Topic awaiting preservation: help me please

<form method="POST" action="<?php echo $editFormAction; ?>" name="single_payment" target="_self" id="single_payment">
        <p>Select Payment Type below:</p>
        <p>One time payment</p>
        <p>Cost:<input name="amount" type="text" id="amount" value="<?php echo $row_Recordset3['course_cost']; ?>" readonly="true" />
          <label for="one_time_payment"></label>
          <input name="date_due" type="hidden" id="date_due" value="<?php echo $row_Recordset3['date_to_limit']; ?>" />
          <input name="payment_reason" type="hidden" id="payment_reason" value="<?php echo $row_Recordset4['course_type']; ?>" />
        </p>
        <p>Student paying now? 
<script type="text/javascript">
function check_paid() {
var form = document.getElementById("payment_recieved");
var date_recieved = document.getElementById("date_recieved");
var currentTime = new Date()
var month = currentTime.getMonth() + 1
var day = currentTime.getDate()
var year = currentTime.getFullYear()
	if(form.payment_recieved.checked!=true){
		form.date_recieved.value = year + "-" + month + "-" + day;
		alert:(this.form.date_recieved.value)
		form.payment_recieved.focus();
	}else{
		form.date_recieved.value = "";
   		form.submit();
		}
	}
</script>
          <input name="payment_recieved" type="checkbox" id="payment_recieved" value="'Y'" onclick="check_paid(single_payment);"/>
          <label for="payment_recieved"></label>
      <input name="date_recieved" type="hidden" value="0000-00-00" />
        <p>
          <input type="submit" name="submit" id="submit" value="Enter Single payment into system" />
        </p>
        <input type="hidden" name="MM_insert" value="single_payment" />
        <input name="student_id" type="hidden" id="student_id" value="<?php echo $row_Recordset1['student_id']; ?>" />
      </form>