492 lines
20 KiB
HTML
492 lines
20 KiB
HTML
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<!DOCTYPE html>
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<html xmlns="http://www.w3.org/1999/xhtml"
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xmlns:th="http://www.thymeleaf.org"
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layout:decorate="~{layouts/page-layout}">
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<head>
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<title th:text="${pageTitle}">Register</title>
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</head>
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<div layout:fragment="page_subtitle">
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<h1 class="title">Registration</h1>
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</div>
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<body layout:fragment="page_content" id="page_register">
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<h2 class="card-title">
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<i class="material-icons">apartment</i>
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<th:block th:text="#{lbl.mc.reg}" />
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</h2>
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<div class="category form-category text-mute">* Required fields</div>
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<br />
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<form id="mcRegisterValidation" th:action="@{#{'/register'}}"
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th:object="${regForm}" th:method="POST" autocomplete="off"
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enctype="multipart/form-data">
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<div class="cd-section" id="basicInfo">
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<h3 class="card-title mt-3" th:text="#{lbl.mc.Details}"></h3>
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<div class="row">
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<div class="col-sm-12 col-md-6 col-lg-6">
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<div class="form-group">
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<label class="required bmd-label-floating"
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th:text="#{lbl.mc.name}"></label> <input type="text"
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class="form-control input-letter" autofocus="autofocus"
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maxlength="255" style="text-transform: uppercase;"
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required="required" th:field="*{mcProfile.mcName}" />
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</div>
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</div>
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<div class="col-sm-12 col-md-6 col-lg-6">
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<div class="form-group">
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<label class="required bmd-label-floating"
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th:text="#{'Registration No.'}"></label> <input type="text"
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maxlength="20" class="form-control input-letter-number-dash"
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required="required" th:field="*{mcProfile.mcRegNo}" />
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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-sm-12 col-md-6 col-lg-6">
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<div class="form-group">
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<label class="required bmd-label-floating"
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th:text="#{lbl.employer.email}"></label> <input type="email"
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maxlength="100" class="form-control" required="required"
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th:field="*{mcProfile.email}" />
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</div>
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</div>
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<div class="col-sm-12 col-md-6 col-lg-6">
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<div class="form-group">
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<label class="required bmd-label-floating"
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th:text="#{lbl.contact}"></label> <input type="text"
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class="form-control input-contact limit-number" maxlength="50"
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required="required" th:field="*{mcProfile.contactNo}"
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data-init-country="BD" />
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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-sm-12 col-md-12 col-lg-12">
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<div class="form-group">
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<label class="required bmd-label-floating" th:text="#{lbl.mc.adr}"></label>
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<textarea class="form-control" required="required" maxlength="100"
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th:field="*{mcProfile.addr1}"></textarea>
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</div>
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</div>
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</div>
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<div class="bd-callout bd-callout-success">
