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Current File : //home/numerotech/mcinfo.numerotech.com/mc_info_update/core/templates/users/edit_delegate.html

{% extends "users/layout.html" %}
{% block content %}
{% block bottomscript %}
{% endblock %}
<br>
<form id="registration_form" method="POST" action="{{ url_for('user.DelegateUpdateRegister',society_id=society_id,id=user_id)}}">
      <div class="container" style="background-color:white;">
         <div class="row">
            <div class="col-sm-2">
               <input type="text" class="form-control" name="user_id" id="user_id"  value="{{output.user_id}}" hidden>
                <input type="text" class="form-control" name="society_id" id="society_id"  value="{{society_id}}" hidden>
               <label>Prefix <span class="mand">*</span></label>
               <select class="form-control w-100 required" id="prefix" name="prefix" required="">
                  <option value="" id="select"> Select  Prefix</option>
                  {% if output %}
                     <option value = "{{output.prefix}}" selected> {{output.prefix|default('')}} </option>
                  {% endif %}
                  <option value="Mr."> Mr. </option>
                  <option value="Mrs."> Mrs. </option>
                  <option value="Dr." > Dr. </option>
                  <option value="Ms."> Ms. </option>
                  <option value="Prof."> Prof. </option>
                  <option value="Others"> Others </option>
               </select>
            </div>


            <div class="col-sm-10">
               <label>Full name <span class="mand">*</span> <br> </label>
                <input type="name" class="form-control" name="name" id="name" placeholder="Enter Full Name" value="{{output.full_name|default('')}}" required="">
            </div>
         </div>
         <br>
         <div class="row">
            <div class="col-sm-6">
               <label>Email <span class="mand">*</span> <br></label>
               <input type="email" class="form-control" name="email" id="email" placeholder="Enter Email-Id" value="{{output.email|default('')}}" required="">
            </div>
            <div class="col-sm-6">
               <label>Mobile <span class="mand">*</span></label>
               <input type="text" class="form-control" id="mobile" name="mobile" value="{{output.mobile|default('')}}" oninput="this.value = this.value.replace(/[^0-9.]/g, '').replace(/(\..*)\./g, '$1');" placeholder="Enter mobile">
            </div>
         </div>
         <br>
         <div class="row">
            <div class="col-sm-6">
               <label>DOB <span class="mand">*</span> <br></label>
               <input type="date" class="form-control" name="dob" id="dob" placeholder="Enter Date"  value = "{{ output.dob|default('')}}" required="">
            </div>
            <div class="col-sm-6">
               <label>Gender <span class="mand">*</span> <br></label><br>
               <input type="radio" name="gender" value="Male" {% if output.gender == 'Male' %} checked="checked" {% endif %}> Male &nbsp;&nbsp;&nbsp;
               <input type="radio" name="gender" value="Female" {% if output.gender == 'Female' %} checked="checked" {% endif %}> Female&nbsp;&nbsp;
               <input type="radio" name="gender" value="Transgender" {% if output.gender == 'Transgender' %} checked="checked" {% endif %}> Transgender&nbsp;&nbsp;&nbsp;</input>
               <br/>
               <span class="error" name="gendererror" id="gendererror"></span>
            </div>
         </div>
         <br>
         <div class="row">
            <div class="col-sm-6">
               <label>Address Line 1 <span class="mand">*</span></label>
               <input type="text" class="form-control" id="address_line_1" name="address_line_1" 
                {% if output.address_line_1 == None: %} value="{{''}}" {% else %} value="{{output.address_line_1|default('')}}" {% endif %} placeholder="Enter Address Line 1" required="">
               <br>
               <label>Address Line 2 <span class="mand">*</span></label>
               <input type="text" class="form-control" id="address_line_2" name="address_line_2"  {% if output.address_line_2 == None: %} value="{{''}}" {% else %} value="{{output.address_line_2|default('')}}" {% endif %} placeholder="Enter Address Line 2" required="">
               <br>
               <label>Address Line 3 <span class="mand">*</span></label>
               <input type="text" class="form-control" id="address_line_3" name="address_line_3" {% if output.address_line_3 == None: %} value="{{''}}" {% else %} value="{{output.address_line_3|default('')}}" {% endif %} placeholder="Enter Address Line 3" required="">
            </div>
        
            <div class="col-sm-6">
               <label>City <span class="mand">*</span> <br></label>
               <input type="text" class="form-control" name="city" id="city" placeholder="Enter City" {% if output.city == None: %} value="{{''}}" {% else %} value="{{output.city|default('')}}" {% endif %} required="">
          
           <br>
            
          <!--   <div class="col-sm-12"> -->
               <label>Pincode <span class="mand">*</span> <br></label>
               <input type="text" class="form-control" name="pincode" id="pincode" {% if output.pincode == None: %} value="{{''}}" {% else %} value="{{output.pincode|default('')}}" {% endif %} placeholder="Enter Pincode"  required="">

