[radio prefix class:form-check-input value:"Mr."]
[radio prefix class:form-check-input value:"Mrs."]
[radio prefix class:form-check-input value:"Ms."]
[radio prefix class:form-check-input value:"Dr."]
[text* full_name class:form-control class:text-truncate class:bg-transparent placeholder "Full
Name"]
[email* email class:form-control class:text-truncate class:bg-transparent placeholder "Email"]
[text* year_group class:form-control class:text-truncate class:bg-transparent placeholder "Year
group of interest"]
[text* entry_date class:form-control class:text-truncate class:bg-transparent placeholder
"Preferred date of entry"]
[text* birthdate class:form-control class:text-truncate class:bg-transparent placeholder "DOB of
your child"]
[text* nationality class:form-control class:text-truncate class:bg-transparent placeholder "Your
child nationality"]
Road 17, 1st District, 3rd Zone,
5th Settlement, New Cairo, Egypt
