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overage_registration.php
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388 lines (335 loc) · 18.6 KB
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<?php
// Initialize the session
if(!isset($_SESSION))
{
session_start();
}
?>
<script>
var email = "<?php echo $_SESSION["newuserinfo"]["email"];?>";
var emailwcharactersreplaced = email.replace(".",",");
var dob = "<?php echo $_SESSION["newuserinfo"]["age"];?>";
var bus_num = "N/A";
var group_num = "N/A";
var cabin_num = "N/A";
var credit_due = "299";
</script>
<!doctype html>
<html lang="en">
<head>
<title>Youth Registration | Youth Spiritual Summit</title>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no">
<link rel="stylesheet" href="/css/main.css">
<link rel="stylesheet" href="https://stackpath.bootstrapcdn.com/bootstrap/4.2.1/css/bootstrap.min.css" integrity="sha384-GJzZqFGwb1QTTN6wy59ffF1BuGJpLSa9DkKMp0DgiMDm4iYMj70gZWKYbI706tWS" crossorigin="anonymous">
</head>
<body>
<?php include("header_loggedout.php")?>
<form id=form1 action="formToDatabase.php" method="post"
enctype="multipart/form-data" onsubmit="return validateImgProcess()">
<div class="container" style = "background: white; margin-top: 20px;">
<!-- Camp Registration Header -->
<h1 align="center" style = "font-size:40px;padding-top: 20px;">Youth Participant Registration</h1>
<!-- NEW STUFF STARTING HERE -->
<div class="block_1"><p style="padding-top:20px"</div>
<hr style="
border-width: medium;
border-color: LightSteelBlue;
" />
<div class="container">
</div>
<div class="container">
<!-- Camper Information -->
<label><p style = "font-size:30px;">Participant Information (18+)</p></label>
<div class="input-group mb-3">
<div class="input-group-prepend">
<span class="input-group-text">First Name:<b style = "color: red;">*</b></span>
</div>
<input type="text" pattern="^[A-Za-z]+(((\'|\-|\.)?([A-Za-z])+))?$" placeholder="Ex: John"
name="first_name" id="firstname" class="form-control" required>
</div>
<div class="input-group mb-3">
<div class="input-group-prepend">
<span class="input-group-text">Last Name:<b style = "color: red;">*</b></span>
</div>
<input type="text" pattern="^[A-Za-z]+(((\'|\-|\.)?([A-Za-z])+))?$" placeholder="Ex: Smith"
name="last_name" id="lastname" class="form-control" required>
</div>
<div class="input-group mb-3">
<div class="input-group-prepend">
<span class="input-group-text">Gender:<b style = "color: red;">*</b></span>
<select class="form-control form-control-md" name="gender" id="gender">
<option disabled selected value> -- select an option -- </option>
<option>Female</option>
<option>Male</option>
</select>
</div>
</div>
<div class="input-group mb-3">
<div class="input-group-prepend">
<span class="input-group-text">Enter A Password:<b style = "color: red;">*</b></span>
</div>
<input type="password" placeholder="Ex: abcde123 (8+ char, at least one number)" pattern="(?=.*[A-Za-z])(?=.*\d)[A-Za-z\d]{8,}" name="password" id="password" class="form-control" required>
</div>
<div class="input-group mb-3">
<div class="input-group-prepend">
<span class="input-group-text">Retype Password:<b style = "color: red;">*</b></span>
</div>
<input type="password" placeholder="Must match above password" pattern="(?=.*[A-Za-z])(?=.*\d)[A-Za-z\d]{8,}" name="password2" id="password2" class="form-control" required>
</div>
<div class="input-group mb-3">
<div class="input-group-prepend">
<span class="input-group-text">Phone number:<b style = "color: red;">*</b></span>
</div>
<input type="tel" pattern="[0-9]{3}-[0-9]{3}-[0-9]{4}" placeholder="Format: 123-456-7890" name="phone" id="phone" class="form-control" required>
</div>
<div class="input-group mb-3">
<div class="input-group-prepend">
<span class="input-group-text">Upcoming School Year:<b style = "color: red;">*</b></span>
<select class="form-control form-control-md" name="year" id="schoolyear">
<option disabled selected value> -- select an option -- </option>
<option>Junior</option>
<option>Senior</option>
<option>Early College</option>
<option>Home School</option>
</select>
</div>
</div>
<div class="input-group mb-3">
<div class="input-group-prepend">
<span class="input-group-text">Sweatshirt Size:<b style = "color: red;">*</b></span>
<select class="form-control form-control-md" name="size" id="size">
<option disabled selected value> -- select an option -- </option>
<option>Small</option>
<option>Medium</option>
<option>Large</option>
<option>XL</option>
<option>XXL</option>
</select>
</div>
</div>
<form enctype="multipart/form-data">
