173 lines
9.6 KiB
HTML
173 lines
9.6 KiB
HTML
|
{{define "content"}}
|
||
|
|
|
||
|
|
<div class="max-w-7xl mx-auto px-4 sm:px-6 md:px-8">
|
||
|
|
<h1 class="text-2xl font-semibold text-gray-900">Ajouter un bénéficiaire</h1>
|
||
|
|
</div>
|
||
|
|
|
||
|
|
<div class="max-w-7xl mx-auto px-4 sm:px-6 md:px-8 mt-8"
|
||
|
|
x-data="{
|
||
|
|
fields: {
|
||
|
|
first_name: null,
|
||
|
|
last_name: null,
|
||
|
|
email: null,
|
||
|
|
phone_number: null,
|
||
|
|
birthdate: null
|
||
|
|
},
|
||
|
|
rules: {
|
||
|
|
first_name: ['required'],
|
||
|
|
last_name: ['required'],
|
||
|
|
email: ['required', 'email'],
|
||
|
|
phone_number: ['required', 'regexMatch:^((\\+)33|0)[1-9](\\d{2}){4}$'],
|
||
|
|
birthdate: ['optional'],
|
||
|
|
},
|
||
|
|
formValidation: {
|
||
|
|
valid: false,
|
||
|
|
fields: {
|
||
|
|
first_name: {valid: null},
|
||
|
|
last_name: {valid: null},
|
||
|
|
email: {valid: null},
|
||
|
|
phone_number: {valid: null},
|
||
|
|
birthdate: {valid: null},
|
||
|
|
}
|
||
|
|
},
|
||
|
|
isFormValid: true,
|
||
|
|
validate() {
|
||
|
|
this.formValidation = Iodine.assert(this.fields, this.rules)
|
||
|
|
},
|
||
|
|
validateField(field) {
|
||
|
|
this.formValidation.fields[field] = Iodine.assert(this.fields[field], this.rules[field])
|
||
|
|
},
|
||
|
|
submit(event) {
|
||
|
|
this.validate()
|
||
|
|
if(!this.formValidation.valid) {
|
||
|
|
this.isFormValid = false
|
||
|
|
event.preventDefault()
|
||
|
|
}
|
||
|
|
return this.formValidation.valid
|
||
|
|
}
|
||
|
|
}">
|
||
|
|
<form class="space-y-6" method="POST" @submit="submit">
|
||
|
|
<div class="bg-white shadow px-4 py-5 sm:rounded-lg sm:p-6">
|
||
|
|
<div class="md:grid md:grid-cols-3 md:gap-6">
|
||
|
|
<div class="md:col-span-1">
|
||
|
|
<h3 class="text-lg font-medium leading-6 text-gray-900">Informations obligatoires</h3>
|
||
|
|
<p class="mt-1 text-sm text-gray-500">Informations personnelles sur le bénéficiaire obligatoires
|
||
|
|
pour créer son profil dans PARCOURSMOB</p>
|
||
|
|
</div>
|
||
|
|
<div class="mt-5 md:mt-0 md:col-span-2">
|
||
|
|
<div class="grid grid-cols-6 gap-6">
|
||
|
|
<div class="col-span-6 sm:col-span-3">
|
||
|
|
<label for="first_name" class="block text-sm font-medium text-gray-700">Prénom</label>
|
||
|
|
<input type="text" name="first_name" id="first_name" autocomplete="given-name"
|
||
|
|
class="mt-1 focus:ring-co-blue focus:border-co-blue block w-full shadow-sm sm:text-sm rounded-2xl"
|
||
|
|
x-model="fields.first_name" @blur="validateField('first_name')"
|
||
|
|
:class="formValidation.fields.first_name.valid == false ? 'border-co-red border-2' : 'border-gray-300'">
|
||
|
|
</div>
|
||
|
|
|
||
|
|
<div class="col-span-6 sm:col-span-3">
|
||
|
|
<label for="last_name" class="block text-sm font-medium text-gray-700">Nom</label>
|
||
|
|
<input type="text" name="last_name" id="last_name" autocomplete="family-name"
|
||
|
|
class="mt-1 focus:ring-co-blue focus:border-co-blue block w-full shadow-sm sm:text-sm rounded-2xl"
|
||
|
|
x-model="fields.last_name" @blur="validateField('last_name')"
|
||
|
|
:class="formValidation.fields.last_name.valid == false ? 'border-co-red border-2' : 'border-gray-300'">
|
||
|
|
</div>
|
||
|
|
|
||
|
|
<div class="col-span-6 sm:col-span-4">
|
||
|
|
<label for="email" class="block text-sm font-medium text-gray-700">Email</label>
|
||
|
|
<input type="text" name="email" id="email" autocomplete="email"
|
||
|
|
class="mt-1 focus:ring-co-blue focus:border-co-blue block w-full shadow-sm sm:text-sm rounded-2xl"
|
||
|
|
x-model="fields.email" @blur="validateField('email')"
|
||
|
|
:class="formValidation.fields.email.valid == false ? 'border-co-red border-2' : 'border-gray-300'">
|
||
|
|
</div>
|
||
|
|
|
||
|
|
<div class="col-span-6 sm:col-span-4">
|
||
|
|
<label for="phone_number" class="block text-sm font-medium text-gray-700">Numéro de
|
||
|
|
téléphone</label>
|
||
|
|
<input type="text" name="phone_number" id="phone_number" autocomplete="phone" placeholder="+33612345678"
|
||
|
|
class="mt-1 focus:ring-co-blue focus:border-co-blue block w-full shadow-sm sm:text-sm rounded-2xl"
|
||
|
|
x-model="fields.phone_number" @blur="validateField('phone_number')"
