[stripe name=”Moontour” description=”Summer Course” amount=”35900″]
[stripe_text label=”Student name:” id=”student_name” required=”true”]
[stripe_text label=”School:” id=”school” required=”true”]
[stripe_number label=”Student age” id=”age” required=”true”]
[stripe_dropdown label=”Class (next school year)” options=”5th class, 6th class, 1st year, 2nd year,3rd year, 4th year”]
[stripe_dropdown label=”Water Confidence” options=”High, Medium, Low”]
[stripe_text placeholder=”Additional information. Please include any health issues, allergies, water confidence issues or special requirements” multiline=”true” rows=”5″]
[stripe_text label=”Emergency contact name:” id=”Emergency contact” required=”true”]
[stripe_text label=”Emergency contact number:” id=”Emergency number” required=”true”]
[stripe_text label=”How did you hear about us?” id=”Heard from” required=”true”]
[stripe_dropdown label=”Which course would you like to book?” options=”Crean 01/7/17 – 12/7/17 5th & 6th Class”]
[stripe_checkbox label=”I accept Moontour’s Terms and Conditions” id=”TC box unchecked” required=”true”]
[/stripe]