{set layout="one_column_layout"}

<div id="st_application-newsletter-unsubscribe" class="box roundies" >

    <div class="title">
        <h2>{__ text="Newsletter"}</h2>
        <p>
            {__ text="Prośba o wypisanie z listy"}
        </p>
    </div>

    <div class="st_content" style="padding: 10px 70px ">
        <form action="{$form.action}" method="post" >

            <div id="newsletter_user_form" class="box_form roundies">
                <h3>{__ text="Dane subskrypcji"}</h3>
                <div style="padding:25px;">
                    <fieldset>

                        <div id="email_field" class="st_row">
                            {$form.errors.email}
                            <div class="st_field">
                                <label for="newsletter_email">{__ text="Adres e-mail"}</label>
                                <input type="text" name="newsletter[email]" value="{$form.email}" id="newsletter_email"  />
                            </div>
                        </div>

                        <div id="captcha_form" >

                          

                            <div class="st_row">
                                {$form.errors.captcha}
                                <div style="margin-bottom: 2px;">
                                    {$form.captcha}
                                </div>
                                <div class="st_field">
                                    <label for="newsletter_captcha">{__ text="Cyfry z obrazka"}</label>
                                    <input type="text" name="newsletter[captcha]" id="newsletter_captcha" />
                                </div>
                            </div>
                          
                        </div>

                        <div class="st_row">
                            <div class="buttons right" style="margin-right:38px;">
                                <button type="submit" class="regular roundies" >
                                    {__ text="Wyślij"}
                                </button>
                            </div>
                        </div>

                    </fieldset>
                </div>
            </div>
        </form>
    </div>
</div>

{literal}
<script type="text/javascript">
    jQuery(function($) {
        $(document).ready(function() {
            $("label").inFieldLabels();

        });

    }); 
</script>
{/literal}