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July 25, 2016 10:02
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<?php | |
/** | |
* Created by PhpStorm. | |
* User: somnath | |
* Date: 21/6/16 | |
* Time: 7:38 PM | |
* | |
* Template Name: registration | |
*/ | |
get_header(); | |
if (isset($_POST['submit'])) { | |
// EDIT THE 2 LINES BELOW AS REQUIRED | |
$email_to = "[email protected]"; | |
$email_subject = "Online Application"; | |
function died($error) | |
{ | |
// your error code can go here | |
echo "We are very sorry, but there were error(s) found with the form you submitted. "; | |
echo "These errors appear below.<br /><br />"; | |
echo $error . "<br /><br />"; | |
echo "Please go back and fix these errors.<br /><br />"; | |
die(); | |
} | |
$title = $_POST['title']; | |
if (isset($title) && count($title) > 0) { | |
$title = implode(',', $title); | |
} else { | |
$title = ''; | |
} | |
$first_name = $_POST['fore_name']; // required | |
$last_name = $_POST['sur_name']; // required | |
$addressOne = $_POST['address_1']; // required | |
$postal_code = $_POST['postal_code']; // required | |
$daytime_telephone = $_POST['daytime_telephone']; // required | |
$mobile_no = $_POST['mobile_no']; // required | |
$email = $_POST['email']; // required | |
$mahram_name = $_POST['mahram_name']; // required | |
$mahram_relationship = $_POST['maharam_reltionship']; // required | |
$passport_no = $_POST['passport_no']; // required | |
$authority = $_POST['authority']; // required | |
$package = $_POST['package1']; | |
if (isset($package) && count($package) > 0) { | |
$package = implode(',', $package); | |
} else { | |
$package = ''; | |
} | |
$roomoccupancy = $_POST['roomoccupancy']; | |
if (isset($roomoccupancy) && count($roomoccupancy) > 0) { | |
$roomoccupancy = implode(',', $roomoccupancy); | |
} else { | |
$roomoccupancy = ''; | |
} | |
// emergency contact one | |
$contact1_fullName = $_POST['fullName1']; // required | |
$contact1_address = $_POST['contact1_address']; // required | |
$contact1_postal_code = $_POST['contact1_postal_code']; // required | |
$contact1_daytime_telephone = $_POST['conatact1_daytime_telephone']; // required | |
$contact1_mobile = $_POST['conatact1_mobile_no']; // required | |
$contact1_email = $_POST['contact1_email']; // required | |
$contact1_relation = $_POST['contact1_reltionship']; // required | |
//emergency contact two | |
$contact2_fullName = $_POST['fullName2']; // required | |
$contact2_address = $_POST['contact2_address2']; // required | |
$contact2_postal_code = $_POST['contact2_postal_code']; // required | |
$contact2_mobile = $_POST['contact2_mobile_no']; // required | |
$contact2_daytime_telephone = $_POST['contact2_daytime_telephone']; // required | |
$contact2_email = $_POST['contact2_email']; // required | |
$contact2_relation = $_POST['contact2_reltionship']; // required | |
$first_price = $_POST['price']; // required | |
$date = $_POST['date']; // required | |
$second_price = $_POST['under_price']; // required | |
$attachments = array(); | |
$temp = $_FILES["sign"]["tmp_name"]; | |
$name = $_FILES['sign']['name']; | |
//var_dump($temp[0]); | |
//var_dump($name[0]); | |
$i = 0; | |
foreach ($temp as $temps) { | |
move_uploaded_file($temp[$i], WP_CONTENT_DIR . '/uploads/' . basename($name[$i])); | |
array_push($attachments, WP_CONTENT_DIR . "/uploads/" . $name[$i]); | |
$i++; | |
} | |
$tempt = $_FILES['under_sign']['tmp_name']; | |
$names = $_FILES['under_sign']['name']; | |
$j = 0; | |
foreach ($tempt as $pic) { | |
move_uploaded_file($tempt[$j], WP_CONTENT_DIR . '/uploads/' . basename($names[$j])); | |
array_push($attachments, WP_CONTENT_DIR . "/uploads/" . $names[$j]); | |
$j++; | |
} | |
$tem = $_FILES['passport_img']['tmp_name']; | |
$nam = $_FILES['passport_img']['name']; | |
$k = 0; | |
foreach ($tem as $picture) { | |
move_uploaded_file($tem[$k], WP_CONTENT_DIR . '/uploads/' . basename($nam[$k])); | |
array_push($attachments, WP_CONTENT_DIR . "/uploads/" . $nam[$k]); | |
$k++; | |
} | |
$te = $_FILES['under_photo']['tmp_name']; | |
$naa = $_FILES['under_photo']['name']; | |
$l = 0; | |
foreach ($te as $et) { | |
move_uploaded_file($te[$l], WP_CONTENT_DIR . '/uploads/' . basename($naa[$l])); | |
array_push($attachments, WP_CONTENT_DIR . "/uploads/" . $naa[$l]); | |
