@extends('layout')



@section('content')

<style type="text/css">
	.form-control:focus {
		border: 1px solid #5993f3;
	}
</style>


@if (session('response'))
    <div class="alert alert-success">
        {{ session('response') }}
    </div>
@endif


<form action="{{url('/')}}/storeentry" method="post">

	@csrf

	<div class="row">

		<div class="col-md-4">

			<h5>Voter Id</h5>

			<input type="text" name="voterid" class="form-control" required="true">

		</div>

		<div class="col-md-4">

			<h5>Select Booth Name</h5>

			<select name="booth" class="form-control" id="booth" required="true">

				<option value="0" selected="selected">Select Booth</option>

				@foreach($booths as $booth)

					<option value="{{$booth->id}}">{{$booth->name}}</option>

				@endforeach

			</select>

		</div>

		<div class="col-md-4">

			<h5>Select Anubhag Name</h5>

			<select name="anubhag" class="form-control" id="anubhag" required="true">

			</select>

		</div>

	</div>

	<div class="row">

		<div class="col-md-4">

			<h5>First Name</h5>

			<input type="text" name="firstName" class="form-control" required="true">

		</div>

		<div class="col-md-4">

			<h5>Last Name</h5>

			<input type="text" name="lastName" class="form-control" required="true">

		</div>

		<div class="col-md-4">

			<h5>Father's \ Husband's \ Mother's Name</h5>

			<input type="text" name="fatherName" class="form-control" required="true">

		</div>

	</div>

	<div class="row">

		<div class="col-md-4">

			<h5>Gender</h5>

				<div class="row">

					<div class="col-md-4">

						<input type="radio" value="Male" name="gender">Male

					</div>

					<div class="col-md-4">

						<input type="radio" value="Female" name="gender">Female

					</div>

					<div class="col-md-4">

						<input type="radio" value="NA" name="gender">NA

					</div>

				</div>

		</div>

		<div class="col-md-4">

			<h5>Age</h5>

			<input type="number" name="age" class="form-control" required="true">

		</div>

		<div class="col-md-4">

			<h5>House No</h5>

			<input type="text" name="houseNo" class="form-control" required="true">

		</div>		

	</div>

	<br>

	<div class="row">

		<div class="col-md-12">

			<input type="submit" name="submit" value="submit" value="Run Querry" class="form-control" style="background-color: #8CBF4E; color: white">

		</div>

	</div>

	

</form>

@endsection