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<!DOCTYPE html>
<html lang="en" data-theme="light">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Background Check Consent Form - The Miracle Worker</title>
<link href="https://cdn.jsdelivr.net/npm/daisyui@4.6.0/dist/full.min.css" rel="stylesheet" type="text/css" />
<script src="https://cdn.tailwindcss.com"></script>
<style>
.signature-pad {
border: 2px solid #e5e7eb;
border-radius: 0.5rem;
background: white;
cursor: crosshair;
touch-action: none;
width: 100%;
}
</style>
</head>
<body class="bg-gradient-to-br from-purple-500 to-indigo-600 min-h-screen py-8 px-4">
<div class="max-w-4xl mx-auto">
<div class="card bg-base-100 shadow-2xl">
<div class="card-body">
<!-- Header -->
<div class="text-center mb-8">
<h1 class="text-3xl font-bold text-primary mb-2">THE CLEMSON LITTLE THEATRE</h1>
<h2 class="text-2xl font-semibold">Background Check Consent Form</h2>
<div class="divider"></div>
</div>
<form id="backgroundForm" action="https://api.web3forms.com/submit" method="POST">
<!-- Web3Forms Configuration -->
<input type="hidden" name="access_key" value="01c86d57-173b-4ad6-a227-421b6538aed6">
<input type="hidden" name="subject" value="Background Check Consent Form - Miracle Worker">
<input type="hidden" name="redirect" value="https://miracle-worker-forms.pages.dev/thank-you.html">
<input type="hidden" name="from_name" value="Miracle Worker Forms">
<!-- Name Row -->
<div class="grid grid-cols-1 md:grid-cols-12 gap-4 mb-4">
<div class="md:col-span-5">
<div class="form-control">
<label class="label">
<span class="label-text font-semibold">LAST NAME <span class="text-error">*</span></span>
</label>
<input type="text" id="lastName" name="Last Name" class="input input-bordered" required>
</div>
</div>
<div class="md:col-span-5">
<div class="form-control">
<label class="label">
<span class="label-text font-semibold">FIRST NAME <span class="text-error">*</span></span>
</label>
<input type="text" id="firstName" name="First Name" class="input input-bordered" required>
</div>
</div>
<div class="md:col-span-2">
<div class="form-control">
<label class="label">
<span class="label-text font-semibold">MI</span>
</label>
<input type="text" id="mi" name="MI" class="input input-bordered" maxlength="1">
</div>
</div>
</div>
<!-- Date of Birth -->
<div class="form-control mb-4">
<label class="label">
<span class="label-text font-semibold">DATE OF BIRTH <span class="text-error">*</span></span>
</label>
<input type="date" id="dob" name="Date of Birth" class="input input-bordered" required>
</div>
<!-- Street Address -->
<div class="form-control mb-4">
<label class="label">
<span class="label-text font-semibold">STREET ADDRESS <span class="text-error">*</span></span>
</label>
<input type="text" id="address" name="Street Address" class="input input-bordered" required>
</div>
<!-- City, State, ZIP -->
<div class="grid grid-cols-1 md:grid-cols-12 gap-4 mb-4">
<div class="md:col-span-6">
<div class="form-control">
<label class="label">
<span class="label-text font-semibold">CITY <span class="text-error">*</span></span>
</label>
<input type="text" id="city" name="City" class="input input-bordered" required>
</div>
</div>
<div class="md:col-span-3">
<div class="form-control">
<label class="label">
<span class="label-text font-semibold">STATE <span class="text-error">*</span></span>
</label>
<input type="text" id="state" name="State" value="SC" class="input input-bordered" required maxlength="2">
</div>
</div>
<div class="md:col-span-3">
<div class="form-control">
<label class="label">
<span class="label-text font-semibold">ZIP <span class="text-error">*</span></span>
</label>
<input type="text" id="zip" name="ZIP Code" class="input input-bordered" required pattern="[0-9]{5}">
</div>
</div>
</div>
<!-- Phone -->
<div class="form-control mb-4">
<label class="label">
<span class="label-text font-semibold">CELL PHONE NUMBER <span class="text-error">*</span></span>
</label>
<input type="tel" id="phone" name="Cell Phone Number" class="input input-bordered" required>
</div>
<!-- Email -->
<div class="form-control mb-4">
<label class="label">
<span class="label-text font-semibold">EMAIL ADDRESS <span class="text-error">*</span></span>
</label>
