<div class="brz-forms__fields css-10cwydl">
<div class="fw-col-sm-6" style="padding-bottom: 20px;"><label class="contactform">Enter Full Name *</label>[text* your-name]</div>

<div class="fw-col-sm-6" style="padding-bottom: 20px;"><label class="contactform">Enter your Phone Number *</label>[tel* phone-number minlength:10 maxlength:10]</div>

<div class="fw-col-sm-6" style="padding-bottom: 20px;"><label class="contactform">Enter your Email ID *</label>[email* email]</div>

<div class="fw-col-sm-6" style="padding-bottom: 20px;"><label class="contactform">Enter your City *</label>[text* your-city]</div>

<div class="fw-col-sm-6" style="padding-bottom: 20px;"><label class="contactform">Enter Full Name of your child *</label>[text* your-childname]</div>

<div class="fw-col-sm-6" style="padding-bottom: 20px;">
<label class="contactform">Are you an existing VConnect member? *</label>[select* selection include_blank "Yes" "No"]</div>

<div class="fw-col-sm-12">
[submit class:vconnect-submit "Send"]</div></div>