@extends('frontend.layouts.app')
@section('content')
<form>
	<div class="row">
		<div class="col-sm-6">
			<div class="form-group">
				<label class="control-label">Member Category</label>
				<select class="form-control" name="member_category_id" required="">
					<option value="">Select Member Category</option>
					@foreach($member_categories as $category)
					<option value="{{$category->id}}" @if($category->id == old('member_category_id')) selected @endif>{{$category->name}}</option>
					@endforeach
				</select>
			</div>
		</div>
		<div class="col-sm-6">
			<div class="form-group">
				<label class="control-label">Password</label>
				<input type="password" name="password" class="form-control {{$errors->has('password')?'is-invalid':''}}" />
				@if($errors->has('password'))
				<div class="invalid-feedback">
					{{$errors->first('password')}}
				</div>
				@endif
			</div>
		</div>
	</div>
	<div class="row">
		<div class="col-sm-6">
			<div class="form-group">
				<label class="control-label">Mobile No</label>
				<input type="text" name="mobbile_number" class="form-control @if($errors->has('mobile_number')) is-invalid @endif" placeholder="Valid Mobile Number" value="{{ old('mobbile_number') }}" />
				@if($errors->has('mobile_number'))
				<div class="invalid-feedback">
					{{ $errors->first('mobile_number') }}
				</div>
				@endif
			</div>
		</div>
		<div class="col-sm-6">
			<div class="form-group">
				<label class="control-label">Email</label>
				<input type="email" name="email" class="form-control @if($errors->has('email')) is-invalid @endif" placeholder="Valid Email Address" value="{{ old('email') }}" />
				@if($errors->has('email'))
				<div class="invalid-feedback">
					{{ $errors->first('email') }}
				</div>
				@endif
			</div>
		</div>
	</div>
	<div class="row">
		<div class="col-sm-6">
			<div class="form-group">
				<label class="control-label">Full Name</label>
				<input type="text" name="full_name" value="{{ old('full_name' )}}" class="form-control {{$errors->has('full_name')?'is-invalid':''}}" placeholder="Full Name" />
				@if($errors->has('full_name'))
				<div class="invalid-feedback">
					{{$errors->first('full_name')}}
				</div>
				@endif
			</div>
			<div class="form-group">
				<label class="control-label">Father's Name</label>
				<input type="text" name="father_name" value="{{ old('father_name') }}" class="form-control {{$errors->has('father_name')?'is-invalid':''}}" placeholder="Father's Name" />
				@if($errors->has('father_name'))
				<div class="invalid-feedback">
					{{$errors->first('father_name')}}
				</div>
				@endif
			</div>
			<div class="form-group">
				<label class="control-label">Mother's Name</label>
				<input type="text" name="mother_name" value="{{ old('mother_name') }}" class="form-control {{$errors->has('mother_name')?'is-invalid':''}}" placeholder="Mother's Name" />
				@if($errors->has('mother_name'))
				<div class="invalid-feedback">
					{{$errors->first('mother_name')}}
				</div>
				@endif
			</div>
			<div class="form-group">
				<label class="control-label">Gender</label>
				<select class="form-control {{$errors->has('gender')?'is-invalid':''}}" name="gender">
					<option value="">Select Gender</option>
					<option value="Male" {{ old('gender') == 'Male'?'selected':'' }}>Male</option>
					<option value="Female" {{ old('gender') == 'Female'?'selected':'' }}>Female</option>
				</select>
				@if($errors->has('gender'))
				<div class="invalid-feedback">
					{{$errors->first('gender')}}
				</div>
				@endif
			</div>
		</div>
		<div class="col-sm-6">
			<div class="form-group">
				<label class="control-label">Marital Status</label>
				<select class="form-control {{$errors->has('marital_status')?'is-invalid':''}}" name="marital_status">
					<option value="">Select Marital Status</option>
					<option value="Married" {{ old('marital_status') == 'Married'?'selected':'' }}>Married</option>
