Help with creating a contact from a custom form

Hi, I am trying to make it so on my website
when somebody signs up for some thing
using a custom form that it creates a new
contact. I tried using the append or create
contact in Velo coding, but it does not
seem to work and each time I try to submit
it says that the new contact state is set to
false. how do I fix this?

here is the velo code I’m trying to use:

Here are some screenshots of my code and what happens when I submit on the live site:

Please help