agree'>Agree TOS</label>
                        <div class='controls'>
                          <label class='checkbox'>
                            <input data-rule-required='true' id='validation_agree' name='validation_agree' type='checkbox' value=''>
                          </label>
                        </div>
                      </div>
                      <div class='control-group'>
                        <label class='control-label' for='validation_date'>Birthdate</label>
                  