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<h3 class="mt-0">Opening Hours </h3>
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<div class="row">
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<div class="col-sm-12 col-md-6 col-lg-6">
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<div class="form-group">
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<label class="required bmd-label-floating"
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th:text="#{lbl.week.days} + ' '+ #{lbl.from}"></label> <select
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th:field="*{mcProfile.weekDaysFrom}" class="form-control"
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required="required">
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<option value="">Select</option>
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<option value="12:00 AM">12:00 AM</option>
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<option value="12:30 AM">12:30 AM</option>
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<option value="01:00 AM">01:00 AM</option>
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<option value="01:30 AM">01:30 AM</option>
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<option value="02:00 AM">02:00 AM</option>
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<option value="02:30 AM">02:30 AM</option>
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<option value="03:00 AM">03:00 AM</option>
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<option value="03:30 AM">03:30 AM</option>
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<option value="04:00 AM">04:00 AM</option>
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<option value="04:30 AM">04:30 AM</option>
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<option value="05:00 AM">05:00 AM</option>
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<option value="05:30 AM">05:30 AM</option>
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<option value="06:00 AM">06:00 AM</option>
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<option value="06:30 AM">06:30 AM</option>
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<option value="07:00 AM">07:00 AM</option>
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<option value="07:30 AM">07:30 AM</option>
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<option value="08:00 AM">08:00 AM</option>
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<option value="08:30 AM">08:30 AM</option>
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<option value="09:00 AM">09:00 AM</option>
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<option value="09:30 AM">09:30 AM</option>
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<option value="10:00 AM">10:00 AM</option>
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<option value="10:30 AM">10:30 AM</option>
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<option value="11:00 AM">11:00 AM</option>
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<option value="11:30 AM">11:30 AM</option>
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<option value="12:00 PM">12:00 PM</option>
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<option value="12:30 PM">12:30 PM</option>
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<option value="01:00 PM">01:00 PM</option>
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<option value="01:30 PM">01:30 PM</option>
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<option value="02:00 PM">02:00 PM</option>
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<option value="02:30 PM">02:30 PM</option>
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<option value="03:00 PM">03:00 PM</option>
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<option value="03:30 PM">03:30 PM</option>
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<option value="04:00 PM">04:00 PM</option>
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<option value="04:30 PM">04:30 PM</option>
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<option value="05:00 PM">05:00 PM</option>
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<option value="05:30 PM">05:30 PM</option>
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<option value="06:00 PM">06:00 PM</option>
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<option value="06:30 PM">06:30 PM</option>
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<option value="07:00 PM">07:00 PM</option>
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<option value="07:30 PM">07:30 PM</option>
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<option value="08:00 PM">08:00 PM</option>
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<option value="08:30 PM">08:30 PM</option>
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<option value="09:00 PM">09:00 PM</option>
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<option value="09:30 PM">09:30 PM</option>
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<option value="10:00 PM">10:00 PM</option>
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<option value="10:30 PM">10:30 PM</option>
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<option value="11:00 PM">11:00 PM</option>
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<option value="11:30 PM">11:30 PM</option>
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</select>
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</div>
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</div>
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<div class="col-sm-12 col-md-6 col-lg-6">
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<div class="form-group">
