179 lines
9.2 KiB
HTML
179 lines
9.2 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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{{ $requiredField := "<span class='inline-block text-[#f39] text-sm align-super'>* required</span>" }}
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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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console.log(data.get("birthdate"));
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const birthdate = new Date(data.get("birthdate"));
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const age = calculate_age(birthdate);
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data.append("age", age);
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var xhr = new XMLHttpRequest();
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xhr.onreadystatechange = function() {
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if (this.readyState == 4 && this.status == 200) {
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// Logic directing where to send the user after form submission based on results.
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// This is how to send them. window.location.href = '/thankyou/';
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var payment = document.getElementById('registration').value;
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window.location.href = '/camp-health-form?registration=' + payment;
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// Need to eventually get the user here: https://secure.myvanco.com/L-Z772/campaign/C-13DM3
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}
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};
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/* xhr.open("POST", "https://n8n.tfcconnection.org/webhook/mt-application"); */
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xhr.open("POST", "https://n8n.tfcconnection.org/webhook-test/camp-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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function calculate_age(dob) {
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var diff_ms = Date.now() - dob.getTime();
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var age_dt = new Date(diff_ms);
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return Math.abs(age_dt.getUTCFullYear() - 1970);
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}
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function process() {
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/* document.getElementById('mt-form').hidden = false */
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}
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document.addEventListener('DOMContentLoaded', process);
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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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<h3 class="basis-full">Camp Form</h3>
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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? <span class='inline-block text-[#f39] text-sm align-sub'>* required</span></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="parentfirstname" class="basis-full">What is your guardian's first and last name? <span class='inline-block text-[#f39] text-sm align-sub'>* required</span></label>
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<input type="text" id="parentfirstname" name="parentfirstname"
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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="parentlastname" name="parentlastname"
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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="birthdate" class="basis-full">When were you born? <span class='inline-block text-[#f39] text-sm align-sub'>* required</span></label>
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<input type="date" id="birthdate" name="birthdate"
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class="basis-full form-date {{ $formClasses }}">
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<label for="gender" class="basis-full">Gender <span class='inline-block text-[#f39] text-sm align-sub'>* required</span></label>
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<select id="gender" name="gender" class="basis-full form-select {{ $formClasses }}">
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<option value="Male">Male</option>
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<option value="Female">Female</option>
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</select>
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<div class="basis-full flex flex-wrap my-4">
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<label for="street" class="basis-full">What is your address? <span class='inline-block text-[#f39] text-sm align-sub'>* required</span></label>
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<input type="text" id="street" name="street"
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class="basis-full form-input {{ $formClasses }}"
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placeholder="Street Address" required>
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<input type="text" id="city" name="city"
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class="flex-auto form-input {{ $formClasses }}"
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placeholder="City" required>
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<input type="text" id="state" name="state"
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class="flex-auto form-input {{ $formClasses }}"
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placeholder="State" required>
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<input type="text" id="zip" name="zip"
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class="flex-auto form-input {{ $formClasses }}"
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placeholder="Zip Code" required>
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</div>
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<div class="basis-full my-4">
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<label for="grade" class="">Grade <span class='inline-block text-[#f39] text-sm align-sub'>* required</span></label>
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<br/>
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<input type="radio" id="grade" name="grade" value="8"
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class="form-input {{ $formClasses }}" checked>
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<label for="grade" class="">8th</label>
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<br/>
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<input type="radio" id="grade" name="grade" value="freshman"
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class="form-input {{ $formClasses }}">
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<label for="grade" class="">Freshman</label>
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<br/>
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<input type="radio" id="grade" name="grade" value="sophomore"
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class="form-input {{ $formClasses }}">
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<label for="grade" class="">Sophomore</label>
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<br/>
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<input type="radio" id="grade" name="grade" value="junior"
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class="form-input {{ $formClasses }}">
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<label for="grade" class="">Junior</label>
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<br/>
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<input type="radio" id="grade" name="grade" value="senior"
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class="form-input {{ $formClasses }}">
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<label for="grade" class="">Senior</label>
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</div>
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<label for="homephone" class="basis-full">Guardian's phone <span class='inline-block text-[#f39] text-sm align-sub'>* required</span></label>
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<input type="tel" id="homephone" name="homephone"
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class="basis-full form-input {{ $formClasses }}">
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<label for="parentemail" class="basis-full">Guardian's Email</label>
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<input type="parentemail" id="parentemail" name="parentemail"
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pattern="^[a-zA-Z0-9]+(?:\.[a-zA-Z0-9]+)*@[a-zA-Z0-9]+(?:\.[a-zA-Z0-9]+)*$"
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class="basis-full form-input {{ $formClasses }}">
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<label for="allergies" class="basis-full">Do you have any food allergies?</label>
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<input type="text" id="allergies" name="allergies"
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class="basis-full form-input {{ $formClasses }}">
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<label for="week" class="basis-full">My Camp Plan <span class='inline-block text-[#f39] text-sm align-sub'>* required</span></label>
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<select id="week" name="tfcgroup" class="flex-auto form-select {{ $formClasses }}">
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<option value="week1">Week 1: July 17-21</option>
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<option value="week2">Week 2: July 24-28</option>
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</select>
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<label for="shirt" class="basis-full">T-Shirt Size</label>
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<select id="shirt" name="shirt" class="flex-auto form-select {{ $formClasses }}">
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<option value="small">Small</option>
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<option value="medium">Medium</option>
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<option value="large">Large</option>
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<option value="xl">XL</option>
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<option value="xxl">2XL</option>
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<option value="xxxl">3XL</option>
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</select>
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<div class="basis-full my-10">
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<label for="final-agreement">
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I understand that in order for my registration to be complete I need to have this form, a health form, and the $65 registration fee.
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</label>
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<div class="my-4">
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<input type="radio" value="yes" id="final-agreement" name="final-agreement"
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class="form-input {{ $formClasses }}" required>
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<label for="final-agreement" class="mt-4">
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I understand <span class='inline-block text-[#f39] text-sm align-sub'>* required</span>
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</label>
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</div>
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</div>
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<label for="registration" class="basis-full">
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Would you like to pay the registration fee now or later? <span class='inline-block text-[#f39] text-sm align-sub'>* required</span>
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</label>
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<div class="basis-full">
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<input type="radio" value="now" id="registration" name="registration"
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class="form-input {{ $formClasses }}" checked>
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<label for="registration" class="">
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Now - $65
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</label>
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</div>
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<div class="basis-full">
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<input type="radio" value="later" id="registration" name="registration"
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class="form-input {{ $formClasses }}">
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<label for="registration" class="">
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Later - Send $65 to the TFC Office
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</label>
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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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