160 lines
4.9 KiB
JavaScript
160 lines
4.9 KiB
JavaScript
import { PageHeader } from "./components/index.js";
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const AnmeldeformularPreview = ({ widgetFor, entry }) => {
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return [
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PageHeader(entry),
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h(
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"section",
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{ className: "section-sm bg-gray" },
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h(
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"div",
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{ className: "container" },
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h(
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"div",
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{ className: "row" },
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h(
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"div",
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{ className: "col-lg-8 mb-4 mb-lg-0" },
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h(
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"form",
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{},
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h(
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"div",
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{ className: "input-group" },
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h("input", {
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className: "form-control mb-3",
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type: "text",
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placeholder: "Name (Schüler/in)",
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}),
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h("input", {
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className: "form-control mb-3",
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type: "text",
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placeholder: "Vorname",
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})
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),
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h(
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"div",
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{ className: "input-group mb-3" },
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h("span", { className: "input-group-text" }, "Geburtsdatum"),
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h("input", { className: "form-control", type: "date" })
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),
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h("input", {
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className: "form-control mb-3",
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type: "text",
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placeholder: "Straße",
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}),
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h(
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"div",
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{ className: "input-group" },
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h("input", {
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className: "form-control mb-3",
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type: "text",
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placeholder: "Hausnummer",
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}),
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h("input", {
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className: "form-control mb-3",
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type: "text",
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placeholder: "Adresszusatz",
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})
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),
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h(
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"div",
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{ className: "input-group" },
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h("input", {
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className: "form-control mb-3",
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type: "text",
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placeholder: "PLZ",
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}),
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h("input", {
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className: "form-control mb-3",
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type: "text",
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placeholder: "Stadt",
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})
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),
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h("input", {
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className: "form-control mb-3",
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type: "text",
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placeholder: "Landkreis",
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}),
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h(
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"div",
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{ className: "input-group" },
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h("input", {
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className: "form-control mb-3",
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type: "text",
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placeholder: "Telefon privat",
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}),
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h("input", {
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className: "form-control mb-3",
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type: "text",
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placeholder: "Telefon dienstl.",
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})
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),
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h("input", {
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className: "form-control mb-3",
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type: "text",
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placeholder: "Abweichender Elternname",
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}),
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h("input", {
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className: "form-control mb-3",
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type: "text",
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placeholder: "Grundschule",
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}),
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h("input", {
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className: "form-control mb-3",
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type: "text",
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placeholder: "Ihre E-Mail-Adresse",
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}),
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h("textarea", {
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className: "form-control mb-3",
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placeholder: "Bemerkungen",
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}),
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h(
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"div",
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{ className: "input-group mb-3" },
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h("input", { className: "form-control", type: "file" }),
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h(
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"span",
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{ className: "input-group-text" },
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"Zeugnis (Vorderseite)"
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)
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),
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h(
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"div",
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{ className: "input-group mb-3" },
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h("input", { className: "form-control", type: "file" }),
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h(
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"span",
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{ className: "input-group-text" },
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"Zeugnis (Rückseite)"
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)
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),
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h(
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"div",
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{ className: "input-group mb-3" },
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h(
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"div",
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{ className: "input-group-text" },
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h("input", {
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className: "form-check-input",
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type: "checkbox",
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})
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),
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h(
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"p",
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{ className: "form-control mb-0" },
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"Hiermit melden wir unser Kind verbindlich zur Aufnahmeprüfung an."
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)
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),
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h("button", { className: "btn btn-primary" }, "Senden")
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)
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),
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h("div", { className: "col-lg-4" }, widgetFor("body"))
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)
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)
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),
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];
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};
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export default AnmeldeformularPreview;
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