st" id="parse_hallmark_weight" placeholder="Weight" data-i18n="[placeholder]weight" readonly value="" />
                        </div>
                        <div class="form-group">
                            <label for="parse_hallmark_date" data-i18n="date">DATE</label>
                            <input type="text" class="form-control" name="date" id="parse_hallmark_date" placeholder="date" data-i18n="[placeholder]date" readonly value="" />
                        </div>
                        <div c