@extends('site.master')

@section('content')
    @include('site.partials.backToEHBO')
    <h1 class="register-header">@lang('auth.register')</h1>
    <div class="register centered">
        <div class="placeholder">
            <form action="{{ route('site.register') }}" method="POST">
                {{ csrf_field() }}
                {{ method_field('POST') }}

                {{--@if($errors->has('message'))--}}
                {{--<div class="alert warning">--}}
                {{--{!! $errors->first('message') !!}--}}
                {{--</div>--}}
                {{--@endif--}}

                @if($errors->any())
                    <div class="general-alert">
                        Niet alle velden zijn correct ingevuld.
                    </div>
                @endif


                @if(Session::has('success'))
                    <div class="alert success">
                        {!! Session::get('success')->first() !!}
                    </div>
                @endif

                <div class="form-group{{ $errors->has('gender') || $errors->has('first_name') || $errors->has('last_name') || $errors->has('birth_date') || $errors->has('age') ? ' has-error' : '' }}">
                    <span class="icon person green">@include('svg.icons.person')</span>
                    <div class="form-element grid-col col-12">

                        @foreach(\App\KommaApp\Users\Genders::getAsArray() as $genderValue)
                            <label class="gender">
                                <input type="radio" name="gender"
                                       {{ (!empty(old('gender')) && old('gender') == $genderValue) ? 'checked' : ''}}
                                       value="{{ $genderValue }}">@lang('auth.genders.'.$genderValue)</label>
                        @endforeach
                        <span class="error-message {{($errors->has('gender')? 'active' :'')}}">{{$errors->first('gender')}}</span>
                    </div>
                    <div class="form-element grid-col col-5">
                        <label for="first_name">@lang('auth.first_name')</label>
                        <input type="text" name="first_name" placeholder="@lang('auth.first_name')"
                               value="{{ old('first_name') }}">
                        <span class="error-message {{($errors->has('first_name')? 'active' :'')}}">{{$errors->first('first_name')}}</span>
                    </div>
                    <div class="form-element grid-col col-6">
                        <label for="last_name">@lang('auth.last_name')</label>
                        <input type="text" name="last_name" placeholder="@lang('auth.last_name')"
                               value="{{ old('last_name') }}">
                        <span class="error-message {{($errors->has('last_name')? 'active' :'')}}">{{$errors->first('last_name')}}</span>
                    </div>
                    <div class="form-element grid-col col-5">
                        <label for="birth_date">@lang('auth.birthdate')</label>
                        <div class="select-wrapper">
                            <select name="birth_date_day">
                                @for($i = 1; $i <= 31; $i++)
                                    <option {{old('birth_date_day') == $i ? 'selected': ''}}>{{str_pad($i, 2, "0", STR_PAD_LEFT)}}</option>
                                @endfor
                            </select>
                            <select name="birth_date_month">
                                @for($i = 1; $i <= 12; $i++)
                                    <option {{old('birth_date_month') == $i ? 'selected': ''}}>{{str_pad($i, 2, "0", STR_PAD_LEFT)}}</option>
                                @endfor
                            </select>
                            <select name="birth_date_year" class="year">
                                @for($i = 1901; $i <= 2008; $i++)
                                    <option {{old('birth_date_year') == $i ? 'selected': ''}}>{{$i}}</option>
                                @endfor
                            </select>
                        </div>
                        <span class="error-message {{($errors->has('birth_date')? 'active' :'')}}">{{$errors->first('birth_date')}}</span>
                    </div>
                    <div class="form-element grid-col col-6">
                        <input type="hidden" readonly class="age" name="age" placeholder="00" value="{{ old('age') }}">
                    </div>
                </div>

                <div class="form-group{{ $errors->has('street') || $errors->has('house_number') || $errors->has('city') || $errors->has('postal_code') ? ' has-error' : '' }}">
                    <span class="icon home green">@include('svg.icons.home')</span>
                    <div class="form-element grid-col col-7">
                        <label for="street">@lang('auth.company_street')</label>
                        <input type="text" name="street" placeholder="@lang('auth.company_street')"
                               value="{{ old('street') }}">
                        <span class="error-message {{($errors->has('street')? 'active' :'')}}">{{$errors->first('street')}}</span>
                    </div>
                    <div class="form-element grid-col col-2">
                        <label for="house_number">@lang('auth.company_house_number')</label>
                        <input type="text" placeholder="00" name="house_number" value="{{ old('house_number') }}">
                        <span class="error-message {{($errors->has('house_number')? 'active' :'')}}">{{$errors->first('house_number')}}</span>
                    </div>
                    <div class="form-element grid-col col-6">
                        <label for="city">@lang('auth.company_city')</label>
                        <input type="text" name="city" placeholder="@lang('auth.company_city')"
                               value="{{ old('city') }}">
                        <span class="error-message {{($errors->has('city')? 'active' :'')}}">{{$errors->first('city')}}</span>
                    </div>
                    <div class="form-element grid-col col-3">
                        <label for="postal_code">@lang('auth.company_zip_code')</label>
                        <input type="text" name="postal_code" placeholder="@lang('auth.company_zip_code')"
                               value="{{ old('postal_code') }}">
                        <span class="error-message {{($errors->has('postal_code')? 'active' :'')}}">{{$errors->first('postal_code')}}</span>
                    </div>
                </div>