$l++; | |
} | |
$p_name = $_POST['p_name']; // required | |
$under_date = $_POST['under_date']; // required | |
$error_message = ""; | |
$email_exp = '/^[A-Za-z0-9._%-]+@[A-Za-z0-9.-]+\.[A-Za-z]{2,4}$/'; | |
if (!preg_match($email_exp, $email)) { | |
$error_message .= 'The Email Address you entered does not appear to be valid.<br />'; | |
} | |
$string_exp = "/^[A-Za-z .'-]+$/"; | |
if (!preg_match($string_exp, $first_name)) { | |
$error_message .= 'The First Name you entered does not appear to be valid.<br />'; | |
} | |
if (strlen($error_message) > 0) { | |
died($error_message); | |
} | |
$email_message = "Form details below.\n\n"; | |
function clean_string($string) | |
{ | |
$bad = array("content-type", "bcc:", "to:", "cc:", "href"); | |
return str_replace($bad, "", $string); | |
} | |
$email_message = "Hello Admin, You have got a new Application with following details: \n\n"; | |
$email_message .= "Title : " . clean_string($title) . "\n"; | |
$email_message .= "First Name : " . clean_string($first_name) . "\n"; | |
$email_message .= "Last Name : " . clean_string($last_name) . "\n"; | |
$email_message .= "Address one : " . clean_string($addressOne) . "\n"; | |
$email_message .= "Postal code : " . clean_string($postal_code) . "\n"; | |
$email_message .= "Email : " . clean_string($email) . "\n"; | |
$email_message .= "Daytime Telephone : " . clean_string($daytime_telephone) . "\n"; | |
$email_message .= "Mobile No : " . clean_string($mobile_no) . "\n"; | |
$email_message .= "Mahram Name : " . clean_string($mahram_name) . "\n"; | |
$email_message .= "Mahram Relationship : " . clean_string($mahram_relationship) . "\n"; | |
$email_message .= "Passport Nn : " . clean_string($passport_no) . "\n"; | |
$email_message .= "Authority : " . clean_string($authority) . "\n"; | |
$email_message .= "Package : " . clean_string($package) . "\n"; | |
$email_message .= "Room Occupancy : " . clean_string($roomoccupancy) . "\n"; | |
$email_message .= "Contact 1 Name : " . clean_string($contact1_fullName) . "\n"; | |
$email_message .= "Contact 1 Address : " . clean_string($contact1_address) . "\n"; | |
$email_message .= "Contact 1 Postal Code : " . clean_string($contact1_postal_code) . "\n"; | |
$email_message .= "Contact 1 Mobile: " . clean_string($contact1_mobile) . "\n"; | |
$email_message .= "Contact 1 Email: " . clean_string($contact1_email) . "\n"; | |
$email_message .= "Contact 1 Daytime Telephone: " . clean_string($contact1_daytime_telephone) . "\n"; | |
$email_message .= "Contact 1 Relationship: " . clean_string($contact1_relation) . "\n"; | |
$email_message .= "Contact 2 Name : " . clean_string($contact2_fullName) . "\n"; | |
$email_message .= "Contact 2 Adderss : " . clean_string($contact2_address) . "\n"; | |
$email_message .= "Contact 2 Postal Code : " . clean_string($contact2_postal_code) . "\n"; | |
$email_message .= "Contact 2 Mobile: " . clean_string($contact2_mobile) . "\n"; | |
$email_message .= "Contact 2 Email: " . clean_string($contact2_email) . "\n"; | |
$email_message .= "Contact 2 Daytime Telephone: " . clean_string($contact2_daytime_telephone) . "\n"; | |
$email_message .= "Contact 2 Relationship: " . clean_string($contact2_relation) . "\n"; | |
$email_message .= "Above 18 Price: " . clean_string($first_price) . "\n"; | |
$email_message .= "Below 18 Price: " . clean_string($second_price) . "\n"; | |
$email_message .= "Print Name: " . clean_string($p_name) . "\n"; | |
$email_message .= "Thanks & Regards, \n" . $first_name . " " . $last_name; | |
$headers = "From: " . $email . "\r\n"; | |
$headers .= "Reply-To: " . $email . "\r\n"; | |
$headers .= "X-Mailer: PHP/" . phpversion(); | |
$headers .= "MIME-Version: 1.0" . "\r\n"; | |
$mail = wp_mail($email_to, $email_subject, $email_message, $headers, $attachments); | |
echo $mail ? "Thank you for connecting with us! We will contact you shortly!" : " Mail failed"; | |
} | |
?> | |
<div class="clear"></div> | |
<div class="main" role="main"> | |
<section class="page-heading"> | |
<div class="container"> | |
<div class="row"> | |
<div class="col-md-6"> | |
<h1><?php the_title(); ?></h1> | |
</div> | |
<div class="col-md-6"> | |
<?php if (have_posts()) : while (have_posts()) : the_post(); ?> | |
<?php the_content(); ?> | |
