<div class="span12 row"> <?php if(isset($data->error)): ?> <?php foreach($data->error as $error): ?> <p class="error-form"><?php echo $error; ?></p> <?php endforeach; ?> <?php endif; ?> <form method="post" action="<?php echo \Request::url(); ?>/bedankt" class="default subscribe specific" autocomplete="off"> <label class="name"><span>Naam<em>*</em></span><input name="name" type="text" placeholder="Naam" required></label> <label class="email"><span>Email<em>*</em></span><input name="email" type="email" placeholder="Emailadres" required></label> <div> <span>Proefles<em>*</em></span> <div class="value-row"> <?php foreach($data->grouplessons as $grouplesson): ?> <label class="checkboxer grouplesson"><span><?php echo $grouplesson->name; ?></span><input type="checkbox" name="grouplesson[]" class="<?php echo $grouplesson->slug; ?> not-full-size" <?php if($data->redirected == $grouplesson->slug): ?> checked <?php endif; ?> value="<?php echo $grouplesson->name; ?>"></label> <?php endforeach; ?> </div> </div> <div class="value-row submit-container"> <p><em>*</em> velden zijn verplicht</p> <input type="submit" name="submit" class="submit" value="Verzenden"> </div> </form> </div>