export default function LearnToRowApplicationForm() { // WordPress Compatible Version // NOTE: // The original design uses Tailwind CSS classes. // If your WordPress site does not load Tailwind, the form will appear unstyled. // Use one of these options: // 1. Elementor + custom CSS // 2. Gutenberg + Tailwind plugin // 3. Convert to plain HTML/CSS // // This version now includes inline fallback styles for WordPress compatibility. // IMPORTANT: // Replace the placeholder logo URL below with your actual WordPress media library URL. // Example: // https://yourdomain.com/wp-content/uploads/2026/05/mini3-logo-mrc.svg // // Current preview uses a placeholder logo so it renders correctly in preview mode. return (

Application for the Adult Learn-to-Row Class 2026

Miami Rowing & Watersports Center

{/* Applicant Information */}

Applicant Information

Applicant Name (Mr. / Ms. / Mrs.) *

Date *

Home Address *

Apt. No.

City *

State *

Zip Code *

Best Contact Phone *

Email *

Date of Birth *

Gender *

Male Female

Dates of the Learn-to-Row Class You Are Applying For *

</div>

<div className="mt-6">
              <label className="block text-sm font-medium mb-3">
                How Did You Hear About Learn-to-Row?
              </label>
              <div className="grid grid-cols-2 md:grid-cols-4 gap-4">
                {[
                  "MRC Website",
                  "Friend / Referral",
                  "Flyer",
                  "Online Search",
                ].map((option) => (
                  <label
                    key={option}
                    className="flex items-center gap-2 border rounded-xl p-3"
                  >
                    <input type="checkbox" />
                    <span className="text-sm">{option}</span>
                  </label>
                ))}
              </div>
            </div>
          </section>

{/* Program Details */}
          <section className="bg-slate-50 border rounded-2xl p-6 space-y-4">
            <h2 className="text-2xl font-semibold">Program Details & Policies</h2>

<ul className="space-y-3 text-sm leading-relaxed text-gray-700 list-disc pl-6">
              <li>Cost: $399 for a three-week class.</li>
              <li>Class space will be reserved only after payment is received.</li>
              <li>Payment must be completed before the first class.</li>
              <li>Accepted payment methods: Visa, MasterCard, Discover, check, or cash.</li>
              <li>American Express is not accepted.</li>
              <li>No refunds for missed regular classes.</li>
              <li>
                For a full refund, notify the club at least one week before the class start date.
              </li>
            </ul>
          </section>

{/* Liability Release */}
          <section>
            <h2 className="text-2xl font-semibold border-b pb-3 mb-6">
              Release of Liability
            </h2>

<div className="border rounded-2xl p-6 bg-gray-50 max-h-[420px] overflow-y-auto text-sm leading-relaxed text-gray-700 space-y-4">
              <p>
                In consideration of being allowed to participate in any rowing activity, I acknowledge that rowing activities involve risks and dangers including bodily injury, disability, paralysis, and death.
              </p>

<p>
                I understand that these risks may result from my actions, the actions of others, the condition of equipment or facilities, or negligence.
              </p>

<p>
                I agree to inspect activities and facilities before participation and notify appropriate authorities of any unsafe conditions.
              </p>

<p>
                I release and hold harmless Miami Rowing Club, its administrators, directors, officers, volunteers, employees, and affiliates from all liability arising from participation in rowing activities.
              </p>

<p>
                I have read and fully understand this release and voluntarily agree to its terms.
              </p>
            </div>

<div className="grid grid-cols-1 md:grid-cols-2 gap-6 mt-6">
              <div>
                <label className="block text-sm font-medium mb-2">
                  Printed Name
                </label>
                <input
                  type="text"
                  className="w-full border rounded-xl px-4 py-3"
                />
              </div>

<div>
                <label className="block text-sm font-medium mb-2">
                  Participant Signature
                </label>
                <input
                  type="text"
                  className="w-full border rounded-xl px-4 py-3"
                  placeholder="Type full name"
                />
              </div>
            </div>
          </section>

{/* Swimming Requirement */}
          <section>
            <h2 className="text-2xl font-semibold border-b pb-3 mb-6">
              Swimming Requirement
            </h2>

<div className="border rounded-2xl p-6 bg-slate-50 space-y-5">
              <label className="flex items-start gap-3">
                <input type="checkbox" className="mt-1" />
                <span>
                  I confirm that I can tread water for 15 minutes and swim 200 yards.
                </span>
              </label>

<div className="grid grid-cols-1 md:grid-cols-2 gap-6">
                <div>
                  <label className="block text-sm font-medium mb-2">
                    Signature
                  </label>
                  <input
                    type="text"
                    className="w-full border rounded-xl px-4 py-3"
                  />
                </div>

{/* Emergency Information */}
          <section>
            <h2 className="text-2xl font-semibold border-b pb-3 mb-6">
              Medical Release & Emergency Information
            </h2>

<div className="space-y-6">
              <div>
                <label className="block text-sm font-medium mb-2">
                  Emergency Information For (Name of Rower)
                </label>
                <input
                  type="text"
                  className="w-full border rounded-xl px-4 py-3"
                />
              </div>

<div>
                <label className="block text-sm font-medium mb-2">Address</label>
                <input
                  type="text"
                  className="w-full border rounded-xl px-4 py-3"
                />
              </div>