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<label class="required bmd-label-floating"
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th:text="#{lbl.week.days}+ ' '+ #{lbl.to}"></label> <select
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th:field="*{mcProfile.weekDaysTo}" class="form-control"
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required="required">
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<option value="">Select</option>
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<option value="12:00 AM">12:00 AM</option>
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<option value="12:30 AM">12:30 AM</option>
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<option value="01:00 AM">01:00 AM</option>
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<option value="01:30 AM">01:30 AM</option>
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<option value="02:00 AM">02:00 AM</option>
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<option value="02:30 AM">02:30 AM</option>
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<option value="03:00 AM">03:00 AM</option>
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<option value="03:30 AM">03:30 AM</option>
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<option value="04:00 AM">04:00 AM</option>
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<option value="04:30 AM">04:30 AM</option>
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<option value="05:00 AM">05:00 AM</option>
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<option value="05:30 AM">05:30 AM</option>
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<option value="06:00 AM">06:00 AM</option>
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<option value="06:30 AM">06:30 AM</option>
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<option value="07:00 AM">07:00 AM</option>
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<option value="07:30 AM">07:30 AM</option>
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<option value="08:00 AM">08:00 AM</option>
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<option value="08:30 AM">08:30 AM</option>
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<option value="09:00 AM">09:00 AM</option>
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<option value="09:30 AM">09:30 AM</option>
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<option value="10:00 AM">10:00 AM</option>
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<option value="10:30 AM">10:30 AM</option>
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<option value="11:00 AM">11:00 AM</option>
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<option value="11:30 AM">11:30 AM</option>
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<option value="12:00 PM">12:00 PM</option>
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<option value="12:30 PM">12:30 PM</option>
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<option value="01:00 PM">01:00 PM</option>
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<option value="01:30 PM">01:30 PM</option>
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<option value="02:00 PM">02:00 PM</option>
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<option value="02:30 PM">02:30 PM</option>
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<option value="03:00 PM">03:00 PM</option>
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<option value="03:30 PM">03:30 PM</option>
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<option value="04:00 PM">04:00 PM</option>
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<option value="04:30 PM">04:30 PM</option>
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<option value="05:00 PM">05:00 PM</option>
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<option value="05:30 PM">05:30 PM</option>
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<option value="06:00 PM">06:00 PM</option>
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<option value="06:30 PM">06:30 PM</option>
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<option value="07:00 PM">07:00 PM</option>
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<option value="07:30 PM">07:30 PM</option>
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<option value="08:00 PM">08:00 PM</option>
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<option value="08:30 PM">08:30 PM</option>
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<option value="09:00 PM">09:00 PM</option>
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<option value="09:30 PM">09:30 PM</option>
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<option value="10:00 PM">10:00 PM</option>
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<option value="10:30 PM">10:30 PM</option>
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<option value="11:00 PM">11:00 PM</option>
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<option value="11:30 PM">11:30 PM</option>
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</select>
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</div>
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</div>
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<div class="col-sm-12 col-md-6 col-lg-6">
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<div class="form-group">
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<label class="required bmd-label-floating"
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th:text="#{lbl.week.end}+' '+ #{lbl.from}"></label> <select
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th:field="*{mcProfile.weekEndFrom}" class="form-control"
