[% main_image = 'img-7.jpg' %]
<h2 id="search">Register</h2>
				<p>If you are already registered please<strong> <a href="login.php">login</a></strong> now.</p>
			  <p>Please register with us by filling out the following form below. Registering on our site is free and once you register, you will receive a customized list of camps based on your needs and those that best fit your child. If at any time in your search you would like personal assistance, please call our Camper Placement Specialist Renee Flax at 212.391.5208 for free, one-on-one assistance in finding a camp for your child.</p>
			  <p><strong>Please note:</strong> If you are looking for a day camp for your child, this web-site ONLY includes day camps in the following areas: New York City (including the 5 boroughs), Long Island, Westchester, Rockland County, and New Jersey.</p>
<p class="required" align="right">*Required</p>
			  <div class="section">

[% IF form_errors %]
<p style="color: red">
You must complete the fields that are required in order to register.<BR>
Or you can  call us  for a personalized consultation at 1-800-777-2267
</p>
[% END #if %]

[% form.start_form %]

<fieldset>
<legend>Log In Information</legend>
<div>[% IF form_errors.email %]<div  class="error">Please enter a valid email.</div>[% END #IF%]
[% IF form_errors.email_already_used %]<div  class="error">That email address is already registered.</div>[% END #IF%]
	<label for="email">* E-mail Address:</label>[% form.email %]</div>
<div>[% IF form_errors.password %]<div  class="error">[% IF form_errors.passwords_do_not_match %]The passwords do not match[% ELSE %]Please enter a password that is at least 6 characters.[% END #if%]</div>[% END #IF%]
	<label for="password">* Password:</label>[% form.password %]</div>
        <div><label for="password_again">* Re-enter Password:</label>[% form.password_again %]</div>

 </fieldset>


<fieldset>
<legend>Parent Information:</legend>


<div style="margin-bottom: 5px;"><label for="title">How did you find our website? Please be as specific as you can...</label>[% form.how_find %]</div>
<div>[% IF form_errors.title %]<div class="error">Please choose a title.</div>[% END #IF%]
	<label for="title">* Title:</label>[% form.title %]<br clear="all"></div>
<div>[% IF form_errors.first_name %]<div class="error">Please enter a first name.</div>[% END #IF%]
	<label for="first_name">* First Name:</label>[% form.first_name %]</div>
<div>[% IF form_errors.last_name %]<div class="error">Please enter a last name.</div>[% END #IF%]
	<label for="last_name">* Last Name:</label>[% form.last_name %]</div>
<div id="employee_id"><input name="employee_id" type="text" value="" size="40" maxlength="100"></div>
<div>[% IF form_errors.address_1 %]<div class="error">Please enter an address.</div>[% END #IF%]
	<label for="address_1">* Address:</label>[% form.address_1 %]</div>
<div>       <label for="address_1"></label>[% form.address_2 %]</div>
<div>[% IF form_errors.city %]<div class="error">Please enter a city.</div>[% END #IF%]
	<label for="city">* City:</label>[% form.city %]</div>
<div>[% IF form_errors.state %]<div class="error">Please enter a state.</div>[% END #IF%]
	<label for="state">* State:</label>[% form.state %]</div>
<div>[% IF form_errors.zip %]<div class="error">Please enter a zip code.</div>[% END #IF%]
	<label for="zip">* Zip:</label>[% form.zip %]</div>
 <div>      <label for="home_phone">Home Phone:</label>[% form.home_phone %]</div>
 <div>      <label for="work_phone">Work Phone:</label>[% form.work_phone %]</div>
 <div>      <label for="fax">Fax Number:</label>[% form.fax %]</div>
 <div>      <label for="extension">Extension:</label>[% form.extension %]</div>
 <div style="margin-bottom: 10px;">     <label for="call_preference">Best place to call<br /> during day (Home/Work):</label>[% form.call_preference %]<br clear="all"></div>
 <div>     <label for="comments">Questions or Comments:</label>[% form.comments %]</div>

 </fieldset>
<p> When you're finished, please click this submit button once only. Submitting more than once will create duplicate registrations. 
We'll get back to you as soon as possible.</p>
[% form.submit %]
                          </div>
</form>