_form.html.erb

<div class="well">
  <form class="form">
    <div data-behaviour="checkbox-toggle-group">
      <input name="blackout[fixed_end]" type="hidden" value="0">
      <input class="is-hidden js-checkbox-toggle" id="blackout_fixed_end" name="blackout[fixed_end]" type="checkbox" value="1">

      <div class="form-group js-toggle-group">
        <label class="form-label" for="blackout_duration">To</label>
        <div class="form-fields">
          <input class="field-text ten percent" id="blackout_duration" name="blackout[duration]" size="30" type="text">
          <select class="field-select" id="blackout_duration_unit" name="blackout[duration_unit]"><option value="days" selected="selected">days</option>
<option value="weeks">weeks</option>
<option value="months">months</option>
<option value="years">years</option>
          </select>
        after (or <label class="field-switch" for="blackout_fixed_end">set a specific end date</label> )
        </div>
      </div>

      <div class="form-group js-toggle-group">
        <label class="form-label" for="blackout_to">To</label>
        <div class="form-fields">
          <div class="field-date "><input autocomplate="off" class="field-day" id="blackout_to_3i" maxlength="2" name="blackout[to(3i)]" placeholder="dd" type="text"><span class="field-separator">/</span><input autocomplate="off" class="field-month" id="blackout_to_2i" maxlength="2" name="blackout[to(2i)]" placeholder="mm" type="text"><span class="field-separator">/</span><input autocomplate="off" class="field-year" id="blackout_to_1i" maxlength="4" name="blackout[to(1i)]" placeholder="yyyy" type="text"></div><i class="icon-calendar"></i>
          after (or <label class="field-switch" for="blackout_fixed_end">set a relative end date</label> )
        </div>
      </div>
    </div>
  </form>
</div>