survey script not working!! agh!!

[gymaholic7]

Hi! I desperately need help with a survey script I'm using. I needed a script that I could ask multiple questions with and this is one of the only ones I could find. I went through a couple of days trying to get it to work and I finally got it. Then like two weeks later it randomnly decided to not work. So I went back to work on it and what happens? My whole script folder deletes!!!! How aggravating! So now I'm back to scratch...I can't figure out the problem with this script. I've checked over everything a million times!!!!

I'll include two links here:
My survey html page:

http://www.pandapages.f2s.com/survey.html

Survey script

http://www.pandapages.f2s.com/survey.txt

Any responses are so greatly appreciated! I'm so desperate!