Upload Picture of Drivers License / Government ID:<b style = "color: red;">*</b>
<input type="file" name="file" id="upload" value="upload" class="form-control" required>
</form>
</div>
<div class="block_1"><p style="padding-top:30px"</div> <hr />
<div class="container">
<!-- Personal Information -->
<label><p style = "font-size:30px;padding-top: 10px;">Personal Information</p></label>
</div>
<div class="container">
<label><p style = "font-size:18px;">How would you rate yourself in the following areas?</p></label>
<div class="input-group mb-3">
<div class="input-group-prepend">
<span class="input-group-text">Spirituality (closeness to God)<b style = "color: red;">*</b></span>
<select class="form-control form-control-md" name="spiritual" id="spiritual">
<option disabled selected value> -- select an option -- </option>
<option>Very High</option>
<option>High</option>
<option>Neutral</option>
<option>Low</option>
<option>Very Low</option>
</select>
</div>
</div>
<div class="input-group mb-3">
<div class="input-group-prepend">
<span class="input-group-text">Religious Knowledge:<b style = "color: red;">*</b></span>
<select class="form-control form-control-md" name="knowledge" id="knowledge">
<option disabled selected value> -- select an option -- </option>
<option>Very High</option>
<option>High</option>
<option>Neutral</option>
<option>Low</option>
<option>Very Low</option>
</select>
</div>
</div>
<div class="input-group mb-3">
<div class="input-group-prepend">
<span class="input-group-text">Actively Improving Myself:<b style = "color: red;">*</b></span>
<select class="form-control form-control-md" name="improvement" id="improvement">
<option disabled selected value> -- select an option -- </option>
<option>Very High</option>
<option>High</option>
<option>Neutral</option>
<option>Low</option>
<option>Very Low</option>
</select>
</div>
</div>
<div class="input-group mb-3">
<div class="input-group-prepend">
<span class="input-group-text">Actively Involved In Making My Community Better:<b style = "color: red;">*</b></span>
<select class="form-control form-control-md" id="community" name="community">
<option disabled selected value> -- select an option -- </option>
<option>Very High</option>
<option>High</option>
<option>Neutral</option>
<option>Low</option>
<option>Very Low</option>
</select>
</div>
</div>
<div class="row initial-task-padding">
<div class="col">
<p>What do you hope to get out of attending Youth Spiritual Summit this year?</p>
<textarea id="hopes" name="hopes" cols="132" rows="3" value=""></textarea>
</div>
</div>
<div class="row initial-task-padding">
<div class="col">
<p>What are some activities that you enjoy?</p>
<textarea id="activities" name="activities" cols="132" rows="3" value=""></textarea>
</div>
</div>
<div class="row initial-task-padding">
<div class="col">
<p>What is one question you would like to have answered during this year's Summit?</b></p>
<textarea id="question" name="question" cols="132" rows="3" value=""></textarea>
</div>
</div>
<div class="block_1"><p style="padding-top:30px"</div> <hr />
<div class="container">
<!-- Emergency Contacts -->
</div>
<label><p style = "font-size:30px;padding-top: 10px;">Emergency Contacts</p></label>
<div class="input-group mb-3">
<div class="input-group-prepend">
<span class="input-group-text">Emergency Contact 1 - Name (First & Last):<b style = "color: red;">*</b></span>
</div>
<input type="text" pattern="[A-Za-z]+((\s)?((\'|\-|\.)?([A-Za-z])+))*" placeholder="Ex: John Smith" name="ec_name1" id="ec_name1" class="form-control" required>
</div>
<div class="input-group mb-3">
<div class="input-group-prepend">
<span class="input-group-text">Emergency Contact 1 - Phone:<b style = "color: red;">*</b></span>
</div>
<input type="tel" pattern="[0-9]{3}-[0-9]{3}-[0-9]{4}" placeholder="Format: 123-456-7890" name="ec_phone1" id="ec_phone1" class="form-control" required>
</div>
<div class="input-group mb-3">
<div class="input-group-prepend">
<span class="input-group-text">Emergency Contact 1 - Relationship:<b style = "color: red;">*</b></span>
</div>
<input type="text" placeholder="Ex: Father" name="ec_relationship1" id="ec_relationship1" class="form-control" required>
</div>
<div class="input-group mb-3">
<div class="input-group-prepend">
<span class="input-group-text">Emergency Contact 2 - Name (First & Last)<b style = "color: red;">*</b></span>
</div>
<input type="text" pattern="[A-Za-z]+((\s)?((\'|\-|\.)?([A-Za-z])+))*" placeholder="Ex: Emma Jones" name="ec_name2" id="ec_name2" class="form-control" required>
</div>
