@section('title', 'Enter')
@extends('layouts.main')


@section('extra-css')
    <style>
        html {
            background-image: url("/assets/images/bg.jpg");
        }
        @media screen and (max-width: 991px) {
            html {
                background-image: url("/assets/images/bg-991.jpg");
            }
        }

        @media screen and (max-width: 600px) {
            html {
                background-image: url("/assets/images/bg-600.jpg");
            }
        }
    </style>
@endsection

@section('content')
    <div class="container-fluid">
        <!--begin:: Check error or success -->
    @include('layouts.partials.success')
    @include('layouts.partials.errors')
    <!--end:: Check error or success -->
        <div class="row">
            <div class="col-md-6 hidden-xs">
                <img src="{{ asset('assets/images/logo-lg.png') }}"
                     class="img-responsive animated slideInLeft" style="display: block; margin: auto;"/>
            </div>
            <div class="col-md-5 col-xs-12">
                <div class="fContent animated slideInRight">
                    <div class="m-t-30 hidden-xs hidden-sm">&nbsp;</div>
                    <form action="{{ route('entries.create') }}" enctype="multipart/form-data" method="post">
                        {{ csrf_field() }}
                        <div class="col-xs-12">
                            <p class="text-center"><strong>Welcome to The Spring clean with Bravecto®. Please complete below fields.</strong></p>
                        </div>
                        <div class="form-group col-md-6">
                            <input class="form-control" type="text" name="name" placeholder="First Name"
                                   value="{{ !empty(session('currentPlayerName')) ? session('currentPlayerName') : '' }}"/>

                        </div>
                        <div class="form-group col-md-6">
                            <input class="form-control" type="text" name="surname" placeholder="Surname"
                                   value="{{ !empty(session('currentPlayerSurname')) ? session('currentPlayerSurname') : '' }}"/>
                        </div>


                        <div class="form-group col-md-12">
                            <input class="form-control" type="text" name="email" id="email" value="{{ !empty(session('currentPlayerEmail')) ? session('currentPlayerEmail') : '' }}"
                                   placeholder="Email Address"/>
                        </div>



                        <div class="form-group col-md-6">
                            <input class="form-control" type="text" name="cell" value="{{ !empty(session('currentPlayerCell')) ? session('currentPlayerCell') : '' }}"
                                   placeholder="Mobile Number"/>
                        </div>
                        <div class="form-group col-md-6">
                            <input class="form-control" type="text" name="vet" value="{{ !empty(session('currentPlayerVet')) ? session('currentPlayerVet') : '' }}" placeholder="Quantity of Bravecto® products bought"/>
                        </div>
                        {{--  <div class="form-group col-md-6">
                              <input class="form-control" type="text" name="cashier" value="{{ old('cashier') }}"
                                     placeholder="Cashier or Receptionist Name"/>
                          </div>--}}
                        <div class="form-group col-md-12">
                            <input class="form-control" type="text" name="receipt" value="{{ !empty(session('currentPlayerReceipt')) ? session('currentPlayerReceipt') : '' }}"
                                   placeholder="Product Purchased"/>
                        </div>
                        <div class="form-group col-md-12">
                            {{--  <input class="form-control" type="file" name="file" placeholder="Upload till slip"/>--}}
                            <label for="slip" style="font-size: 14px; font-weight: bold;">Upload Proof of Purchase.</label>
                            <input type="file" name="file"  class="form-control" id="slip"/>
                        </div>
                        <div class="col-md-12 form-group">
                            <p><span><strong>One entry will be permitted per Bravecto® product bought.</strong></span></p>
                            <hr style="border-top:1px solid #000; border-bottom: 0px solid #fff;">
                            <p>Opt-in for future communication from MSD Animal Health (makers of Bravecto®)</p>
                        </div>
                        <div class="col-md-2 form-group ">
                            <label class="custom-input-container">Yes
                                <input type="radio" checked="checked" name="communicate" value="Yes"
                                       checked="checked">
                                <span class="checkmark-radio"></span>
                            </label>
                        </div>
                        <div class="col-md-2 form-group ">
                            <label class="custom-input-container">No
                                <input type="radio" name="communicate" value="No">
                                <span class="checkmark-radio"></span>
                            </label>
                        </div>
                        <div class="col-md-8">&nbsp;</div>
                        <div class="col-md-12 form-group">
                            <p>Opt-in to receive Bravecto® SA's monthly newsletter about pet health and promotions.</p>
                        </div>

                        <div class="col-md-2 form-group ">
                            <label class="custom-input-container">Yes
                                <input type="radio" checked="checked" name="newsletter" value="Yes"
                                       checked="checked">
                                <span class="checkmark-radio"></span>
                            </label>
                        </div>
                        <div class="col-md-2 form-group ">
                            <label class="custom-input-container">No
                                <input type="radio" name="newsletter" value="No">
                                <span class="checkmark-radio"></span>
                            </label>
                        </div>
                        <div class="col-md-8">&nbsp;</div>

                        <br>

                        <div class="col-md-12">
                            <label class="custom-input-container"> Accept Terms and Conditions
                                <br><a href="https://blog.bravecto.co.za/terms-and-conditions/"
                                       target="_blank" style="color:#000; text-decoration: underline;">See T&C's</a>
                                <input type="checkbox" name="read_terms" value="Yes" checked>
                                <span class="checkmark"></span>
                            </label>
                            <p></p>
                        </div>

                        <div class="col-md-12 m-t-30 hidden-xs hidden-sm"></div>
                        <div class="col-md-12 text-center">
                            <button type="submit" class="btn btn-primary">START</button>
                            <br>
                            <br>
                        </div>
                    </form>
                </div>
            </div>
        </div>
        <div class="clearfix"></div>
    </div>

    <div class="container-fluid" style="background: #fff;">
        <div class="row">
            <div class="col-md-2">
                <br>
                <img src="{{ asset('/assets/images/footer-logo.png') }}" class="img-responsive" width="100"/>
                <br>
            </div>
            <div class="col-md-10">

                <p style="color:#000; font-size: 11px; margin-top: 20px; margin-bottom: 10px;">Bravecto® Reg No G4083 (Act 36/1947) each chew contains 25 mg Fluralaner per kg body weight . Bravecto® Spot-On Reg. No. G4292 (Act 36/1947) each 1 mℓ of Bravecto® Spot-On contains 280 mg Fluralaner. Bravecto® Plus Reg. No. G4408 (Act 36/1947) each 1 mℓ of Bravecto® Plus contains 280 mg Fluralaner and 14 mℓ Moxidectin.
                    ZA-BRV-220900007</p>
            </div>
        </div>
    </div>
@endsection



@section('extra-js')
    <script type="text/javascript" src="{{ asset('/assets/plugins/light-pick/moment.min.js') }}"></script>
    <script type="text/javascript" src="{{ asset('/assets/plugins/light-pick/lightpick.js') }}"></script>
    <script>
        var picker = new Lightpick({
            field: document.getElementById('dob'),
            onSelect: function(date){
                document.getElementById('dob_results').innerHTML = date.format('DD/MM/YYYY');
            }
        });

    </script>
@endsection()