checklist with text entry?

do you happen to have a widget for a checklist...that allows for the person submitting to click the checkmark...but then add text.  for instance we are using the checkmarks for our employees who check off their PTO.  however, when they check off a PTO day, we would like for them to enter a date next to the entry (for the day they took off).  we are also hoping to accumulate these submissions each week...so it is saved on the form.  is this possible?

thanks!

Have you tried our Checklist widget? http://widgets.jotform.com/widget/checklist

This will allow the user to enter text as well. Hope this helps.