					<option value="Single" {{ old('marital_status') == 'Single'?'selected':'' }}>Single</option>
					<option value="Widowed" {{ old('marital_status') == 'Widowed'?'selected':'' }}>Widowed</option>
					<option value="Separated" {{ old('marital_status') == 'Separated'?'selected':'' }}>Separated</option>
				</select>
				@if($errors->has('marital_status'))
				<div class="invalid-feedback">
					{{$errors->first('marital_status')}}
				</div>
				@endif
			</div>
			<div class="form-group">
				<label class="control-label">Date of Birth</label>
				<input type="text" name="dob" value="{{ old('dob') }}" class="form-control single-date-picker {{$errors->has('dob')?'is-invalid':''}}"  autocomplete="off" />
				@if($errors->has('dob'))
				<div class="invalid-feedback">
					{{$errors->first('dob')}}
				</div>
				@endif
			</div>
			<div class="form-group">
				<label class="control-label">Nationality</label>
				<select name="country_id" class="form-control select2 {{$errors->has('country_id')?'is-invalid':''}}">
					{!! nationalityDropDown(old('country_id')) !!}
				</select>
				@if($errors->has('country_id'))
				<div class="invalid-feedback">
					{{$errors->first('country_id')}}
				</div>
				@endif
			</div>
			<div class="form-group">
				<label class="control-label">Blood Group</label>
				<select class="form-control {{$errors->has('blood_group')?'is-invalid':''}}" name="blood_group">
					<option value="">Select Blood Group</option>
					<option value="A Positive" {{ old('blood_group') == 'A Positive'?'selected':'' }}>A Positive</option>
					<option value="A Negative" {{ old('blood_group') == 'A Negative'?'selected':'' }}>A Negative</option>
					<option value="B Positive" {{ old('blood_group') == 'B Positive'?'selected':'' }}>B Positive</option>
					<option value="B Negative" {{ old('blood_group') == 'B Negative'?'selected':'' }}>B Negative</option>
					<option value="AB Positive" {{ old('blood_group') == 'AB Positive'?'selected':'' }}>AB Positive</option>
					<option value="AB Negative" {{ old('blood_group') == 'AB Negative'?'selected':'' }}>AB Negative</option>
					<option value="O Positive" {{ old('blood_group') == 'O Positive'?'selected':'' }}>O Positive</option>
					<option value="O Negative" {{ old('blood_group') == 'O Negative'?'selected':'' }}>O Negative</option>
				</select>
				@if($errors->has('blood_group'))
				<div class="invalid-feedback">
					{{$errors->first('blood_group')}}
				</div>
				@endif
			</div>
		</div>
	</div>
	<div class="row">
		<div class="col-sm-6">
			<div class="form-group">
				<label class="control-label">Present Address</label>
				<textarea class="form-control" name="present_address @if($errors->has('present_address')) is-invalid @endif">{{ old('present_address') }}</textarea>
				@if($errors->has('present_address'))
				<div class="invalid-feedback">
					{{ $errors->first('present_address') }}
				</div>
				@endif
			</div>
		</div>
		<div class="col-sm-6">
			<div class="form-group">
				<label class="control-label">Permanent Address</label>
				<textarea class="form-control @if($errors->has('permanent_address')) is-invalid @endif"  name="permanent_address">{{ old('permanent_address') }}</textarea>
				@if($errors->has('permanent_address'))
				<div class="invalid-feedback">
					{{ $errors->first('permanent_address') }}
				</div>
				@endif
			</div>
		</div>
	</div>
	<div class="row">
		<div class="col-sm-12">
			<div class="form-group">
				<label class="control-label">Additional Information</label>
				<textarea class="form-control {{$errors->has('additional_info')?'is-invalid':''}}" rows="5" name="additional_info">{{ old('additional_info') }}</textarea>
				@if($errors->has('additional_info'))
				<div class="invalid-feedback">
					{{$errors->first('additional_info')}}
				</div>
				@endif
			</div>
		</div>
	</div>	
</form>
@endsection