@extends('layout')
@section('content')
    <div class="content-wrapper">
        <div class="content">
            <div id="floating-alert-container">
                @if (session('success'))
                    <div class="alert alert-success alert-dismissible fade show floating-alert">
                        <strong>{{ session('success') }}</strong>
                        <button type="button" class="close" data-dismiss="alert">×</button>
                    </div>
                @endif

                @if (session('error'))
                    <div class="alert alert-danger alert-dismissible fade show floating-alert">
                        <strong>{{ session('error') }}</strong>
                        <button type="button" class="close" data-dismiss="alert">×</button>
                    </div>
                @endif

                @if ($errors->any())
                    @foreach ($errors->all() as $error)
                        <div class="alert alert-danger alert-dismissible fade show floating-alert">
                            <strong>{{ $error }}</strong>
                            <button type="button" class="close" data-dismiss="alert">×</button>
                        </div>
                    @endforeach
                @endif
            </div>
            {{-- <div id="ajax-container-organization-details" data-url="{{ url('get-organization-details') }}"></div> --}}
            <div class="form">
                {{ Form::open(['url' => url('/donor-save'), 'method' => 'POST', 'id' => 'donorForm', 'class' => 'search-form']) }}
                <div class="row">
                    <div class="form-group col-md-3">
                        <label for="Name">Name</label>
                        <input type="text" id="donor_name" name="donor_name" class="form-control">
                    </div>
                    <div class="form-group col-md-5">
                        <label for="Address">Address</label>
                        <textarea class="form-control form-control-sm" id="donor_address" name="donor_address"></textarea>
                    </div>
                    <div class="form-group col-md-2">
                        <label for="PNI">PIN</label>
                        <input type="text" id="donor_pincode" name="donor_pincode" class="form-control">
                    </div>
                    <div class="form-group col-md-2">
                        <label for="Date">Date</label>
                        <input type="date" id="camp_date" name="camp_date" class="form-control datepicker"
                            value="{{ $data['campDetails']->camp_date }}">
                    </div>
                    <div class="form-group col-md-2">
                        <label for="Bag No">Bag No.</label>
                        <input type="text" id="bag_no" name="bag_no" class="form-control">
                    </div>
                    <div class="form-group col-md-1">
                        <label for="Age">Age</label>
                        <input type="number" id="age" name="age" class="form-control">
                    </div>
                    <div class="form-group col-md-2">
                        <label for="gender">Gender</label>
                        <select id="gender" name="gender" class="form-control">
                            <option value="" selected disabled>--Select--</option>
                            <option value="Male">Male</option>
                            <option value="Female">Female</option>
                            <option value="Other">Other</option>
                        </select>
                    </div>
                    <div class="form-group col-md-1">
                        <label for="Weight">Weight</label>
                        <input type="number" id="weight" name="weight" class="form-control">
                    </div>
                    <div class="form-group col-md-2">
                        <label for="Blood Bank">Blood Bank</label>
                        <input type="text" id="blood_bank" name="blood_bank" class="form-control">
                    </div>
                    <div class="form-group col-md-2">
                        <label for="blood_group">Group</label>
                        <select id="blood_group" name="blood_group" class="form-control">
                            <option value="" selected disabled>--Select--</option>
                            <option value="A+">A+</option>
                            <option value="A-">A-</option>
                            <option value="B+">B+</option>
                            <option value="B-">B-</option>
                            <option value="AB+">AB+</option>
                            <option value="AB-">AB-</option>
                            <option value="O+">O+</option>
                            <option value="O-">O-</option>
                        </select>
                    </div>
                    <div class="form-group col-md-2">
                        <label for="blood_rh">RH.</label>
                        <select id="blood_rh" name="blood_rh" class="form-control">
                            <option value="" selected disabled>--Select--</option>
                            <option value="Rh-positive (+)">Rh-positive (+)</option>
                            <option value="Rh-negative (-)">Rh-negative (-)</option>
                        </select>
                    </div>
                    <div class="form-group col-md-2">
                        <label for="Phone No">Phone No.</label>
                        <input type="number" id="phone_no" name="phone_no" class="form-control">
                    </div>
                    <div class="form-group col-md-2">
                        <label for="Whatsapp No">Whatsapp No.</label>
                        <input type="number" id="whatsapp_no" name="whatsapp_no" class="form-control">
                    </div>
                    <div class="form-group col-md-3">
                        <label for="Email">Email</label>
                        <input type="email" id="email" name="email" class="form-control">
                    </div>
                    <div class="col-md-2">
                        <input type="hidden" id="camp_id" name="camp_id" value="{{ request('camp_id') }}">
                        <button type="submit" class="btn"
                            style="height: calc(2.25rem + 2px); margin-top: 18px; background-color: #e60000; color: white;">Submit</button>
                    </div>
                </div>
                {{ Form::close() }}
            </div>
        </div>
    </div>
    {{-- <script src="{{ asset('dist/js/pages/campRequest.js') }}"></script> --}}
@endsection