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- <!DOCTYPE html>
- <html lang="en">
- <head>
- <title>Belajar Form Validation</title>
- <link rel="stylesheet" href="https://stackpath.bootstrapcdn.com/bootstrap/4.4.1/css/bootstrap.min.css">
- <link rel="stylesheet" href="style.css">
- </head>
- <header>
- <div class="kotak"></div>
- <div class="jarak"></div>
- <h4>
- <img src="Logo ITS.png" alt="logoIts" height="100" width="100">
- VALIDASI VAKSIN COVID
- </h4>
- </header>
- <style>
- body{
- background-image: url(BG.jpg);
- background-repeat: no-repeat;
- background-size:cover;
- }
- </style>
- <body>
- <div class="dsc">
- <p>
- Pengisian form dibutuhkan sebagai syarat untuk melakukan pembelajaran secara tatap muka langsung
- </p>
- </div>
- <div class="jarak"></div>
- <div class="container" style="max-width: 600px;">
- <form name="formPendaftaran" >
- <div class="form-group">
- <label>Nama lengkap</label>
- <input type="text" name="nama" placeholder="Nama lengkap" class="form-control">
- </div>
- <div class="form-group">
- <label>NRP </label>
- <input type="text" name="NRP" placeholder="NRP Mahasiswa" class="form-control">
- </div>
- <div class="form-group">
- <label>Asal Daerah </label>
- <input type="text" name="ASAL" placeholder="Kota, Provinsi" class="form-control">
- </div>
- <div class="form-group">
- <label>Alamat KTP </label>
- <textarea class="form-control" name="Alamat" id="alm" rows="3" style="margin-top: 0px; margin-bottom: 0px; height: 95px;"></textarea>
- </div>
- <div class="form-group">
- <label>Jurusan</label>
- <select name="jurusan" class="form-control">
- <option value="0">Pilih Jurusan</option>
- <option value="1">Informatika</option>
- <option value="2">Sistem Informasi</option>
- <option value="3">Teknologi Informasi</option>
- </select>
- </div>
- <div class="form-group">
- <label>Status Vaksininasi</label>
- <select name="jurusan" class="form-control">
- <option value="0">Belum Vaksin</option>
- <option value="1">Vaksin 1</option>
- <option value="2">Vaksin 2</option>
- <option value="3">Takut Paksin</option>
- </select>
- </div>
- <div class="form-group">
- <label>Email</label>
- <input type="email" name="email" placeholder="Email Aktif" class="form-control">
- <small id="emailHelp" class="form-text text-muted">Email Akan Digunakan Untuk Mengirimkan Notifikasi.</small>
- </div>
- <button type="submit" class="btn btn-primary " >SUBMIT</button>
- </form>
- </div>
- </body>
- <footer>
- <div class="jarak2"></div>
- @Copyright Baru Buat 2021
- </footer>
- </html>
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