Edit in JSFiddle

	<form class="grid-form">
		<fieldset>
			<legend>なんか入力してください</legend>
			<div data-row-span="1">
				<div data-field-span="1">
					<label>お名前</label>
					<input type="text" autofocus>
				</div>
			</div>
            <div data-row-span="4">
				<div data-field-span="1">
					<label>性別</label>
					<label><input type="radio" name="customer-title[]"> 男</label> &nbsp;
					<label><input type="radio" name="customer-title[]"> 女</label> &nbsp;
					<label><input type="radio" name="customer-title[]"> パンダ</label>
				</div>
				<div data-field-span="3">
					<label>性格</label>
					<input type="text">
				</div>
			</div>
		</fieldset>
	</form>