List as checkboxes

This is a great plugin and while I think it might be a bit much to ask for, is there a way to make the resulting list have a checkbox next to each? Basically, I have a page that I am dynamically listing all of the child pages (which are tour itineraries) and I’d like to include this into a form so that the visitor completing the form could check off the box next to each that they would like more info about.

I’m using the jetpack plugin for the form.

Thanks in advance

http://wordpress.org/extend/plugins/list-pages-shortcode/