@extends('layouts.Layout')

@section('content')
<form role="form" action="{{route('pendaftar.store')}}" method="post" class="f1">
	{{ csrf_field() }}
	<h3>Form Pendaftaran</h3>
  	<p>Isi Form dengan lengkap</p>
        <div class="f1-steps">
      		<div class="f1-progress">
          		<div class="f1-progress-line" data-now-value="32.66" data-number-of-steps="3" style="width: 32.66%;"></div>
      		</div>
      		<div class="f1-step active">
          		<div class="f1-step-icon"><i class="fa fa-user"></i></div>
          		<p>Data Diri</p>
     		</div>
      		<div class="f1-step">
          		<div class="f1-step-icon"><i class="fa fa-key"></i></div>
          		<p>Data Periodik</p>
      		</div>
     		<div class="f1-step">
          		<div class="f1-step-icon"><i class="fa fa-twitter"></i></div>
          		<p>Data Asal Sekolah</p>
      		</div>
  		</div>
         <?php
         $ko = mt_rand(1000,9999).mt_rand(1000,9999);
         $string = str_shuffle($ko);?>          
        <fieldset>
	    	<center><h4>Data Pribadi</h4></center>
	    	<form role="form" action="{{route('pendaftar.store')}}" method="post" class="f1">
	    	{{csrf_field()}}
	    	<div class="row">
	    		<div class="col-lg-4">
	    			<div class="form-group  @if($errors->has('no_pendaftar')) has-error @endif">
	    			<label>No Pendaftar : </label>
	    				<input class="form-control border-input" type="text" name="no_pendaftar" value="<?php echo mt_rand(1000,9999).mt_rand(1000,9999);?>" disabled="">
	    			</div>
	    		</div>
	    	</div>
		    <div class="row">
			    <div class="col-lg-6">
		         	<div class="form-group @if($errors->has('nama')) has-error @endif">
		                <input type="text" class="form-control border-input" value="{{old('nama')}}" name="nama" placeholder="Nama Lengkap">
		                <span id="helpBlock2" class="help-block" >{{$errors->first('nama')}}</span>
		            </div>
		           </div>
	            
			    <div class="col-lg-3">
		            <div class="form-group @if($errors->has('jeniskelamin')) has-error @endif">
		                <select class="form-control border-input" value="{{old('jeniskelamin')}}" name="jeniskelamin">
		                <option class="0" disabled="true"  selected="true">---Jenis Kelamin---</option>
		                <option>Perempuan</option>
		                <option>Laki-laki</option>
		                </select>
		            </div>
		        </div>
		        <div class="col-lg-3">
		            <div class="form-group @if($errors->has('agama')) has-error @endif">
		             <select class="form-control border-input" value="{{old('agama')}}" name="agama">
		                <option class="0" disabled="true"  selected="true">---Pilih Agama---</option>
		                <option>Kristen Protestan</option>
		                <option>Kristen Katolik</option>
		                <option>Islam</option>
		                <option>Hindu</option>
		                <option>Buddha</option>
		                <option>Konghuchu</option>
		                </select>
		                <span id="helpBlock2" class="help-block">{{$errors->first('agama')}}</span>
		            </div>
		        </div>
		    	</div>
		    	
		    	<div class="row">   
			    	<div class="col-lg-2">
		                <div class="form-group @if($errors->has('tempatlahir')) has-error @endif">
		                    <input type="text" class="form-control border-input" value="{{old('tempatlahir')}}" name="tempatlahir" placeholder="Tempat lahir">
		                    <span id="helpBlock2" class="help-block">{{$errors->first('tempatlahir')}}</span>
		                </div>
		            </div>

