This is kind of a mess :smiley_cat: what about something like [this gist](https://gist.github.com/icaaq/7ef92d231005cc0c6ab3) instead.
More info on fieldsets and how to use them :) 
http://www.w3.org/html/wg/drafts/html/master/forms.html#the-fieldset-element
http://webaim.org/techniques/forms/controls