109 lines
5.2 KiB
HTML
109 lines
5.2 KiB
HTML
{{ $formClasses := "bg-neutral-500 text-neutral-50 placeholder-neutral-300 focus:ring-2 focus:ring-primary-500 focus:ring-offset-2 focus:ring-offset-transparent m-2 p-3 rounded-lg hover:bg-neutral-500 checked:text-neutral-500" }}
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<script>
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function submitForm(e) {
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e.preventDefault();
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const form = document.getElementById('form');
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const data = new FormData(form);
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var xhr = new XMLHttpRequest();
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xhr.open("POST", "https://n8n.tfcconnection.org/webhook-test/mt-parent-form");
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xhr.send(data);
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console.log(data);
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console.log("Hallo!");
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return false;
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}
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</script>
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<div id="mt-form" class="form text-lg w-full">
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<form id='form' onsubmit="submitForm(event)" autocomplete="on" method="post" target="_parent" class="w-full items-center flex flex-wrap">
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<div class="basis-full flex flex-wrap my-4">
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<label for="firstname" class="basis-full">What is your first and last name?</label>
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<br/>
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<input type="text" id="firstname" name="firstname"
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placeholder="First Name" class="flex-1 form-input {{ $formClasses }}">
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<input type="text" id="lastname" name="lastname"
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placeholder="Last Name" class="flex-1 form-input {{ $formClasses }}">
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</div>
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<div class="basis-full flex flex-wrap my-4">
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<label for="studentnfirstname" class="basis-full">Teenager's first and last name?</label>
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<input type="text" id="studentfirstname" name="studentfirstname"
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class="flex-1 form-input {{ $formClasses }}"
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placeholder="First Name">
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<input type="text" id="studentlastname" name="studentlastname"
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class="flex-1 form-input {{ $formClasses }}"
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placeholder="Last Name">
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</div>
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<label for="email" class="basis-full">What is your email address?</label>
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<input type="email" id="email" name="email"
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pattern="^[a-zA-Z0-9]+(?:\.[a-zA-Z0-9]+)*@[a-zA-Z0-9]+(?:\.[a-zA-Z0-9]+)*$"
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class="basis-full form-input {{ $formClasses }}">
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<div class="basis-full mt-10">
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<label for="authority" class="p-4">
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Describe how your teenager responds to authority (towards you and others):
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</label>
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<br/>
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<textarea id="authority" name="authority"
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class="form-input w-full h-64 {{ $formClasses }}"
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placeholder="notes..."></textarea>
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</div>
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<div class="basis-full mt-10">
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<label for="positive" class="p-4">
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Positive characteristics you see in your teenager are:
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</label>
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<br/>
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<textarea id="positive" name="positive"
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class="form-input w-full h-64 {{ $formClasses }}"
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placeholder=""></textarea>
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</div>
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<div class="basis-full mt-10">
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<label for="negative" class="p-4">
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Negative characteristics you see in your teenager are:
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</label>
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<br/>
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<textarea id="negative" name="negative"
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class="form-input w-full h-64 {{ $formClasses }}"
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placeholder=""></textarea>
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</div>
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<div class="basis-full mt-10">
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<label for="family-relation" class="p-4">
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How does your teenager relate and respond within your family unit?
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</label>
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<br/>
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<textarea id="family-relation" name="family-relation"
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class="form-input w-full h-64 {{ $formClasses }}"
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placeholder=""></textarea>
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</div>
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<div class="basis-full mt-10">
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<label for="previous-trip-info" class="p-4">
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If your teen has been on a previous Mission Trip, describe any positive or negative changes you noticed in their lives.
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</label>
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<br/>
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<textarea id="previous-trip-info" name="previous-trip-info"
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class="form-input w-full h-64 {{ $formClasses }}"
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placeholder=""></textarea>
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</div>
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<div class="basis-full mt-10">
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<label for="trip-feelings" class="p-4">
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Please tell us any negative or positive feelings you have about your teenager being involved in this trip:
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</label>
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<br/>
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<textarea id="trip-feelings" name="trip-feelings"
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class="form-input w-full h-64 {{ $formClasses }}"
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placeholder=""></textarea>
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</div>
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<div class="basis-full mt-10">
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<label for="extra-info" class="p-4">
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What else would you like to tell us about your teenager that might be relevant as we consider them for a Mission Trip?
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</label>
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<br/>
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<textarea id="extra-info" name="extra-info"
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class="form-input w-full h-64 {{ $formClasses }}"
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placeholder=""></textarea>
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</div>
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<div class="basis-full mt-8">
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<button type="submit" class="content-right rounded-lg bg-primary-700 h-12 w-24 focus:bg-primary-900 focus:ring focus:ring-primary-700 hover:bg-primary-900 float-right">Submit</button>
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</div>
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</form>
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</div>
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