@extends('layouts.index')
@section('content')

<main class="main">
	<!-- loder -->
	  <div class="loader-wrapper">
		<div class="loader"></div>
		<div class="loder-section left-section"></div>
		<div class="loder-section right-section"></div>
	</div>

	<!--==================================================-->
	<!-- Start  Polytia Breadcumb Area -->
	<!--==================================================-->
	
	<!--==================================================-->
	<!-- End  Polytia Breadcumb Area -->
	<!--==================================================-->

	<!--==================================================-->
	<!-- Start charina donate section  -->
	<!--==================================================-->
	<div class="donate-section">
		<div class="container">
			<div class="row">
				<div class="col-lg-12">
					<div class="section-title text-center">
						<div class="section-main-title">
							<h1>FORMULAIRE D'ENREGISTREMENT - PERSONNE </h1>
						</div>
					</div> 
				</div>
			</div>
			<div class="row">
				<div class="col-lg-12">
					<!-- contact form box -->
					<div class="contact-form-box">
						@if ($message = Session::get('success'))
						<div class="alert alert-success alert-block">
							<button type="button" class="close" data-dismiss="alert">×</button>
							<strong>{{ $message }}</strong>
						</div>
						@endif
						<form action="{{ url('/personne') }}" method="POST" id="dreamit-form">
							@csrf
							<div class="row">
								<div class="col-lg-6 col-md-6">
									<!-- from title -->
									<div class="form-title">
										<h6><b>Votre Nom </b><b style="color : red">* :</b></h6>
									</div>
									<div class="form-box up">
										<input type="text" name="nom" placeholder="Votre Nom">
									</div>
								</div>

								<div class="col-lg-6 col-md-6">
									<!-- from title -->
									<div class="form-title">
										<h6><b>Votre Prénom(s) </b><b style="color : red">* :</b></h6>
									</div>
									<div class="form-box up">
										<input type="text" name="prenom" placeholder="Votre Prénom">
									</div>
								</div>

								<div class="col-lg-6 col-md-6">
									<!-- from title -->
									<div class="form-title">
										<h6><b>Nationalité </b><b style="color : red">* :</b></h6>
									</div>
									<div class="form-box up">
										<input type="text" name="nationalite" placeholder="Votre  Nationalité">
									</div>
								</div>
								
								<div class="col-lg-6 col-md-6">
									<!-- from title -->
									<div class="form-title">
										<h6><b>Téléphone </b><b style="color : red">* :</b></h6>
									</div>
									<div class="form-box up">
										<input type="text" name="telephone" placeholder="Votre Téléphone">
									</div>
								</div>

								<div class="col-lg-6 col-md-6">
									<!-- from title -->
									<div class="form-title">
										<h6><b>Adresse </b><b style="color : red">* :</b></h6>
									</div>
									<div class="form-box up">
										<input type="text" name="adresse" placeholder="Votre Adresse">
									</div>
								</div>
								<div class="col-lg-6 col-md-6">
									<!-- from title -->
									<div class="form-title">
										<h6><b>Email :</b></h6>
									</div>
									<div class="form-box up">
										<input type="text" name="email" placeholder="Votre email">
									</div>
								</div>

								<div class="col-lg-6 col-md-6">
									<!-- from title -->
									<div class="form-title">
										<h6><b>Téléphone Proche</b> <b style="color : red">* :</b></h6>
									</div>
									<div class="form-box up">
										<input type="text" name="telephone2" placeholder="Votre  Téléphone  d'un Proche">
									</div>
								</div>
								
								<div class="col-lg-6 col-md-6">
									<!-- from title -->
									<div class="form-title">
										<h6><b>Téléphone Whatssap</b><b style="color : red">* :</b></h6>
									</div>
									<div class="form-box up">
										<input type="text" name="telephone1" placeholder="Votre Téléphone Whatssap">
									</div>
								</div>

								<div class="col-lg-6 col-md-6">
									<!-- from title -->
									<div class="form-title">
										<h6><b>Groupe Sanguin</b><b style="color : red">* :</b></h6>
									</div>
									<div class="form-box up">
										<select class="form-select" name="groupesanguin" aria-label="Default select example">
                                            <option selected>Choisir Ici</option>
                                            <option value="O+">O+</option>
											<option value="O-">O-</option>
											<option value="AB+">AB+</option>
											<option value="AB+">AB+</option>
                                        </select>
									</div>
								</div>

								<div class="col-lg-6 col-md-6">
									<!-- from title -->
									<div class="form-title">
										<h6><b>Sexe</b> <b style="color : red">* :</b></h6>
									</div>
									<div class="form-box up">
										 <select class="form-select" name="sexe" aria-label="Default select example">
                                            <option selected>Choisir Ici</option>
                                            <option value="Masculin">Masculin</option>
											<option value="Feminin">Féminin</option>
                                        </select>
									</div>
								</div>
							</div>

							<div class="campaigns-button pt-3">
								<button>Valider</button>
							</div>
						</form>

						
						<div id="status"></div>
					</div> 					
				</div>
			</div>
		</div>
	</div>
	<!--==================================================-->
	<!-- End charina donate Secton -->
	<!--==================================================-->
</main>

@endsection