-
Notifications
You must be signed in to change notification settings - Fork 0
/
Copy pathdonate_blood.php
87 lines (84 loc) · 3.01 KB
/
donate_blood.php
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
<html>
<head>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no">
<meta name="description" content="">
<meta name="author" content="">
<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/4.5.2/css/bootstrap.min.css">
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.5.1/jquery.min.js"></script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/popper.js/1.16.0/umd/popper.min.js"></script>
<script src="https://maxcdn.bootstrapcdn.com/bootstrap/4.5.2/js/bootstrap.min.js"></script>
</head>
<body>
<?php
$active ='donate';
include('head.php') ?>
<div id="page-container" style="margin-top:50px; position: relative;min-height: 84vh;">
<div class="container">
<div id="content-wrap" style="padding-bottom:50px;">
<div class="row">
<div class="col-lg-6">
<h1 class="mt-4 mb-3">Donate Blood </h1>
</div>
</div>
<form name="donor" action="savedata.php" method="post">
<div class="row">
<div class="col-lg-4 mb-4">
<div class="font-italic">Full Name<span style="color:red">*</span></div>
<div><input type="text" name="fullname" class="form-control" required></div>
</div>
<div class="col-lg-4 mb-4">
<div class="font-italic">Mobile Number<span style="color:red">*</span></div>
<div><input type="text" name="mobileno" class="form-control" required></div>
</div>
<div class="col-lg-4 mb-4">
<div class="font-italic">Email Id</div>
<div><input type="email" name="emailid" class="form-control"></div>
</div>
</div>
<div class="row">
<div class="col-lg-4 mb-4">
<div class="font-italic">Age<span style="color:red">*</span></div>
<div><input type="text" name="age" class="form-control" required></div>
</div>
<div class="col-lg-4 mb-4">
<div class="font-italic">Gender<span style="color:red">*</span></div>
<div><select name="gender" class="form-control" required>
<option value="">Select</option>
<option value="Male">Male</option>
<option value="Female">Female</option>
</select>
</div>
</div>
<div class="col-lg-4 mb-4">
<div class="font-italic">Blood Group<span style="color:red">*</span></div>
<div><select name="blood" class="form-control" required>
<option value=""selected disabled>Select</option>
<?php
include 'conn.php';
$sql= "select * from blood";
$result=mysqli_query($conn,$sql) or die("query unsuccessful.");
while($row=mysqli_fetch_assoc($result)){
?>
<option value=" <?php echo $row['blood_id'] ?>"> <?php echo $row['blood_group'] ?> </option>
<?php } ?>
</select>
</div>
</div>
</div>
<div class="row">
<div class="col-lg-4 mb-4">
<div class="font-italic">Address<span style="color:red">*</span></div>
<div><textarea class="form-control" name="address" required></textarea></div></div>
</div>
<div class="row">
<div class="col-lg-4 mb-4">
<div><input type="submit" name="submit" class="btn btn-primary" value="Submit" style="cursor:pointer"></div>
</div>
</div>
</div>
</div>
<?php include('footer.php') ?>
</div>
</body>
</html>