solidarity carpool
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@@ -103,7 +103,7 @@
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</div>
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<div class="col-span-6 sm:col-span-3">
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<label for="file_number" class="block text-sm font-medium text-gray-700">Numéro de dossier (CAF / Pole Emploi ...)</label>
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<label for="file_number" class="block text-sm font-medium text-gray-700">Numéro de dossier</label>
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<input type="text" name="file_number" id="file_number"
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class="mt-1 focus:ring-co-blue focus:border-co-blue block w-full shadow-sm sm:text-sm rounded-2xl"
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x-model="fields.file_number" @blur="validateField('file_number')"
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@@ -135,6 +135,55 @@
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</select>
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</div>
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</div>
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<div class="col-span-6 sm:col-span-3">
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<label for="situation" class="block text-sm font-medium text-gray-700">Situation sociale</label>
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<div class="sm:mt-0 sm:col-span-2">
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<select id="situation" name="situation" autocomplete="situation" x-model="other_properties.situation"
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class="max-w-lg mt-1 block focus:ring-co-blue focus:border-co-blue w-full shadow-sm sm:max-w-xs sm:text-sm border-gray-300 rounded-2xl">
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<option value="">Inconnu</option>
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<option value="BRSA">BRSA</option>
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<option value="Demandeur d'emploi">Demandeur d'emploi</option>
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<option value="Chantier">Chantier</option>
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<option value="Jeune -25">Jeune -25</option>
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</select>
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</div>
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</div>
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<div class="col-span-6 sm:col-span-3">
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<label for="situation" class="block text-sm font-medium text-gray-700">Motif d'inscription</label>
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<div class="sm:mt-0 sm:col-span-2">
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<select id="situation" name="situation" autocomplete="situation" x-model="other_properties.subscription_reason"
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class="max-w-lg mt-1 block focus:ring-co-blue focus:border-co-blue w-full shadow-sm sm:max-w-xs sm:text-sm border-gray-300 rounded-2xl">
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<option value="Autre">Inconnu</option>
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<option value="Pas de permis">Pas de permis</option>
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<option value="Pas de véhicule">Pas de véhicule</option>
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<option value="Perte d'autonomie">Perte d'autonomie</option>
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<option value="Autre">Autre</option>
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</select>
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</div>
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</div>
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<div class="col-span-6 sm:col-span-3">
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<label for="status" class="block text-sm font-medium text-gray-700">Statut (prioritaire / non prioritaire)</label>
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<div class="sm:mt-0 sm:col-span-2">
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<select id="status" name="status" autocomplete="status" x-model="other_properties.status"
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class="max-w-lg mt-1 block focus:ring-co-blue focus:border-co-blue w-full shadow-sm sm:max-w-xs sm:text-sm border-gray-300 rounded-2xl">
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<option value="Non prioritaire">Non prioritaire</option>
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<option value="Prioritaire">Prioritaire</option>
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</select>
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</div>
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</div>
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<div class="col-span-6 sm:col-span-3">
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<label for="last_subscription_date" class="block text-sm font-medium text-gray-700">Date de dernière adhésion</label>
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<input type="date" name="last_subscription_date" id="last_subscription_date" autocomplete="last_subscription_date" placeholder="JJ/MM/AAAA"
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class="mt-1 focus:ring-co-blue focus:border-co-blue block w-full shadow-sm sm:text-sm rounded-2xl"
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x-model="other_properties.last_subscription_date">
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</div>
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<div class="col-span-6 sm:col-span-3">
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<label for="comment" class="block text-sm font-medium text-gray-700">Commentaire</label>
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<textarea name="comment" id="comment"
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class="mt-1 focus:ring-co-blue focus:border-co-blue block w-full shadow-sm sm:text-sm rounded-2xl"
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x-model="other_properties.comment"></textarea>
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</div>
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<!-- <div class="col-span-3 sm:col-span-3">
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<label class="block text-sm font-medium text-gray-700"> Photo </label>
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@@ -186,4 +235,4 @@
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</div>
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</form>
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</div>
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{{end}}
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{{end}}
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