|
||
|
|
:class="formValidation.fields.phone_number.valid == false ? 'border-co-red border-2' : 'border-gray-300'">
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
|
||
|
|
<div class="bg-white shadow px-4 py-5 sm:rounded-lg sm:p-6">
|
||
|
|
<div class="md:grid md:grid-cols-3 md:gap-6">
|
||
|
|
<div class="md:col-span-1">
|
||
|
|
<h3 class="text-lg font-medium leading-6 text-gray-900">Informations optionnelles</h3>
|
||
|
|
<p class="mt-1 text-sm text-gray-500">Autres informations de profil optionnelles</p>
|
||
|
|
</div>
|
||
|
|
<div class="mt-5 space-y-6 md:mt-0 md:col-span-2">
|
||
|
|
<div class="grid grid-cols-6 gap-6">
|
||
|
|
|
||
|
|
<div class="col-span-6 sm:col-span-3">
|
||
|
|
<label for="birthdate" class="block text-sm font-medium text-gray-700">Date de
|
||
|
|
naissance</label>
|
||
|
|
<input type="date" name="birthdate" id="birthdate" autocomplete="birthdate" placeholder="JJ/MM/AAAA"
|
||
|
|
class="mt-1 focus:ring-co-blue focus:border-co-blue block w-full shadow-sm sm:text-sm rounded-2xl"
|
||
|
|
x-model="fields.birthdate" @blur="validateField('birthdate')"
|
||
|
|
:class="formValidation.fields.birthdate.valid == false ? 'border-co-red border-2' : 'border-gray-300'">
|
||
|
|
</div>
|
||
|
|
|
||
|
|
<div class="col-span-6 sm:col-span-3">
|
||
|
|
<label for="gender" class="block text-sm font-medium text-gray-700">Genre</label>
|
||
|
|
<div class="sm:mt-0 sm:col-span-2">
|
||
|
|
<select id="gender" name="gender" autocomplete="gender" x-model="gender"
|
||
|
|
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">
|
||
|
|
<option value="0">Inconnu</option>
|
||
|
|
<option value="1">Masculin</option>
|
||
|
|
<option value="2">Féminin</option>
|
||
|
|
<option value="9">Sans objet</option>
|
||
|
|
</select>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
|
||
|
|
<!-- <div class="col-span-3 sm:col-span-3">
|
||
|
|
<label class="block text-sm font-medium text-gray-700"> Photo </label>
|
||
|
|
<div class="mt-1 flex items-center space-x-5">
|
||
|
|
<span class="inline-block h-12 w-12 rounded-co overflow-hidden bg-gray-100">
|
||
|
|
{{.IconSet.Icon "img:profile-picture-placeholder" "h-full w-full"}}
|
||
|
|
</span>
|
||
|
|
<button type="button"
|
||
|
|
class="bg-white py-2 px-3 border border-gray-300 rounded-2xl shadow-sm text-sm leading-4 font-medium text-gray-700 hover:bg-gray-50 focus:outline-none focus:ring-2 focus:ring-offset-2 focus:ring-co-blue">
|
||
|
|
Charger la photo
|
||
|
|
</button>
|
||
|
|
</div>
|
||
|
|
</div> -->
|
||
|
|
|
||
|
|
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
<div class="bg-white shadow px-4 py-5 sm:rounded-lg sm:p-6">
|
||
|
|
<div class="md:grid md:grid-cols-3 md:gap-6">
|
||
|
|
<div class="md:col-span-1">
|
||
|
|
<h3 class="text-lg font-medium leading-6 text-gray-900">Paramètres</h3>
|
||
|
|
<p class="mt-1 text-sm text-gray-500">Paramètres liés au bénéficiaire, utiles pour exploiter les fonctionnalités de PARCOURSMOB</p>
|
||
|
|
</div>
|
||
|
|
<div class="mt-5 space-y-6 md:mt-0 md:col-span-2">
|
||
|
|
|
||
|
|
{{ $fieldName := "address" }}
|
||
|
|
{{ template "address_autocomplete" dict "FieldName" $fieldName }}
|
||
|
|
|
||
|
|
<!-- will dolater : tags, groups, ... -->
|
||
|
|
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
</div>
|
||
|
|
|
||
|
|
<div class="flex justify-end">
|
||
|
|
<p x-show="! isFormValid" class="px-4 py-2 text-sm text-co-red">Certains champs de sont pas valides.</p>
|
||
|
|
<a href="/app/beneficiaries/">
|
||
|
|
<button type="button"
|
||
|
|
class="bg-white py-2 px-4 border border-gray-300 rounded-2xl shadow-sm text-sm font-medium text-gray-700 hover:bg-gray-50 focus:outline-none focus:ring-2 focus:ring-offset-2 focus:ring-co-blue">Annuler</button>
|
||
|
|
</a>
|
||
|
|
<button type="submit"
|
||
|
|
class="ml-3 inline-flex justify-center py-2 px-4 border border-transparent shadow-sm text-sm font-medium rounded-2xl text-white bg-co-blue hover:bg-co-blue focus:outline-none focus:ring-2 focus:ring-offset-2 focus:ring-co-blue">Créer le bénéficiaire</button>
|
||
|
|
</div>
|
||
|
|
</form>
|
||
|
|
</div>
|
||
|
|
{{end}}
|