<?php endwhile; endif; ?> | |
</div> | |
</div> | |
</div> | |
</section> | |
<section class="page-content pc"> | |
<div class="container"> | |
<form id="regd_form" enctype="multipart/form-data" method="post" | |
action=""> | |
<div class="row"> | |
<div class="col-md-6"> | |
<label> | |
<p><b>Personal Details :</b></p><br> | |
</label> | |
</div> | |
<div class="col-md-6"> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label class="control-label" for="title">Title</label> | |
</div> | |
</div> | |
<div class="col-md-6"> | |
<div class="form-group"> | |
<label class="checkbox-inline"> | |
<input type="checkbox" name="title[]" value="Dr"> | |
Dr | |
</label> | |
<label class="checkbox-inline"> | |
<input type="checkbox" name="title[]" value="Mr"> | |
Mr | |
</label> | |
<label class="checkbox-inline"> | |
<input type="checkbox" name="title[]" value="Mrs"> | |
Mrs | |
</label> | |
<label class="checkbox-inline"> | |
<input type="checkbox" name="title[]" value="Miss"> | |
Miss | |
</label> | |
<label class="checkbox-inline"> | |
<input type="checkbox" name="title[]" value="Ms"> | |
Ms | |
</label> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
Firstname | |
</label> | |
</div> | |
</div> | |
<div class="col-md-9"> | |
<div class="form-group"> | |
<input type="text" class="form-control" name="fore_name" id="fore_name"> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
Surname | |
</label> | |
</div> | |
</div> | |
<div class="col-md-9"> | |
<div class="form-group"> | |
<input type="text" class="form-control" name="sur_name" id="sur_name"> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
Address 1 | |
</label> | |
</div> | |
</div> | |
<div class="col-md-9"> | |
<div class="form-group"> | |
<!-- <input type="text" class="form-control" name="address_1" id="address_1">--> | |
<textarea rows="4" cols="77" name="address_1" style="width: 100%"></textarea> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
Postal Code | |
</label> | |
</div> | |
</div> | |
<div class="col-md-9"> | |
<div class="form-group"> | |
<input type="text" class="form-control" name="postal_code" id="postal_code"> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
Daytime Telephone | |
</label> | |
</div> | |
</div> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<input type="text" class="form-control" name="daytime_telephone" id="daytime_telephone"> | |
</div> | |
</div> | |
<div class="col-md-1"> | |
<div class="form-group"> | |
<label> | |
Mobile | |
</label> | |
</div> | |
</div> | |
<div class="col-md-5"> | |
<div class="form-group"> | |
<input type="text" class="form-control" name="mobile_no" id="mobile_no"> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
</label> | |
</div> | |
</div> | |
<div class="col-md-9"> | |
<div class="form-group"> | |
<input type="email" class="form-control" name="email" id="email"> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
Mahram's Name<br> | |
( Female's Only ) | |
</label> | |
</div> | |
</div> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<input type="text" class="form-control" name="mahram_name" id="mahram_name"> | |
</div> | |
</div> | |
<div class="col-md-1"> | |
<div class="form-group"> | |
<label> | |
Relation of ( Mahram ) | |
</label> | |
</div> | |
</div> | |
<div class="col-md-5"> | |
<div class="form-group"> | |
<input type="text" class="form-control" name="maharam_reltionship" id="maharam_reltionship"> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
Passport number | |
</label> | |
</div> | |
</div> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<input type="text" class="form-control" name="passport_no" id="passport_no"> | |
</div> | |
</div> | |
<div class="col-md-1"> | |
<div class="form-group"> | |
<label> | |
Authority | |
</label> | |
</div> | |
</div> | |
<div class="col-md-5"> | |
<div class="form-group"> | |
<input type="text" class="form-control" name="authority" id="authority"> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label class="control-label" for="package1">Package</label> | |
</div> | |
</div> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label class="checkbox-inline"> | |
<input type="checkbox" name="package1[]" value="2week"> | |
2 week | |
</label> | |
<label class="checkbox-inline"> | |
