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index.html
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index.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Vaccination Record</title>
<!-- Bootstrap CSS -->
<!-- build:css css/main.css -->
<link rel="stylesheet" href="./node_modules/bootstrap/dist/css/bootstrap.min.css">
<link rel="stylesheet" href="/css/style.css">
<link rel="stylesheet" href="/css/index.css">
<link rel="stylesheet" href="./node_modules/font-awesome/css/font-awesome.min.css">
<link rel="preconnect" href="https://fonts.googleapis.com">
<link rel="preconnect" href="https://fonts.gstatic.com" crossorigin>
<link href="https://fonts.googleapis.com/css2?family=Oxygen&display=swap" rel="stylesheet">
<link rel="stylesheet" href="/css/style.css">
<!-- endbuild -->
</head>
<body>
<div id="navBar"></div>
<div class="container">
<div class="intro">
<div class="subtitle">
<h2 id="first">Fight against</h2>
<h2 id="second">COVID-19</h2>
<h2 id="third">together.</h2>
</div>
</div>
<div class="row">
<div class="col-12 col-md-6">
</div>
<div class="card col-12">
<div class="card-header bg-success text-white d-flex align-items-center">
<h4>Submit your vaccination information</h4>
</div>
<div class="card-body">
<form class="needs-validation" id="add-form">
<fieldset>
<div class="form-card">
<div class="form-group row">
<label for="first-name-input" class="col-12 col-md-3 col-form-label">Name</label>
<div class="col-12 col-md-4">
<input type="text" class="form-control" name="name" id="first-name-input" placeholder="First Name" required>
<div class="invalid-feedback">Please provide your first name.</div>
</div>
<div class="col-12 col-md-4">
<input type="text" class="form-control" name="name" id="last-name-input" placeholder="Last Name" required>
<div class="invalid-feedback">Please provide your last name.</div>
</div>
</div>
<div class="form-group row">
<label for="student-id-input" class="col-12 col-md-3 col-form-label">Student ID</label>
<div class="col-12 col-md-6">
<input type="text" class="form-control" name="studentId" id="student-id-input" placeholder="12345678" required>
<div class="invalid-feedback">Please provide your student ID.</div>
</div>
</div>
<div class="form-group row">
<label for="faculty-input" class="col-12 col-md-3 col-form-label">Faculty</label>
<div class="col-12 col-md-6">
<select class="form-control" name="faculty" id="faculty-input" required>
<option selected value="1">AHS</option>
<option value="2">ARTS</option>
<option value="3">ENG</option>
<option value="4">ENV</option>
<option value="5">MATH</option>
<option value="6">SCI</option>
</select>
<div class="invalid-feedback">Please select your faculty.</div>
</div>
</div>
<div class="form-group row">
<label for="visa-input" class="col-12 col-md-3 col-form-label">Visa Status</label>
<div class="col-12 col-md-6">
<select class="form-control" name="visa" id="visa-input" required>
<option selected value="1">Canadian</option>
<option value="2">Canadian Permanent Resident</option>
<option value="3">International</option>
</select>
<div class="invalid-feedback">Please select your visa status.</div>
</div>
</div>
<div class="form-group row">
<div class="d-flex justify-content-center">
<input type="button" name="next" class="btn btn-primary next action-button" value="Next" />
</div>
</div>
</div>
</fieldset>
<fieldset>
<div class="form-card">
<div class="form-group row">
<label for="dose-num-input" class="col-12 col-md-4 col-form-label">Number of Doses</label>
<div class="col-12 col-md-2">
<select class="form-control col-12 col-md-6" name="doseNum" id="dose-num-input">
<option selected value="0">0</option>
<option value="1">1</option>
<option value="2">2</option>
</select>
<div class="invalid-feedback">Please select the number of doses.</div>
</div>
</div>
<div class="vaccine-info" id="first-dose">
<div class="form-group row">
<label for="vaccine-date-input" class="col-12 col-md-3 col-form-label">Date</label>
<div class="col-12 col-md-9">
<input class="form-control" type="date" name="vaccine-date" id="vaccine-date-input-1">
<div class="invalid-feedback">Please provide your vaccination date.</div>
</div>
</div>
<div class="form-group row">
<label for="vaccine-type-input" class="col-12 col-md-3 col-form-label">Manufacturer</label>
<div class="col-12 col-md-9">
<select class="form-control" name="vaccine-type" id="vaccine-type-input-1">
<option selected value="1">Pfizer BioNTech Manufacturing
GmbH</option>
<option value="2">AstraZeneca, AB</option>
<option value="3">Moderna Biotech</option>
<option value="4">Janssen–Cilag International NV</option>
<option value="5">Sinovac</option>
<option value="6">Sinoharm/BIBP</option>
<option value="7">Other</option>
</select>
<div class="invalid-feedback">Please select the manufacurer name.</div>
</div>
</div>
</div>
<div class="vaccine-info" id="second-dose">
<div class="form-group row">
<label for="vaccine-date-input" class="col-12 col-md-3 col-form-label">Date</label>
<div class="col-12 col-md-9">
<input class="form-control" type="date" name="vaccine-date" id="vaccine-date-input-1">
<div class="invalid-feedback">Please provide your vaccination date.</div>
</div>
</div>
<div class="form-group row">
<label for="vaccine-type-input-1" class="col-12 col-md-3 col-form-label">Manufacturer</label>
<div class="col-12 col-md-9">
<select class="form-control" name="vaccine-type" id="vaccine-type-input-1">
<option selected value="1">Pfizer BioNTech Manufacturing
GmbH</option>
<option value="2">AstraZeneca, AB</option>
<option value="3">Moderna Biotech</option>
<option value="4">Janssen–Cilag International NV</option>
<option value="5">Sinovac</option>
<option value="6">Sinoharm/BIBP</option>
<option value="7">Other</option>
</select>
<div class="invalid-feedback">Please select the manufacurer name.</div>
</div>
</div>
</div>
<div class="form-group row">
<div class="d-flex justify-content-center">
<input type="button" name="prev" class="btn btn-secondary prev action-button" value="Previous" />
<input type="button" name="next" id="submit-btn" class="btn btn-primary next action-button submit-btn" value="Submit" />
</div>
</div>
</div>
</fieldset>
<fieldset>
<div class="form-group row">Thanks for your submission!</div>
<div class="form-group row">
<div class="d-flex justify-content-center">
<a class="return-btn" href="index.html">Return to Home<span class="sr-only">(current)</span></a>
</div>
</div>
</fieldset>
</form>
</div>
</div>
</div>
</div>
<div id="footer"></div>
<!-- build:js js/main.js -->
<script src="https://ajax.googleapis.com/ajax/libs/jquery/2.1.1/jquery.min.js"></script>
<script src="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/js/bootstrap.min.js"></script>
<script src="/node_modules/popper.js/dist/umd/popper.min.js"></script>
<!-- endbuild -->
<script type='text/javascript' src='/js/index.js'></script>
</body>
</html>