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required="required">
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<option value="">Select</option>
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<option value="12:00 AM">12:00 AM</option>
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<option value="12:30 AM">12:30 AM</option>
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<option value="01:00 AM">01:00 AM</option>
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<option value="01:30 AM">01:30 AM</option>
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<option value="02:00 AM">02:00 AM</option>
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<option value="02:30 AM">02:30 AM</option>
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<option value="03:00 AM">03:00 AM</option>
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<option value="03:30 AM">03:30 AM</option>
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<option value="04:00 AM">04:00 AM</option>
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<option value="04:30 AM">04:30 AM</option>
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<option value="05:00 AM">05:00 AM</option>
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<option value="05:30 AM">05:30 AM</option>
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<option value="06:00 AM">06:00 AM</option>
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<option value="06:30 AM">06:30 AM</option>
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<option value="07:00 AM">07:00 AM</option>
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<option value="07:30 AM">07:30 AM</option>
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<option value="08:00 AM">08:00 AM</option>
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<option value="08:30 AM">08:30 AM</option>
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<option value="09:00 AM">09:00 AM</option>
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<option value="09:30 AM">09:30 AM</option>
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<option value="10:00 AM">10:00 AM</option>
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<option value="10:30 AM">10:30 AM</option>
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<option value="11:00 AM">11:00 AM</option>
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<option value="11:30 AM">11:30 AM</option>
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<option value="12:00 PM">12:00 PM</option>
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<option value="12:30 PM">12:30 PM</option>
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<option value="01:00 PM">01:00 PM</option>
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<option value="01:30 PM">01:30 PM</option>
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<option value="02:00 PM">02:00 PM</option>
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<option value="02:30 PM">02:30 PM</option>
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<option value="03:00 PM">03:00 PM</option>
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<option value="03:30 PM">03:30 PM</option>
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<option value="04:00 PM">04:00 PM</option>
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<option value="04:30 PM">04:30 PM</option>
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<option value="05:00 PM">05:00 PM</option>
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<option value="05:30 PM">05:30 PM</option>
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<option value="06:00 PM">06:00 PM</option>
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<option value="06:30 PM">06:30 PM</option>
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<option value="07:00 PM">07:00 PM</option>
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<option value="07:30 PM">07:30 PM</option>
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<option value="08:00 PM">08:00 PM</option>
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<option value="08:30 PM">08:30 PM</option>
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<option value="09:00 PM">09:00 PM</option>
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<option value="09:30 PM">09:30 PM</option>
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<option value="10:00 PM">10:00 PM</option>
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<option value="10:30 PM">10:30 PM</option>
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<option value="11:00 PM">11:00 PM</option>
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<option value="11:30 PM">11:30 PM</option>
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</select>
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</div>
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</div>
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<div class="col-sm-12 col-md-6 col-lg-6">
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<div class="form-group">
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<label class="required bmd-label-floating"
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th:text="#{lbl.week.end}+' '+ #{lbl.to}"></label> <select
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th:field="*{mcProfile.weekEndTo}" class="form-control"
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required="required">
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<option value="">Select</option>
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<option value="12:00 AM">12:00 AM</option>
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<option value="12:30 AM">12:30 AM</option>
