HEX
Server: Microsoft-IIS/8.5
System: Windows NT YDAWBH120 6.3 build 9600 (Windows Server 2012 R2 Standard Edition) AMD64
User: tentjecom_web (0)
PHP: 7.4.14
Disabled: NONE
Upload Files
File: D:/HostingSpaces/SBogers107/jeugdsportdagen.nl/app/storage/views/6865b48bcac6e911018716965856cd5a
<div class="contact-form subscribe-form host-form <?php if(\Input::has('v') && \Input::get('v') == 'b'): ?> small-form <?php endif; ?> ">
    <div class="inner">
        <h3>Inschrijfformulier</h3>

        <?php if(\Input::has('success') && \Input::get('success') == 'true'): ?>
            <div class="thanks">
                <h2><?php echo \Illuminate\Support\Facades\Lang::get('mail.thanks'); ?></h2>
                <p>
                    <?php echo \Illuminate\Support\Facades\Lang::get('mail.contact.thanksMessage'); ?>
                </p>
            </div>
        <?php else: ?>

            <?php echo Form::open(['url' => URL::to(route('hostForm.process'), [], true), 'id' => 'hostForm', 'class' => 'form']); ?>

            <div class="form-first-column">
                <div class="name form-element multiple-elements">
                    <div class="first_name">
                        <span class="error <?php echo ($errors->has('first_name')? 'active' :''); ?>"><?php echo $errors->first('first_name'); ?></span>
                        <?php echo Form::label('first_name',trans('translations.first_name')); ?>

                        <?php echo Form::text('first_name', Input::old('first_name'), ['id' => 'first_name', 'placeholder'=> trans('translations.first_name')]); ?>

                    </div>
                    <div class="last_name">
                        <span class="error <?php echo ($errors->has('last_name')? 'active' :''); ?>"><?php echo $errors->first('last_name'); ?></span>
                        <?php echo Form::label('last_name',trans('translations.last_name')); ?>

                        <?php echo Form::text('last_name', Input::old('last_name'), ['id' => 'last_name', 'placeholder'=> trans('translations.last_name')]); ?>

                    </div>
                </div>

                <div class="address form-element">
                    <span class="error <?php echo ($errors->has('address')? 'active' :''); ?>"><?php echo $errors->first('address'); ?></span>
                    <?php echo Form::label('address',trans('translations.address')); ?>

                    <?php echo Form::text('address', Input::old('address'), ['id' => 'address', 'placeholder'=> trans('translations.address')]); ?>

                </div>

                <div class="city-location form-element multiple-elements">

                    <div class="zip">
                        <span class="error <?php echo ($errors->has('zip')? 'active' :''); ?>"><?php echo $errors->first('zip'); ?></span>
                        <?php echo Form::label('zip',trans('translations.zip')); ?>

                        <?php echo Form::text('zip', Input::old('zip'), ['id' => 'zip', 'placeholder'=> trans('translations.zip')]); ?>

                    </div>

                    <div class="city">
                        <span class="error <?php echo ($errors->has('city')? 'active' :''); ?>"><?php echo $errors->first('city'); ?></span>
                        <?php echo Form::label('city',trans('translations.city')); ?>

                        <?php echo Form::text('city', Input::old('city'), ['id' => 'city', 'placeholder'=> trans('translations.city')]); ?>

                    </div>

                </div>

                <div class="phone form-element">
                    <span class="error <?php echo ($errors->has('phone')? 'active' :''); ?>"><?php echo $errors->first('phone'); ?></span>
                    <?php echo Form::label('phone',trans('translations.mobilePhone')); ?>

                    <?php echo Form::text('phone', Input::old('phone'), ['id' => 'phone', 'placeholder'=> trans('translations.mobilePhone')]); ?>

                </div>


                <div class="email form-element">
                    <span class="error <?php echo ($errors->has('email')? 'active' :''); ?>"><?php echo $errors->first('email'); ?></span>
                    <?php echo Form::label('email',trans('translations.email_clean')); ?>