                <div class="form-group{{ $errors->has('email') || $errors->has('phone') || $errors->has('mobile') || $errors->has('iban') ? ' has-error' : '' }}">
                    <span class="icon phone green">@include('svg.icons.phone')</span>
                    <div class="form-element grid-col col-7">
                        <label for="email">@lang('auth.email_address')</label>
                        <input type="text" name="email" placeholder="@lang('auth.email_address')"
                               value="{{ old('email') }}">
                        <span class="error-message {{($errors->has('email')? 'active' :'')}}">{{$errors->first('email')}}</span>
                    </div>
                    <div class="form-element grid-col col-7">
                        <label for="phone">@lang('auth.phone_number')</label>
                        <input type="tel" name="phone" placeholder="@lang('auth.phone_number')"
                               value="{{ old('phone') }}">
                        <span class="error-message {{($errors->has('phone')? 'active' :'')}}">{{$errors->first('phone')}}</span>
                    </div>
                    <div class="form-element grid-col col-4">
                        <label for="mobile">@lang('auth.mobile_number')</label>
                        <input type="tel" name="mobile" placeholder="@lang('auth.mobile_number')"
                               value="{{ old('mobile') }}">
                        <span class="error-message {{($errors->has('mobile')? 'active' :'')}}">{{$errors->first('mobile')}}</span>
                    </div>
                    <div class="form-element grid-col col-7">
                        <label for="iban">@lang('auth.bank_account_number')</label>
                        <input type="text" name="iban" placeholder="@lang('auth.bank_account_number')"
                               value="{{ old('iban') }}">
                        <span class="error-message {{($errors->has('iban')? 'active' :'')}}">{{$errors->first('iban')}}</span>
                    </div>
                </div>

                <div class="form-group{{ $errors->has('certificate_number') || $errors->has('status') || $errors->has('years_certified') || $errors->has('expiration_date') ? ' has-error' : '' }}">
                    <span class="icon plus green">@include('svg.icons.plus')</span>
                    <div class="form-element grid-col col-12">
                        <label for="certificate_number">@lang('site/certificates.number.label')</label>
                        <input type="text" name="certificate_number"
                               placeholder="@lang('site/certificates.number.placeholder')"
                               value="{{ old('certificate_number') }}">
                        <span class="error-message {{($errors->has('certificate_number')? 'active' :'')}}">{{$errors->first('certificate_number')}}</span>
                    </div>
                    <div class="form-element grid-col col-4">
                        <label for="years_certified">@lang('site/certificates.years_certified')</label>
                        <input type="number" name="years_certified" placeholder="05"
                               value="{{ old('years_certified') }}">
                        <span class="error-message {{($errors->has('years_certified')? 'active' :'')}}">{{$errors->first('years_certified')}}</span>
                    </div>
                    <div class="form-element grid-col col-7">
                        <label for="expiration_date">@lang('auth.expiration_date')</label>
                        <div class="select-wrapper">
                            <select name="expiration_date_day">
                                @for($i = 1; $i <= 31; $i++)
                                    <option {{old('expiration_date_day') == $i ? 'selected': ''}}>{{str_pad($i, 2, "0", STR_PAD_LEFT)}}</option>
                                @endfor
                            </select>
                            <select name="expiration_date_month">
                                @for($i = 1; $i <= 12; $i++)
                                    <option {{old('expiration_date_month') == $i ? 'selected': ''}}>{{str_pad($i, 2, "0", STR_PAD_LEFT)}}</option>
                                @endfor
                            </select>
                            <select name="expiration_date_year" class="year">
                                @for($i = \Carbon\Carbon::now()->year; $i <= \Carbon\Carbon::now()->addYears(2)->year; $i++)
                                    <option {{old('expiration_date_year') == $i ? 'selected': ''}}>{{$i}}</option>
                                @endfor
                            </select>
                        </div>
                        <span class="error-message {{($errors->has('expiration_date')? 'active' :'')}}">{{$errors->first('expiration_date')}}</span>
                    </div>
                </div>

                <input type="submit" value="@lang('auth.register')">
            </form>
        </div>
    </div>
@endsection