -->
<div class="col-xs-12">
    <div class="form-group">
        <label  class="control-label" for="text_6">Cedula1</label>
        <input type="text" id="text_6" name="text_6" value="" data-alias="" class="form-control">
    </div>
</div>

<!-- Text -->
<div class="col-xs-12">
    <div class="form-group">
        <label  class="control-label" for="text_7">Usuario 2:</label>
        <input type="text" id="text_7" name="text_7" value="" data-alias="" class="form-control">
    </div>
</div>

<!-- Text -->
<div class="col-xs-12">
    <div class="form-group">
        <label  class="control-label" for="text_8">Cedula2</label>
        <input type="text" id="text_8" name="text_8" value="" data-alias="" class="form-control">
    </div>
</div>

<!-- Text -->
<div class="col-xs-12">
    <div class="form-group">
        <label  class="control-label" for="text_9">Usuario 3:</label>
        <input type="text" id="text_9" name="text_9" value="" data-alias="" class="form-control">
    </div>
</div>

<!-- Text -->
<div class="col-xs-12">
    <div class="form-group">
        <label  class="control-label" for="text_10">Cedula3</label>
        <input type="text" id="text_10" name="text_10" value="" data-alias="" class="form-control">
    </div>
</div>

<!-- Text -->
<div class="col-xs-12">
    <div class="form-group">
        <label  class="control-label" for="text_11">Usuario 4:</label>
        <input type="text" id="text_11" name="text_11" value="" data-alias="" class="form-control">
    </div>
</div>

<!-- Text -->
<div class="col-xs-12">
    <div class="form-group">
        <label  class="control-label" for="text_12">Cedula4</label>
        <input type="text" id="text_12" name="text_12" value="" data-alias="" class="form-control">
    </div>
</div>

<!-- Text -->
<div class="col-xs-12">
    <div class="form-group">
        <label  class="control-label" for="text_13">Usuario 5:</label>
        <input type="text" id="text_13" name="text_13" value="" data-alias="" class="form-control">
    </div>
</div>

<!-- Text -->
<div class="col-xs-12">
    <div class="form-group">
        <label  class="control-label" for="text_14">Cedula5</label>
        <input type="text" id="text_14" name="text_14" value="" data-alias="" class="form-control">
    </div>
</div>

<!-- Text -->
<div class="col-xs-12">
    <div class="form-group">
        <label  class="control-label" for="text_15">Usuario 6:</label>
        <input type="text" id="text_15" name="text_15" value="" data-alias="" class="form-control">
    </div>
</div>

<!-- Text -->
<div class="col-xs-12">
    <div class="form-group">
        <label  class="control-label" for="text_16">Usuario 6:</label>
        <input type="text" id="text_16" name="text_16" value="" data-alias="" class="form-control">
    </div>
</div>

<!-- Text -->
<div class="col-xs-12">
    <div class="form-group">
        <label  class="control-label" for="text_17">Cedula6</label>
        <input type="text" id="text_17" name="text_17" value="" data-alias="" class="form-control">
    </div>
</div>

<!-- Spacer -->
<div class="col-xs-12">
    <div style="height: 50px" ></div>
</div>

<!-- Heading -->
<div class="col-xs-12">
    <h5 class="legend">DETALLE DE ARTE</h5>
</div>

<!-- Paragraph Text -->
<div class="col-xs-12">
    <p>Arte de pesca utilizado:</p>
</div>

<!-- Checkbox -->
<div class="col-xs-12">
    <div class="form-group required-control"> 
        <label  class="control-label" for="checkbox_1">Marque lo que corresponda</label>
        <div class="checkbox ">
            <input type="checkbox" name="checkbox_1[]" id="checkbox_1_0" value="Línea de arrastre" data-alias=""data-required="true"  ><label for="checkbox_1_0" class="checkbox-inline">
                Línea de arrastre </label>
        </div>
        <div class="checkbox ">
            <input type="checkbox" name="checkbox_1[]" id="checkbox_1_1" value="Empate de fondo" data-alias=""data-required="true"  ><label for="checkbox_1_1" class="checkbox-inline">
                Empate de fondo </label>
        </div>
        <div class="checkbox ">
            <input type="checkbox" name="checkbox_1[]" id="checkbox_1_2" value="Caña" data-alias=""data-required="true"  ><label for="checkbox_1_2" class="checkbox-inline">
                Caña </label>
        </div> 
        <span id="checkbox_1"></span>
        
    </div>
</div>

<!-- Heading -->
<div class="col-xs-12">
    <h5 class="legend">ESPECIES CAPTURADAS</h5>
</div>

<!-- Select List -->
<div class="col-xs-12">
    <div class="form-group required-control">
        <label  class="control-label" for="selectlist_1">Marque las especies que pesco </label>
        <select id="selectlist_1" name="selectlist_1[]" data-alias=""  class="form-control" required  >
            <option value="Libras" >Bacalao</option>
            <option value="Atún" >Atún</option>
            <option value="Palometa" >Palometa</option>
            <option value="Corvina" >Corvina</option>
        </select>
    </div>
</div>

<!-- Text -->
<div class="col-xs-12">
    <div class="form-group">
        <label  class="control-label" for="text_18">Observaciones:</label>
        <input type="text" id="text_18" name="text_18" value="" data-alias="" maxlength="500" class="form-control">
    </div>
</div>

<!-- Signature -->
<div class="col-xs-12">
    <div class="form-group required-control">
        <label  class="control-label" for="signature_1">RESPONSABLE ARMADOR</label>
        <div class="signature-pad">
            <canvas id="signature_1" width="400" height="200" data-color="black" ></canvas>
        </div>
        
        <div class="signature-pad-actions">
            <button type="button" id="clear_signature_1" name="clear_signature_1" class="btn btn-sm btn-default btn-clear" data-exclude="true">Clear</button>
            <button type="button" id="undo_signature_1" name="undo_signature_1" class="btn btn-sm btn-default btn-undo" data-exclude="true">Undo</button>
        </div>
        <input type="hidden" name="hidden_signature_1" id="hidden_signature_1" value="" data-alias="" data-label="RESPONSABLE ARMADOR"  required />
    </div>
</div>

</fieldset>
</form>
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