@extends('layouts.home.site')

<link rel="stylesheet" type="text/css" href="{{CSS}}select2.css">
@section('content')

    <section class="call-to-action"  >
        <div class="anim-icons">
            <!--            <span class="icon icon-cloud wow shake"></span>-->
            <span class="icon butterfly-1 wow zoomIn"></span>
            <!--            <span class="icon butterfly-2 wow zoomIn"></span>-->
        </div>

        <div class="auto-container">
            <div class="outer-box clearfix" style="text-align: -webkit-center;">
                <div class="title-column">
                    <h3 style="width:100%; text-transform: uppercase;"> Healthy Baby Contest</h3>
                </div>
            </div>
        </div>
    </section>
<br><br>

<div class="register-content">   
	@include('errors.errors')  
	<div class="flash-message">
    @foreach (['danger', 'warning', 'success', 'info'] as $msg)
      @if(Session::has('alert-' . $msg))
      <p class="alert alert-{{ $msg }}">{{ Session::get('alert-' . $msg) }} <a href="#" class="close" data-dismiss="alert" aria-label="close">&times;</a></p>
      @endif
    @endforeach
  	</div> <!-- end .flash-message -->

	{!! Form::open(array('url' => URL_YOUNG_GENIUS, 'method' => 'POST', 'name'=>'formLanguage ', 'name'=>"registrationForm",'enctype'=>'multipart/form-data')) !!}		
<div class="row">
	<div class="col-md-4">
	<div class="tab-content"> 
		<h5> Healthy Baby Contest Form </h5>
		 <div class="row" style="padding-top: 15px;">		 	
			<fieldset class="form-group col-md-12">
			{{ Form::label('name', getphrase('Student Name')) }}
			<span class="text-red" >*</span>
				{{ Form::text('name', $value = null , $attributes = array('class'=>'form-control', 'placeholder' => 'Student Name')) }}
			</fieldset>
			<fieldset class="form-group col-md-12">
				{{ Form::label('date_of_birth', getphrase('date_of_birth')) }}
				<span class="text-red" >*</span>
				<div id="dpYears" class="input-group date"  data-date-viewmode="years"  data-provide="datepicker" data-date-format="{{getDateFormat()}}">
				{{ Form::text('date_of_birth', $value = date('Y/m/d') , $attributes = array('class'=>'form-control', 'placeholder' => 'Date Of Birth', 'id'=>'dp')) }}
					<div class="input-group-addon">
						<span class="mdi mdi-calendar" style="font-size: 45px; color: #999;"></span>
					</div>
				</div>
			</fieldset>
			</div>
			<div class="row">
			<fieldset class="form-group col-md-12">
			{{ Form::label('father_name', getphrase('Father\'s Name')) }}
			<span class="text-red" >*</span>
				{{ Form::text('father_name', $value = null , $attributes = array('class'=>'form-control', 'placeholder' => 'Father\'s Name')) }}
			</fieldset>
			<fieldset class="form-group col-md-12">
			{{ Form::label('mobile', getphrase('Mobile No.')) }}
			<span class="text-red" >*</span>
				{{ Form::text('mobile', $value = null , $attributes = array('class'=>'form-control', 'placeholder' => 'Mobile No.')) }}
			</fieldset>
			</div>
			<div class="row">
			<fieldset class="form-group col-md-12">
			{{ Form::label('school_name', getphrase('School')) }}
			<span class="text-red" >*</span>
				{{ Form::text('school_name', $value = null , $attributes = array('class'=>'form-control', 'placeholder' => 'School')) }}
			</fieldset>
			<fieldset class="form-group col-md-12">
			{{ Form::label('class_name', getphrase('Present Class')) }}
			<span class="text-red" >*</span>
				{{ Form::text('class_name', $value = null , $attributes = array('class'=>'form-control', 'placeholder' => 'Present Class')) }}
			</fieldset>
			</div>
			<div class="row">
			<fieldset class="form-group col-md-12">
				{{ Form::label('address', getphrase('address')) }}
				<span class="text-red" >*</span>
				{{ Form::textarea('address', $value = null , $attributes = array('class'=>'form-control', 'placeholder' => 'Address', 'rows'=>'3')) }}
			</fieldset>
			</div>
			<div class="row">
			<fieldset class="form-group col-md-12">				
				{{ Form::label('check_up1', 'Participate in:',array('style'=>'font-weight:bold; font-size:15px;')) }}<br>
				{{ Form::radio('participate',0,false, array('id'=>'check_up','style'=>'display:block;float: left; margin-right: 10px; margin-top: 7px;')) }}
				{{ Form::label('check_up', 'For Check-up Only') }}<br>
				{{ Form::radio('participate',1,false, array('id'=>'competition','style'=>'display:block;float: left; margin-right: 10px; margin-top: 7px;')) }}
				{{ Form::label('competition', 'For Healthy Baby Competition') }}<br>
				{{ Form::radio('participate',2,true, array('id'=>'both','style'=>'display:block;float: left; margin-right: 10px; margin-top: 7px;')) }}
				{{ Form::label('both', 'Both') }}
			</fieldset>
			</div>
			<div class="row">
			<fieldset class="form-group col-md-12">
				<ul>
					<li>*Photograph of the child.</li>
					<li>*birth certificate.</li>
					<li>*Vaccine Card</li>
					<li>*Contest will before upto 8yrs.</li>
					<li>*Free health Check-up upto 10yrs.</li>
					<li>*registration form’s print.</li>
					<li>*TSN’s school students will not be allowed to participate in the contest they can avail the free health check-up facility.</li>
				</ul>
			</fieldset>
			</div>
		</div>	
		<div class="buttons text-center">
			<button type="submit" class="btn btn-lg btn-primary button">{{getPhrase('Submit')}}</button>
		</div>
	</div>  
	<div class="col-md-8">
		<img src='{{IMAGES}}healthy_baby.jpeg'>
	</div>
	{!! Form::close() !!} 	 
</div>
</div>
</br>

@stop

@section('footer_scripts')  
	<script src="{{JS}}moment.min.js"></script>
	<script src="{{JS}}bootstrap-datepicker.min.js"></script>
	<script src="{{JS}}bootstrap-datetimepicker.js"></script>
@stop