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<option value="01:00 AM">01:00 AM</option>
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<option value="01:30 AM">01:30 AM</option>
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<option value="02:00 AM">02:00 AM</option>
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<option value="02:30 AM">02:30 AM</option>
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<option value="03:00 AM">03:00 AM</option>
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<option value="03:30 AM">03:30 AM</option>
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<option value="04:00 AM">04:00 AM</option>
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<option value="04:30 AM">04:30 AM</option>
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<option value="05:00 AM">05:00 AM</option>
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<option value="05:30 AM">05:30 AM</option>
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<option value="06:00 AM">06:00 AM</option>
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<option value="06:30 AM">06:30 AM</option>
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<option value="07:00 AM">07:00 AM</option>
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<option value="07:30 AM">07:30 AM</option>
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<option value="08:00 AM">08:00 AM</option>
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<option value="08:30 AM">08:30 AM</option>
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<option value="09:00 AM">09:00 AM</option>
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<option value="09:30 AM">09:30 AM</option>
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<option value="10:00 AM">10:00 AM</option>
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<option value="10:30 AM">10:30 AM</option>
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<option value="11:00 AM">11:00 AM</option>
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<option value="11:30 AM">11:30 AM</option>
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<option value="12:00 PM">12:00 PM</option>
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<option value="12:30 PM">12:30 PM</option>
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<option value="01:00 PM">01:00 PM</option>
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<option value="01:30 PM">01:30 PM</option>
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<option value="02:00 PM">02:00 PM</option>
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<option value="02:30 PM">02:30 PM</option>
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<option value="03:00 PM">03:00 PM</option>
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<option value="03:30 PM">03:30 PM</option>
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<option value="04:00 PM">04:00 PM</option>
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|
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<option value="04:30 PM">04:30 PM</option>
|
||
|
|
<option value="05:00 PM">05:00 PM</option>
|
||
|
|
<option value="05:30 PM">05:30 PM</option>
|
||
|
|
<option value="06:00 PM">06:00 PM</option>
|
||
|
|
<option value="06:30 PM">06:30 PM</option>
|
||
|
|
<option value="07:00 PM">07:00 PM</option>
|
||
|
|
<option value="07:30 PM">07:30 PM</option>
|
||
|
|
<option value="08:00 PM">08:00 PM</option>
|
||
|
|
<option value="08:30 PM">08:30 PM</option>
|
||
|
|
<option value="09:00 PM">09:00 PM</option>
|
||
|
|
<option value="09:30 PM">09:30 PM</option>
|
||
|
|
<option value="10:00 PM">10:00 PM</option>
|
||
|
|
<option value="10:30 PM">10:30 PM</option>
|
||
|
|
<option value="11:00 PM">11:00 PM</option>
|
||
|
|
<option value="11:30 PM">11:30 PM</option>
|
||
|
|
|
||
|
|
</select>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
<div class="row">
|
||
|
|
<div class="col-sm-12 col-md-6 col-lg-6">
|
||
|
|
<div class="form-group">
|
||
|
|
<label class="required bmd-label-floating"
|
||
|
|
th:text="#{lbl.mc.country}"></label> <select
|
||
|
|
th:field="*{mcProfile.country.cntryCode}" class="form-control"
|
||
|
|
required="required">
|
||
|
|
<option value="" />
|
||
|
|
<option th:each="cntry : ${@staticreference.allCountry()}"
|
||
|
|
th:value="${cntry.cntryCode}" th:text="${cntry.cntryDesc}" />
|
||
|
|
</select>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
<div class="col-sm-12 col-md-6 col-lg-6" th:each="doc, row : ${regForm.regFile}">
|
||
|
|
<extra:file extra:document="${doc.fileType}" th:field="*{regFile[__${row.index}__]}"></extra:file>
|
||
|
|
</div>
|
||
|
|
<div class="col-sm-12 col-md-6 col-lg-6"
|
||
|
|
th:each="doc, row : ${regForm.mcFile}">
|
||
|
|
<extra:file extra:document="${doc.fileType}"
|
||
|
|
th:field="*{mcFile[__${row.index}__]}"></extra:file>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
<div class="cd-section" id="ownerDetails">
|
||
|
|
<h3 class="card-title mt-3">Owner Details</h3>
|
||
|
|
<div class="row">
|
||
|
|
<div class="col-sm-12 col-md-6 col-lg-6">
|
||
|
|
<div class="form-group">
|
||
|
|
<label class="required bmd-label-floating" th:text="#{lbl.name}"></label>
|
||
|
|
<input th:field="*{mcProfile.mcOwner.fullname}" maxlength="255"
|
||
|
|
style="text-transform: uppercase;" type="text"
|
||
|
|
class="form-control input-letter" required="required" />
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
<div class="col-sm-12 col-md-6 col-lg-6">
|
||
|
|
<div class="form-group">
|
||
|
|
<label class="required bmd-label-floating" th:text="#{lbl.design}"></label>
|
||
|
|
<input th:field="*{mcProfile.mcOwner.designation}" type="text"
|
||
|
|
maxlength="100" class="form-control" required="required" />
