Paste this HTML into your page and change the fields as directed in the comments.

<div><!--The Form statement should be entered exactly as given here -->

<FORM ACTION="http://coldfusion.mcps.k12.md.us/cfms/webteam/mailer/mailer.cfm" METHOD=POST onSubmit="return emailCheck(senderemail.value)">

<!-- Here are the four required form fields. You MUST change the recipient value. You may substitute your own values for returnpage, subject, and listtype or leave as is and a default value will be used. -->

<!-- FIRST REQUIRED FORM FIELD: The Email address to receive the completed form data. You may enter more than one address by separating the addresses with semi-colons. Do not change the type or name of the field, only the value. -->
<INPUT TYPE=hidden NAME=recipient VALUE="webmaster_email@example.org">

<!--SECOND REQUIRED FORM FIELD: The URL link to a Web page to return to after the user completes the form. By default, the MCPS home page is used. Do not change the type or name of the field, only the value. -->
<input name="returnpage" type="hidden" value="http://www.montgomeryschoolsmd.org/departments/web/mailer/">

<!--THIRD REQUIRED FORM FIELD: Subject which will appear on the Email. By default a subject of "No Subject Specified" is used. Do not change the type or name of the field, only the value. -->
<input name="subject" type="hidden" value="Test Only - Parent Volunteer Survey">

<!-- FOURTH REQUIRED FORM FIELD: Type of list which will be mailed. By default a listtype of "default" is used. This will produce a labelled list. The other options are: tablist (will produce a tab-delimited list), commalist (will produce a comma-delimited list), crlist (will produce a list with a value on each line). Do not change the type or name of the field, only the value. -->
<INPUT TYPE=hidden NAME=listtype VALUE="default">

<!--OPTIONAL FORM FIELD: If present, it ensures that any checkboxes/radio buttons will appear in the mailed output, even if they are left unchecked by the user. The value of this should be a comma- separated list of the names of any checkboxes and/or radio buttons on the form. Do not change the type or name of the field, only the value. -->
<input name="listcheck" type="hidden" id="listcheck" value="membership, fundraising, bts_night, picnic, fieldday, teacher_tu, helper, reader, mathaide, GradeLevel">

<!-- CUSTOMIZABLE FORM ELEMENTS: Now the fun begins. You may put any form element you like here. Cautions: The field names may contain numbers, any letter of the alphabet, or the underscore character. Field names MUST NOT begin with a number, contain spaces, or contain special characters (such as ', ", -, #, &, /, $ etc.). -->

<h1 align="center"><a href="http://www.montgomeryschoolsmd.org"><img src="/gr/mcpslogo.gif" alt="MCPS logo" width="160" height="100" border="0" align="middle" /></a> Parent Volunteer Survey</h1>

<p align="left">Please help us this year with your time and talent. Thanks for taking a minute to let us know how best to use your skills by completing the form below.</p>

<table width="600" height="27" border="0" align="center" cellpadding="2" cellspacing="0">

<tr>
<td width="50"><img src="/images/spacer.gif" width="50" height="1" /></td>

<td width="588">

<p align="left"><strong>Title:</strong>
<select name="title" size="1" id="title">
<option selected="selected">Mrs.</option>
<option>Mr.</option>
<option>Dr.</option>
<option>Ms.</option>
<option>Miss</option>
</select>

<strong>Name</strong>:
<input name="fname" type="text" id="fname3" value="First Name" size="20" maxlength="40" />
<input name="lname" type="text" id="lname2" value="Last Name" size="30" maxlength="40" /> </p>

<p align="left"><strong>Phone:</strong>
<input name="phone" type="text" id="phone4" value="Use xxx-xxx-xxxx format" maxlength="15" />

<strong>Email:</strong>
<input name="email" type="text" id="email" value="name@domain" maxlength="70" /> </p>

<p align="left"><strong>Check those committees on which you are willing to serve this school year:</strong></p>

<p align="left">
<input name="membership" type="checkbox" id="membership" value="1" /> Membership

<input name="fundraising" type="checkbox" id="fundraising" value="1" /> Fundraising

<input name="bts_night" type="checkbox" id="bts_night" value="1" /> Back-to-School Nite Hosting</p>

<p align="left">
<input name="picnic" type="checkbox" id="picnic" value="1" /> All-school Picnic

<input name="fieldday" type="checkbox" id="fieldday" value="1" /> Field Day Support

<input name="teacher_tu" type="checkbox" id="teacher_tu" value="1" /> Teacher Recognition Week</p>

<p align="left"> <input name="helper" type="checkbox" id="helper" value="checkbox" />
Help Teacher with Materials Gathering/Preparation</p>

<p align="left"> <input name="reader" type="checkbox" id="room_mother2" value="1" />
Classroom Reading Helper

<input name="mathaide" type="checkbox" id="mathaide" value="1" />
Classroom Math Helper</p>

<p align="left"><strong>My child is in: </strong>
<label> <input type="radio" name="GradeLevel" value="K" /> K</label>
<label> <input type="radio" name="GradeLevel" value="1-2" /> 1-2</label>
<label> <input type="radio" name="GradeLevel" value="3-5" /> 3-5</label>
<strong>grade.</strong> </p>

<p align="left"><strong>Please share any ideas you have for parent programs this year in the space below:</strong></p>

<p align="left"> <textarea name="ideabox" cols="60" rows="4" id="ideabox"></textarea> </p>

<P><!-- Your form elements should end here. -->

<!-- The remaining HTML statements should be left unchanged. --></P>

<p align="center"> <input type="submit" name="Submit" value="Submit" />
<input name="Reset" type="reset" id="Reset" value="Reset" /> </p>
</td>

<td width="50"><img src="/images/spacer.gif" width="50" height="1" /></td>

</tr>
</table>

<p align="left"> </p> <p align="left"> </p>

</form>

<!-- Feedback form written and maintained in ColdFusion by Elaine Keagle -->

</div>