<input type="checkbox" name="package1[]" value="3week"> | |
3 week | |
</label> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3" id="type_of_business"> | |
<div class="form-group"> | |
<div class="form-group"> | |
<label class="control-label" for="roomoccupancy">Room occupancy</label> | |
</div> | |
</div> | |
</div> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label class="checkbox-inline"> | |
<input type="checkbox" name="roomoccupancy[]" value="Double"> | |
Double | |
</label> | |
<label class="checkbox-inline"> | |
<input type="checkbox" name="roomoccupancy[]" value="Triple"> | |
Triple | |
</label> | |
<label class="checkbox-inline"> | |
<input type="checkbox" name="roomoccupancy[]" value="Quadruple"> | |
Quadruple | |
</label> | |
</div> | |
</div> | |
</div> | |
<!--//=======================================================contact details (1)=========================================================================//--> | |
<div class="row"> | |
<div class="col-md-6 upload-form"> | |
<div class="form-group"> | |
<p><b> Emergency Contact Details</b></p> | |
<p>In case of an emergency please provide contact details:</p> | |
<p><b>Contact (1)</b></p> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
Full Name | |
</label> | |
</div> | |
</div> | |
<div class="col-md-9"> | |
<div class="form-group"> | |
<input type="text" class="form-control" name="fullName1" id="fullName1"> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
Address | |
</label> | |
</div> | |
</div> | |
<div class="col-md-9"> | |
<div class="form-group"> | |
<!-- <input type="text" class="form-control" name="address_1" id="address_1">--> | |
<textarea rows="4" cols="77" name="contact1_address" style="width: 100%"></textarea> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
Postal Code | |
</label> | |
</div> | |
</div> | |
<div class="col-md-9"> | |
<div class="form-group"> | |
<input type="text" class="form-control" name="contact1_postal_code" | |
id="contact1_postal_code"> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
Daytime Telephone | |
</label> | |
</div> | |
</div> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<input type="text" class="form-control" name="conatact1_daytime_telephone" | |
id="conatact1_daytime_telephone"> | |
</div> | |
</div> | |
<div class="col-md-1"> | |
<div class="form-group"> | |
<label> | |
Mobile | |
</label> | |
</div> | |
</div> | |
<div class="col-md-5"> | |
<div class="form-group"> | |
<input type="text" class="form-control" name="conatact1_mobile_no" id="conatact1_mobile_no"> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
</label> | |
</div> | |
</div> | |
<div class="col-md-9"> | |
<div class="form-group"> | |
<input type="email" class="form-control" name="contact1_email" id="contact1_email"> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
Relation | |
</label> | |
</div> | |
</div> | |
<div class="col-md-9"> | |
<div class="form-group"> | |
<input type="text" class="form-control" name="contact1_reltionship" | |
id="contact1_reltionship"> | |
</div> | |
</div> | |
</div> | |
<!--//=======================================================end contact detailsvc(1)================================================================//--> | |
<!--//=======================================================contact details (2)=========================================================================//--> | |
<div class="row"> | |
<div class="col-md-6 upload-form"> | |
<div class="form-group"> | |
<p><b>Contact (2)</b></p> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
Full Name | |
</label> | |
</div> | |
</div> | |
<div class="col-md-9"> | |
<div class="form-group"> | |
<input type="text" class="form-control" name="fullName2" id="fullName2"> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
Address | |
</label> | |
</div> | |
</div> | |
<div class="col-md-9"> | |
<div class="form-group"> | |
<!-- <input type="text" class="form-control" name="address_1" id="address_1">--> | |
<textarea rows="4" cols="77" name="contact2_address2" style="width: 100%"></textarea> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
Postal Code | |
</label> | |
</div> | |
</div> | |
<div class="col-md-9"> | |
<div class="form-group"> | |
<input type="text" class="form-control" name="contact2_postal_code" | |
