{{--ID--}} @include('components.form.input_row', [ 'name' => 'id', 'label' => 'ID', 'validation' => 'maxLength="4" pattern="^[A-Z1-9]?\d{3}$"', 'label_class' => 'col-md-4', 'input_class' => 'col-md-8', ])
@include('components.form.input_toggle_radio_static_row', [ 'label' => 'Gender', 'name' => 'gender_id', 'label_class' => 'col-md-4', 'input_class' => 'col-md-8', 'items' => [ [ 'label' => 'Male', 'value' => '0', ], [ 'label' => 'Female', 'value' => '1', ], ], ])
{{--Name--}}
@include('components.form.input_row', [ 'name' => 'first_name', 'label' => 'First Name', 'validation' => 'maxLength="30"', 'label_class' => 'col-md-4', 'input_class' => 'col-md-8', ])
@include('components.form.input_row', [ 'name' => 'last_name', 'label' => 'Last Name', 'validation' => 'maxLength="30"', 'label_class' => 'col-md-4', 'input_class' => 'col-md-8', ])
{{--Country of Origin & Race--}}
{{ $errors->first('country_id', ':message') }}
{{ $errors->first('race_id', ':message') }}
{{--Date of Birth & Phone Number--}}
@include('components.form.input_row', [ 'type' => 'date', 'name' => 'date_of_birth', 'label' => 'Date of Birth', 'validation' => 'min="1920-01-01" max="' . date('Y-m-d') . '"', 'label_class' => 'col-md-4', 'input_class' => 'col-md-8', ])
@include('components.form.input_row', [ 'type' => 'tel', 'name' => 'phone_number', 'label' => 'Phone No.', 'validation' => 'maxLength="10" placeholder="4694537777"', 'label_class' => 'col-md-4', 'input_class' => 'col-md-8', 'optional' => true, ])
{{--Address--}} @include('components.form.input_address', [ 'states' => $states, 'address_line1' => 'address_line1', 'address_line2' => 'address_line2', 'city' => 'city', 'state' => 'state_id', 'country' => 'country', 'zip' => 'zip', ]) {{--Pregnant--}}
@php($is_pregnant = old('is_pregnant') == 'yes' ? 'yes' : 'no') @include('components.form.input_toggle_radio_static_row', [ 'label' => 'Pregnant', 'name' => 'is_pregnant', 'label_class' => 'col-md-4', 'input_class' => 'col-md-8', 'value' => $is_pregnant, 'items' => [ [ 'label' => 'No', 'value' => 'no', ], [ 'label' => 'Yes', 'value' => 'yes', ], ], ])
{{ $errors->first('pregnant_due_date', ':message') }}
{{--Family Size--}}
@include('components.form.input_toggle_radio_static', [ 'name' => 'family_size', 'label_class' => 'mb-1 btn-member-size', 'items' => [ [ 'label' => '1', 'value' => '1', ], [ 'label' => '2', 'value' => '2', ], [ 'label' => '3', 'value' => '3', ], [ 'label' => '4', 'value' => '4', ], [ 'label' => '5', 'value' => '5', ], [ 'label' => '6', 'value' => '6', ], [ 'label' => '7', 'value' => '7', ], [ 'label' => '8', 'value' => '8', ], [ 'label' => '9', 'value' => '9', ], [ 'label' => '10', 'value' => '10', ], ], ])
{{ $errors->first('family_size', ':message') }}
{{--Additional Notes--}} @include('components.form.textarea_row', [ 'name' => 'note', 'label' => 'Additional Notes', 'validation' => 'maxLength="170"', 'label_class' => 'col-md-2', 'input_class' => 'col-md-10', 'optional' => true, 'rows' => 3, ])
{{--Next Step--}}
Next