rosehill/blocks/html/internments/addInternmentForm.inc

92 lines
3.1 KiB
PHP

<?php
/**
* @copyright 2009 City of Bloomington, Indiana
* @license http://www.gnu.org/copyleft/gpl.html GNU/GPL, see LICENSE.txt
* @author Cliff Ingham <inghamn@bloomington.in.gov>
*/
?>
<h1>Add Internment</h1>
<form method="post" action="<?php echo $_SERVER['SCRIPT_NAME']; ?>">
<fieldset><legend>Internment Info</legend>
<table>
<tr><td><label for="internment-section">Section</label></td>
<td><input name="internment[section]" id="internment-section"
size="5" maxlength="5" />
<label for="internment-lot">Lot</label>
<input name="internment[lot]" id="internment-lot"
size="5" maxlength="5" />
</td>
</tr>
<tr><td><label for="internment-book">Book</label></td>
<td><input name="internment[book]" id="internment-book"
size="4" maxlength="4" />
<label for="internment-pageNumber">Page</label>
<input name="internment[pageNumber]" id="internment-pageNumber"
size="5" maxlength="5" />
</td>
</tr>
<tr><td><label for="internment-firstname">Name</label></td>
<td><label for="internment-firstname">First</label>
<input name="internment[firstname]" id="internment-firstname" />
<label for="internment-middleInitial">MI</label>
<input name="internment[middleInitial]" id="internment-middleInitial" />
<label for="internment-lastname">Last</label>
<input name="internment[lastname]" id="internment-lastname" />
</td>
</tr>
<tr><td><label for="internment-birthPlace">Place of Birth</label></td>
<td><input name="internment[birthPlace]" id="internment-birthPlace" />
</td>
</tr>
<tr><td><label for="internment-lastResidence">Last Residence</label></td>
<td><input name="internment[lastResidence]" id="internment-lastResidence" />
</td>
</tr>
<tr><td><label for="internment-deceasedDate">Date of Death</label></td>
<td><input name="internment[deceasedDate]" id="internment-deceasedDate" size="10" />
<label for="internment-age">Age</label>
<input name="internment[age]" id="internment-age" size="3" maxlength="3" />
<label for="internment-sex">Gender</label>
<select name="internment[sex]" id="internment-sex">
<option></option>
<option>M</option>
<option>F</option>
</select>
</td>
</tr>
<tr><td><label for="internment-cemetery_id">Cemetery</label></td>
<td><select name="internment[cemetery_id]" id="internment-cemetery_id">
<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="internment-notes">Notes</label></td>
<td><textarea name="internment[notes]" id="internment-notes" rows="3" cols="60"></textarea>
</td>
</tr>
</table>
<button type="submit" class="submit">Submit</button>
<button type="button" class="cancel" onclick="document.location.href='<?php echo BASE_URL; ?>/internments';">
Cancel
</button>
</fieldset>
</form>