id="contact2_postal_code"> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
Daytime Telephone | |
</label> | |
</div> | |
</div> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<input type="text" class="form-control" name="contact2_daytime_telephone" | |
id="contact2_daytime_telephone"> | |
</div> | |
</div> | |
<div class="col-md-1"> | |
<div class="form-group"> | |
<label> | |
Mobile | |
</label> | |
</div> | |
</div> | |
<div class="col-md-5"> | |
<div class="form-group"> | |
<input type="text" class="form-control" name="contact2_mobile_no" id="contact2_mobile_no"> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
</label> | |
</div> | |
</div> | |
<div class="col-md-9"> | |
<div class="form-group"> | |
<input type="email" class="form-control" name="contact2_email" id="contact2_email"> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
Relation | |
</label> | |
</div> | |
</div> | |
<div class="col-md-9"> | |
<div class="form-group"> | |
<input type="text" class="form-control" name="contact2_reltionship" | |
id="contact2_reltionship"> | |
</div> | |
</div> | |
</div> | |
<!--//=======================end contact detailsvc(2)==================================================//--> | |
<div class="row"> | |
<div class="col-md-12"> | |
<div class="form-group"> | |
<label> | |
<p><b>Declaration</b></p> | |
<p> I declare that all the information on this booking form is correct to the best of my | |
knowledge. I accept and abide by the booking terms and conditions, available at | |
www.hajjltd.com/terms, which I have read and understood.</p> | |
</label> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
I have paid a deposit of | |
</label> | |
</div> | |
</div> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<input type="text" class="form-control" name="price" id="price"> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-4"> | |
<div class="form-group"> | |
<label> | |
<p><b>Please attach the following with this application:</b></p> | |
</label> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
</div> | |
</div> | |
<div class="col-md-7"> | |
<div class="form-group"> | |
<label> | |
<br> | |
<ul style="list-style-type: square;"> | |
<li><p> Copy of your Passport (valid for at least 6 months from the date of | |
departure).</p></li> | |
<li><p> 2 passport sized photos with your name printed at the back of each | |
photo. </p></li> | |
</ul> | |
</label> | |
<label> | |
<br> | |
<p><b>Please Note:</b>Pilgrim must not have travelled to perform Hajj within the past 5 | |
years (to attach old passport) Birth Certificates/Marriage certificates need to be | |
submitted with passports as proof of relationship status for | |
women/children with a Mahram</p> | |
</label> | |
</div> | |
</div> | |
<div class="col-md-2"> | |
<div class="form-group"> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
Proof of Passport : | |
</label> | |
</div> | |
</div> | |
<div class="col-md-3" id="servicesAdd3"> | |
<div class="form-group"> | |
<input type="button" class="form-control" value="Add More" onclick="uploadFile3()"> | |
<div id="services3"> | |
<input type="file" class="form-control" name="sign[]" id="sign1"> | |
</div> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
Passport image : | |
</label> | |
</div> | |
</div> | |
<div class="col-md-3" id="servicesAdd2"> | |
<div class="form-group"> | |
<input type="button" class="form-control" value="Add More" onclick="uploadFile2()"> | |
<div id="services2"> | |
<input type="file" class="form-control" name="passport_img[]" id="passport_img"> | |
</div> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
</div> | |
<div class="row"> | |
<div class="col-md-12"> | |
<div class="form-group"> | |
<label> | |
<p><b>For applicants under 18 years of age:</b></p> | |
<p>I declare as the parent/ guardian of the child named on this booking form, take full | |
responsibility that the information I provided is correct to the best of my | |
knowledge. I accept and abide by the booking terms and conditions, available at | |
www.hajjltd.com/terms, which I have read and understood.</p> | |
</label> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
I have paid a deposit of | |
</label> | |
</div> | |
