59 lines
3.7 KiB
HTML
59 lines
3.7 KiB
HTML
{{ define "main" }}
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<section class="section bg-gray">
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<div class="container">
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<div class="row">
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<div class="col-lg-7 mb-4 mb-lg-0">
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<form action="https://php.cantorgymnasium.de/formtools/process.php" method="post" enctype="multipart/form-data">
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<input type="hidden" name="form_tools_form_id" value="5" />
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<div style="display:none">
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<input type="text" name="bad_email" value="" />
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</div>
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<input type="text" class="form-control mb-3" id="surname" name="visitor_surname" placeholder="Name (Schüler/in)" required>
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<input type="text" class="form-control mb-3" id="name" name="visitor_name" placeholder="Vorname" required>
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<label for="birthday">Geburtsdatum</label>
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<input type="date" class="form-control mb-3" id="birthday" name="visitor_birthday" min="2005-01-01" required>
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<div class="row">
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<input type="text" class="form-control mb-3 col-lg-8 ml-3 mr-4" id="street" name="street" placeholder="Straße" required><input type="text" class="form-control mb-3 col-lg-3" id="house" name="house" placeholder="Hausnummer" required>
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</div>
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<input type="text" class="form-control mb-3" id="adresszusatz" name="adresszusatz" placeholder="Adresszusatz">
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<div class="row">
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<input type="text" inputmode="numeric" class="form-control mb-3 col-lg-5 ml-3 mr-4" id="zipcode" name="zipcode" placeholder="PLZ" pattern="[0-9]{5}" title="Postleitzahlen bestehen aus exakt 5 Ziffern" required><input type="text" class="form-control mb-3 col-lg-6" id="city" name="city" placeholder="Stadt" required>
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</div>
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<input type="text" class="form-control mb-3" id="landkreis" name="landkreis" placeholder="Landkreis">
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<div class="row">
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<input type="tel" class="form-control mb-3 col-lg-5 ml-3 mr-4" id="tpriv" name="tpriv" placeholder="Telefon privat"><input type="tel" class="form-control mb-3 col-lg-6" id="tdienstl" name="tdienstl" placeholder="Telefon dienstl.">
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</div>
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<input type="text" class="form-control mb-3" id="dpname" name="dpname" placeholder="Abweichender Elternname">
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<input type="text" class="form-control mb-3" id="grundschule" name="grundschule" placeholder="Grundschule" required>
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<input type="email" class="form-control mb-3" id="mail" name="visitor_email" placeholder="Ihre E-Mail Adresse" required>
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<textarea name="visitor_message" id="message" class="form-control mb-3" placeholder="Bemerkungen"></textarea>
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<label for="zeugnis_1">Zeugnis (Vorderseite)</label>
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<input type="file" class="form-control mb-3" id="zeugnis_1" name="zeugnis_1" accept="image/*,.pdf">
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<label for="zeugnis_2">Zeugnis (Rückseite)</label>
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<input type="file" class="form-control mb-3" id="zeugnis_2" name="zeugnis_2" accept="image/*,.pdf">
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<label for="slbe">Schullaufbahnempfehlung</label>
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<input type="file" class="form-control mb-3" id="slbe" name="slbe" accept="image/*,.pdf">
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<input type="checkbox" id="accept" name="accept" required>
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<label for="accept">Hiermit melden wir unser Kind verbindlich zur Aufnahmeprüfung an.</label>
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<button type="submit" value="send" class="btn btn-primary">{{ i18n "send" }}</button>
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</form>
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</div>
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<div class="col-lg-5">
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{{ .Content }}
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<a href="mailto:{{ .Params.email }}" class="btn btn-primary">{{ .Params.email_pretty | safeHTML }}</a>
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</div>
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</div>
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</div>
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</section>
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<section class="section pt-0 bg-gray">
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<div class="container">
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<div id="map">
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<script src="/js/map.js"></script>
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</div>
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</div>
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</section>
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{{ end }}
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