<div class="input-group mb-3">
<div class="input-group-prepend">
<span class="input-group-text">Emergency Contact 2 - Phone:<b style = "color: red;">*</b></span>
</div>
<input type="tel" pattern="[0-9]{3}-[0-9]{3}-[0-9]{4}" placeholder="Format: 123-456-7890" name="ec_phone2" id="ec_phone2" class="form-control" required>
</div>
<div class="input-group mb-3">
<div class="input-group-prepend">
<span class="input-group-text">Emergency Contact 2 - Relationship:<b style = "color: red;">*</b></span>
</div>
<input type="text" placeholder="Ex: Mother" name="ec_relationship2" id="ec_relationship2" class="form-control" required>
</div>
<div class="block_1"><p style="padding-top:30px"></div> <hr>
<div class="container">
<!-- Health Information -->
</div>
<label><p style = "font-size:30px;padding-top: 10px;">Health Information</p></label>
<div class="row initial-task-padding">
<div class="col">
<p>Please List Any Allergies You Have. If none, type N/A.<b style = "color: red;">*</b></p>
<input type="text" name="allergies" id="allergies" times-label="allergies" class="form-control" required>
</div>
</div>
<div class="row initial-task-padding">
<div class="col">
<p>Please List Any Medication You Are Currently On. If none, type N/A<b style = "color: red;">*</b></p>
<input type="text" name="meds" id="meds" times-label="meds" class="form-control" required>
</div>
</div>
<div class="row initial-task-padding">
<div class="col">
<p>Please List Any Activity Restrictions.</b></p>
<input type="text" name="activity_restrictions" value="" id="activity_restrictions" times-label="activity_restrictions" class="form-control">
</div>
</div>
<div class="row initial-task-padding">
<div class="col">
<p>Please List Any Dietary Restrictions.</b></p>
<input type="text" name="dietary_restrictions" value="" id="dietary_restrictions" times-label="dietary_restrictions" class="form-control">
</div>
</div>
<div class="row initial-task-padding">
<div class="col">
<p>Other Important Information </b></p>
<input type="text" name="other" value="" id="other" times-label="other" class="form-control">
</div>
</div>
<div class="input-group mb-3" style = "padding-top: 20px;">
<div class="input-group-prepend">
<span class="input-group-text">Insurance Provider:<b style = "color: red;">*</b></span>
</div>
<input type="text" placeholder="Ex: PPO" name="insurance" id="insurance" class="form-control" required>
</div>
<div class="input-group mb-3">
<div class="input-group-prepend">
<span class="input-group-text">Policy Holder:<b style = "color: red;">*</b></span>
</div>
<input type="text" placeholder="Ex: Kaiser" name="policy_holder" id="policy_holder" class="form-control" required>
</div>
<div class="block_1"><p style="padding-top:30px"</div> <hr />
<!-- Submit -->
<div class="row margin-data" style = "padding-bottom: 50px;padding-top: 10px;" align="center">
<div class="col">
<!-- <button id="myBtn">Submit</button> -->
<input type="submit" class="rounded" value="Submit" name="subscribe" id="submit">
</div>
</div>
</div>
</form>
<script src="https://www.gstatic.com/firebasejs/5.10.0/firebase-app.js"></script>
<script src="https://www.gstatic.com/firebasejs/5.10.0/firebase-database.js"></script>
<script src="https://www.gstatic.com/firebasejs/5.10.0/firebase-storage.js"></script>
<!--<script src="counselor_app.js"></script>
<script src="firebaseSetup.js"></script>-->
<script>
var dlImage;
function uploadImage(evt){
licenseUpload = document.getElementById('upload');
dlImage = new File([licenseUpload.files[0]], emailwcharactersreplaced);
}
document.getElementById('upload').addEventListener('change', uploadImage, false);
function validateImgProcess(){
var password = document.getElementById("password").value;
var password2 = document.getElementById("password2").value;
if(password != password2){
alert("Retyped password must match password");
return false;
}
else {
var config = {
apiKey: "AIzaSyDJrK2EexTLW7UAirbRAByoHN5ZJ-uE35s",
authDomain: "yss-project-69ba2.firebaseapp.com",
databaseURL: "https://yss-project-69ba2.firebaseio.com",
projectId: "yss-project-69ba2",
storageBucket: "yss-project-69ba2.appspot.com",
messagingSenderId: "530416464878"
};
firebase.initializeApp(config);
var storageRef = firebase.storage().ref();
var database = firebase.database();
var storageRef = firebase.storage().ref('dl/' + dlImage.name);
//alert("here! image name: " + dlImage.name);
var metadata = {
contentType: 'image/jpeg'
};
storageRef.put(dlImage, metadata).then(function(snapshot) {
console.log("Uploaded an array!");
});
return true;
}
}
</script>
</body>
</html>