            <br>

               <label>State <span class="mand">*</span> <br></label>
               <select class = "form-control" id = "state" name = "state">
                  <option value = "" id = "select">Select state</option>
                  {% if states :%}
                     {% for state in states :%}
                     <option value = "{{state.state_id}}"> {{state.state_name}} </option>
                        {% if state.state_id == output.state : %}
                           <option value = "{{state.state_id}}" selected> {{state.state_name}} </option>
                        {% endif %}
                     {% endfor %}
                  {% endif %}
            </select>
            </div>
     </div>

   <br>

         <div class="row">
            <div class="col-sm-6">
                <label>Country <span class="mand">*</span> <br></label>
               <input type="text" class="form-control" name="country" id="country"  value="India" >
            </div>
        


            <div class="col-sm-6">
               <label>MC Number <span class="mand">*</span> <br></label>
               <input type="text" class="form-control" name="mc_number" id="mc_number" {% if output.mc_number == None: %} value="{{''}}" {% else %} value="{{output.mc_number|default('')}}" {% endif %} placeholder="Enter MC Number"  required="">
            </div>
         </div>

         <br>

               <div class="row">
            <div class="col-sm-6">
               <label>MC State<span class="mand">*</span> <br></label>
             <select class = "form-control " id = "mc_state" name = "mc_state">
                  <option value = "" id = "select">Select mc state</option>
                  {% if states %}
                  {% for mc in states %}
                  <option value = "{{mc.state_id}}"> {{mc.state_name}} </option>
                       {% if mc.state_id == output.mc_state : %}
                          <option value = "{{mc.state_id}}" selected> {{mc.state_name}} </option>
                     {% endif %}
                  {% endfor %}
                  {% endif %}
            </select>
            </div>


            <div class="col-sm-6">
               <label>Register Type<span class="mand">*</span> <br></label>
             <select class = "form-control " id = "reg_type_id" name = "reg_type_id" disabled>
                  <option value = "" id = "select" >Select register type</option>
                  {% if reg_type %}
                  {% for mc in reg_type %}
                  <option value = "{{mc.reg_type_id}}" > {{mc.type_name}} </option>
                       {% if mc.reg_type_id == output.reg_type_id : %}
                          <option value = "{{mc.reg_type_id}}" selected > {{mc.type_name}} </option>
                     {% endif %}
                  {% endfor %}
                  {% endif %}
            </select>
            </div>
         </div>
         <br>
         <div class="row">
             <div class="col-sm-6">
               <label>Amount <span class="mand">*</span> <br></label>
               {% if reg_type %}
                  {% for mc in reg_type %}
                       {% if mc.reg_type_id == output.reg_type_id : %}
                       <input type="text" class="form-control" name="amount" id="amount" {% if mc.reg_type_id == output.reg_type_id : %} value="{{mc.amount}}" {% else %} value="{{mc.amount}}" {% endif %} placeholder="Enter Amount"  required="" disabled>
                         
                     {% endif %}
                  {% endfor %}
                  {% endif %}
               
            </div>

            <div class="col-sm-3" >
                  <label><span class="mand"></span> <br></label>
               <a style="color:white;"  href="{{ url_for('user.RegType',id=output.user_id,society_id=society_id) }}"><button type="button" name="edit_button"  class="btn btn-primary btn-md btn-block text-uppercase"  style="align-items: center;"> Previous </button> </a>
         
               
            </div>

            <div class="col-sm-3" >
               <label><span class="mand"></span> <br></label>
                <input type="submit" class="btn btn-primary btn-md btn-block text-uppercase submit_btn"  id="submit_btn" name="submit_btn" value="Next">
              
            </div>
         </div>

         <br>

      </div>
</form>
<script type="text/javascript">
   var BaseUrl = document.location.origin

      $("#registration_form").validate({
             // in 'rules' user have to specify all the constraints for respective fields
             rules : {
                  prefix : "required",
                  name : {
                      required:true,
                       
                  },
                  email : {
                      required : true,
                      email : true
                  },
                  mobile :{
                     required:true,
                       
                  },                    
                  password : "required",
                  password : "required",
                  confirm_password : {
                   required : true,
                 minlength : 4,
                 equalTo : "#password",
                 
             },
                  
              },
         
              messages : {
                  prefix : "Please select the Prefix",
                  name : "Please enter the Name",
         
                  email : {
                      required : "Please enter the Email id",
                      email : "Please enter valid Email Id"
                  },
                  mobile : {
                      required : "Please enter Mobile number",
                      
                  },

                
                  password : "Please enter the password",
                  confirm_password : "Please enter the confirm password",
   
              },

      

             });

  
   
</script>

{% endblock %}

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