Admin Control Panel v2.0

WASO

Web Admin System Organizer

Server Information

PHP Version 5.6.40

Server Software Apache

Disk Usage 36.07%

Free Space 1006.1 GB

✎ Editing: 4a3ce1a6b312242b8238b3e068f23db9 ← Back

<?php echo $__env->make('frondend.common.header', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>
<?php echo $__env->make('frondend.common.headermenu', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>

<div class="intro-body">

<div class="brand-bar tp-bar"></div>

<div class="innerBanner" style="background:url(<?php echo asset('assets/images/about-banner.jpg');?>)"></div>

</div>

<section id="aboutDesc">

<div class="aboutDesc">

<div class="container">

<h1>Registeration Form</h1>

<div class="registerFormMsg"></div>

<?php echo Form::open(array('url' => 'registerform', 'class' => 'form-blk main','role'=>'form','id'=>'registerForm')); ?>

<div class="block2 br1">

<div class="row">

<div class="br-blk">

<div class="col-md-6 pdr-rht">

<h3>Child's Information</h3>

<div class="row">

<div class=" col-sm-4">

<div class="form-group">

<label>Full name </label>

</div>

</div>

<div class="col-sm-8 ">

<div class="form-group">

<input type="text" id="children_full_name"  name="children_full_name" id="exampleInputEmail1" class="form-control ">

</div>

</div>

<div class="clearfix"></div>

</div>

<div class="row">

<div class=" col-sm-4">

<div class="form-group">

<label>Date of Birth </label>

</div>

</div>

<div class="col-sm-8 ">

<div class="form-group">

<input type="text" name="children_date_of_birth"  id="children_date_of_birth" class="form-control ">

</div>

</div>

<div class="clearfix"></div>

</div>

<div class="row">

<div class=" col-sm-4">

<div class="form-group">

<label>Age </label>

</div>

</div>

<div class="col-sm-8 ">

<div class="form-group">

<input type="text" name="children_age" id="children_age" class="form-control ">

</div>

</div>

<div class="clearfix"></div>

</div>

<div class="row">

<div class=" col-sm-4">

<div class="form-group">

<label>Gender </label>

</div>

</div>

<div class="col-sm-8 ">

<div class="form-group">

<select name="children_gender"  id="children_gender" class="form-control ">

<option value="male">Male</option>

<option value="female">Female</option>

</select>

</div>

</div>

<div class="clearfix"></div>

</div>

<div class="row">

<div class=" col-sm-4">

<div class="form-group">

<label>Home Address </label>

</div>

</div>

<div class="col-sm-8 ">

<div class="form-group">

<textarea name="children_home_address" id="children_home_address" class="form-control"></textarea>

</div>

</div>

<div class="clearfix"></div>

</div>

</div>

<div class="col-md-6 pdr-lft ">

<h3>Family Information</h3>

<div class="row">

<div class=" col-sm-4">

<div class="form-group">

<label>Father’s Name </label>

</div>

</div>

<div class="col-sm-8 ">

<div class="form-group">

<input type="text" name="family_father_name"  id="family_father_name" class="form-control ">

</div>

</div>

<div class="clearfix"></div>

</div>

<div class="row">

<div class=" col-sm-4">

<div class="form-group">

<label>Profession </label>

</div>

</div>

<div class="col-sm-8 ">

<div class="form-group">

<input type="text" name="family_father_profession" id="family_father_profession" class="form-control ">

</div>

</div>

<div class="clearfix"></div>

</div>

<div class="row">

<div class=" col-sm-4">

<div class="form-group">

<label>Mother’s Name </label>

</div>

</div>

<div class="col-sm-8 ">

<div class="form-group">

<input type="text" name="family_mother_name"  id="family_mother_name" class="form-control ">

</div>

</div>

<div class="clearfix"></div>

</div>

<div class="row">

<div class=" col-sm-4">

<div class="form-group">

<label> Profession </label>

</div>

</div>

<div class="col-sm-8 ">

<div class="form-group">

<input type="text" name="family_mother_profession"  id="family_mother_profession" class="form-control ">

</div>

</div>

<div class="clearfix"></div>

</div>

<div class="row">

<div class=" col-sm-4">

<div class="form-group">

<label> Nationality</label>

</div>

</div>

<div class="col-sm-8 ">

<div class="form-group">

<input type="text" name="family_nationality"  id="family_nationality" class="form-control ">

</div>

</div>

<div class="clearfix"></div>

</div>

<div class="row">

<div class=" col-sm-4">

<div class="form-group">

<label> Language's </label>

</div>

</div>

<div class="col-sm-8 ">

<div class="form-group">

<input type="text" name="family_language" id="family_language" class="form-control ">

</div>

</div>

<div class="clearfix"></div>

</div>

</div>

<div class="clearfix"></div>

</div>

<div class="br-blk">

<div class="container"> <h3>Emergency Information</h3></div>

<div class="br2">

<div class="col-md-6 pdr-rht">

<div class="row">

<div class=" col-sm-4">

<div class="form-group">

<label>Name </label>

</div>

</div>

<div class="col-sm-8 ">

<div class="form-group">

<input type="text" name="emergency_name" id="emergency_name" class="form-control ">

</div>

</div>

</div>

</div>

<div class="col-md-6 pdr-lft">

<div class="row">

<div class=" col-sm-4">

<div class="form-group">

<label>Email</label>

</div>

</div>

<div class="col-sm-8 ">

<div class="form-group">

<input type="text" name="emergency_email"  id="emergency_email" class="form-control ">

</div>

</div>

</div>

</div>

</div>

<div class="br2">

<div class="col-md-6 pdr-rht">

<div class="row">

<div class=" col-sm-4">

<div class="form-group">

<label>Mobile No </label>

</div>

</div>

<div class="col-sm-8 ">

<div class="form-group">

<input type="text" name="emergency_mobileno"  id="emergency_mobileno" class="form-control ">

</div>

</div>

</div>

</div>

<div class="col-md-6 pdr-lft">

<div class="row">

<div class=" col-sm-4">

<div class="form-group">

<label>Alternate Phone </label>

</div>

</div>

<div class="col-sm-8 ">

<div class="form-group">

<input type="text" name="emergency_alter_phone"  id="emergency_alter_phone" class="form-control ">

</div>

</div>

</div>

</div>

</div>

</div>

<div class="row">

<div class="col-md-6 col-sm-push-4 col-lg-push-2 col-md-push-2" >

<div class="captcha">

<div class="text tm2"><?php echo HTML::image(Captcha::img(), 'Captcha image'); ?></div>

<input class="form-control enter" name="captchacode" name="captchacode">

</div>

<button type="button"  id="btnRegisterForm"  name="btnRegisterForm" class="btn submit">Submit</button>

</div>

</div>

</div>

</div>

<?php echo Form::close(); ?>

</div>

</div>

</section>

<?php echo $__env->make('frondend.common.footermenu', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>

<?php echo $__env->make('frondend.common.footer', array_except(get_defined_vars(), array('__data', '__path')))->render(); ?>

Cancel