1 files changed, 67 insertions, 0 deletions
diff --git a/mobile/screens/Form1.js b/mobile/screens/Form1.js
new file mode 100644
index 0000000..1a0fb04
--- /dev/null
+++ b/mobile/screens/Form1.js
@@ -0,0 +1,67 @@
+import React, { Component } from 'react';
+import {Text, Alert, AppRegistry, Button, StyleSheet, View, TextInput } from 'react-native';
+
+export default class ButtonBasics extends Component {
+  _onPressButton() {
+    Alert.alert('Thanks for letting us know!')
+  }
+  constructor(props) {
+    super(props);
+    this.state = {age: '',
+		name: '',
+		appearance: '',
+		injured: false,
+		why: ''};
+  }
+
+  render() {
+    return (
+      
+
+        <View style={{padding: 40}}>
+          <Text>Age:</Text>
+          <TextInput
+            style={{height: 40}}
+            placeholder="(Estimate if unknown)"
+            onChangeText={(age) => this.setState({age})}
+          />
+          
+          
+          <Text>Name:</Text>
+          <TextInput
+            style={{height: 40}}
+            placeholder="Type the name here"
+            onChangeText={(name) => this.setState({name})}
+          />
+          <Text>Appearance:</Text>
+          <TextInput
+            style={{height: 40}}
+            placeholder="What are they Wearing"
+            onChangeText={(appearance) => this.setState({appearance})}
+          />
+          <Text>Injured?</Text>
+          {/* insert radio button???*/}
+          <Text>Please let us know why do you think they need help</Text>
+          <TextInput
+            style={{height: 40}}
+            placeholder="Reason"
+            onChangeText={(why) => this.setState({why})}
+          />
+
+          {/*additional questions*/}
+
+          <Button
+            onPress={this._onPressButton}
+            title="Submit!"
+          />
+        </View>
+
+
+
+    );
+  }
+}
+
+
+
+