import { PageHeader } from "./components/index.js";

const AnmeldeformularPreview = ({ widgetFor, entry }) => {
  return [
    PageHeader(entry),
    h(
      "section",
      { className: "section-sm bg-body-tertiary" },
      h(
        "div",
        { className: "container" },
        h(
          "div",
          { className: "row" },
          h(
            "div",
            { className: "col-lg-8 mb-4 mb-lg-0" },
            h(
              "form",
              {},
              h(
                "div",
                { className: "input-group" },
                h("input", {
                  className: "form-control mb-3",
                  type: "text",
                  placeholder: "Name (Schüler/in)",
                }),
                h("input", {
                  className: "form-control mb-3",
                  type: "text",
                  placeholder: "Vorname",
                })
              ),
              h(
                "div",
                { className: "input-group mb-3" },
                h("span", { className: "input-group-text" }, "Geburtsdatum"),
                h("input", { className: "form-control", type: "date" })
              ),
              h("input", {
                className: "form-control mb-3",
                type: "text",
                placeholder: "Straße",
              }),
              h(
                "div",
                { className: "input-group" },
                h("input", {
                  className: "form-control mb-3",
                  type: "text",
                  placeholder: "Hausnummer",
                }),
                h("input", {
                  className: "form-control mb-3",
                  type: "text",
                  placeholder: "Adresszusatz",
                })
              ),
              h(
                "div",
                { className: "input-group" },
                h("input", {
                  className: "form-control mb-3",
                  type: "text",
                  placeholder: "PLZ",
                }),
                h("input", {
                  className: "form-control mb-3",
                  type: "text",
                  placeholder: "Stadt",
                })
              ),
              h("input", {
                className: "form-control mb-3",
                type: "text",
                placeholder: "Landkreis",
              }),
              h(
                "div",
                { className: "input-group" },
                h("input", {
                  className: "form-control mb-3",
                  type: "text",
                  placeholder: "Telefon privat",
                }),
                h("input", {
                  className: "form-control mb-3",
                  type: "text",
                  placeholder: "Telefon dienstl.",
                })
              ),
              h("input", {
                className: "form-control mb-3",
                type: "text",
                placeholder: "Abweichender Elternname",
              }),
              h("input", {
                className: "form-control mb-3",
                type: "text",
                placeholder: "Grundschule",
              }),
              h("input", {
                className: "form-control mb-3",
                type: "text",
                placeholder: "Ihre E-Mail-Adresse",
              }),
              h("textarea", {
                className: "form-control mb-3",
                placeholder: "Bemerkungen",
              }),
              h(
                "div",
                { className: "input-group mb-3" },
                h("input", { className: "form-control", type: "file" }),
                h(
                  "span",
                  { className: "input-group-text" },
                  "Zeugnis (Vorderseite)"
                )
              ),
              h(
                "div",
                { className: "input-group mb-3" },
                h("input", { className: "form-control", type: "file" }),
                h(
                  "span",
                  { className: "input-group-text" },
                  "Zeugnis (Rückseite)"
                )
              ),
              h(
                "div",
                { className: "input-group mb-3" },
                h(
                  "div",
                  { className: "input-group-text" },
                  h("input", {
                    className: "form-check-input",
                    type: "checkbox",
                  })
                ),
                h(
                  "p",
                  { className: "form-control mb-0" },
                  "Hiermit melden wir unser Kind verbindlich zur Aufnahmeprüfung an."
                )
              ),
              h("button", { className: "btn btn-primary" }, "Senden")
            )
          ),
          h("div", { className: "col-lg-4" }, widgetFor("body"))
        )
      )
    ),
  ];
};

export default AnmeldeformularPreview;