Printing a date from an input field

I have a form that is 19 pages long. When complete, it is sent to a database and also printed.

This is the header for the form

<fieldset class="major1"> <!--fieldset header -->
<table>
<tr><td colspan="5">Date: <input type="text" name="ard3date$$DOCID$$"  value="$$ard3date$$DOCID$$$$" class="sp5" /></td>
</tr>
<tr>
	<td>Student Name: $$F1$$</td>
	<td class="sp2">&nbsp;</td>
	<td>Student ID: $$F6$$</td>
	<td class="sp2">&nbsp;</td>
	<td>Grade: <input type="text" name="ard3Grade$$DOCID$$" class="sp3"  value="$$ard3Grade$$DOCID$$$$"   /></td>
</tr>

<tr><td>Date of Birth:  $$F7$$</td> 
	<td class="sp2">&nbsp;</td>
	<td>Medicaid #:  $$F9$$</td>
	<td class="sp2">&nbsp;</td>
	<td>Campus: $$F4$$</td>
	</tr>

</table>
</fieldset><!-- end fieldset header -->

I need the "student name", date, and "student ID" on each printed page.

The name and ID do not present a problem because they pull automatically from the database.

I insert the following code to print the Student name, ID, and add a page break on the printed copy

<div class="break">$$F1$$&nbsp;&nbsp;&nbsp;$$F6$$<br />
	<br />
	</div>

Stylesheet for screen

.break {
	display:none;}
.sp2 {
	width:2em;}

Print Stylesheet

.break {
	page-break-before:always;
	padding-top:0.3in;
	}
fieldset.major1 {
	padding:0 0.25in;  
	border:1px solid black;}

I want to embed a javascript that will print the value of the date input field beside the student ID.

I know enough javascript to read code and figure out what is going on. I can write some code, but this is beyond my skills. Any help would be appreciated.