aquadot.xyz

Assignment 3 requested a form be implemented on a page, with validation, that can be submitted to my e-mail address.
Well, here it is!

First Name:
Last Name:
Street Address:
City:
State:
ZIP Code:
Phone Number:
Email Address:
Enter a year to continue.
Birth Year:

Verify you're human with the following question:
How many times does "r" appear in the word "strawberry?"