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
<div class="row">
|
||
|
|
<div class="col-sm-12 col-md-6 col-lg-6">
|
||
|
|
<div class="form-group">
|
||
|
|
<label class="required bmd-label-floating" th:text="#{lbl.email}"></label>
|
||
|
|
<input th:field="*{mcProfile.mcOwner.email}" type="email"
|
||
|
|
maxlength="100" class="form-control" required="required" />
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
|
||
|
|
|
||
|
|
<div class="col-sm-12 col-md-6 col-lg-6">
|
||
|
|
<div class="form-group">
|
||
|
|
<label class="required bmd-label-floating"
|
||
|
|
th:text="#{lbl.contact}"></label> <input type="text"
|
||
|
|
class="form-control input-contact limit-number" maxlength="50"
|
||
|
|
required="required" th:field="*{mcProfile.mcOwner.contactNo}"
|
||
|
|
data-init-country="BD" />
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
<div class="row">
|
||
|
|
<div class="col-sm-12 col-md-6 col-lg-6"
|
||
|
|
th:each="doc, row : ${regForm.mcOwnerFile}">
|
||
|
|
<extra:file extra:document="${doc.fileType}"
|
||
|
|
th:field="*{mcOwnerFile[__${row.index}__]}"></extra:file>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
|
||
|
|
|
||
|
|
</div>
|
||
|
|
<h3 class="card-title mt-3">Person In Charge</h3>
|
||
|
|
<div class="form-check">
|
||
|
|
<label class="form-check-label"> <input
|
||
|
|
class="form-check-input" type="checkbox" th:field="*{sameAsOwner}"
|
||
|
|
onchange="hidePic(event)"> <th:block
|
||
|
|
th:text="#{lbl.own.pic.is.same}" /> <span class="form-check-sign">
|
||
|
|
<span class="check"></span>
|
||
|
|
</span>
|
||
|
|
</label>
|
||
|
|
</div>
|
||
|
|
<div class="cd-section" id="picDetails">
|
||
|
|
<div id="picOwner">
|
||
|
|
<div class="row">
|
||
|
|
<div class="col-sm-12 col-md-6 col-lg-6">
|
||
|
|
<div class="form-group">
|
||
|
|
<label class="required bmd-label-floating" th:text="#{lbl.name}"></label>
|
||
|
|
<input th:field="*{mcProfile.picOwner.fullname}" maxlength="255"
|
||
|
|
style="text-transform: uppercase;" type="text"
|
||
|
|
class="form-control input-letter" required="required" />
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
<div class="col-sm-12 col-md-6 col-lg-6">
|
||
|
|
<div class="form-group">
|
||
|
|
<label class="required bmd-label-floating" th:text="#{lbl.design}"></label>
|
||
|
|
<input th:field="*{mcProfile.picOwner.designation}" type="text"
|
||
|
|
maxlength="100" class="form-control" required="required" />
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
<div class="row">
|
||
|
|
<div class="col-sm-12 col-md-6 col-lg-6">
|
||
|
|
<div class="form-group">
|
||
|
|
<label class="required bmd-label-floating" th:text="#{lbl.email}"></label>
|
||
|
|
<input th:field="*{mcProfile.picOwner.email}" type="email"
|
||
|
|
maxlength="100" class="form-control" required="required" />
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
|
||
|
|
|
||
|
|
<div class="col-sm-12 col-md-6 col-lg-6">
|
||
|
|
<div class="form-group">
|
||
|
|
<label class="required bmd-label-floating"
|
||
|
|
th:text="#{lbl.contact}"></label> <input type="text"
|
||
|
|
class="form-control input-contact limit-number" maxlength="50"
|
||
|
|
required="required" th:field="*{mcProfile.picOwner.contactNo}"
|
||
|
|
data-init-country="BD" />
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
<div class="row">
|
||
|
|
<div class="col-sm-12 col-md-6 col-lg-6"
|
||
|
|
th:each="doc, row : ${regForm.mcPicFile}">
|
||
|
|
<extra:file extra:document="${doc.fileType}"
|
||
|
|
th:field="*{mcPicFile[__${row.index}__]}"></extra:file>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
<div
|
||
|
|
class="col-sm-12 col-md-12 col-lg-12 mt-4 justify-content-center pl-0">
|
||
|
|
<div class="form-check">
|
||
|
|
<label class="form-check-label"> <input
|
||
|
|
class="form-check-input" name="acceptTerms" type="checkbox"
|
||
|
|
required="required"> I agree to the <a target="_blank"
|
||
|
|
rel="noopener" th:href="@{/termsOfUse}">Terms of Use</a>. <span
|
||
|
|
class="form-check-sign"> <span class="check"></span>
|
||
|
|
</span>
|
||
|
|
</label>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
<div class="d-flex pb-4 justify-content-center mt-2">
|
||
|
|
<div id="captcha" class="form-captcha"></div>
|
||
|
|
</div>
|
||
|
|
<input type="hidden" th:value="${recaptchaSiteKey}" id="recaptchaId" />
|
||
|
|
<div class="row pb-3 align-items-center">
|
||
|
|
<div class="ml-auto">
|
||
|
|
<a class="btn waves-effect waves-light btn-secondary" href="#" th:href="@{#{url.login}}"><i class="material-icons">keyboard_backspace</i>
|
||
|
|
Back to Login Page</a>
|
||
|
|
<button type="submit" class="btn btn-primary">Submit</button>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</form>
|
||
|
|
</body>
|
||
|
|
<nav id="cd-vertical-nav">
|
||
|
|
<ul>
|
||
|
|
<li><a href="#basicInfo" data-number="1"> <span
|
||
|
|
class="cd-dot"></span> <span class="cd-label">
|
||
|
|
<li><a href="#ownerDetails" data-number="2"> <span
|
||
|
|
class="cd-dot"></span> <span class="cd-label">Medical
|
||
|
|
Center Details</span>
|
||
|
|
</a></li>
|
||
|
|
</span>
|
||
|
|
</a></li>
|
||
|
|
<li><a href="#ownerDetails" data-number="2"> <span
|
||
|
|
class="cd-dot"></span> <span class="cd-label">Owner Details</span>
|
||
|
|
</a></li>
|
||
|
|
<li><a href="#picDetails" data-number="2"> <span
|
||
|
|
class="cd-dot"></span> <span class="cd-label">PIC Details</span>
|
||
|
|
</a></li>
|
||
|
|
</ul>
|
||
|
|
</nav>
|
||
|
|
</html>
|
||
|
|
<th:block layout:fragment="page_script"
|
||
|
|
th:with="baseUrl=${@webHelper.baseUrl()}">
|
||
|
|
<script
|
||
|
|
src="https://www.google.com/recaptcha/api.js?onload=onloadCallback&render=explicit"
|
||
|
|
async defer></script>
|
||
|
|
</th:block>
|