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<!-- ======= Header include ========= -->
<?php echo $__env->make('front.includes.header', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))->render(); ?>
<!-- ======= Header include ========= -->
<style>
.gender-form>.form-check {
justify-content: normal !important;
width: fit-content;
cursor: pointer;
}
.gender-form {
display: flex;
align-items: center;
gap: 20px;
}
</style>
<body class="home page-template-default page page-id-2039 gdlr-core-body woocommerce-no-js tribe-no-js kingster-body kingster-body-front kingster-full kingster-with-sticky-navigation kingster-blockquote-style-1 gdlr-core-link-to-lightbox">
<div class="addmision-form-area">
<div class="container my-4 py-5">
<div class="row align-item-center">
<div class="col-lg-7 col-xs-12 col-sm-12">
<div class="admission-image">
<!--<img src="./assets/images/admission-form-poster.jpg" class="img-fluid" alt="" />-->
</div>
</div>
<div class="col-lg-5 col-xs-12 col-sm-12">
<?php if(session()->has('message')): ?>
<div class="alert alert-success">
<?php echo e(session()->get('message')); ?>
</div>
<?php endif; ?>
<form class="registration-form" method="post" action="<?php echo e(url('save-lead')); ?>" enctype="multipart/form-data" autocomplete="off">
<?php echo csrf_field(); ?>
<input type="hidden" name="edit_id" value="<?php echo base64_decode($_GET['q']); ?>">
<div class="row">
<div class="col-md-12 col-xs-12 col-sm-12">
<div class="addmission-form-title">
<h4>Registration Form</h4>
<h5>For Admission</h5>
</div>
<div class="form-group">
<label>Full Name</label>
<input class="form-control" type="text" required placeholder="Full Name" name="full_name" autocomplete="off" />
</div>
<div class="form-group">
<label>Father Name</label>
<input class="form-control" type="text" required placeholder="Father Name" name="father_name" autocomplete="off" />
</div>
<div class="form-group">
<label>Mother Name</label>
<input class="form-control" type="text" required placeholder="Mother Name" name="mother_name" autocomplete="off" />
</div>
<div class="form-group">
<label>Aadhar card number</label>
<input class="form-control" type="text" required placeholder="Aadhar card number" name="aadhar_number" autocomplete="off" />
</div>
<div class="form-group">
<label style="display:block;">Student Photo</label>
<input class="form-control" type="file" required name="image" autocomplete="off" />
</div>
<!--<div class="form-group">-->
<!-- <label>Mother Name</label>-->
<!-- <input class="form-control" type="text" required placeholder="Mother Name" name="mother_name" autocomplete="off" />-->
<!--</div>-->
<div class="form-group">
<label style="display:block;">Date of Birth</label>
<input class="form-control" type="date" name="dob" required autocomplete="off"/>
</div>
<div class="form-group">
<label style="display:block;">Select Current Standard</label>
<select class="form-control" name="grade" required>
<option value="select_class">Select</option>
<!--<option value="LKG">LKG</option>-->
<!-- <option value="UKG">UKG</option>-->
<!-- <option value="1st Class">1st Class</option>-->
<!-- <option value="2nd Class">2nd Class</option>-->
<!-- <option value="3rd Class">3rd Class</option>-->
<!-- <option value="4th Class">4th Class</option>-->
<!-- <option value="5th Class">5th Class</option>-->
<option value="6th Class">6th Class</option>
<option value="7th Class">7th Class</option>
<option value="8th Class">8th Class</option>
<option value="9th Class">9th Class</option>
<option value="10th Class">10th Class</option>
<option value="11th Class">11th Class</option>
<option value="12th Class">12th Class</option>
</select>
</div>
<div class="form-group">
<label>Phone Number</label>
<input class="form-control" type="tel" name="phone" required placeholder="Enter Phone Number" />
</div>
<!--<div class="form-group">-->
<!-- <label>Country</label>-->
<!-- <select class="form-control" name="country" id="country">-->
<!-- <option value="">Select Country</option>-->
<!-- <?php $__currentLoopData = $countries; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $country): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>-->
<!-- <option id="<?php echo e($country->id); ?>" value="<?php echo e($country->name); ?>"><?php echo e($country->name); ?></option>-->
<!-- <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>-->
<!-- </select>-->
<!--</div>-->
<!--<div class="form-group">-->
<!-- <label>State</label>-->
<!-- <select class="form-control" name="state" id="state">-->