			    	<div class="col-lg-2">
		                <div class="form-group @if($errors->has('tanggallahir')) has-error @endif">
		                    <input type="date" class="form-control border-input" value="{{old('tanggallahir')}}" name="tanggallahir" placeholder="Tanggal lahir">
		                    <span id="helpBlock2" class="help-block">{{$errors->first('tanggallahir')}}</span>
		                </div>
		            </div>
		            <div class="col-lg-3">
		                <div class="form-group @if($errors->has('kebutuhan_khusus')) has-error @endif">
		                    <select class="form-control border-input"  value="{{old('kebutuhan_khusus')}}" name="kebutuhan_khusus">
				                    <option class="0" disabled="true"  selected="true">Berkebutuhan khusus ?</option>
				                    <option>Tidak</option>
				                    <option>Netra(A)</option>
				                    <option>Rungu</option>
				                    <option>Grahita Ringan</option>
				                    <option>Grahita Sedang</option>
				                    <option>Daksa Ringan</option>
				                    <option>Daksa Sedang</option>
				                    <option>Laras</option>
				                    <option>Wicara</option>
				                    <option>Hiper Aktif</option>
				                    <option>Cerdas Istimewa</option>
				                    <option>Bakat Istimewa</option>
				                    <option>Kesulitan Belajar</option>
				                    <option>Narkoba</option>
				                    <option>Indigo</option>
				                    <option>Autis</option>
				                    <option>Down Sindrome</option>
				                    <option>Lainnya</option>
			                    </select>
		                    <span id="helpBlock2" class="help-block">{{$errors->first('kebutuhan_khusus')}}</span>
		                </div>
		            </div>
		            <div class="col-lg-3">
		                <div class="form-group @if($errors->has('alamat')) has-error @endif">
		                    <input type="text" class="form-control border-input" value="{{old('alamat')}}" name="alamat" placeholder="Alamat Lengkap">
		                    <span id="helpBlock2" class="help-block">{{$errors->first('alamat')}}</span>
		                </div>
		            </div>
		            <div class="col-lg-2">
		                <div class="form-group @if($errors->has('no_hp')) has-error @endif">
		                    <input type="text" class="form-control border-input" value="{{old('no_hp')}}" name="no_hp" placeholder="Nomor Telepon">
		                    <span id="helpBlock2" class="help-block">{{$errors->first('no_hp')}}</span>
		                </div>
		            </div>
		         </div>
		       	
	            <div class="f1-buttons">
	                <button type="button" class="btn btn-next">Next</button>
	            </div>
        		</fieldset>

				<fieldset>
		            <div class="row">
		            <center><h4>Data Periodik</h4></center>
		           		<div class="col-lg-2">
			                <div class="form-group @if($errors->has('tinggi_badan')) has-error @endif">
			                    <input type="text" placeholder="Tinggi badan (CM)" class="form-control border-input" value="{{old('tinggi_badan')}}" name="tinggi_badan">
			                    <span id="helpBlock2" class="help-block">{{$errors->first('tinggi_badan')}}</span>
			                </div>
			            </div>
				    	<div class="col-lg-2">
			                <div class="form-group @if($errors->has('berat_badan')) has-error @endif">
			                    <input type="text" placeholder="Berat badan (KG)" class="form-control border-input" value="{{old('berat_badan')}}" name="berat_badan">
			                    <span id="helpBlock2" class="help-block">{{$errors->first('berat_badan')}}</span>
			                </div>
			            </div>
				    	<div class="col-lg-3">
			                <div class="form-group @if($errors->has('jarak_kesekolah')) has-error @endif">
			                    <input type="text" placeholder="Jarak rumah ke sekolah (M)" class="form-control border-input" value="{{old('jarak_kesekolah')}}" name="jarak_kesekolah">
			                    <span id="helpBlock2" class="help-block">{{$errors->first('jarak_kesekolah')}}</span>
			                </div>
			            </div>

				    	<div class="col-lg-3">
			                <div class="form-group @if($errors->has('waktu_tempuh')) has-error @endif">
			                    <input type="text" placeholder="Waktu tempuh (Menit)" class="form-control border-input" value="{{old('waktu_tempuh')}}" name="waktu_tempuh">
			                    <span id="helpBlock2" class="help-block">{{$errors->first('waktu_tempuh')}}</span>
			                </div>
			            </div>