<input type="email" id="email" name="Email Address" class="input input-bordered" required>
</div>
<!-- Gender -->
<div class="form-control mb-6">
<label class="label">
<span class="label-text font-semibold">GENDER <span class="text-error">*</span></span>
</label>
<div class="flex gap-6">
<label class="label cursor-pointer gap-2">
<input type="radio" name="Gender" value="Male" class="radio radio-primary" required>
<span class="label-text">Male</span>
</label>
<label class="label cursor-pointer gap-2">
<input type="radio" name="Gender" value="Female" class="radio radio-primary" required>
<span class="label-text">Female</span>
</label>
</div>
</div>
<!-- Authorization Text -->
<div class="alert alert-info mb-6">
<svg xmlns="http://www.w3.org/2000/svg" fill="none" viewBox="0 0 24 24" class="stroke-current shrink-0 w-6 h-6"><path stroke-linecap="round" stroke-linejoin="round" stroke-width="2" d="M13 16h-1v-4h-1m1-4h.01M21 12a9 9 0 11-18 0 9 9 0 0118 0z"></path></svg>
<div>
<p class="text-sm leading-relaxed">I authorize The Clemson Little Theatre to conduct a complete criminal history check as a basis of my placement as an employee, volunteer, cast or crew member with the organization. I understand that I am to report any changes in my criminal history to The Clemson Little Theatre.</p>
</div>
</div>
<!-- Signature Section -->
<div class="divider">SIGNATURE</div>
<div class="mb-4">
<label class="label">
<span class="label-text font-semibold">Please sign below <span class="text-error">*</span></span>
</label>
<canvas id="signaturePad" class="signature-pad" width="700" height="150"></canvas>
<div class="mt-2">
<button type="button" class="btn btn-error btn-sm" onclick="clearSignature()">Clear Signature</button>
</div>
<input type="hidden" id="signatureData" name="Signature" required>
</div>
<!-- Date -->
<div class="form-control mb-6">
<label class="label">
<span class="label-text font-semibold">DATE <span class="text-error">*</span></span>
</label>
<input type="date" id="signatureDate" name="Date" class="input input-bordered" required>
</div>
<!-- Submit Button -->
<button type="submit" class="btn btn-primary btn-lg w-full">Submit Background Check Consent Form</button>
</form>
</div>
</div>
</div>
<script>
// Signature pad functionality
const canvas = document.getElementById('signaturePad');
const ctx = canvas.getContext('2d');
let isDrawing = false;
let lastX = 0;
let lastY = 0;
ctx.strokeStyle = '#000';
ctx.lineWidth = 2;
ctx.lineCap = 'round';
ctx.lineJoin = 'round';
function getCoordinates(e) {
const rect = canvas.getBoundingClientRect();
const scaleX = canvas.width / rect.width;
const scaleY = canvas.height / rect.height;
if (e.touches) {
return {
x: (e.touches[0].clientX - rect.left) * scaleX,
y: (e.touches[0].clientY - rect.top) * scaleY
};
}
return {
x: (e.clientX - rect.left) * scaleX,
y: (e.clientY - rect.top) * scaleY
};
}
function startDrawing(e) {
isDrawing = true;
const coords = getCoordinates(e);
[lastX, lastY] = [coords.x, coords.y];
}
function draw(e) {
if (!isDrawing) return;
e.preventDefault();
const coords = getCoordinates(e);
ctx.beginPath();
ctx.moveTo(lastX, lastY);
ctx.lineTo(coords.x, coords.y);
ctx.stroke();
[lastX, lastY] = [coords.x, coords.y];
}
function stopDrawing() {
isDrawing = false;
}
canvas.addEventListener('mousedown', startDrawing);
canvas.addEventListener('mousemove', draw);
canvas.addEventListener('mouseup', stopDrawing);
canvas.addEventListener('mouseout', stopDrawing);
canvas.addEventListener('touchstart', startDrawing);
canvas.addEventListener('touchmove', draw);
canvas.addEventListener('touchend', stopDrawing);
function clearSignature() {
ctx.clearRect(0, 0, canvas.width, canvas.height);
document.getElementById('signatureData').value = '';
}
document.getElementById('backgroundForm').addEventListener('submit', function(e) {
// Check signature
const signatureData = canvas.toDataURL();
const blankCanvas = document.createElement('canvas');
blankCanvas.width = canvas.width;
blankCanvas.height = canvas.height;
if (signatureData === blankCanvas.toDataURL()) {
e.preventDefault();
alert('Please provide your signature before submitting.');
return false;
}
document.getElementById('signatureData').value = signatureData;
});
document.getElementById('signatureDate').valueAsDate = new Date();
</script>
</body>
</html>