Java Script and PHP Issue

I am using a JS date picker and it works great all by itself. However when I link it to a  MySQL db the JS no longer works.  Here is my source code below any help would be appreciated.
Thanks
Joe
<?php require_once('Connections/Runin_db.php'); ?>
<?php
if (!function_exists("GetSQLValueString")) {
function GetSQLValueString($theValue, $theType, $theDefinedValue = "", $theNotDefinedValue = "")
  if (PHP_VERSION < 6) {
    $theValue = get_magic_quotes_gpc() ? stripslashes($theValue) : $theValue;
  $theValue = function_exists("mysql_real_escape_string") ? mysql_real_escape_string($theValue) : mysql_escape_string($theValue);
  switch ($theType) {
    case "text":
      $theValue = ($theValue != "") ? "'" . $theValue . "'" : "NULL";
      break;   
    case "long":
    case "int":
      $theValue = ($theValue != "") ? intval($theValue) : "NULL";
      break;
    case "double":
      $theValue = ($theValue != "") ? doubleval($theValue) : "NULL";
      break;
    case "date":
      $theValue = ($theValue != "") ? "'" . $theValue . "'" : "NULL";
      break;
    case "defined":
      $theValue = ($theValue != "") ? $theDefinedValue : $theNotDefinedValue;
      break;
  return $theValue;
$editFormAction = $_SERVER['PHP_SELF'];
if (isset($_SERVER['QUERY_STRING'])) {
  $editFormAction .= "?" . htmlentities($_SERVER['QUERY_STRING']);
if ((isset($_POST["MM_insert"])) && ($_POST["MM_insert"] == "form1")) {
  $insertSQL = sprintf("INSERT INTO `time` (`Time 1`, `Time 2`) VALUES (%s, %s)",
                       GetSQLValueString($_POST['Time_1'], "text"),
                       GetSQLValueString($_POST['Time_2'], "text"));
  mysql_select_db($database_Runin_db, $Runin_db);
  $Result1 = mysql_query($insertSQL, $Runin_db) or die(mysql_error());
?>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Untitled Document</title>
</head>
<form action="<?php echo $editFormAction; ?>" method="post" name="form1" id="form1">
  <table align="center">
    <tr valign="baseline">
      <td nowrap="nowrap" align="right">Time 1:</td>
      <td><input name="Time 1" type="text" id="Time 1" value="" />
      <a href="javascript:show_calendar('document.tstest.timestamp', document.tstest.timestamp.value);"><img src="images/cal.gif" width="16" height="16" border="0" alt="Click Here to Pick up the timestamp" /></a></td>
    </tr>
    <tr valign="baseline">
      <td nowrap="nowrap" align="right">Time 2:</td>
      <td><input name="Time 2" type="text" id="Time 2" value="" />
      <a href="javascript:show_calendar('document.tstest.timestamp', document.tstest.timestamp.value);"><img src="images/cal.gif" width="16" height="16" border="0" alt="Click Here to Pick up the timestamp" /></a></td>
    </tr>
    <tr valign="baseline">
      <td nowrap="nowrap" align="right"> </td>
      <td><input type="submit" value="Insert record" /></td>
    </tr>
  </table>
  <input type="hidden" name="MM_insert" value="form1" />
</form>
<p> </p>
<p> </p>
<p> </p>
</body>
</html>

I would like to know how to do this process.  I would like my students to complete the module and then enter there name in the certificate line.  Then have them enter their email address so that the certificate can be emailed to them and they can print it off.  I would like to have the certificate be a PDF file so they cannot alter the name of the person who took the course.

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