<div className="grid grid-cols-1 md:grid-cols-2 gap-6">
                <div>
                  <label className="block text-sm font-medium mb-2">Email</label>
                  <input
                    type="email"
                    className="w-full border rounded-xl px-4 py-3"
                  />
                </div>

<div>
                  <label className="block text-sm font-medium mb-2">Phone</label>
                  <input
                    type="tel"
                    className="w-full border rounded-xl px-4 py-3"
                  />
                </div>
              </div>

<div className="grid grid-cols-1 md:grid-cols-2 gap-6">
                <div>
                  <label className="block text-sm font-medium mb-2">
                    Physician Name
                  </label>
                  <input
                    type="text"
                    className="w-full border rounded-xl px-4 py-3"
                  />
                </div>

<div>
                  <label className="block text-sm font-medium mb-2">
                    Physician Phone
                  </label>
                  <input
                    type="tel"
                    className="w-full border rounded-xl px-4 py-3"
                  />
                </div>
              </div>

<div>
                <label className="block text-sm font-medium mb-2">
                  Medical Conditions, Allergies, or Medications
                </label>
                <textarea
                  rows={4}
                  className="w-full border rounded-xl px-4 py-3"
                  placeholder="Provide relevant medical information"
                />
              </div>
            </div>
          </section>

{/* Credit Card Authorization */}
          <section>
            <h2 className="text-2xl font-semibold border-b pb-3 mb-6">
              Credit Card Authorization
            </h2>

<div className="grid grid-cols-1 md:grid-cols-2 gap-6">
              <div>
                <label className="block text-sm font-medium mb-2">
                  Cardholder Name
                </label>
                <input
                  type="text"
                  className="w-full border rounded-xl px-4 py-3"
                />
              </div>

<div>
                <label className="block text-sm font-medium mb-2">
                  Student Name
                </label>
                <input
                  type="text"
                  className="w-full border rounded-xl px-4 py-3"
                />
              </div>
            </div>

<div className="mt-6">
              <label className="block text-sm font-medium mb-3">
                Credit Card Type
              </label>

<div className="flex flex-wrap gap-4">
                {["Visa", "MasterCard", "Discover"].map((card) => (
                  <label
                    key={card}
                    className="flex items-center gap-2 border rounded-xl px-4 py-3"
                  >
                    <input type="radio" name="cardType" />
                    {card}
                  </label>
                ))}
              </div>

<p className="text-sm text-red-600 mt-3 font-medium">
                American Express Not Accepted
              </p>
            </div>

<div className="mt-6">
              <label className="block text-sm font-medium mb-2">
                Credit Card Number
              </label>
              <input
                type="text"
                className="w-full border rounded-xl px-4 py-3"
              />
            </div>

<div className="grid grid-cols-1 md:grid-cols-3 gap-6 mt-6">
              <div>
                <label className="block text-sm font-medium mb-2">
                  Expiration Date
                </label>
                <input
                  type="month"
                  className="w-full border rounded-xl px-4 py-3"
                />
              </div>

<div>
                <label className="block text-sm font-medium mb-2">
                  Amount Authorized
                </label>
                <input
                  type="text"
                  className="w-full border rounded-xl px-4 py-3"
                  placeholder="$0.00"
                />
              </div>
            </div>

<div className="mt-6">
              <label className="block text-sm font-medium mb-2">
                Billing Address
              </label>
              <input
                type="text"
                className="w-full border rounded-xl px-4 py-3"
              />
            </div>
          </section>

{/* Signature */}
          <section className="border-t pt-8">
            <div className="grid grid-cols-1 md:grid-cols-2 gap-6">
              <div>
                <label className="block text-sm font-medium mb-2">
                  Applicant Signature *
                </label>
                <input
                  type="text"
                  className="w-full border rounded-xl px-4 py-3"
                  placeholder="Type full name"
                />
              </div>

<div>
                <label className="block text-sm font-medium mb-2">
                  Signature Date
                </label>
                <input
                  type="date"
                  className="w-full border rounded-xl px-4 py-3"
                />
              </div>
            </div>

<button
              type="submit"
              className="mt-8 w-full bg-slate-900 hover:bg-slate-800 text-white font-semibold py-4 rounded-2xl transition-all"
            >
              Submit Application
            </button>
          </section>
        </div>
      </div>
    </div>
  );
}
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				<div class="elementor-widget-container">
					
		<div id="ld-fancy-heading-6a8863ba80c2a" class="ld-fancy-heading pos-rel">
			<p class="ld-fh-element d-inline-block pos-rel  lqd-highlight-classic lqd-highlight-grow-left p"  > <strong>Mailing Address</strong><br>
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				<div class="elementor-widget-container">
					
		<div id="ld-fancy-heading-6a8863ba80f33" class="ld-fancy-heading pos-rel">
			<h6 class="ld-fh-element d-inline-block pos-rel  elementor-heading-title lqd-highlight-classic lqd-highlight-grow-left h6"  > Hours of Operation</h6>		</div>

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Monday to Friday: 4:30 pm to 6:45 pm<br>
Saturday and Sunday: Rowing Office is closed</p>		</div>

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Monday to Friday 5:30 am to 8:00 pm<br>
Saturday 5:30 am to 2:00 pm<br>
Sunday 6:45 to 2:00 pm</p>		</div>

</div>
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