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yanachristian

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Mar 20th, 2017
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  1. <h2>Registration Page</h2>
  2.  
  3. <form method="post">
  4. <fieldset>
  5. <legend>Student Data</legend>
  6. <table>
  7. <tr>
  8. <td>First Name</td>
  9. <td> : <input type="text" name="first_name" autofocus="">
  10. <font color = "red"><p><?php echo form_error('first_name'); ?></p></font>
  11. </td>
  12. </tr>
  13. <tr>
  14. <td>Middle Name</td>
  15. <td> : <input type="text" name="middle_name">
  16. <font color = "red"><p><?php echo form_error('middle_name'); ?></p></font>
  17. </td>
  18. </tr>
  19. <tr>
  20. <td>Last Name</td>
  21. <td> : <input type="text" name="last_name">
  22. <font color = "red"><p><?php echo form_error('last_name'); ?></p></font>
  23. </td>
  24. </tr>
  25. <tr>
  26. <td>Gender</td>
  27. <td>
  28. : <input type="radio" name="gender" value="M"> Male &nbsp;
  29. <input type="radio" name="gender" value="F"> Female
  30. <font color = "red"><p><?php echo form_error('gender'); ?></p></font>
  31. </td>
  32. </tr>
  33. <tr>
  34. <td>Email</td>
  35. <td> : <input type="text" name="email">
  36. <font color = "red"><p><?php echo form_error('email'); ?></p></font>
  37. </td>
  38. </tr>
  39. <tr>
  40. <td>Place of Birth</td>
  41. <td> : <input type="text" name="place_of_birth">
  42. <font color = "red"><p><?php echo form_error('place_of_birth'); ?></p></font>
  43. </td>
  44. </tr>
  45. <tr>
  46. <td>Date of Birth</td>
  47. <td> : <input type="date" name="date_of_birth">
  48. <font color = "red"><p><?php echo form_error('date_of_birth'); ?></p></font>
  49. </td>
  50. </tr>
  51. <tr>
  52. <td>Home Address</td>
  53. <td> : <textarea name="address" cols="30" rows="10"></textarea>
  54. <font color = "red"><p><?php echo form_error('address'); ?></p></font>
  55. </td>
  56. </tr>
  57. <tr>
  58. <td>Province</td>
  59. <td> : <input type="text" name="province">
  60. <font color = "red"><p><?php echo form_error('province'); ?></p></font>
  61. </td>
  62. </tr>
  63. <tr>
  64. <td>Districts</td>
  65. <td> : <input type="text" name="districts">
  66. <font color = "red"><p><?php echo form_error('districts'); ?></p></font>
  67. </td>
  68. </tr>
  69. <tr>
  70. <td>Postal Code</td>
  71. <td> : <input type="text" name="postal_code">
  72. <font color = "red"><p><?php echo form_error('postal_code'); ?></p></font>
  73. </td>
  74. </tr>
  75. <tr>
  76. <td>Phone No.</td>
  77. <td> : <input type="text" name="phone">
  78. <font color = "red"><p><?php echo form_error('phone'); ?></p></font>
  79. </td>
  80. </tr>
  81. </table>
  82. </fieldset>
  83. <p>&nbsp;</p>
  84. <fieldset>
  85. <legend>Parent's Data</legend>
  86. <table>
  87. <tr>
  88. <td>Father's Full Name</td>
  89. <td> : <input type="text" name="father_name">
  90. <font color = "red"><p><?php echo form_error('father_name'); ?></p></font>
  91. </td>
  92. </tr>
  93. <tr>
  94. <td>Father's Occupation</td>
  95. <td> : <input type="text" name="father_occupation">
  96. <font color = "red"><p><?php echo form_error('father_occupation'); ?></p></font>
  97. </td>
  98. </tr>
  99. <tr>
  100. <td>Father's Phone No.</td>
  101. <td> : <input type="text" name="father_phone">
  102. <font color = "red"><p><?php echo form_error('father_phone'); ?></p></font>
  103. </td>
  104. </tr>
  105. <tr><td>&nbsp;</td></tr>
  106. <tr>
  107. <td>Mother's Full Name</td>
  108. <td> : <input type="text" name="mother_name">
  109. <font color = "red"><p><?php echo form_error('mother_name'); ?></p></font>
  110. </td>
  111. </tr>
  112. <tr>
  113. <td>Mother's Occupation</td>
  114. <td> : <input type="text" name="mother_occupation">
  115. <font color = "red"><p><?php echo form_error('mother_occupation'); ?></p></font>
  116. </td>
  117. </tr>
  118. <tr>
  119. <td>Mother's Phone No.</td>
  120. <td> : <input type="text" name="mother_phone">
  121. <font color = "red"><p><?php echo form_error('mother_phone'); ?></p></font>
  122. </td>
  123. </tr>
  124. <tr><td>&nbsp;</td></tr>
  125. <tr>
  126. <td>Parent's Address</td>
  127. <td> : <textarea name="parent_address" cols="30" rows="10"></textarea>
  128. <font color = "red"><p><?php echo form_error('parent_address'); ?></p></font>
  129. </td>
  130. </tr>
  131. <tr>
  132. <td colspan="2" align="right"> <input type="submit" value="Submit Data"> </td>
  133. </tr>
  134. </table>
  135. </fieldset>
  136. <p>&nbsp;</p>
  137. </form>
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