172 lines
7.7 KiB
PHP
172 lines
7.7 KiB
PHP
@extends('frontend.layouts.template')
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@section('title', 'Enquiry Form')
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@section('content')
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<div class="container login-section py-5">
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<div class="row">
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<div class="col-md-3">
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<img src="{{ asset('images/access.png') }}" alt="" class="img-fluid">
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</div>
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<div class="col-md-9">
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<!--h2 class="login-right-title pt-5">
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@if(isset($campaign))
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{{$campaign->name}}
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@endif
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</h2-->
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</div>
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</div>
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<div class="row gx-5">
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<div class="col-lg-7 col-md-8">
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<div class="login-form bg-light mt-4 pb-4">
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@if(isset($campaign) && $campaign->banner)
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<img class="img-fluid" src="{{ asset($campaign->banner_path)}}"/>
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@endif
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@if(Illuminate\Support\Facades\Session::has('success'))
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<div class="alert alert-success mt-3 mb-3" id="alert_message">
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{{Illuminate\Support\Facades\Session::get('success')}}
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<button type="button" class="close" data-dismiss="alert" aria-label="Close">
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<span aria-hidden="true">×</span>
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</button>
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</div>
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@endif
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<h5 class="login_welcome text-center pt-4 pb-1">Register now for Appointments</h5>
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<form method="GET" id="enquiry_form" name="enq" action="{{ route('customerform.store',['headers'=> $campaign->name, 'user_agent'=> $campaign->id]) }}" class="p-3">
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@csrf
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@if(isset($campaign))
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<input type="hidden" name="campaign_id" id="" value="{{$campaign->id}}">
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@endif
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<input type="hidden" name="source" id="" value="registration">
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<div class="row">
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<div class="form-group col-12">
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<input required="required" placeholder="Enter Name" id="first-name" class="form-control"
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name="name" type="text">
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</div>
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</div>
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<div class="row">
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<div class="form-group col-8">
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<input required="required" placeholder="Enter Email" id="email" class="form-control"
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name="email" type="email">
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</div>
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<div class="form-group col-4">
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<input required="required" placeholder="Enter Phone" id="phone" class="form-control"
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name="phone" type="number">
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</div>
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</div>
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<div class="row">
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<div class="form-group col-4">
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<select name="highest_qualification" class="form-control">
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<option value="" disabled selected>Select Qualification</option>
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@foreach ($qualifications as $qualification)
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<option value="{{$qualification->name}}">{{$qualification->name}}</option>
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@endforeach
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</select>
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</div>
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<div class="form-group col-4">
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<input placeholder="Grade" class="form-control"
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name="highest_grade" type="text">
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</div>
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<div class="form-group col-4">
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<input placeholder="Stream" class="form-control"
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name="highest_stream" type="text">
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</div>
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</div>
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<div class="row">
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<div class="form-group col-6">
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<select name="test_name" class="form-control">
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<option value="" disabled selected>Select Test Preparation</option>
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@foreach ($preparations as $preparation)
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<option value="{{$preparation->name}}">{{$preparation->name}}</option>
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@endforeach
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</select>
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</div>
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<div class="form-group col-6">
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<input placeholder="Enter Test Score " class="form-control"
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name="test_score" type="text">
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</div>
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</div>
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{{-- <div class="row">
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<div class="form-group col-md-12">
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<select class="form-select form-control" name="preffered_location" aria-label="Default select example">
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<option selected disabled>Registering For</option>
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<option value="baneshwor">NZ Admission Day New Baneshor (24 August)</option>
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<option value="biratnagar">NZ Admission Day Biratnagar (25 August)</option>
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<option value="pokhara">NZ Admission Day Pokhara (26 August)</option>
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<option value="chitwan">NZ Admission Day Chitwan (28 August)</option>
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<option value="butwal">NZ Admission Day Butwal (29 August)</option>
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<option value="putalisadak">NZ Admission Day Putalisadak (30 August)</option>
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</select>
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</div>
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</div> --}}
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@if(!empty($campaign_course[0]))
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<div class="row">
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<div class="form-group col-6">
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<select name="intrested_course[]" data-placeholder="Please Select Intrested Course" class="form-control offerd_course mt-1 mt-2" multiple>
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@foreach ($campaign_course as $course)
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<option value="{{$course}}">{{$course}}</option>
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@endforeach
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</select>
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</div>
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</div>
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@endif
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<div class="row">
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<div class="col-lg-12 justify-content-center align-center">
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<button type="submit" title="Submit Your Message!" class="btn btn-submit" name="submit"
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value="Submit">Submit</button>
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</div>
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</form>
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</div>
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</div>
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<div class="col-lg-5 col-md-4 d-flex align-items-center pl-5">
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<div class="login-right">
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<div class="login-right-list pt-4 ">
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@if(isset($campaign))
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{!! $campaign->description !!}
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@endif
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</div>
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</div>
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</div>
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</div>
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</div>
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@endsection
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@section('page-specific-scripts')
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<script>
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$('.offerd_course').select2({
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});
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setTimeout(() => {
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$('#alert_message').hide();
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}, 6000);
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$('#enquiry_form').submit(function(){
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$(this).find(':input[type=submit]').prop('disabled', true);
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});
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</script>
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@endsection
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