82 lines
5.2 KiB
PHP
82 lines
5.2 KiB
PHP
@extends('layouts.general')
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@section('content')
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<main role="main" id="" class="">
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<section id="" class="container mt20 mb20">
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<div class="row">
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<div class="col-12 col-lg-10 offset-0 offset-lg-1 mt20 mb20">
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<div class="card border-success">
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<div class="card-header border-success">
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<h5 class="card-title text-success">新規会員登録</h5>
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</div>
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<div class="card-body mt30">
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<p class="h4">会員情報を入力してください。</p>
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<section id="" class="container mt50 mb50">
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<form class="row form" action="{{route('member_regist_confirm', ['management_code' => $management_code])}}" method="post">
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<div class="col-12 col-md-3 offset-0 offset-md-1">
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<label class="required">お名前</label>
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</div>
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<div class="col-12 col-lg-6 mb10">
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<input type="text" class="form-control form-control-lg" name="name" value="{{ old('name') }}" placeholder="自転車 太郎">
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</div>
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<div class="col-12 col-md-3 offset-0 offset-md-1">
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<label class="required">フリガナ</label>
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</div>
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<div class="col-12 col-lg-6 mb10">
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<input type="text" class="form-control form-control-lg" name="kana" value="{{ old('kana') }}" placeholder="ジテンシャ タロウ">
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</div>
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<div class="col-12 col-md-3 offset-0 offset-md-1">
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<label>自宅電話番号</label>
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</div>
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<div class="col-12 col-lg-6 mb10">
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<div class="row justify-content-between col-12 m-0 p-0">
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<input type="text" maxlength="5" name="phone[]" value="{{ old('phone.0') }}" class="form-control form-control-lg check_key_int col-3"/>
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<div class="align-self-center">ー</div>
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<input type="text" maxlength="4" name="phone[]" value="{{ old('phone.1') }}" class="form-control form-control-lg check_key_int col-3"/>
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<div class="align-self-center">ー</div>
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<input type="text" maxlength="4" name="phone[]" value="{{ old('phone.2') }}" class="form-control form-control-lg check_key_int col-3"/>
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</div>
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</div>
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<div class="col-12 col-md-3 offset-0 offset-md-1">
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<label>携帯電話番号</label>
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</div>
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<div class="col-12 col-lg-6 mb10">
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<div class="row justify-content-between col-12 m-0 p-0">
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<input type="text" maxlength="5" name="mobile[]" value="{{ old('mobile.0') }}" class="form-control form-control-lg check_key_int col-3"/>
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<div class="align-self-center">ー</div>
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<input type="text" maxlength="4" name="mobile[]" value="{{ old('mobile.1') }}" class="form-control form-control-lg check_key_int col-3"/>
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<div class="align-self-center">ー</div>
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<input type="text" maxlength="4" name="mobile[]" value="{{ old('mobile.2') }}" class="form-control form-control-lg check_key_int col-3"/>
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</div>
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</div>
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<div class="col-12 col-md-3 offset-0 offset-md-1">
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<label class="required">生年月日</label>
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</div>
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<div class="col-12 col-lg-6 mb10">
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<input type="date" class="form-control form-control-lg" name="birthdate" value="{{ old('birthdate') }}">
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</div>
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<div class="col-12 col-md-3 offset-0 offset-md-1">
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<label class="required">メールアドレス</label>
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</div>
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<div class="col-12 col-lg-6 mb10">
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<input type="email" class="form-control form-control-lg" readonly="readonly" name="email" value="{{ session('email') }}">
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</div>
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<div class="col-12 col-md-6 offset-0 offset-md-3 mt10">
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<p style="color: red;">
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@if ($errors->has('name')) {{ $errors->first('name') }}<br /> @endif
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@if ($errors->has('kana')) {{ $errors->first('kana') }}<br /> @endif
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@if ($errors->has('phone')) {{ $errors->first('phone') }}<br /> @endif
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@if ($errors->has('mobile')) {{ $errors->first('mobile') }}<br /> @endif
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@if ($errors->has('birthdate')) {{ $errors->first('birthdate') }}<br /> @endif
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</p>
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<button type="submit" class="btn btn-block btn-lg btn-success">入力確認</button>
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</div>
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@csrf
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</form>
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</section>
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</div>
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</div>
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</div>
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</div>
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</section>
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</main>
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@endsection |