151 lines
4.4 KiB
PHP
151 lines
4.4 KiB
PHP
@extends('layouts.app')
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@section('social_media')
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<meta property="fb:app_id" content="{{ config('social-media-manager.facebook.app_id') }}"/>
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<meta property="og:type" content="website"/>
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@endsection
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@section('content')
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<article class="post-item card pt-3 pb-3 mb-lg-5 shadow-sm">
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<div class="row">
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<h1 class="col-lg-12 card-title">
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Anmeldung zur Corona-Schutzimpfung für Feuerwehrangehörige der Freiwilligen Feuerwehr Eppingen
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</h1>
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</div>
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<div class="row">
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<div class="col-lg-12">
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<hr>
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</div>
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</div>
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<!-- -- >
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<div class="row">
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<div class="col-lg-6">
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Links
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</div>
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<div class="col-lg-6 text-right">
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Rechts
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</div>
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</div>
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<div class="row">
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<div class="col-lg-12">
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<hr>
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</div>
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</div>
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<!-- -->
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@if($expired)
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<div class="row">
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<div class="col">
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Es tut uns Leid, aber der Anmeldezeitraum für die Corona-Impfung ist abgelaufen.
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Sobald wieder Kontingente zur Verfügung stehen, werden wir das Formular wieder freischalten.
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</div>
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</div>
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@else
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<div class="row">
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<div class="col">
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<ul>
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<li>
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Wann: Mittwoch, 21.04.2021, 13:30 - 21 Uhr. Die genaue Uhrzeit ist nicht frei wählbar und wird noch mitgeteilt.
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</li>
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<li>
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Wo: Kreisimpfzentrum Ilsfeld
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</li>
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<li>
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Impfstoff: AstraZeneca
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</li>
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</ul>
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</div>
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<div class="row">
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<div class="col">
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Aufgrund des begrenzten Kontingents an Impfstoff kann nicht garantiert werden, dass jeder angemeldete Feuerwehrangehörige auch einen tatsächlichen Impftermin erhält.
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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-lg-12 card-content">
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<form action="{{ config('app.url') . '/anmeldung/abschliessen' }}" method="POST">
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<input type="hidden" value="{{ csrf_token() }}" name="_token" />
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@include('inc.forms.inputText', [
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'name' => 'lastname',
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'label' => 'Nachname *',
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'placeholder' => 'Nachname',
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'value' => $formdata->firstname
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])
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@include('inc.forms.inputText', [
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'name' => 'firstname',
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'label' => 'Vorname *',
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'placeholder' => 'Vorname',
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'value' => $formdata->lastname
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])
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@include('inc.forms.inputText', [
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'name' => 'birthday',
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'label' => 'Geburtstag *',
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'placeholder' => 'tt.mm.jjjj',
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'value' => $formdata->birthday
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])
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@include('inc.forms.inputText', [
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'name' => 'street',
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'label' => 'Straße *',
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'placeholder' => 'Straße',
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'value' => $formdata->street
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])
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@include('inc.forms.inputText', [
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'name' => 'streetnumber',
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'label' => 'Hausnummer *',
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'placeholder' => 'Hausnummer',
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'value' => $formdata->streetnumber
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])
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{{ $formdata->streetnumber }}
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@include('inc.forms.inputSelect', [
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'name' => 'city',
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'label' => 'Wohnort *',
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'placeholder' => 'Wohnort',
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'selected' => old('city.0'),
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'modelValue' => 'city',
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'modelLabel' => 'city',
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'models' => [
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(object)['city' => ''],
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(object)['city' => 'Adelshofen'],
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(object)['city' => 'Elsenz'],
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(object)['city' => 'Eppingen'],
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(object)['city' => 'Kleingartach'],
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(object)['city' => 'Mühlbach'],
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(object)['city' => 'Richen'],
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(object)['city' => 'Rohrbach']
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]
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])
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@include('inc.forms.inputSelect', [
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'name' => 'department',
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'label' => 'Abteilung *',
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'placeholder' => 'Abteilung',
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'selected' => old('department.0'),
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'modelValue' => 'department',
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'modelLabel' => 'department',
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'models' => [
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(object)['department' => ''],
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(object)['department' => 'Adelshofen'],
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(object)['department' => 'Elsenz'],
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(object)['department' => 'Eppingen'],
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(object)['department' => 'Kleingartach'],
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(object)['department' => 'Mühlbach'],
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(object)['department' => 'Richen'],
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(object)['department' => 'Rohrbach']
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]
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])
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<div class="form-group">
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* Pflichtfeld
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</div>
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<div class="form-group">
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<button class="btn btn-primary">Anmelden</button>
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</div>
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</form>
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</div>
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</div>
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@endif
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<div class="row mt-3">
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<div class="col-lg-12 social-share">
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@include('inc.social_media.facebook.likeShare')
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</div>
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</div>
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</article>
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@endsection |