                    <?php echo Form::email('email', Input::old('email'), ['id' => 'email', 'placeholder'=> trans('translations.email_clean')]); ?>

                </div>

                <?php if ( ! (\Input::has('v') && \Input::get('v') == 'b')): ?>

            </div>

            <div class="form-second-column">

                <?php endif; ?>


                <div class="sleepPlaces select-element form-element">
                    <?php echo Form::label('sleepPlaces',trans('translations.sleepPlaces')); ?>

                    <span class="icon"></span>
                    <?php echo Form::select('sleepPlaces',['2' => '2','3' => '3','4'=> '4','5'=> '5','6'=> '6',],Input::get('sleepPlaces'), ['id' =>'sleepPlaces']); ?>

                </div>

                <div class="countryPreference select-element form-element">
                    <?php echo Form::label('countryPreference',trans('translations.countryPreference')); ?>

                    <span class="icon"></span>
                    <?php echo Form::select('countryPreference',['Geen voorkeur' => 'Geen voorkeur', 'Belgiƫ' => 'Belgiƫ','Duitsland' => 'Duitsland','Luxemburg'=> 'Luxemburg'],Input::get('countryPreference'), ['id' =>'countryPreference']); ?>

                </div>

                <div class="genderPreference select-element form-element">
                    <?php echo Form::label('genderPreference','Voorkeur jongens of meisjes?'); ?>

                    <span class="icon"></span>
                    <?php echo Form::select('genderPreference',['Geen voorkeur' => 'Geen voorkeur','Meisjes' => 'Meisjes','Jongens'=> 'Jongens',],Input::get('genderPreference'), ['id' =>'genderPreference']); ?>

                </div>

                <div id="sport" class="sport checkboxes form-element">
                    <p>Voorkeur voor sporters?<br/><small>Bij geen voorkeur leeg laten.</small></p>
                    <span class="error-message <?php echo ($errors->has('sport')? 'active' :''); ?>"><?php echo $errors->first('sport'); ?></span>
                    <span class="icon"></span>
                    <?php foreach(['Volleybal','Atletiek','Voetbal','Zwemmen','Basketbal'] as $key => $sport): ?>
                        <label>
                            <?php echo Form::checkbox('sport[]', $sport); ?>

                            <?php echo $sport; ?>

                        </label>
                    <?php endforeach; ?>
                </div>

                <div id="sport_type" class="sport_type checkboxes form-element">
                    <p>Ik bied plaats aan:<br/><small>Bij geen voorkeur leeg laten.</small></p>
                    <span class="error-message <?php echo ($errors->has('sport_type')? 'active' :''); ?>"><?php echo $errors->first('sport_type'); ?></span>
                    <span class="icon"></span>
                    <?php foreach(['Sporters','Coaches'] as $key => $sport_type): ?>
                        <label>
                            <?php echo Form::checkbox('sport_type[]', $sport_type); ?>

                            <?php echo $sport_type; ?>

                        </label>
                    <?php endforeach; ?>
                </div>

                <div class="extra_message form-element text-area">
                    <span class="error <?php echo ($errors->has('formMessage')? 'active' :''); ?>"><?php echo $errors->first('formMessage'); ?></span>
                    <?php echo Form::label('formMessage',trans('translations.extraMessage2')); ?>

                    <?php echo Form::textarea('formMessage', Input::old('formMessage') ,['id'=>'formMessage', 'rows'=>'6', 'data-autoresize'=>'', 'placeholder' => trans('translations.extraMessage2')]); ?>

                </div>
                <div class="submit">
                    <?php /*<p><?php echo \Illuminate\Support\Facades\Lang::get('translations.send'); ?></p>*/ ?>
                    <?php echo Form::submit(trans('translations.send')); ?>

                </div>
            </div>


            <?php echo Form::close(); ?>

        <?php endif; ?>
    </div>
</div>