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regdonor.html
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regdonor.html
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<!DOCTYPE HTML>
<html>
<head>
<meta charset="UTF-8"/>
<meta name="viewport" content="width=device-width, initial-scale=1.0"/>
<title>Donor registration form</title>
<link rel="stylesheet" type="text/css" href="style/style.css" title="style" />
<style>
form {margin:01px;padding:05px;border:02px;display:inline-block;line-height:25px;}
label {margin:01px;padding:05px;border:02px;display:inline-block;width:80px;font-weight:bold;}
input {margin:01px;padding:05px;border:01px solid;width:40vw;}
input[type="radio"] {width:12px;}
input[type="file"] {border:01px;width:40vw;}
input[type="checkbox"] {margin:0px 0px 0px 110px;width:10px;}
input::placeholder {color:black;}
.subheader {margin:01px;padding:05px;border:02px;font-weight:bold;font-size:20px;}
.button {margin:08px 01px;padding:05px;border:01px;border-radius:08px;cursor:pointer;font-weight:bold;}
</style>
</head>
<body>
<div id="main">
<div id="header">
<div id="logo">
<div id="logo_text">
<h1><a href="index.html">Blood-donation</a></h1>
<h2>Give blood, be a hero.</h2>
</div>
</div>
<div id="menubar">
<ul id="menu">
<li><a href="index.html">Home</a></li>
<li class="selected"><a href="regdonor.html">Become donor</a></li>
<li><a href="donorlist.php">Donor list</a></li>
<li><a href="search.php">Search donor</a></li>
<li><a href="contact.php">Contact</a></li>
<li><a href="./log/login.php">Donor log in</a></li>
</ul>
</div>
</div>
<div id="site_content">
<div class="subheader"> Registrartion form </div>
<form action="action.php" name="bgregform" onsubmit="return validate()" autocomplete="off" method="post" enctype="multipart/form-data">
<label> Name </label>: <input type="text" name="name" id="dname" placeholder="Enter Your name..." required=""/><br/>
<label> Image </label>: <input type="file" name="image" id="dimage" accept="image/x-png,image/gif,image/jpeg" title="file name should not contain any space" required=""/><br/>
<label> Gender </label>:
<input type="radio" name="sex" value="male" checked=""/> Male
<input type="radio" name="sex" value="female"/> Female <br/>
<label> Mobile </label>: <input type="text" name="number" id="dnumber" placeholder="01*********" required=""/> <br/>
<label> E-mail </label>: <input type="text" name="email" id="dmail" placeholder="Enter Your E-mail..." required=""/> <br/>
<label> Address </label>: <input type="text" name="address" id="daddress" placeholder="Your thana or upzila" title="caracter limit 20" required=""/> <br/>
<label> Blood group</label>:
<select name="bloodgroup">
<option value="A+ve"> A+ve </option>
<option value="A-ve"> A-ve </option>
<option value="B+ve"> B+ve </option>
<option value="B-ve"> B-ve </option>
<option value="AB+ve"> AB+ve </option>
<option value="AB-ve"> AB-ve </option>
<option value="O+ve"> O+ve </option>
<option value="O-ve"> O-ve </option>
</select>
<br/>
<label> Last Donate </label>: <input type="date" name="ldonate" id="ldd" placeholder="YYYY-MM-DD" required=""/> <br/>
<input type="checkbox" id="check" onchange="inputdisable()"/> check this box if you never donate blood before. <br/>
<label> Password </label>: <input type="password" name="password" id="pass" placeholder="Create a 4-8 digit password..." title="alphanumaric and @,#,$,%,& are allow" required=""/> <br/>
<button type="submit" value="Submit" class="button"> Submit </button>
<button type="Reset" value="Reset" class="button"> Reset </button> <br/>
</form>
</div>
<div id="content_footer"></div>
<div id="footer">
Copyright © Blood Donation | <a href="http://www.html5webtemplates.co.uk">Design by html5webtemplates</a>
</div>
</div>
<script>
function inputdisable(){
var checkvalue = document.getElementById('check').checked;
if(checkvalue == true){
document.getElementById('ldd').disabled = "true";
}
}
function validate(){
//Reguler Expressions
var namepattern = /^[a-z ]{3,30}$/i;
var numberpattern = /^[0-9]{11}$/;
var emailpattern = /^[a-zA-Z0-9]+[a-zA-Z0-9_.-]+[a-zA-Z0-9_-]+@[a-zA-Z0-9]+[a-zA-Z0-9.-]+[a-zA-Z0-9]+.[a-z]{2,4}$/;
var addresspattern = /^[a-z0-9 \,]{5,25}$/i;
var passwordpattern = /^[a-z0-9\@\#\$\%\&]{4,8}$/i;
//Values from user
var namevalue = document.getElementById('dname').value;
var numbervalue = document.getElementById('dnumber').value;
var emailvalue = document.getElementById('dmail').value;
var addressvalue = document.getElementById('daddress').value;
var passwordvalue = document.getElementById('pass').value;
//Validate the value
if(!namepattern.test(namevalue)){
alert("Incorrect name");
return false;
}
else if(!numberpattern.test(numbervalue)){
alert("Incorrect number");
return false;
}
else if(!emailpattern.test(emailvalue)){
alert("Incorrect E-mail");
return false;
}
else if(!addresspattern.test(addressvalue)){
alert("Incorrect address");
return false;
}
else if(!passwordpattern.test(passwordvalue)){
alert("Incorrect password");
return false;
}
else
confirm("Thank you, " + namevalue + ". Registrartion form fillup!\nRemember Your password for future use.");
}
</script>
</body>
</html>