How do I create an outlook form with checkboxes?

[Rmcta]

I would like to create a form to send out to someone with a list of times and a checkbox and the side of each item.
I need the person to check the boxes that apply.
Can it be done?
I tried Tools/Forms/Design a Form/(p.2)/
From the Toolbox I dragged a couple of checkboxes into the page.
Form/Run this Form
Sent it to myself.

I received it okay but when I hit reply...p.2 is no longer there

How do I create the form I need?