</div> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<input type="text" class="form-control" name="under_price" id="price"> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-4"> | |
<div class="form-group"> | |
<label> | |
<p><b>Please attach the following with this application:</b></p> | |
</label> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
</div> | |
</div> | |
<div class="col-md-7"> | |
<div class="form-group"> | |
<label> | |
<br> | |
<ul style="list-style-type: square;"> | |
<li><p> Copy of the Childs Passport.</p></li> | |
<li><p> 2 passport sized photos with the name printed at the back of each | |
photo. </p></li> | |
</ul> | |
</label> | |
<label> | |
<br> | |
<p><b>Please Note:</b>Pilgrim must not have travelled to perform Hajj within the past 5 | |
years (to attach old passport) Birth Certificates/Marriage certificates need to be | |
submitted with passports as proof of relationship status for | |
women/children with a Mahram</p> | |
</label> | |
</div> | |
</div> | |
<div class="col-md-2"> | |
<div class="form-group"> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
Proof of Passport(child) : | |
</label> | |
</div> | |
</div> | |
<div class="col-md-3" id="servicesAdd1"> | |
<div class="form-group"> | |
<input type="button" class="form-control" value="Add More" onclick="uploadFile1()"> | |
<div id="services1"> | |
<input type="file" class="form-control" name="under_sign[]" id="sign"> | |
</div> | |
</div> | |
</div> | |
</div> | |
<div class=" row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
Passport image : | |
</label> | |
</div> | |
</div> | |
<div class="col-md-3" id="servicesAdd"> | |
<div class="form-group"> | |
<input type="button" class="form-control" value="Add More" | |
onclick="uploadFile()"> | |
<div id="services"> | |
<input type="file" class="form-control" name="under_photo[]" id="under_photo"> | |
</div> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<label> | |
Print Name: | |
</label> | |
</div> | |
</div> | |
<div class="col-md-3"> | |
<div class="form-group"> | |
<input type="text" class="form-control" name="p_name" id="p_name"> | |
</div> | |
</div> | |
</div> | |
</div> | |
<div class="row"> | |
<div class="col-md-6"><input type="submit" name="submit" value="Submit" id="submit" | |
class="btn btn-primary" style="margin-left: 376px;"></div> | |
<div class="col-md-6"><input type="button" | |
onclick="window.location.href='http://178.62.55.80/hajjltd/'" | |
name="button" value="Back" id="reset1" | |
class="btn btn-primary" style="margin-left: 470px;"></div> | |
</div> | |
</form> | |
</div> | |
</section> | |
<div class="clear"></div> | |
<script src='https://cdnjs.cloudflare.com/ajax/libs/jquery/3.1.0/jquery.min.js' type="text/javascript"></script> | |
<script type="text/javascript"> | |
function uploadFile() { | |
var listSizee = $('#servicesAdd #services').size(); | |
$('#servicesAdd').append(uploadFileMultiple('Temporary')); | |
console.log(listSizee); | |
} | |
function uploadFileMultiple(type) { | |
var image = '<input type="file" class="form-control" name="under_photo[]" id="under_photo">' | |
return image; | |
} | |
// ------- | |
function uploadFile1() { | |
var listSizee = $('#servicesAdd1 #services1').size(); | |
$('#servicesAdd1').append(uploadFileMultiple1('Temporary')); | |
console.log(listSizee); | |
} | |
function uploadFileMultiple1(type) { | |
var image = '<input type="file" class="form-control" name="under_sign[]" id="sign">' | |
return image; | |
} | |
// ------- | |
function uploadFile2() { | |
var listSizee = $('#servicesAdd2 #services2').size(); | |
$('#servicesAdd2').append(uploadFileMultiple2('Temporary')); | |
console.log(listSizee); | |
} | |
function uploadFileMultiple2(type) { | |
var image = '<input type="file" class="form-control" name="passport_img[]" id="passport_img">' | |
return image; | |
} | |
// ------ | |
function uploadFile3() { | |
var listSizee = $('#servicesAdd3 #services3').size(); | |
$('#servicesAdd3').append(uploadFileMultiple3('Temporary')); | |
console.log(listSizee); | |
} | |
function uploadFileMultiple3(type) { | |
var image = '<input type="file" class="form-control" name="sign[]" id="sign1">' | |
return image; | |
} | |
</script> | |
<?php get_footer(); ?> |
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