82 lines
4.7 KiB
HTML
82 lines
4.7 KiB
HTML
{{ define "main" }}
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<section class="section" data-pagefind-body>
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<div class="container">
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<div class="row">
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<div class="col-lg-8 mb-4 mb-lg-0">
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<form action="https://forms.cantorgymnasium.de/form/gcg-aufnahmeformular" method="post" enctype="multipart/form-data">
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<div hidden>
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<input type="text" id="bad_email" name="bad_email" value="" />
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</div>
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<div class="input-group">
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<input type="text" class="form-control mb-3" id="student_surname" name="student_surname" placeholder="Name (Schüler/in)" required>
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<input type="text" class="form-control mb-3" id="student_name" name="student_name" placeholder="Vorname" required>
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</div>
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<div class="input-group mb-3">
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<input type="text" class="form-control" id="student_sex" name="student_sex" placeholder="Geschlecht" required>
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<span class="input-group-text">Geburtsdatum</span>
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<input type="date" class="form-control" id="student_birthday" name="student_birthday" min="2005-01-01" required>
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</div>
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<input type="text" class="form-control mb-3" id="street" name="street" placeholder="Straße" required>
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<div class="input-group">
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<input type="text" class="form-control mb-3" id="house" name="house" placeholder="Hausnummer" required>
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<input type="text" class="form-control mb-3" id="adresszusatz" name="adresszusatz" placeholder="Adresszusatz">
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</div>
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<div class="input-group">
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<input type="text" inputmode="numeric" class="form-control mb-3" id="zipcode" name="zipcode" placeholder="PLZ" pattern="[0-9]{5}" title="Postleitzahlen bestehen aus exakt 5 Ziffern" required>
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<input type="text" class="form-control mb-3" id="city" name="city" placeholder="Stadt" required>
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</div>
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<input type="text" class="form-control mb-3" id="landkreis" name="landkreis" placeholder="Landkreis">
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<div class="input-group">
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<input type="tel" class="form-control mb-3" id="tpriv" name="tpriv" placeholder="Telefon privat">
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<input type="tel" class="form-control mb-3" id="tdienstl" name="tdienstl" placeholder="Telefon dienstl.">
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</div>
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<div class="input-group">
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<select class="form-control" name="anrede_1" id="anrede_1" required>
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<option value="keine Angabe">keine Angabe</option>
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<option value="Herr">Herr</option>
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<option value="Frau">Frau</option>
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</select>
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<input type="text" class="form-control" id="parent_name_1" name="parent_name_1" placeholder="Nachname (Erziehungsberechtigter 1)" required>
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</div>
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<div class="input-group mb-3">
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<select class="form-control" name="anrede_2" id="anrede_2">
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<option value="keine Angabe">keine Angabe</option>
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<option value="Herr">Herr</option>
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<option value="Frau">Frau</option>
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</select>
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<input type="text" class="form-control" id="parent_name_2" name="parent_name_2" placeholder="Nachname (Erziehungsberechtigter 2)">
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</div>
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<input type="text" class="form-control mb-3" id="grundschule" name="grundschule" placeholder="Grundschule" required>
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<input type="email" class="form-control mb-3" id="parent_email" name="parent_email" placeholder="Ihre E-Mail-Adresse" required>
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<textarea id="message" name="message" class="form-control mb-3" placeholder="Bemerkungen"></textarea>
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<div class="input-group mb-3">
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<input type="file" class="form-control" id="zeugnis_1" name="zeugnis_1" accept="image/*,.pdf">
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<span class="input-group-text">Zeugnis (Vorderseite)</span>
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</div>
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<div class="input-group mb-3">
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<input type="file" class="form-control" id="zeugnis_2" name="zeugnis_2" accept="image/*,.pdf">
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<span class="input-group-text">Zeugnis (Rückseite)</span>
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</div>
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<div class="input-group mb-3">
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<input type="file" class="form-control" id="slbe" name="slbe" accept="image/*,.pdf">
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<span class="input-group-text">Schullaufbahnempfehlung</span>
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</div>
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<div class="input-group mb-3">
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<div class="input-group-text">
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<input type="checkbox" class="form-check-input" id="accept" name="accept" required>
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</div>
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<p class="form-control mb-0">Hiermit melden wir unser Kind verbindlich zur Aufnahmeprüfung an.</p>
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</div>
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<button type="submit" value="send" class="btn btn-primary">Senden</button>
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</form>
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</div>
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<div class="col-lg-4">
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{{ .Content }}
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</div>
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</div>
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</div>
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</section>
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{{ end }}
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