<!-- <option value="">Select State</option>-->
<!-- </select>-->
<!--</div>-->
<div class="form-group">
<label>City</label>
<!--<select class="form-control" name="city" id="city">-->
<!-- <option value="">Select District</option>-->
<!--</select>-->
<input class="form-control" type="text" name="city" placeholder="Enter city" autocomplete="off" required />
</div>
<div class="form-group">
<label>Address</label>
<input class="form-control" type="text" name="address" placeholder="Enter Address" autocomplete="off" required />
</div>
<div class="form-group">
<label style="display:block;">Email</label>
<input class="form-control" type="email" name="email" required placeholder="example@gmail.com" autocomplete="off" />
</div>
<div class="form-group">
<label style="display:block;">Registration Type</label>
<select class="form-control" name="registration_type" required>
<option value="">Select Type</option>
<option value="Day School">Day School</option>
<option value="Day Boarding School">Day Boarding School</option>
<option value="Boarding School">Boarding School</option>
</select>
</div>
<div class="form-group">
<label style="display:block;">How do you Reach</label>
<select class="form-control" name="how_reach" id="leads" required>
<option value="">Select Option</option>
<option value="website">Website</option>
<option value="social-media">Social Media</option>
<option class="empName" value="employee">Employee</option>
</select>
</div>
<div class="form-group" id="empName" style="display: none;">
<label>Employee Email</label>
<input class="form-control" type="text" name="employee_email" placeholder="Employee email id" autocomplete="off" />
</div>
<button class="btn btn-success btn-block my-3 py-2 float-right" type="submit"
style="
font-size: 18px;
font-weight: bold;
letter-spacing: 0.5px;
text-transform: uppercase;
"
>
Yes! I want to Enroll
</button>
</div>
</div>
</form>
</div>
</div>
</div>
</div>
<!-- ======= Footer include ========= -->
<?php echo $__env->make('front.includes.footer', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))->render(); ?>
<!-- ======= Footer include ========= -->
<script>
$(document).ready(function(){
var current_fs, next_fs, previous_fs; //fieldsets
var opacity;
$(".next").on("click", function() {
$("body").scrollTop(0);
});
$(".next").click(function(){
current_fs = $(this).parent();
next_fs = $(this).parent().next();
//Add Class Active
$("#progressbar li").eq($("fieldset").index(next_fs)).addClass("active");
//show the next fieldset
next_fs.show();
//hide the current fieldset with style
current_fs.animate({opacity: 0}, {
step: function(now) {
// for making fielset appear animation
opacity = 1 - now;
current_fs.css({
'display': 'none',
'position': 'relative'
});
next_fs.css({'opacity': opacity});
},
duration: 600
});
});
$(".previous").click(function(){
current_fs = $(this).parent();
previous_fs = $(this).parent().prev();
//Remove class active
$("#progressbar li").eq($("fieldset").index(current_fs)).removeClass("active");
//show the previous fieldset
previous_fs.show();
//hide the current fieldset with style
current_fs.animate({opacity: 0}, {
step: function(now) {
// for making fielset appear animation
opacity = 1 - now;
current_fs.css({
'display': 'none',
'position': 'relative'
});
previous_fs.css({'opacity': opacity});
},
duration: 600
});
});
$('.radio-group .radio').click(function(){
$(this).parent().find('.radio').removeClass('selected');
$(this).addClass('selected');
});
$(".submit").click(function(){
return false;
})
});
$(document).ready(function(){
$('#leads').change(function(){
if($(this).val()=='employee'){
$('#empName').show();
}else{
$('#empName').hide();
}
});
$('body').on('change','#country',function(){
let id = $('option:selected', this).attr('id');
$.ajax({
url: "<?php echo e(url('get-state')); ?>",
dataType:"html",
data:{
country_id:id
},
success: function(result){
$('#state').html('');
$('#state').html("<option value=''>Select State</option>");
$('#state').append(result);
}
});
});
$('body').on('change','#state',function(){
let id = $('option:selected', this).attr('id');
$.ajax({
url: "<?php echo e(url('get-city')); ?>",
dataType:"html",
data:{
state_id:id
},
success: function(result){
$('#city').html('');
$('#city').html("<option value=''>Select State</option>");
$('#city').append(result);
}
});
});
});
</script><?php /**PATH /home/u589835532/domains/kiskarnal.in/public_html/resources/views/front/registration-form.blade.php ENDPATH**/ ?>