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70 lines
4.3 KiB
70 lines
4.3 KiB
<style>.toolbar {float:left;} tr.row_selected td{background-color: #d9edf7 !important;}</style>
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<div style="display:none;">
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<form role="form" data-toggle="validator" novalidate="novalidate" action="javascript:;" method="post" id="noshow_walk_in_form">
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<!-- Edit event schedule -->
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<div class="panel">
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<div class="row">
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<div class="col-md-12">
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<div class="form-group has-feedback">
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<label for="civility">Civilité: <span class="font-required">*</span></label>
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<br>
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<input style="display: inline-block; position: relative; margin-top: -15px;top: 2px; margin-left: 10px; margin-right: 5px;" type="radio" class="female civility" value="Madame" id="civility" name="civility" checked="checked" required> Madame
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<input style="mdisplay: inline-block; position: relative; margin-top: -15px;top: 2px; margin-left: 10px; margin-right: 5px;" type="radio" value="Monsieur" class="male civility" id="civility" name="civility" required> Monsieur
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<span id="civility_options">
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</span>
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<div class="help-block with-errors"></div>
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-md-12">
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<div class="form-group has-feedback">
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<label for="last_name" class="control-label"><?=$this->lang->line("last_name")?><span class="font-required"> *</span></label>
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<input type="text" class="form-control" id="last_name" name="last_name" placeholder="<?=$this->lang->line("last_name")?>" required/>
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<div class="help-block with-errors"></div>
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-md-12">
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<div class="form-group has-feedback">
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<label for="first_name" class="control-label"><?=$this->lang->line("first_name")?><span class="font-required"> *</span></label>
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<input type="text" class="form-control" id="first_name" name="first_name" placeholder="<?=$this->lang->line("first_name")?>" required />
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<div class="help-block with-errors"></div>
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-md-12">
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<div class="form-group has-feedback">
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<label for="email_address" class="control-label"><?=$this->lang->line("email_address")?><span class="font-required"></span></label>
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<input type="email" class="form-control" id="email_address" name="email_address" placeholder="<?=$this->lang->line("email_address")?>" />
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<span id="sucessEmailValidation" class="form-control-feedback glyphicon glyphicon-ok hidden"></span>
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<div class="help-block with-errors"></div>
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-md-12">
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<div class="form-group has-feedback">
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<label for="attendance" class="control-label"><?=$this->lang->line("attendance")?><span class="font-required"> *</span></label>
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<input type="number" class="form-control" id="attendance" name="attendance" value="1" min="1" max="100" required/>
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<div class="help-block with-errors"></div>
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</div>
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</div>
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</div>
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<div class="row">
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<div class="col-md-12">
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<div class="form-group has-feedback">
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<label for="note" class="control-label"><?=$this->lang->line("note")?></label>
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<input type="text" class="form-control" id="note" name="note" placeholder="<?=$this->lang->line("note")?>"/>
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<div class="help-block with-errors"></div>
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</div>
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</div>
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</div>
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</div><!-- /.modal-dialog -->
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</form>
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</div><!-- /.event schedule form specific-->
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