/
donor-org.py
executable file
·102 lines (97 loc) · 5.47 KB
/
donor-org.py
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#!/usr/bin/python2
import commands,cgi
import cgitb
cgitb.enable()
print "content-type: text/html"
print ""
print """
<!DOCTYPE html>
<html>
<head>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>ReserveChain</title>
<link rel="stylesheet" href="assets/bootstrap/css/bootstrap.min.css">
<link rel="stylesheet" href="https://fonts.googleapis.com/css?family=Bitter:400,700">
<link rel="stylesheet" href="assets/css/Navigation-Clean.css">
<link rel="stylesheet" href="assets/css/Registration-Form-with-Photo.css">
<link rel="stylesheet" href="assets/css/styles.css">
</head>
<body>
<div>
<nav class="navbar navbar-light navbar-expand-md navigation-clean">
<div class="container"><a class="navbar-brand" href="index.html"><strong>Blood Benefaction - Through Fair Means</strong></a><button class="navbar-toggler" data-toggle="collapse" data-target="#navcol-1"><span class="sr-only">Toggle navigation</span><span class="navbar-toggler-icon"></span></button>
<div
class="collapse navbar-collapse" id="navcol-1">
<ul class="nav navbar-nav ml-auto">
<li class="nav-item" role="presentation"><a class="nav-link active" href="donor-org.py">Donate Blood</a></li>
<li class="nav-item" role="presentation"><a class="nav-link" href="blood-status.py">Check Status</a></li>
<li class="nav-item" role="presentation"><a class="nav-link" href="reserves.py">City Reserves</a></li>
</ul>
</div>
</div>
</nav>
</div>
<div class="register-photo">
<div class="form-container">
<div class="image-holder" style="background-image:url("assets/img/bloodbottle-01.jpg");margin:0px;"></div>
<form method="post" action="form.py" >
<h2 class="text-center"><strong>DONATION INFORMATION</strong></h2>
<div class="table-responsive">
<table class="table">
<thead>
<tr> <div class="form-group"><input class="form-control" type="text" name="donor-number" required="" placeholder="Donor Contact Number" inputmode="numeric"></div></tr>
</thead>
<tbody>
<tr></tr>
<tr>
<td>
<div class="form-group" style="width:100%">
<select class="form-control" name="blood-type">
<option>A</option>
<option>B</option>
<option>AB</option>
<option>O</option>
</select>
</div>
</td>
<td>
<div class="form-group">
<select class="form-control" name="rh-factor">
<option>POSITIVE</option>
<option>NEGETIVE</option>
</select>
</td>
</tr>
<tr>
<td>
<div class="table-responsive" style="vertical-align: middle;">
Unit:
</div>
</td>
<td><input type="number" placeholder="unit" class="form-control" min="0.1" step="0.1" value="1" max="1" name="unit-amount" style="padding:0px;"/></td>
</tr>
<tr>
<td>Donation Date:</td>
<td><input class="form-control" type="date" name="dateDonated" required=""></td>
</tr>
<tr></tr>
</tbody>
</table>
</div>
<div class="form-group"><input class="form-control" type="text" name="org-name" required="" placeholder="Donor Organisation/Hospital/NGO"><input class="form-control" type="text" name="org-number" required="" placeholder="Contact Number" inputmode="numeric"></div>
<div
class="form-group"><input class="form-control" type="text" name="org-city" required="" placeholder="City (eg. Jaipur)"><input class="form-control" type="text" name="org-state" placeholder="State (eg. Rajasthan)"><input class="form-control" type="text" name="pincode"
placeholder="Zipcode (eg. 302004)"></div>
<div class="form-group">
<div class="form-check"><label class="form-check-label"><input class="form-check-input" type="checkbox" required=""><strong>I confirm that the information given in this form is true, complete and accurate.</strong></label></div>
</div>
<div class="form-group"><button class="btn btn-primary btn-block" type="submit">Submit</button></div>
</form>
</div>
</div>
<script src="assets/js/jquery.min.js"></script>
<script src="assets/bootstrap/js/bootstrap.min.js"></script>
</body>
</html>
"""