session_start();
?>

    Add Record



    body{
        background-repeat:no-repeat;
        background: url('childback.jpg');
    }
    .text{
        background-color:#c2d6d6;
        border:none;
        padding:9px 10px;
    }
    .container {
        position:absolute;
        margin: 22px 50px 50px 40px;
        padding: 25px;
        background-color: white;
        font-family:Century Gothic;
    }
    select{
        width: 200px; 
        height: 30px;
    }
    input[type='submit']{
        width:100px;
        height:35px;
        border-radius:50px 50px 50px 50px;
    }

Can you help me for a code of table in SQL with the following data above.

Code for table last name, first name, middle name, age, category, date of first dose and date of second dose. just for the SQL table please the one that you insert on SQL database itself

and can you remove the BCG its in the code with picture above

Extracted text: Last Name Enter Last Name First Name Enter First Name Middle Name Enter Middle Name Age Enter Age Gender O Male OFemale Address Enter Middle Name Birthday mm /yyyy Category Select a category OBCG Save Record