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<form class="form-horizontal mt-4" action="" method="POST" enctype="multipart/form-data">
@csrf
@if (count($errors) > 0)
<div class="alert alert-danger">
<ul>
@foreach ($errors->all() as $error)
<li>{{ $error }}</li>
@endforeach
</ul>
</div>
@endif
@if ($message = Session::get('success'))
<div class="alert alert-success alert-block">
<button type="button" class="close" data-dismiss="alert">×</button>
<strong>{{ $message }}</strong>
</div>
@endif
<div class="row">
<div class="col-md-12">
<h4 class="mb-40">Abu Dhabi Summer Outreach Program</h4>
<div class="form-row">
<div class="form-group col-md-6">
<strong>Name:</strong>
<input type="text" name="name" class="form-control" value="{{ old('name') }}">
@if ($errors->has('name'))
<span class="text-danger">{{ $errors->first('name') }}</span>
@endif
</div>
<div class="form-group col-md-6">
<strong>Email:</strong>
<input type="email" name="email" class="form-control" value="{{ old('email') }}">
@if ($errors->has('email'))
<span class="text-danger">{{ $errors->first('email') }}</span>
@endif
</div>
</div>
<div class="form-row">
<div class="form-group col-md-6">
<strong>Guardian's Contact number:</strong>
<input type="phone" name="phone" class="form-control" value="{{ old('phone') }}">
@if ($errors->has('phone'))
<span class="text-danger">{{ $errors->first('phone') }}</span>
@endif
</div>
<div class="form-group col-md-6">
<strong>Age:</strong>
<input type="number" name="age" class="form-control" value="{{ old('age') }}">
@if ($errors->has('age'))
<span class="text-danger">{{ $errors->first('age') }}</span>
@endif
</div>
</div>
<div class="form-row">
<div class="form-group col-md-6">
<strong>Program the Student is Applying for
:</strong>
<select class="form-control dropdown" id="program_type" name="program_type">
<option value="" selected="selected" disabled="disabled">-- select one --</option>
<option value="math immerssion">Math Immersion </option>
<option value="abu dhabi outreach">abu dhabi outreach </option>
<option value="and both ">and both </option>
</select>
</div>
<div class="form-group col-md-6 mt-30">
<strong>Mode of Attending the Course :</strong>
<input type="radio" value="Physical" id="physical" name="attend" selected>
<label for="physical">Physical</label>
<input type="radio" value="online" id="online" name="attend">
<label for="online">Online</label>
</div>
</div>
<div class="form-row">
<div class="form-group col-md-6">
<strong>Nationality:</strong>
<select class="form-control dropdown" id="program_type" name="nationality">
<option value="" selected="selected" disabled="disabled">-- select one --</option>
@foreach ($countries as $country)
<option value="{{$country->id}}">{{$country->name}} - {{$country->code}}</option>
@endforeach
</select>
</div>
<div class="form-group col-md-6 mt-30">
<strong>Gender:</strong>
<input type="radio" value="Male" id="male" name="gender" selected>
<label for="male">Male</label>
<input type="radio" value="Female" id="female" name="gender">
<label for="female">Female</label>
<input type="radio" value="Not to say" id="female" name="Not to say">
<label for="female">Prefer not to say</label>
</div>
</div>
<div class="form-row">
<div class="form-group col-md-6">
<strong>Food allergies (If any):</strong>
<input type="text" name="food" class="form-control" value="{{ old('food') }}">
@if ($errors->has('food'))
<span class="text-danger">{{ $errors->first('food') }}</span>
@endif
</div>
<div class="form-group col-md-6">
<strong>Any special assistance request:</strong>
<input type="text" name="special" class="form-control" value="{{ old('special') }}">
@if ($errors->has('special'))
<span class="text-danger">{{ $errors->first('special') }}</span>
@endif
</div>
</div>
<div class="form-row">
<div class="form-group col-md-6">
<strong>Education:</strong>
<select class="form-control dropdown" id="education" name="education">
<option value="" selected="selected" disabled="disabled">-- select one --</option>
<option value="k12">K-12</option>
<option value="UG">UG student</option>
<option value="PG">PG student</option>
</select>
</div>
<div class="form-group col-md-6">
<strong>Your expectation from the program </strong>
<input type="text" name="expectation" class="form-control" value="{{ old('expectation') }}">
@if ($errors->has('expectation'))
<span class="text-danger">{{ $errors->first('expectation') }}</span>
@endif
</div>
</div>
<div class="form-group ">
<div class="col-md-12">
</div>
</div>
<div class="form-row">
<div class="form-group col-md-6">
<label for="input-file-now" class="ar-label">Upload marksheet <span class="text-danger">*</span></label>
<input type="file" id="input-file-now" class="dropify " name="marksheet" data-allowed-file-extensions="["jpg", "png", "jpeg","pdf"]" data-max-file-size="5M" >
</div>
</div>
<div class="form-row">
<div class="form-group">
<label><input type="checkbox" name="terms" value="terms"> I understand that my application will be reviewed by the respective teams and only eligible candidates will be invited to attend the course.
</label>
</div>
</div>
<div class="section-field submit-button">
<input type="hidden" name="action"/>
<button name="submit" type="submit" value="Send" class="button"> Submit</button>
</div>
</div>
</div>
</div>
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