root
37 lines
1.9 KiB
PHP
37 lines
1.9 KiB
PHP
<div class="emergency-contact-form border rounded p-3 mb-3 bg-white shadow-sm">
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<h5 class="mb-3 text-primary">Emergency Contact Information</h5>
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<div class="row">
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<div class="col-md-6 mb-3">
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<label class="form-label">First Name <span class="text-danger">*</span></label>
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<input type="text" class="form-control" name="emergency_firstname[]" required data-base-name="emergency_firstname" maxlength="30">
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</div>
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<div class="col-md-6 mb-3">
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<label class="form-label">Last Name <span class="text-danger">*</span></label>
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<input type="text" class="form-control" name="emergency_lastname[]" required data-base-name="emergency_lastname" maxlength="30">
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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-6 mb-3">
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<label class="form-label">Phone Number <span class="text-danger">*</span></label>
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<input type="tel" class="form-control" id="phoneInput" name="emergency_phone[]" required data-base-name="emergency_phone" maxlength="12">
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<div id="validationStatus" class="validation-status">
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</div>
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</div>
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<div class="col-md-6 mb-3">
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<label class="form-label">Relationship to Student(s) <span class="text-danger">*</span></label>
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<select class="form-select" name="emergency_relation[]" required data-base-name="emergency_relation">
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<option value="">Select Relationship</option>
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<option value="Parent">Parent</option>
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<option value="Sibling">Sibling</option>
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<option value="Relative">Relative</option>
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<option value="Friend">Friend</option>
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<option value="Neighbor">Neighbor</option>
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<option value="Guardian">Guardian</option>
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<option value="Other">Other</option>
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</select>
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</div>
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</div>
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</div> |