rosehill/blocks/html/interments/addIntermentForm.inc

93 lines
3.4 KiB
PHP

<?php
/**
* @copyright 2009-2010 City of Bloomington, Indiana
* @license http://www.gnu.org/copyleft/gpl.html GNU/GPL, see LICENSE.txt
* @author Cliff Ingham <inghamn@bloomington.in.gov>
* @param URL $this->return_url
*/
$return_url = isset($this->return_url) ? $this->return_url : BASE_URL.'/interments';
?>
<h1>Add Interment</h1>
<form method="post" action="<?php echo BASE_URL; ?>/interments/addInterment.php">
<fieldset><legend>Interment Info</legend>
<input type="hidden" name="return_url" value="<?php echo $return_url; ?>" />
<table>
<tr><td><label for="interment-cemetery_id" class="required">Cemetery</label></td>
<td><select name="interment[cemetery_id]" id="interment-cemetery_id"
onchange="COB.populateSections(this.options[this.selectedIndex].value,'interment-section_id','<?php echo BASE_URL; ?>')">
<option></option>
<?php
$list = new CemeteryList();
$list->find();
foreach ($list as $cemetery) {
$name = View::escape($cemetery->getName());
echo "<option value=\"{$cemetery->getId()}\">$name</option>";
}
?>
</select>
</td>
</tr>
<tr><td><label for="interment-section_id">Section</label></td>
<td><select name="interment[section_id]" id="interment-section_id">
<option></option>
</select>
<label for="interment-lot">Lot</label>
<input name="interment[lot]" id="interment-lot" size="5" maxlength="5" />
</td>
</tr>
<tr><td><label for="interment-book">Book</label></td>
<td><input name="interment[book]" id="interment-book" size="4" maxlength="4" />
<label for="interment-pageNumber">Page</label>
<input name="interment[pageNumber]" id="interment-pageNumber" size="5" maxlength="5" />
</td>
</tr>
<tr><td><label for="interment-firstname">First</label></td>
<td><input name="interment[firstname]" id="interment-firstname" /></td>
</tr>
<tr><td><label for="interment-middleInitial">MI</label></td>
<td><input name="interment[middleInitial]" id="interment-middleInitial" size="1" maxlength="1" />
</td>
</tr>
<tr><td><label for="interment-lastname">Last</label></td>
<td><input name="interment[lastname]" id="interment-lastname" /></td>
</tr>
<tr><td><label for="interment-birthPlace">Place of Birth</label></td>
<td><input name="interment[birthPlace]" id="interment-birthPlace" />
</td>
</tr>
<tr><td><label for="interment-lastResidence">Last Residence</label></td>
<td><input name="interment[lastResidence]" id="interment-lastResidence" />
</td>
</tr>
<tr><td><label for="interment-deceasedDate">Date of Death</label></td>
<td><input name="interment[deceasedDate]" id="interment-deceasedDate" size="10" />
<label for="interment-age">Age</label>
<input name="interment[age]" id="interment-age" size="3" maxlength="3" />
<label for="interment-sex">Gender</label>
<select name="interment[sex]" id="interment-sex">
<option></option>
<option>M</option>
<option>F</option>
</select>
</td>
</tr>
</table>
<div><label for="interment-notes">Notes</label></div>
<div><textarea name="interment[notes]" id="interment-notes" rows="3" cols="60"></textarea></div>
<button type="submit" class="submit">Submit</button>
<button type="button" class="cancel" onclick="document.location.href='<?php echo $return_url; ?>';">
Cancel
</button>
</fieldset>
</form>