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emergency_form.html
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emergency_form.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Emergency</title>
<!-- link to css file -->
<link rel="stylesheet" type="text/css" href="organise.css">
<!-- Link of Fontawsm CDN -->
<link rel="stylesheet" href="https://stackpath.bootstrapcdn.com/font-awesome/4.7.0/css/font-awesome.min.css">
<link rel="stylesheet" href="assets/css/loader.css">
<script src="https://www.gstatic.com/firebasejs/7.19.0/firebase-app.js"></script>
<script src="https://www.gstatic.com/firebasejs/7.19.0/firebase-database.js"></script>
<script src="https://www.gstatic.com/firebasejs/7.19.0/firebase-auth.js"></script>
<script src="https://www.gstatic.com/firebasejs/7.19.0/firebase-storage.js"></script>
</head>
<body>
<div class="pagewrap">
<div class="pagewrap-overlay"></div>
<div class="content">
<!-- ------------Header------------ -->
<header>
<div class="header-content">
<h1><span class="main-heading">Emergency Situation Details</span></h1>
</div>
<div class="slanted"></div>
</header>
<section class="sec">
<!-- ------------------Emergency Form-------------------- -->
<form>
<!-- Emergency Situation -->
<div class="form-group">
<label for="situation">Emergency Situation:</label>
<input type="text" name="situation" id="situation" class="form-control text"
placeholder=" Enter your Emergency Situation">
</div>
<!-- Emergency Situation Type -->
<div class="form-group">
<label for="type">Emergency Situation Type:</label>
<select id="type" name="type" class="form-control text">
<option id="status_0">Option1</option>
<option id="status_1">Option2</option>
<option id="status_2">Option3</option>
</select>
</div>
<!------ Name -------->
<div class="form-group">
<label>Your Name:</label>
<input type="text" name="name" id="name" class="form-control text"
placeholder=" Enter your Name">
</div>
<!--Address -->
<div class="form-group">
<label for="add">Address / Location:</label>
<input type="text" name="add" id="add" class="form-control text" placeholder=" Enter Address">
</div>
<!-- state -->
<div class="form-group">
<label>Your State:</label>
<input type="text" name="state" id="state" class="form-control text"
placeholder=" Enter your state">
</div>
<!--country -->
<div class="form-group">
<label>Country:</label>
<input type="text" name="country" id="country" class="form-control text"
placeholder=" Enter Country">
</div>
<!-- Email ID -->
<div class="form-group">
<label>Email ID:</label>
<input type="email" name="email" id="email" class="form-control text"
placeholder=" Email ID (Optional)">
</div>
<!-- Contact No -->
<div class="form-group">
<label>Contact No:</label>
<input type="text" name="mobile_num" id="mobile_num" class="form-control text"
placeholder=" Enter Contact No">
</div>
<!-- Money -->
<div class="form-group">
<label>Amount Needed</label>
<input type="number" name="money" id="money" class="form-control text"
placeholder=" Enter Amount Needed">
</div>
<br>
<!-- -----------Paragraphs---------------- -->
<div>
<p id="paragraph1" class="para1">NOTE: For Verification of Contact number we will be sending you
OTP</p>
</div>
<br>
<div>
<p id="paragraph2" class="para2">Our Team will be Contacting You within 48 hours.</p>
</div>
<hr>
<!-- ------------Documents upload----------- -->
<div>
<h4 id="dochead">Mandatory to upload below documents:</h4>
<p id="docpara1" class="docs">1. Your identity Proof (Any government proof</p>
<input type="file" id="uploadbutton1" style="display:block" accept="image/*" value="Upload"
required>
<p id="docpara2" class="docs">2. Address Proof (LightBill / Aadhar Card / PAN Card / Driving
License)</p>
<input type="file" id="uploadbutton2" style="display:block" accept="image/*" value="Upload"
required>
<p id="docpara3" class="docs">3. Proof of Emergency Situation (You can upload photos of
emergency situation)</p>
<!-- Upload button -->
<input type="file" id="uploadbutton3" style="display:block" accept="image/*" value="Upload"
required>
</div>
<br>
<hr>
</form>
</section>
<button id="submitbutton" onclick="org_reg()">Submit</button>
<div class="loading" id="loader">Loading…</div>
</div>
</div>
<script src="assets/js/emer.js"></script>
</body>
</html>