@extends('layouts.applicant')
@section('content')
<div class="row">
	
    @if($info>=1)
    <div class="page-header">
		<h4>@if(!empty($status)) {{$status}}  @endif</h4>
		
	</div>
	<!-- /.row -->
	@if(session('message'))
    <div class="alert alert-warning">
     	{{ session('message')}}
    </div>

	@endif
    	
 <!-- /.row -->
            <div class="row">
            	<!-- /.col-lg-6 -->
                <div class="col-lg-12">
                    <div class="panel panel-default">
                        <div class="panel-heading">
                           Fill in the form
                        </div>
                        <!-- /.panel-heading -->
                        <div class="panel-body">
                            
                            	@if (count($errors) > 0)
							    <div class="alert alert-danger">
							        <ul>
							            @foreach ($errors->all() as $error)
							                <li>{{ $error }}</li>
							            @endforeach
							        </ul>
							    </div>
							@endif
							<form method="POST" role="form" action="{{url('parentsinfo')}}">
                            	<input type="hidden" name="_token" value="{{ csrf_token() }}">
	                            <div class="row ">
	                            	<div class="col-lg-12 alert alert-success">
	                            		<div class="">
	                            			@if(session('status'))
	                            			 {{session('status')}}
	                            			@else
	                            				<strong>Parent's Information </strong>	
	                            			@endif
	                            		</div>
	                            	</div>
	                            </div>
	                            <div class="row">
	                            	<div class="col-lg-5">
	                            		<div class="form-group">
	                            		<input type="hidden" name="user" value="{{Auth::User()->id}}">
	                            			<label>Father's Name(Fullname as Per National ID)</label>
	                            			<input type="text" name="father_name" value="{{old('father_name')}}" placeholder="Father's Name" class="form-control" required>
	                            		</div>
	                            	</div>
	                            	<div class="col-lg-4">
	                            		<div class="form-group">
	                            			<label>Tel.</label>
	                            			<input type="text" value="{{old('father_telephone')}}" name="father_telephone" placeholder="e.g.7123456789" class="form-control">
	                            		</div>
	                            	</div>
	                            	<div class="col-lg-3">
	                            		<div class="form-group">
	                            			<label>Check One</label><br>
	                            			<input type="radio" name="father_status" {{ old('father_status')=="alive" ? 'checked='.'"'.'checked'.'"' : '' }} class="radio-inline" value="alive" >Alive

	                            			<input type="radio" name="father_status" {{ old('father_status')=="deceased" ? 'checked='.'"'.'checked'.'"' : '' }} class="radio-inline" value="deceased">Deceased

	                            			<input type="radio" name="father_status" {{ old('father_status')=="N/A" ? 'checked='.'"'.'checked'.'"' : '' }} class="radio-inline" value="N/A">N/A
	                            		</div>
	                            	</div>
	                            </div>
	                            <div class="row">
	                            	<div class="col-lg-5">
	                            		<div class="form-group">
	                            			<label>Mother's Name(Fullname as Per National ID)</label>
	                            			<input type="text" value="{{old('mother_name')}}" name="mother_name" placeholder="Mother's Name" class="form-control" required>
	                            		</div>
	                            	</div>
	                            	<div class="col-lg-4">
	                            		<div class="form-group">
	                            			<label>Tel.</label>
	                            			<input type="text" name="mother_telephone" placeholder="e.g.7123456789" class="form-control" value="{{old('mother_telephone')}}">
	                            		</div>
	                            	</div>
	                            	<div class="col-lg-3">
	                            		<div class="form-group">
	                            			<label>Check One</label><br>
	                            			<input type="radio" name="mother_status" {{ old('mother_status')=="alive" ? 'checked='.'"'.'checked'.'"' : '' }} class="radio-inline" value="alive" >Alive

	                            			<input type="radio" name="mother_status" {{ old('mother_status')=="deceased" ? 'checked='.'"'.'checked'.'"' : '' }} class="radio-inline" value="deceased">Deceased

	                            			<input type="radio" name="mother_status" {{ old('mother_status')=="N/A" ? 'checked='.'"'.'checked'.'"' : '' }} class="radio-inline" value="N/A">N/A
	                            		</div>
	                            	</div>
	                            
	                            </div>
	                            <div class="row ">
	                            	<div class="col-lg-12 alert alert-success">
	                            		<div class="">
	                            			<strong>Educational Background Information </strong>	
	                            		</div>
	                            	</div>
	                            </div>
	                            <div class="row ">
	                            	<div class="col-lg-6">
	                            		<div class="form-group">
	                            			<label>Secondary School Attended.</label>	
	                            			<input type="text" name="school_attended" value="{{old('school_attended')}}" placeholder="School Attended" class="form-control" required>
	                            		</div>
	                            	</div>
	                            	<div class="col-lg-3">
	                            		<div class="form-group">
	                            			<label>Ethnicity/Tribe</label>	
	                            			<input type="text" name="tribe" placeholder="Tribe" value="{{old('tribe')}}" class="form-control" required>
	                            		</div>
	                            	</div>
	                            	<div class="col-lg-3">
	                            		<div class="form-group">
	                            			<label>Refugee Camp</label>	
	                            			<!-- <input type="text" name="tribe" placeholder="Refugee Camp" value="{{old('tribe')}}" class="form-control"> -->
											<select class="form-control" name="refugee_camp" required>
												<option value="">--Select--</option>
												<option value="Kakuma">Kakuma</option>
												<option value="Kalobeye">Kalobeye</option>
												<option value="NA">Not In any of the above</option>


											</select>
	                            		</div>
	                            	</div>
	                            </div>
	                            <div class="row">
	                            	<div class="col-sm-6">
	                            		<div class="form-group">
	                            			<input type="submit" name="go" class="btn btn-primary" value="Save Info">
	                            		</div>
	                            	</div>
	                            </div>
                            </form>
                        </div>
                        <!-- /.panel-body -->
                    </div>
                    <!-- /.panel -->
                </div>
                <!-- /.col-lg-6 -->
            	
            </div>

    @else
    <div class="panel-body">
    	<div class="row alert alert-danger">
    		<div class="col-lg-8">
    			<div class="form-group">
    				<p>
    				<strong>Could not Apply for the program</strong>.Please  Check requirements versus your scores
    				</p>
    			</div>
    		</div>
    	</div>
    </div>

    @endif
	
</div>

@stop