				    	<div class="col-md-2">
			                <div class="form-group @if($errors->has('jumlah_saudara')) has-error @endif">
			                    <input type="text" placeholder="Jumlah Saudara" class="form-control border-input" value="{{old('jumlah_saudara')}}" name="jumlah_saudara">
			                    <span id="helpBlock2" class="help-block">{{$errors->first('jumlah_saudara')}}</span>
			                </div>
			            </div>
			        </div>
                    <div class="f1-buttons">
                        <button type="button" class="btn btn-previous">Previous</button>
                        <button type="button" class="btn btn-next">Next</button>
                    </div>
                </fieldset>

                <fieldset>
                    <center><h4>Data Asal Sekolah</h4></center>
	           		<div class="row">
				    	<div class="col-lg-4">
			                <div class="form-group @if($errors->has('nama_sekolah')) has-error @endif">
			                    <input type="text" placeholder="Nama SMP" class="form-control border-input" value="{{old('nama_sekolah')}}" name="nama_sekolah">
			                    <span id="helpBlock2" class="help-block">{{$errors->first('nama_sekolah')}}</span>
			                </div>
			            </div>

				    	<div class="col-lg-4">
			                <div class="form-group @if($errors->has('alamat_sekolah')) has-error @endif">
			                    <input type="text" placeholder="Alama lengkap sekolah" class="form-control border-input" value="{{old('alamat_sekolah')}}" name="alamat_sekolah">
			                    <span id="helpBlock2" class="help-block">{{$errors->first('alamat_sekolah')}}</span>
			                </div>
			            </div>
		            	<div class="col-lg-4">
			                <div class="form-group @if($errors->has('nik')) has-error @endif">
			                    <input type="text" placeholder="NIK" class="form-control border-input" value="{{old('nik')}}" name="nik">
			                    <span id="helpBlock2" class="help-block">{{$errors->first('nik')}}</span>
			                </div>
			        	</div>
	            	</div>
		            <div class="row">	
			            <div class="col-lg-3">
			                <div class="form-group @if($errors->has('no_ujiannasional')) has-error @endif">
			                    <input type="text" placeholder="Nomor Ujian Nasional" class="form-control border-input" value="{{old('no_ujiannasional')}}" name="no_ujiannasional">
			                    <span id="helpBlock2" class="help-block">{{$errors->first('no_ujiannasional')}}</span>
			                </div>
			            </div>
			            <div class="col-lg-3">
			                <div class="form-group @if($errors->has('nisn')) has-error @endif">
			                    <input type="text" placeholder="Nomor Induk Siswa Nasional" class="form-control border-input" value="{{old('nisn')}}" name="nisn">
			                    <span id="helpBlock2" class="help-block">{{$errors->first('nisn')}}</span>
			                </div>
			            </div>
				    	<div class="col-lg-3">
			                <div class="form-group @if($errors->has('no_ijazah')) has-error @endif">
			                    <input type="text" placeholder="Nomor Ijazah SMP" class="form-control border-input" value="{{old('no_ijazah')}}" name="no_ijazah">
			                    <span id="helpBlock2" class="help-block">{{$errors->first('no_ijazah')}}</span>
			                </div>
			            </div>
				    	<div class="col-lg-3">
			                <div class="form-group @if($errors->has('no_skhun')) has-error @endif">
			                    <input type="text" placeholder="Nomor SKHUN" class="form-control border-input" value="{{old('no_skhun')}}" name="no_skhun">
			                    <span id="helpBlock2" class="help-block">{{$errors->first('no_skhun')}}</span>
			                </div>
			            </div>
            		</div>
            		<div class="row">
			        	<div class="col-md-12">
			        		<button type="button" class="btn btn-previous">Previous</button>
							<input value="Save" type="submit" class="btn btn-default">
		         		</div>
		        	</div>
            	</fieldset>
</form>               
@endsection