Your IP : 216.73.216.91
<?php require_once('header.php');?>
<div class="container container-margin">
<div class="mx-auto col-12 col-md-12 col-lg-12">
<form method="post" id="create_family_form">
<input type="hidden" name="id" id="id" value="<?=(isset($_GET['id']) && !empty($_GET['id'])) ? $_GET['id'] : "-1";?>">
<fieldset>
<h2 class="form-heading">Create Family Tree</h2>
<hr class="colorgraph">
<div class=" row form-group">
<div class="col-lg-4 col-md-4 col-sm-12">
<label>Father CNIC</label>
<input value="<?php if(isset($_GET['father_cnic']) && !empty($_GET['father_cnic'])){echo $_GET['father_cnic'];}?>" type="text" name="father_cnic" id="father_cnic" class="form-control input-lg" placeholder="Enter Father CNIC">
</div>
<div class="col-lg-4 col-md-4 col-sm-12">
<label>Father Name</label>
<input type="text" name="father_name" id="father_name" class="form-control input-lg" placeholder="Enter Father Name">
</div>
<div class="col-lg-4 col-md-4 col-sm-12">
<label>Father Phone</label>
<input type="text" name="father_phone" id="father_phone" class="form-control input-lg" placeholder="Enter Father Phone">
</div>
</div>
<div class="row form-group">
<div class="col-lg-4 col-md-4 col-sm-12">
<label>Father Occupation</label>
<input type="text" name="father_occup" id="father_occup" class="form-control input-lg" placeholder="Enter Father Occupation">
</div>
<div class="col-lg-4 col-md-4 col-sm-12">
<label>Address</label>
<input type="text" name="address" id="address" class="form-control input-lg" placeholder="Enter Address">
</div>
<div class="col-lg-4 col-md-4 col-sm-12">
<label># Of Children</label>
<input type="text" name="children_count" id="children_count" class="form-control input-lg" placeholder="Enter # Of Children">
</div>
</div>
<div class="row form-group">
<div class="col-lg-6 col-md-6 col-sm-122">
<label>Religion</label>
<select name="religion" id="religion" class="form-control input-lg select-placeholder">
<option value="">Select Religion</option>
<option value="Islam">Islam</option>
<option value="Christianity">Christianity</option>
<option value="Hinduism">Hinduism</option>
</select>
</div>
<div class="col-lg-6 col-md-6 col-sm-122 btn-group btn-group-toggle" data-toggle="buttons">
<label class="col-lg-6 col-md-6 col-sm-6 btn btn-secondary radio-line-height">
<input type="radio" name="zakat" id="zakat_yes" value="Yes"> Zakat
</label>
<label class="col-lg-6 col-md-6 col-sm-6 btn btn-secondary radio-line-height">
<input type="radio" name="zakat" id="zakat_no" value="No"> Non Zakat
</label>
</div>
</div>
<hr class="colorgraph thin">
<div class=" row form-group">
<div class="col-lg-4 col-md-4 col-sm-12">
<label>Mother Name</label>
<input type="text" name="mother_name" id="mother_name" class="form-control input-lg" placeholder="Enter Mother Name">
</div>
<div class="col-lg-4 col-md-4 col-sm-12">
<label>Mother CNIC</label>
<input type="text" name="mother_cnic" id="mother_cnic" class="form-control input-lg" placeholder="Enter Mother CNIC">
</div>
<div class="col-lg-4 col-md-4 col-sm-12">
<label>Mother Occupation</label>
<input type="text" name="mother_occup" id="mother_occup" class="form-control input-lg" placeholder="Enter Mother Occupation">
</div>
</div>
<div class=" row form-group">
<div class="col-lg-4 col-md-4 col-sm-12">
<label>Emergency Contact Name</label>
<input type="text" name="emerg_name" id="emerg_name" class="form-control input-lg" placeholder="Enter Emergency Cotnact Name">
</div>
<div class="col-lg-4 col-md-4 col-sm-12">
<label>Relation</label>
<select name="emerg_relation" id="emerg_relation" class="form-control input-lg select-placeholder">
<option value="-1">Select Relation With Student</option>
<option>Father</option>
<option>Mother</option>
<option>Brother</option>
<option>Sister</option>
<option>Grand Father</option>
<option>Grand Mother</option>
<option>Uncle</option>
<option>Aunt</option>
<option>Cousin</option>
<option>Maternal Grand Father</option>
<option>Maternal Grand Mother</option>
<option>Maternal Uncle</option>
<option>Maternal Aunt</option>
<option>Maternal Cousin</option>
</select>
<!-- <label>Relation With Student</label>
<input class="form-control input-lg" id="emerg_relation" name="emerg_relation"> -->
</div>
<div class="col-lg-4 col-md-4 col-sm-12">
<label>Emergency Contact #</label>
<input type="text" name="emerg_num" id="emerg_num" class="form-control input-lg" placeholder="Enter Emergency Cotnact Number">
</div>
</div>
<hr class="colorgraph thin">
<div class="row form-group">
<div class="col-lg-4 col-md-4 col-sm-12">
<input type="submit" id="fam_submit" class="btn btn-lg btn-primary btn-block llcf-pri" value="Save">
</div>
<div class="col-lg-4 col-md-4 col-sm-12">
<input type="button" id="reset" class="btn btn-lg btn-danger btn-block" value="Reset">
</div>
<div class="col-lg-4 col-md-4 col-sm-12">
<a class="btn btn-lg btn-secondary btn-block" href="<?=Config::getConfig('familyGridRedirect')?>">Family List</a>
</div>
</div>
</fieldset>
</form>
</div>
</div>
<?php require_once('footer.php');?>